Epilepsy is a neurological disorder characterized by the occurrence of multiple seizures over time. A seizure is the result of an abnormal electrical discharge in the brain. It is important to remember that not everyone who has a seizure has epilepsy.
A seizure occurs when excitable brain neurons (nerve cells) give off abnormal electrical discharges. There are different types of seizures. Epilepsy is diagnosed when an individual has multiple seizures over time.
Seizures are divided into two main types: generalized and partial. Generalized seizures occur when the abnormal discharges are start on both sides of the brain simultaneously. Partial seizures result from abnormal discharges from only one area of the brain.
Partial seizures are further separated into complex or simple. Complex partial seizures affect an individual's awareness or consciousness during the event whereas simple seizures do not.
Generalized seizure types include: absence seizuresatonic seizuresclonic seizuresmyoclonic seizurestonic seizurestonic-clonic seizures
Partial seizure types include:complex partial seizuressecondary generalized seizuressimple partial seizures
Signs and symptoms of seizure vary according to the type of seizure and include:
Generalized seizure types:Absence seizures used to be called petit mal seizures. They have the following characteristics:include small movements of the face or eyesinvolve staring into spacelast from a few seconds to a minutemay include dulling of consciousnessmost commonly appear in children
Tonic-clonic seizures were formerly called grand mal seizures. These seizures have the following characteristics: begin suddenly without warningcause confusion or fatigue afterwardinclude jerking of the arms and legsinclude loss of bladder controlinvolve stiffening of the bodylast 1 to 2 minutes, with consciousness returning up to 15 minutes later
Some of the characteristics of atonic seizures include: consciousness may or may not be lostinvolve a loss of muscle tonelast a few secondsthe person may drop to the ground without warning
Myoclonic seizures generally are characterized by the following: involve quick muscle jerkingmay be triggered by too much alcoholmay be triggered by lack of sleepusually don't cause loss of consciousnessusually happen in the early morning
Clonic seizures may have the following characteristics: cause loss of consciousnessinvolve muscle jerkingmost common in childhood
Partial seizure types:Simple partial seizures usually can be identified by the following: consciousness is not changedlast a few secondsmay involve body movementsmay lead to a generalized tonic-clonic seizuremay result in a complex partial seizurethings may look, sound, feel, or taste differently
Complex partial seizures may include the following characteristics: automatic behaviors, such as lip smackingconfusion after the seizure is overloss of contact with the environment, even though the person is consciousloss of memory for events that occur during the seizuremay go on to a generalized tonic-clonic seizure
Epilepsy may be caused by many diseases and conditions. Some of the conditions that can cause epilepsy are as follows: strokebrain tumorshead injuryhereditary seizure disorder infections involving the brain, including encephalitis and bacterial meningitisadvanced liver diseaseAlzheimer's disease and other types of dementiahistory of bleeding into the brain, such as a subarachnoid hemorrhagecongenital diseases or conditionshereditary diseasesabnormalities in the blood vessels of the brainhistory of brain surgeryillegal drugs, such as cocaineinjury during birth or in the uteruslead poisoning
Damage to an unborn child during pregnancy and delivery may increase the risk of epilepsy. Women with high-risk pregnancies should be monitored closely. Many childhood infections can be prevented by appropriate vaccination. Protection against lead poisoning will help prevent epilepsy.
Following sports safety guidelines for children, adolescents, and adults can prevent some injuries. Many times, there is no way to prevent epilepsy. Individuals can lower their risk of seizures by taking the following steps: avoiding excess alcoholavoiding illegal drugs, especially marijuana and cocainegetting enough sleeplimiting intake of stimulants such as caffeinerecognizing and avoiding known factors that trigger their own seizuresseeking prompt treatment for fever and illnesstaking all medications as prescribed
Diagnosis of epilepsy begins with a history and physical exam. The healthcare professional will ask about contributing illnesses or injuries. An electroencephalogram (EEG) will be ordered. An EEG measures electrical activity within the brain. If a seizure occurs during the EEG, the abnormal activity can be detected. However, a normal EEG does not rule out epilepsy because it may simply not have been run at the time seizure activity occurred.
Other tests that may be ordered include the following: blood tests to look for diseases or conditions causing the seizurescranial CT scan to look for abnormalities in the braincranial MRI to provide a closer look at brain structurespositron emission tomography (PET) scans, to identify the abnormal brain area
Seizures can lead to physical injury from falling. Epilepsy may interfere with school or work.
Epilepsy is not contagious and poses no risk to others. Medications used to treat epilepsy can cause damage to an unborn child. Women with epilepsy need careful monitoring during pregnancy because they cannot be continued on the same types or doses of medication.
Medications used to treat epilepsy are known as anticonvulsants. Common anticonvulsants include the following: carbamazepine (i.e., Tegretol)ethosuxamide, also known as Zarontingabapentin (i.e., Neurontin)lamotrigine (i.e., Lamictal)phenobarbital (i.e., Solfoton)phenytoin (i.e., Dilantin)primidone (i.e., Mysoline)tiagabine (i.e., Gabitril)topiramate (i.e., Topamax)valproate sodium (i.e., Epilim)
If a person's seizures are not controlled with medicine, a vagal nerve stimulator may be used. A small pacemaker-like box is inserted under the skin of the chest. It sends regular electrical discharges to the vagus nerve. This discharge can disrupt the abnormal electrical charges. A vagal nerve stimulator does not involve any surgery on the brain.
People with severe, uncontrollable seizures may be candidates for brain surgery. The surgeon opens the skull with a craniotomy. He or she then removes the abnormal brain tissue.
Underlying problems, such as a brain tumor, may require further treatment. A person with epilepsy may be embarrassed or depressed. Counseling about the condition may help the individual and the family. Support groups exist for those with epilepsy.
Medications used to treat epilepsy may cause side effects. Side effects depend on the drug used; however, drowsiness at least initially is common to all. Insertion of a vagal nerve stimulator involves a small risk for bleeding, infection, or allergic reaction to the anesthetic. With a craniotomy, these risks are somewhat higher.
Many anticonvulsants decrease the effectiveness of oral contraceptives.
Many substances interfere with the action of anticonvulsants. These include over-the-counter medicines, prescription medications, and herbal remedies. Individuals with epilepsy should consult their healthcare professionals before taking any new products.
Treatment of epilepsy is lifelong. If seizures are well-controlled, the individual may live a normal lifestyle. Some people may have significant disabilities from their epilepsy. Individuals with epilepsy may be able to drive if they are seizure-free. Laws governing driving vary from place to place.
People with seizures can participate in most activities of regular life. They may be advised to avoid hazardous activities. Federal law prohibits discrimination in employment. There are also laws precluding people with epilepsy from certain jobs, such as commercial trucking. A person with epilepsy should use an identification bracelet or card informing others of the condition.
Individuals with epilepsy should routinely be seen by a healthcare professional for follow-up on the success or failure of the antiepileptic medications. Blood is tested regularly to monitor the levels of anticonvulsants and to screen for any untoward effects on the liver, kidney, or bone marrow. Any new or worsening symptoms should be reported to the healthcare professional.
