Epilepsy

What Is Epilepsy?

Epilepsy is a general term used for a group of disorders that cause disturbances in electrical signaling in the brain. Like an office building or a computer, the brain is a highly complex electrical system, powered by roughly 80 pulses of energy per second. These pulses move back and forth between nerve cells to produce thoughts, feelings, and memories.

An epileptic seizure occurs when these energy pulses come much more rapidly-as many as 500 per second for a short time-due to an electrical abnormality in the brain. This brief electrical surge can happen in just a small area of the brain, or it can affect the whole brain. Depending on the part of the brain that is affected, the surge of electrical energy can cause:

• Changes in a person’s sensations or state of consciousness.
• Uncontrolled movements of certain parts of the body or of the whole body.

These changes are known as an epileptic seizure.

• Epilepsy is also known as a seizure disorder because the tendency is to have recurrent seizures.
• Epileptic seizures vary in severity and frequency, and even in the time of day they occur.
• While some people may experience no more than two or three seizures during their entire lifetime, others will have several seizures in one day.

Does Everyone Who Has A Seizure Have Epilepsy?

A seizure is a symptom of epilepsy, but not all seizures are caused by epilepsy.

A seizure not related to epilepsy can be caused by a reaction to:

• A drug
• A high fever
• A severe head injury
• Other disorders such diabetes, some heart conditions, and narcolepsy, among others.

Sometimes people have a single seizure for which no cause can ever be found.

Several conditions or behaviors mimic epilepsy but are not epilepsy.

• Epilepsy is not a fainting disorder.
• Epilepsy cannot be caused by holding the breath. Some children act out by holding their breath until they faint. This is not epilepsy.
• Epilepsy is not momentary confusion, forgetfulness, or a lack of concentration.
• Epilepsy is not catatonia, a specific type of schizophrenia characterized by stupor and bizarre movements.

Epilepsy is not contagious. A tendency toward epilepsy may be inherited, but it cannot be caught like a cold from another person.

What Brings On An Epileptic Seizure?

Seizures can be sparked by a variety of stimuli, including:

• Lights that flash at a certain speed
• The flicker of a television screen or TV monitor
• A sudden loud noise or repetitive sounds
• Alcohol consumption
• Cigarette smoking
• Stress
• Headache
• Menstruation
• Lack of sleep
• Having a bad day
• Some people with epilepsy have seizures only during their sleep.

Sexual activity does not trigger seizures.

But seizures can also occur seemingly for no reason at all.

What Causes Epilepsy?

Anything that disturbs the normal pattern of activity in the brain can trigger epilepsy.

The cause can be illness, brain damage, or abnormal development of the brain. No cause can be determined for about three-quarters of the cases of epilepsy.

Because epilepsy has so many causes and can be linked to a number of other conditions, it is sometimes very difficult to determine the cause of a particular case. They include:

• Brain chemistry
• Hereditary causes
• Other disorders
• Head injury
• Prenatal injuries
• Environmental causes

Brain Chemistry

Epilepsy may develop because of an imbalance in those chemicals in the brain that help the nerve cells in the brain transmit electrical impulses. These chemicals are called neurotransmitters.

Researchers think that some people who have epilepsy have too much of a neurotransmitter that increases impulse transmission (an excitatory neurotransmitter) and others have too little of neurotransmitters that reduce transmission (an inhibitory neurotransmitter).

Gamma-aminobutyric acid (GABA) is a neurotransmitter that slows electrical transmission between the nerve cells. Low levels of GABA in the body have been linked to epilepsy and an increased risk for seizure. A number of the drugs used to treat epilepsy stimulate production of GABA.

Epilepsy may also be caused by changes in brain cells called glia. Glia regulate concentrations of chemicals in the brain that can change the way neurons signal.

The tendency to abnormal brain chemistry can sometimes be inherited and can sometimes be caused by an injury or a disease.

Hereditary Causes

Many types of epilepsy tend to run in families, and some have been traced to an abnormality in a specific gene. These genetic abnormalities can cause subtle changes in the way the body processes calcium, potassium, sodium, and other body chemicals.

People who have progressive myoclonus epilepsy are missing a gene that helps break down protein. Those with a severe form of epilepsy called LaFora’s disease are missing a gene that helps break down carbohydrates.

Hereditary factors are not always a direct cause of epilepsy but may influence the disease indirectly. Genes can affect the way people process drugs or can cause areas of malformed neurons in the brain.

Other Disorders

Epilepsy can be triggered by brain damage caused by other disorders.

Epilepsy can sometimes be stopped by treating these underlying disorders. In other cases, epileptic seizures will continue after the underlying cause is treated.

Whether the seizures can be stopped depends on the type of disorder, the part of the brain that is affected, and how much damage has been done. Disorders that may trigger epilepsy include:

• Brain tumors, alcoholism, and Alzheimer’s disease can cause epilepsy because they alter the normal workings of the brain.
• Stroke, heart attacks, and other conditions that affect the blood supply to the brain (cerebrovascular diseases) can cause epilepsy by depriving the brain of oxygen. About a third of all new cases of epilepsy that develop in older people are caused by cerebrovascular diseases.
• Infectious diseases such as meningitis, viral encephalitis, and AIDS, can cause epilepsy.
• Cerebral palsy, autism, and a number of other developmental and metabolic disorders can cause epilepsy.

Head Injury

Head injuries can cause seizures. If the head injury is severe, the seizures may not begin until years later. If the injury is mild, the risk is slight.

Prenatal Injuries

In a fetus, the developing brain is susceptible to prenatal injuries that may occur if the pregnant mother has an infection, doesn’t eat properly, smokes or abuses drugs or alcohol. These conditions may cause cerebral palsy.

About 20% of seizures in children are caused by cerebral palsy or other nervous system diseases. Sometimes epilepsy is linked to areas in the brain where neurons may not have formed properly during prenatal development.

Environmental Causes

Epilepsy can be caused by:

• Environmental and occupational exposure to lead, carbon monoxide, and certain chemicals
• Use of street drugs and alcohol
• Lack of sleep, stress, or hormonal changes
• Withdrawal from certain antidepressant and anti-anxiety drugs

Different Types of Epilepsy

Just as there are many different types of seizures, there are many different types of epilepsy syndromes. Each epilepsy syndrome has a specific set of symptoms.

There are hundreds of epilepsy syndromes, many of them very rare. These syndromes are often named for their symptoms or for the part of the brain where they originate.

Many of these epilepsy syndromes originate in childhood or even in infancy. Others begin in adulthood and even in old age.

Some of the most common types of epilepsy are:

• Absence epilepsy
• Temporal lobe epilepsy
• Frontal lobe epilepsy
• Occipital lobe epilepsy
• Parietal lobe epilepsy

Absence Epilepsy

People with absence epilepsy have repeated absence seizures. Absence epilepsy tends to run in families. The seizures frequently begin in childhood or adolescence. If the seizures begin in childhood, they usually stop at puberty.

Although the seizures don’t have a lasting effect on intelligence or other brain functions, children with absence epilepsy frequently have so many seizures that it interferes with school and other normal activities.

Temporal Lobe Epilepsy

Temporal lobe epilepsy (TLE) is the most frequent cause of partial seizures and aura. The temporal lobe is located close to the ear. It is the part of the brain where smell is processed and where the choice is made to express a thought or remain silent.

TLE often begins in childhood. Repeated TLE seizures can damage the hippocampus, a part of the brain that is important for memory and learning. Although the damage progresses very slowly, it is important to treat TLE as early as possible.

Frontal Lobe Epilepsy

The frontal lobes of the brain lie behind the forehead. They are the largest of the five lobes and are thought to be the centers that control personality and higher thought processes, including language and speech.

Frontal lobe epilepsy causes a cluster of short seizures that start and stop suddenly. The symptoms depend upon the part of the frontal lobe affected.

Occipital Lobe Epilepsy

The occipital lobe lies at the back of the skull. Occipital lobe epilepsy is like frontal and temporal lobe epilepsies, except that the seizures usually begin with visual hallucinations, rapid blinking, and other symptoms related to the eyes.

Parietal Lobe Epilepsy

The parietal lobe lies between the frontal and temporal lobes. Parietal lobe epilepsy is similar to other types in part because parietal lobe seizures tend to spread to other areas of the brain.

Different Types Of Seizures

Just as there are many types of epilepsy, there are many types of seizures. Not all seizures are epilepsy. Seizures fall into two major categories:

Partial seizures take place in one particular part of the brain.

Generalized seizures affect the whole brain.

Partial Seizures

Partial seizures are often named for the part of the brain in which they happen. For example, a person might be said to have partial frontal lobe seizures if the abnormalities occur in the part of the brain right behind the forehead. About 60% of all people who have epilepsy have this type of seizure.

Recurrent partial seizures are sometimes called psychomotor seizures. The term “psychomotor” refers to the interaction between brain and muscles, and in this case refers to the twitches and hallucinations that characterize the seizures. There are several types of partial seizures:

• Simple partial seizures
• Complex partial seizures
• Aura
• Secondarily generalized seizures

Simple partial seizures.

People who have simple partial seizures stay awake and aware but may hear, see, smell, or taste things that aren’t real. They may also suddenly feel afraid, angry, happy or sad for no reason. They may become confused or experience jerking or tingling in an arm or leg.

This type of seizure is sometimes called a focal seizure. It may also be called Jacksonian epilepsy, after Hughlings Jackson, a British doctor who was the first to describe it.

Complex partial seizures.

Complex partial seizures usually begin with a blank stare that indicates a brief loss of consciousness. People who have these seizures may blink, twitch, chew or smack the lips repeatedly. They may seem drunk, express exaggerated anger or fear, and throw things around. They may struggle against restraint. These seizures usually last no more than two minutes.

About 80% of these complex partial seizures take place in the temporal lobe of the brain, which is close to the ear, and they are sometimes called temporal lobe seizures. These seizures may also originate in the frontal lobes.

Aura.

Some people who have partial seizures experience unusual sensations that warn them that they are about to have a seizure. This premonitory state is called aura.

Auras take several different forms:

• Sometimes it is perceived as a sinking feeling in the pit of the stomach or a sense of “deja vu” (already seen).
• Sometimes it takes the form of an auditory hallucination, like an advertising jingle.

A person experiencing an aura is having a simple partial seizure without losing consciousness.

Secondarily generalized seizures.

Sometimes people have partial seizures that spread to the whole brain and become generalized seizures. This transition can be so rapid that the partial seizure isn’t noticed.

Generalized Seizures

Generalized seizures affect a more widespread area of the brain than the partial seizures do and they have more serious consequences. The types of generalized seizures are:

• Absence seizures (Petit mal)
• Tonic seizures
• Clonic seizures
• Myoclonic seizures
• Atonic seizures
• Tonic-clonic seizures (Grand mal)

Absence seizures.

Absence seizures, also called petit mal (which means “little sickness”), cause a momentary loss of consciousness. These episodes usually last less than 30 seconds and may be so brief that they go unnoticed. People with absence epilepsy can experience as many as 50 to 100 of these seizures a day. They may look as though they are simply staring off into space or they may go rigid or jerk and twitch.

Tonic seizures.

Tonic seizures cause the muscles to stiffen, but no twitching occurs. These seizures usually affect the back, arms, and legs. People who have tonic seizures lose consciousness for about 10 seconds.

Clonic seizures.

Clonic seizures cause muscles to jerk on both sides of the body, but the body does not go rigid as in tonic seizures. This type of seizure is rare and affects mostly young children.

Myoclonic seizures.

Myoclonic seizures may cause the muscles to jerk and twitch in a part of the body such as an arm or leg, or in the whole body.

Atonic seizures.

Atonic seizures cause a complete loss of muscle tone. These seizures are also called drop attacks because people who have them will suddenly lose consciousness and collapse. After a period as short as 10 seconds, the person regains consciousness and can stand and walk again.

• Atonic seizures are sometimes mistaken for fainting. But a faint begins slowly and can be avoided by lying down.
• Atonic seizures can also affect a single part of the body such as the jaw and neck. In this case, the jaw will briefly go slack and the head will drop.

Tonic-clonic seizures.

Also known as grand mal (which means “big sickness”), tonic-clonic seizures cause a mixture of symptoms:

• The seizure may begin with a tonic phase in which the muscles suddenly go rigid.
• After about 30 seconds, the seizure may enter the clonic phase in which the muscles go rigid and relax in spasms.
• Bladder and bowel control may be lost.
• The throat tightens so that breathing makes a high-pitched sound called stridor.

Some people have an aura before a tonic-clonic seizure. These seizures usually last two or three minutes. They are followed by a brief sleep-like state. People feel very tired and confused after tonic-clonic seizures.

What Kinds Of Seizure Are Not Epilepsy?

• First-time seizures
• Febrile seizures
• Pseudoseizures
• Eclampsia

First-time seizures.

Many people have a single seizure at some point in their lives. These seizures may be provoked by something like a reaction to a drug, but sometimes they happen for no obvious reason.

Only if the person has had a serious head injury at some point in their lives, or has a family history of epilepsy, would a solitary seizure be potentially considered epilepsy. Only about a third of the people who have first seizures ever have a second episode.

Febrile seizures.

“Febrile” comes from the Latin word for fever and indicates seizure caused by a high fever. Children sometimes have an episode of convulsions during an illness with high fever, but most children who have a febrile seizure do not develop epilepsy. Only 2% to 3% of children who have febrile seizures continue to have seizures.

Pseudoseizures.

Sometimes people have episodes that look like seizures, but their brains show no abnormal activity. These episodes are called pseudoseizures or nonepileptic events. Sometimes pseudoseizures are caused by psychological stresses. They can also be caused by other diseases and conditions.

Eclampsia.

If a pregnant woman develops a sudden rise in blood pressure and experiences seizures, the condition is called eclampsia. This condition is life-threatening and should be treated as an emergency. Eclampsia is treated in the hospital. The seizures usually disappear once the pregnancy is over.

How Does A Doctor Make The Diagnosis Of Epilepsy?

The first step in making a diagnosis of epilepsy is a complete medical history. The doctor will ask questions about:

• Whether the person or the person’s family has a history of seizures.
• What the seizure looked like.
• What happened just before the seizure began.
• Possible causes other than epilepsy, such as alcohol withdrawal, infections, head injury, or drug abuse.

Because some people with seizure disorders can’t always remember what happened just before or during a seizure, a family member may also be asked for details.

A number of tests will be ordered to confirm the diagnosis of epilepsy. These include:

• Electroencephalography
• Brain imaging (CT, MRI, PET)
• Blood tests
• Developmental, neurological, and behavioral tests

Electroencephalography

The most frequently used diagnostic tool for epilepsy is the electroencephalograph (EEG). This test uses electrodes attached to the scalp to read the brain’s electrical messaging system. People who have epilepsy often have unusual brain wave patterns even when they are not having a seizure. EEG is most accurate, however, when it is performed within 24 hours of a seizure.

The EEG test usually lasts about an hour and can be done in the doctor’s office or as an outpatient at the hospital. In some cases, however, a doctor may want a 24-hour recording. Brain activity can be quite different during sleep, and it can be helpful to measure brain waves during sleep time.

Portable EEG units can be used to monitor brain waves throughout the day and during many different types of activities. The doctor may also want to do video monitoring along with the EEG. Some medical centers have special video monitoring units that help them determine whether seizures are caused by epilepsy or by some other condition such as narcolepsy or heart disease.

About half the people who have had an epileptic seizure have normal EEG readings. Therefore, other diagnostic tests may be needed.

Brain Imaging

Brain imaging is often used when an adult has had a first seizure or when a child is having convulsive seizures that are not caused by fever.

• Computerized tomography (CT or CAT scan) and Magnetic Resonance Imaging (MRI) can be used to reveal the structure of the brain. Both use computers to produce precise images of the brain. These tests are useful in identifying tumors, cysts, and other structural abnormalities.
• Positron Emission Tomography (PET) and functional MRI (fMRI) can be used to monitor the brain’s activity and to detect abnormalities in its working. These tests can find damaged areas in the brain that are the focal points for seizures. They can help determine whether a patient is a good candidate for surgery and can be used to guide surgery.

Blood Tests

Doctors use blood tests to screen for metabolic or genetic disorders that may be linked to seizures and to look for other conditions that may cause seizures, such as infections, lead poisoning, anemia, or diabetes. Metabolic and genetic screening is most often done when examining a child.

Developmental, Neurological, And Behavioral Tests

Tests to measure coordination and muscle control, behavior, and intellectual capacity can help find out what is causing epilepsy and how the seizures may be affecting the patient.

How Is Epilepsy Treated?

Several treatments are available for epilepsy.

The key to finding an effective treatment is an accurate diagnosis of the type of epilepsy a person has.

Current treatment options can control seizures for about 80% of the people in the United States who have epilepsy. Once a diagnosis of epilepsy is established, it is important to begin treatment right away. The longer treatment is delayed, the more difficult the epilepsy is to treat.

• Medications
• Surgery
• Vagus nerve stimulation
• Diet

Medications

Antiepileptic drugs are the most frequently used treatment of epilepsy. More than 20 such drugs are now available. The choice of drug is determined by:

• The types of seizure a person has
• How frequently they happen
• Lifestyle and age
• In a woman, whether she may become pregnant.

Long-term drug therapy is usually begun after a child or adult has had two or three seizures.

Most seizures can be controlled by single drug therapy, but drugs also may be used in combination for more serious types of seizures.

Below is a list of some of the most commonly prescribed antiepileptic drugs:

• Carbamazapine is most effective against partial or tonic-clonic (grand mal) seizures. Side effects: double vision, headache, sleepiness, dizziness, and upset stomach. These usually subside in about a week.
• Clonazepam is used to treat myoclonic and atonic seizures that cannot be controlled by other drugs. Side effects: About half the people who take clonazepam experience drowsiness, about a third have problems with balance, and about a third have personality changes like irritability. Children may become hyperactive.
• Ethosuximide is used for treating absence (petit mal) seizures. It stops seizures for 60% of the people who take it and controls seizures for 90%. Side effects: stomach problems, dizziness, clumsiness, and lethargy (lack of energy and ambition).
• Phenobarbital is used to treat tonic-clonic (grand mal) and simple partial seizures. Side effects: drowsiness, changes in behavior, rash, learning problems.
• Phenytoin is most effective in treating tonic-clonic (grand mal) and simple and complex partial seizures. Side effects: High doses can cause drowsiness, staggering, nausea, shrinking gums, and growth of body hair.
• Primidone has the same uses as phenobarbital, although it may not be as effective in some people.
• Valproate is usually the first drug chosen to treat all generalized seizures. Side effects: can cause liver problems, stomach problems, blood disorders, tremor, and hair loss. For most people these side effects are minor and disappear after the first few weeks of treatment.

A number of new drugs have become available in recent years.Lamotrigine, gabapentin, and topiramate are among the many new drugs used in treating epilepsy. These drugs are often used in combination with older medications and are sometimes called “add-on” drugs.

Women who have more seizures during the menstrual cycle are sometimes prescribed drugs to stop the ovaries from producing eggs.

Side Effects

Most antiepileptic drugs have relatively minor side effects like tiredness, dizziness, or weight gain. Some drugs may affect thinking and reasoning, others may cause headache, double vision, and skin reactions. Some of these effects will subside after a short period of time; others can be moderated by adjusting dosage levels.

Anti-seizure medication can interfere with the efficacy of other prescription medication, including birth control pills; likewise, other medications can reduce the efficacy of the anti-seizure medicine. Drug interactions can also cause dangerous side effects, so it is important that people taking antiepileptic drugs tell their doctor about any other medications they might be taking, including over-the-counter medications and vitamins.

Surgery

If seizures cannot be controlled by medication, doctors may recommend surgery.

Surgery usually isn’t considered until the patient has tried two or three different medications for a period of time without success, and the seizures warrant consideration for surgery.

Surgery has become a safer option in recent years because of advances in brain imaging and surgical techniques that make it possible to pinpoint the area of the brain where the seizures occur, and to remove just that area. The goal is to remove just enough of the damaged brain tissue to stop seizures.

The first step is to pinpoint the area of the brain where the abnormal electrical activity happens. This area can be found by long-term EEGmonitoring with help from MRI and PET scans. Functional MRI can be used to determine whether the affected brain cells perform a vital function. Surgeons avoid operating on areas of the brain that control speech, language, hearing, and other vital functions. There are several types of surgery:

• Lesionectomy
• Lobectomy
• Corpus callosotomy
• Hemispherectomy

Lesionectomy. The most frequently used type of surgery for epilepsy aims to remove a seizure focus; a small area of abnormality in the brain where seizures originate. These areas are called lesions, and the surgery is called a lesionectomy or lesion removal. This type of surgery is most appropriate for partial seizures.

Lobectomy. A lobectomy or lobe removal takes away a larger area of the brain but is still intended to remove only the area of seizure focus. Temporal lobectomy is the most frequently performed surgical procedure to treat epilepsy. Removal of the temporal lobe stops temporal lobe epilepsy about 90% of the time.

Corpus callosotomy. Corpus callosotomy is a surgical procedure that cuts the connection between the left and right sides, or hemispheres, of the brain. This procedure is most often used to treat children with severe seizures that start on one side of the brain and spread to the other. This procedure can end atonic seizures (drop attacks) and other generalized seizures. Partial seizures will still occur on one side of the brain.

Hemispherectomy. This procedure removes half of the cortex or outer layer of the brain. It is used only to treat children with conditions such as Rasmussen’s encephalitis that cause catastrophic seizures that originate on one side of the brain. This procedure is used only as a last resort, but children often recover from it very well and can regain nearly normal abilities. This procedure is almost never done after a child has reached age 13.

Vagus Nerve Stimulation

The two vagus nerves run from the brain along each side of the neck and down the throat to the gastrointestinal tract (stomach and bowels). These nerves help control swallowing and speech. They are widely connected in the brain and seem to connect to the parts that are affected by epileptic seizures.

Electrical stimulation of the vagus nerve is helpful in controlling seizures that don’t respond well to medication.

The vagus nerve stimulator is a battery-powered device somewhat like a pacemaker. It is implanted under the skin of the chest and attached to the vagus nerve in the lower part of the neck. It delivers short bursts of electrical energy along the vagus nerve to the brain.

The vagus nerve stimulator can cause shortness of breath, hoarseness, ear pain, a sore throat, coughing, and nausea and vomiting. These effects are usually mild and can be stopped by adjusting the strength of the electrical charge.

The batteries must be replaced every three to five years, a procedure that requires minor surgery that can usually be done in an outpatient facility such as the doctor’s office.

The vagus nerve stimulator has been approved by the US Food and Drug Administration since 1997. It has been found to reduce seizures by about 20% to 40%.

Diet

Seizures have been treated by diet since ancient times. The earliest dietary treatment was fasting. The diet used most frequently in modern times is very low in sugars and proteins and high in fat.

The diet forces the body to burn fats for energy instead of sugars and is somewhat similar to currently popular weight-loss diets. It is known as the ketogenic diet because burning fats is thought to increase ketones in the body, a condition called ketosis. Ketones are thought to prevent irritation of the central nervous system, that is, the spinal column and the brain.

The ketogenic diet was first introduced in the 1920s but fell out of use after the introduction of antiepileptic drugs. It is currently being revived for treating children with severe seizures that do not respond to medications.

It is a very difficult diet to keep. The children are allowed to eat almost nothing but fat (butter, heavy cream) with very little meat and a limited range of low-sugar vegetables such as lettuce, celery, and cucumbers.

The diet often causes nausea and diarrhea. It can cause poor development from lack of nutrition and kidney stones from a build-up of uric acid in the system. Use of the diet must be supervised by a doctor.

The diet seems most effective in children under eight years old but it is occasionally helpful for adults. It has been shown to help 25% to 50% of children who have uncontrollable seizures.

How Can I Help Someone Who Is Having an Epileptic Seizure?

Seizures vary in their severity.

Sometimes the person having the seizure goes into a kind of altered state for a short period of time. The person may looked dazed or stare into space. In such a case, it is enough to stay by the person and wait for the seizure to pass. The most important thing is to be calm.

More severe seizures may require more direct action.

Can Epilepsy Be Prevented?

Although researchers have not been able to determine exactly what causes epilepsy, it is often triggered by events or conditions that cause injury to the brain. One way to try to prevent epilepsy is to prevent the events or conditions that lead to its development.

• Epilepsy is sometimes linked to head injuries. Head injuries can be prevented by wearing seatbelts and bicycle and motorcycle helmets, and by putting children in car seats.
• Epilepsy is sometimes linked to abnormalities in fetal brain development. These abnormalities can be prevented by good prenatal care, including treatment of high blood pressure during pregnancy and infections during pregnancy.
• Epilepsy is sometimes linked to another condition that can cause damage to the brain. Conditions that sometimes trigger epilepsy include high blood pressure, cardiovascular disease, and infections. By seeking early treatment and control of these conditions, it may be possible to prevent the kind of brain damage that may cause epilepsy.
• Conditions such as encephalitis, a brain tumor, a high fever, or a serious head injury must be treated early and rigorously in order to prevent serious complications such as epilepsy from developing.

Does Having Epilepsy Mean My Entire Life Will Change?

Epilepsy is a condition that cannot be ignored. With proper treatment, however, epilepsy can be well managed in 80% of cases.

Epilepsy should not be a reason to remove yourself from the joys and responsibilities of daily living. People with epilepsy can work, be with children, go out with friends, play sports, and have meaningful relationships, including marriage.

In short, there is very little in life that having epilepsy should prevent you from doing.

There are, however, some distinct areas of life that may be affected by epilepsy:

• Social and behavior problems
• Driving
• Recreation
• Sexuality
• Pregnancy

Social And Behavior Problems

Although epilepsy causes no differences in intelligence or behavior, people with epilepsy tend to be slightly less likely than the general population to attain higher education, hold jobs, marry, and have children. These difficulties may be due in part to fear of having an unexpected seizure. Seizures can have embarrassing consequences and other people are sometimes cruel or tend to avoid people who have epilepsy.

Rates of depression and suicide are also higher among those who have epilepsy. Some antiepileptic drugs may cause depression.

Counseling services and epilepsy support groups can help families learn to cope and live with epilepsy in ways that are positive.

Driving

Most states require a person who has epilepsy to show that they have gone a certain length of time without having a seizure. This period varies from a few months to several years.

• Some states make exceptions for people whose seizures don’t impair consciousness.
• Some states will issue restrictive licenses that limit, for example, the distance and time of day a person with epilepsy is allowed to drive.

Studies have shown that the risk of having a seizure-related accident decreases as the length of time since the last seizure increases.

Recreation

People with epilepsy can and should participate in recreational activities. Sports and other recreation have a very positive effect. Activities such as jogging and football are perfectly safe as long as the person avoids dehydration, overexertion, and low blood sugar.

People with epilepsy should avoid sports such as skydiving in which a moment’s inattention might be very dangerous. Other activities such as swimming and sailing should be done cautiously and with supervision.

Sexuality

About a third of men with epilepsy experience difficulty getting an erection. Women with epilepsy may experience pain during intercourse because of vaginal dryness. Antiepileptic medications also may affect sexual desire or arousal. Fear of having a seizure during sex may also affect one’s personal feelings about oneself as a sexual being.

There is help, however, for problems relating to sexuality in epilepsy.

• Medication is available to help with erectile dysfunction.
• Special creams and gels can be purchased over the counter to help take care of vaginal dryness.
• A certified, experienced sex therapist may be able to help couples and individuals deal with specific sexual problems related to epilepsy.

Epilepsy And Pregnancy

Women with epilepsy have a 90% chance of having a healthy, normal baby.

• The risk that children of parents with epilepsy will themselves develop epilepsy is only about 5% unless the parent has a clearly hereditary form of the disorder. A genetic counselor can help determine the risks for a specific type of epilepsy. Amniocentesis and ultrasound can help assure that a baby is developing normally.
• Some antiepileptic drugs can slightly increase the risk for birth defects such as cleft palate, spinal problems and heart problems. Under ideal circumstances, a woman should give her doctor enough time to adjust medications before she tries to become pregnant. However, if a woman becomes pregnant before talking with her doctor, she should continue taking seizure medication as prescribed until the doctor can make any necessary changes.
• Labor and delivery are usually normal for women with epilepsy. Antiepileptic drugs can be given intravenously during labor to reduce the risk of a seizure. Babies sometimes have symptoms of withdrawal from the mother’s seizure medication, but these wear off after a few months and usually don’t cause long-term problems.
• Women on antiepileptic medications can breast-feed safely.The amount of medication consumed in the breast milk is considerably lower than the amount the baby was exposed to in the womb, and the benefits of breast-feeding usually outweigh the risks.

Epilepsy – The Outlook

The outlook for epilepsy is good. According to a recent conference of neuroscience researchers and clinicians held on the disease at the National Institutes of Health, a cure for epilepsy is conceivable within the next 10 or 20 years.

Research is underway to increase understanding of the body mechanisms that cause epilepsy, such as brain chemistry and genetic abnormalities. This research allows for the development of new medications for epilepsy.

New diagnostic techniques are becoming available that will help determine the type of epilepsy and the area of the brain in which seizures occur.

Magnetoencephalography (MEG) is being used in some medical centers to detect magnetic signals generated by the nerve cells in the brain. MEG is like EEG but does not require electrodes and can measure signals from deeper within the brain. MEG makes it possible to monitor activity in different parts of the brain over a period of time, revealing different brain functions.

Single photon emission computed tomography (SPECT) is a more sensitive type of CT scan that can map the inside of the brain. This technique is sometimes used to locate seizure activity in the brain.

Magnetic resonance spectroscopy (MRS) can detect abnormalities in the brain’s biochemical processes and near-infrared spectroscopy can detect oxygen levels in brain tissue.

Researchers are also working on new devices to treat epilepsy.

• Transcranial magnetic stimulation applies strong magnets to the outside of the head to influence brain activity.
• Work is also being done to develop implantable devices to deliver drugs to specific areas of the brain, and with a device that may be able to predict seizures a few minutes before they occur.
• Work is also being done on cell transplantation from fetal pig brains to correct abnormalities in the brain chemistry of people with epilepsy.

Epilepsy: Frequently Asked Questions

Here are some frequently asked questions related to epilepsy.

Q: Is epilepsy a mental illness?

A: Epilepsy is not a form of mental illness and it does not cause mental illness.

Q: Is epilepsy a sign of reduced intelligence?

A: Epilepsy is not an indicator of intelligence. Epilepsy affects people of average intelligence as well as those above and below average. Some people with mental retardation may have epilepsy, but few with epilepsy are mentally retarded. Epilepsy may also accompany other neurological or developmental disorders, but this does not mean that everyone with epilepsy also has another type of brain dysfunction. More than a few people known for their intelligence have had epilepsy, most notably Julius Caesar and Napoleon, Charles Dickens and Fyodor Dostoevsky, Socrates and Alfred Nobel, inventor of dynamite and creator of the Nobel Prize.

Q: I’ve heard that you should put a wallet or something soft in the mouth of someone having a seizure. Is this true?

A: No. You should not put anything in the mouth of someone who is having a seizure. Nor should you try to hold the person down or try to stop the jerking or shaking. Seizures usually last about 2 to 3 minutes. If you witness a seizure that is lasting for a longer period of time, or if the person having the seizure is pregnant or has diabetes, you should seek emergency attention. Otherwise, just stay close to the person having the seizure and keep away sharp objects or other items that might be harmful. Try to roll the person onto his or her side. The seizure will stop.

Q: Is it true that people with epilepsy aren’t allowed to drive?

A: Generally, people who have epilepsy but who have been seizure-free for 12 months or more should be able to drive. Some states issue restrictive licenses that limit the times of day and distance that people with epilepsy may legally drive.

Q: Is it true that epilepsy is caused by vaccinations that have gone wrong?

A: In a few rare cases, high fever after DTP (diphtheria-tetanus-pertussis) vaccination has triggered febrile seizures in children. These seizures have been temporary and without serious consequence.

Q: Can flickering lights, television, or computer screens trigger an epileptic seizure?

A: Yes. Various stimuli can trigger seizure, including those mentioned. Stress, headache, and lack of sleep can also trigger seizures. Seizures can also occur with no clearly identifiable cause or reason.

Q: Can people with epilepsy hold a job?

A: By law in the United States, people with epilepsy and other handicaps cannot be denied employment because of their seizures. However, epilepsy varies greatly in severity, and people with more severe types may find it difficult to work or attend school. About 75% of adults with epilepsy are employed.

Q: Do relaxation techniques, such as yoga or meditation, help stop seizures?

A: Stress is sometimes a trigger for seizures and stress reduction techniques should be beneficial. Although relaxation techniques don’t stop seizures, some people have found that they reduce their severity. However, deep breathing has been reported as a trigger for some people. Adequate and restful sleep is very important for people who have epilepsy.

Epilepsy: Putting It All Together

Here is a summary of the important facts and information related to epilepsy.

• Epilepsy is not a mental illness, and it does not cause mental illness.
• Most epilepsy can be successfully treated with medications.
• There are several different types of epileptic seizures-some are quite mild, while others are more severe.
• Epilepsy does not necessarily keep people from driving or holding a job.
• Epileptic seizures cannot be stopped by holding the person who is having the seizure. Trying to do so will only harm the person.
• Do not put anything in the mouth of a person having a seizure.
• Epilepsy is not contagious.
• Only rare forms of epilepsy are inherited.

Epilepsy: Glossary

Here are definitions of medical terms related to epilepsy.

Absence seizure: A specific type of seizure in which a person does not lose consciousness but goes into an altered state for a very short period of time.

Computed tomography (CT) scan: A CAT scan, a view of a section of the body made by a machine that combines x-ray technology with computer technology.

Electroencephalograph (EEG): A machine for tracing and recording the electrical activity of the brain by means of electrodes attached to the scalp.

Epilepsy: A brain disorder in which the energy circuits in the brain misfire to cause a seizure.

Functional Magnetic Resonance Imaging (fMRI): A type of brain scan that can be used to monitor the brain’s activity and to detect abnormalities in how it works.

Grand mal seizure: A specific type of seizure in which the person may lose consciousness, fall down, and experience jerking and twitching of the muscles. These seizures last for two to three minutes.

Magnetic Resonance Imaging (MRI): More advanced than an x-ray, an MRI is an imaging machine that produces detailed computerized images of internal body organs and tissues.

Myoclonic seizure: A specific type of seizure in which the person may jerk and twitch but will not lose consciousness.

Narcolepsy: A condition that causes sudden uncontrollable desire to sleep and sometimes causes visual or auditory hallucinations at the onset of sleep.

Neurology: The study of the nervous system; medical practice focused on the study and treatment of disorders of the nerves, including the brain.

Neuron: A nerve cell.

Neurotransmitters: Chemicals in the brain that aid in transmitting signals and messages back and forth between neurons.

Partial seizure: The most common type of seizure. A person undergoing a partial seizure will not lose consciousness or have distorted muscle movements but will see, hear, or smell things that are not really there.

Petit mal seizure: Same as absence seizure.

Positron emission tomography: A type of brain scan that can be used to monitor the brain’s activity and to detect abnormalities in how it works.

Seizure: A sudden attack.

Tonic-clonic seizure: A specific type of seizure in which the person may lose consciousness, fall down, and experience jerking and twitching of the muscles. These seizures last for two to three minutes.

Epilepsy: Additional Sources of Information

Here are some reliable sources that can provide more information on epilepsy.

For more information about new and developing treatments for epilepsy and about basic research into epilepsy and brain function, visit these sites:

Epilepsy Foundation of America 
Phone: (800) EFA-1000
Fax: (301) 577-4941

http://www.efa.org/

American Epilepsy Society 
Phone: (860) 586-7505
Fax: (860) 586-7550
Email: kmurray@aesnet.org

http://www.AESnet.org/

National Institute of Neurological Disorders and Stroke Office of Communications and Public Liaison

http://www.ninds.nih.gov

Neurosciences on the Internet

http://www.neuroguide.com/

A searchable and “browsable” index of neuroscience resources available on the Internet: Neurobiology, neurology, neurosurgery, psychiatry, psychology, cognitive science sites and information on human neurological diseases.