Epilepsy

Epilepsy is a set of chronic neurological disorders that are characterized by seizures. The seizures may be provoked or unprovoked, and they may be recurrent. A single seizure that is combined with some brain alterations can increase the chance of seizures in the future.

Who Gets Epilepsy?

Epilepsy results from the excessive or abnormal activity of the brain. This activity, called hypersynchronus neuronal activity, can cause more seizures as an epileptic ages. About 50 million people worldwide have epilepsy. New onset cases of epilepsy are most common in the elderly and in infants, and those recovering from brain surgery are more likely to have an epileptic seizure. Epilepsy isn’t a single disorder, so it should be considered as syndromic. This means it will have different symptoms that result because of the activity of the brain. Seizures, of course, are the main symptom, but not all seizures are caused by epilepsy.

Can Epilepsy Be Cured?

If you or a loved one has epilepsy, you may wonder if it can be cured. The answer is no, although it can be controlled well with medication in some cases. Even with medication, about 30 percent of patients have problems controlling their seizures, and in these cases, doctors might suggest that patients have surgery. Some people who develop epilepsy will grow out of the disorder; epilepsy in some forms can be confined to the stages of childhood.

What Causes Epileptic Seizures?

Epileptic seizures are diagnosed by the fact that the seizures are spontaneous. However, some kinds of epilepsy will be triggered by certain factors. This kind of epilepsy is called reflex epilepsy. Things like heat stress, sleep, sleep deprivation, and emotional stress can all be triggers for someone with reflex epilepsy. Catamenial epilepsy is when a seizure is related to the menstrual cycle.

Different age groups tend to have different triggers for epilepsy. Infants may have epilepsy caused by trauma, metabolic disorders, or other conditions. Adolescents and adults may suffer from CNS lesions, which can cause epileptic fits. Brain tumors and trauma can also cause epilepsy in this age group. For older adults and the elderly, cerebrovascular disease can cause epilepsy. This is not the only reason, though. Other causes include degenerative diseases, head trauma, and tumors in the central nervous system.

Mutations in genes can also cause epilepsy. These mutated genes are most commonly causes of generalize epilepsy and infantile seizure syndromes. In these cases, sodium channels may stay open too long, which causes the neurons in the brain to be hyperexcitable.

What Kind of Seizures Are There?

If you have epilepsy, you might have partial or focal onset seizures or distributed generalized seizures. Partial seizures can be simple partial seizures or complex partial seizures. These seizures can spread through the brain. This is called secondary generalization and can be divided into categories depending on which parts of the body are involved.

Some types of these seizures include:

• Absence (petit mal)
• Myoclonic
• Clonic
• Tonic
• Tonic-clonic (grand mal)
• Atonic

Some children may exhibit behaviors that are not caused by epilepsy but may be confused with epileptic seizures.

These include:

• Shudders
• Nodding or rocking
• Conversion disorder

What Kind of Epilepsy Can I Have?

Epilepsy comes in four main groups. Each syndrome has a different combination of seizure types, ages, EEG findings, treatments, and prognosis.

These groups can be divided into these types and more:

• Rolandic epilepsy
• Frontal lobe epilepsy
• Infantile spasms
• Juvenile myoclonic epilepsy
• Juvenile absence epilepsy
• Hot water epilepsy
• Lennox-Gastaut Syndrome
• Landau-Kleffner Syndrome
• Dravet Syndrom
• Progressive myoclonus epilepsies
• Reflex epilepsy
• Rasmussen’s syndrome

This is just a short list of the many types of epilepsy syndromes. The classifications divide the syndromes into groups by the location and area of the brain that is affected. The syndromes are divided into:

• Localization-related epilepsy
• Generalized epilepsy
• Epilepsies of unknown localization

What Are Some Common Seizure Syndromes?

People who have seizures during sleep may have autosomal dominant nocturnal frontal lobe epilepsy, also known as ADNFLE. Dravet’s syndrome might be indicated if an infant has epileptic seizures that don’t respond well to treatment. The first seizure usually occurs with a fever. Ohtahara syndrome is rare, but it starts in the first weeks of life. The EEG will show the characteristics of this syndrome, but the prognosis is poor. About 50 percent of infants with this syndrome pass away within the first year, and the rest can be intellectually disabled or have cerebral palsy. Primary reading epilepsy’s main trigger is reading.

How Are Seizures Managed?

You may manage your seizures with medication. Operations may cure certain types of epilepsy in some cases, although the surgery required is often risky. A special diet may have an effect on the quantity or duration of seizures, and in others, the stimulation of the vagus nerve might help.
When a seizure occurs, the person should be moved away from sharp objects and something soft should be placed under his head. When possible, the patient should be rolled on his side to prevent fluids from entering the airway. If this isn’t done, it can result in choking and death. It is important to seek medical help if is the first seizure the patient has had, the seizure lasts more than five minutes or if it happens more than once without a patient waking up.

There are over 20 medications approved for the treatment of seizures.

Some of these include:

• Clorazepate
• Clonazepam
• Felbamate
• Pregabalin
• Tiagabine
• Valproic acid

Some medications are still under clinical trials, so they have not been released. Medications that can interrupt a seizure include diazepam and lorazepam. For cases of refractory status epilepticus, paraldehyde, midazolam, or pentobarbital may be used.

These anticonvulsants are normally safe; however, 88 percent of patients in one survey had reported at least one side effect. Most of these are mild and happen less when patients take the minimum dosage needed.

Some side effects include:

• Aplastic anemia
• Rashes
• Liver toxicity
• Mood changes
• Sleepiness

The goal of the medication is to stabilize and control seizures with minimal side effects.

View Resources

• Eeoc.gov – Questions and answers about epilepsy in the workplace and the Americans with disabilities ACT
• VA.gov – Epilepsy
• NY.gov – Epilepsy Fact Sheet
• Nih.gov – Epilepsy
• Ghr.nlm.nih.gov – Pyridoxine-dependent epilepsy