SEIZURES/EPILEPSY:


Description
Epilepsy is in a family of more than 40 neurological conditions that share a common symptom of seizures. It affects about 2.5 million people in the United States.

Nerve cells communicate with each other through electrical impulses. During a seizure, these impulses become overactive. This leads to irregular brain activity. The result is often unusual behavior in the person having the seizure.

Anyone can have epilepsy. It can start at any age. In the United States, it affects about one in 100 people, or around 2.9 million Americans. Another 300,000 people develop the disorder each year. Forty percent of those people are children under age 18. Worldwide, more than 50 million people have been diagnosed with the disorder. It is not contagious and it is not a mental illness. Most forms of epilepsy are not inherited, but it may run in some families.

Epilepsy can be very different from one person to another. Some people have seizures that are easily controlled, donít affect their daily lives, and go away in time. Others may be overwhelmed by constant seizures that affect their thinking and/or memory. The seizures can be so serious that they cause frequent injuries. They leave people unable to work, drive a car, or have an enjoyable social or family life.

There is no known single cause of epilepsy and in 70% of diagnosed cases, no cause is ever found. Some of the known causes include: brain injury, infections that damage the brain, toxic substances, injury that caused a lack of oxygen to the brain, stroke, nutritional imbalances, tumors of the brain, hereditary diseases affecting the brain, high fevers, and degenerative diseases.

Symptoms
The most visible and sometimes frightening sign of epilepsy is a seizure. Seizures are short spells of uncontrolled body behavior. They usually last seconds to several minutes. They may appear as convulsions, muscle spasms, or odd sensations. Sometimes they may be brief stares or moments of automatic behavior and changed awareness. The spells are usually the same from one time to another.

Complex partial seizures occur when the abnormal activity involves one area of the brain. The person may lose consciousness, have jerky random movements of one part of the body, experience sudden fear, uncontrolled facial movements, hallucinations, and disturbances of hearing, smell, nausea, vomiting or stomach discomfort. Complex partial seizures can last 2-4 minutes.

Absence seizures are characterized by the person having a change in consciousness, dazed and confused behaviors, mumbling, wandering randomly and behaving in unusual ways. Most people who experience an absence seizure will not remember what they have experienced. They are often accused of daydreaming and are unaware that a seizure has taken place.

Generalized seizures (grand mal) occur when the whole brain is involved in the seizure. Seizures may have tonic or clonic components. The tonic phase is characterized by a sudden loss of consciousness, falling, involuntary crying out, muscle stiffening and temporary loss of the ability to breathe. The clonic phase is characterized by alternate periods of muscle spasm and relaxation, possible cheek and tongue biting, foamy salivation, and cessation of breathing. Generalized tonic-clonic seizures usually last 1-3 minutes.

Some experience an aura before having a seizure. They may feel tense or anxious, hear a musical sound, sense an odor or taste or experience a change in some other sensation.

Diagnosis
Epilepsy is diagnosed when a person has had 2 or more seizures. You can have seizures without being diagnosed with epilepsy. A diagnosis comes from careful medical history and physical exam, as well as an accurate observed description of the seizures. Usually an electroencephalogram (EEG) is ordered to test the brain waves. Magnetic resonance imaging (MRI) can evaluate the brain for structural abnormalities.

Your doctor will take a history of your type of seizures. Your medical and family history can point to illnesses that may have caused your seizures. Tests are usually ordered to check for different causes of the seizures. This will depend on your age and the results of the history and physical exam.

Tests to check for epilepsy may include:
  • EEG (electroencephalography), which is a painless method of recording of your brain waves
  • Brain imaging (CT, or computerized tomography scan; MRI, or magnetic resonance imaging) to see if there is any physical problem in the brain
  • Blood tests
Treatments
To prevent seizures, most patients will need to be maintained on anticonvulsant therapy for the remainder of their lives. Anti-convulsant therapy can be initiated and titrated until a dose is found that will prevent seizures.

Some do not respond to anticonvulsant therapy and may have surgery to remove the injured area of brain tissue.

First aid for seizures
The goal of first aid is to keep the person safe for the few minutes most generalized seizures last. Seizures can be quite dramatic and even frightening for bystanders. But it is important not to panic. Simply follow these guidelines:
  • Keep calm. Help the person to the floor. Loosen clothing around the neck.
  • Remove sharp or hot objects that could injure.
  • Turn the person on one side so saliva can flow out of the mouth.
  • Place a cushion, such as a folded coat, under the head.
  • DO NOT put anything into the personís mouth.
  • After the seizure, allow the person to rest or sleep if necessary.
  • Some people will be confused or weak after a seizureĖ they may need help getting home.
  • Contact the parent or guardian if a child had the seizure.

During and after partial seizures, the person may be confused. Gently tell him or her that they will be alright. There is nothing you can do to make the seizure shorter. Stay calm and keep the person safe for the short time the seizure lasts.

People often wonder if they should call an ambulance when someone has a seizure. If you know the person has epilepsy, an ambulance is probably not needed unless the seizure lasts more than five minutes. If you donít know the person, or if the person is pregnant, diabetic, or seems otherwise ill, play it safe and call for help.

Seizures that repeat without the person fully recovering between them are called ďstatus epilepticus.Ē In this situation, it is very important to get medical help right away. Continuing seizures may cause brain injury.

Ongoing treatment for epilepsy
The most common treatment to prevent seizures is the daily use of anti-epileptic medications. More than 80 percent of people using such drugs are free of seizures and have few restrictions on their activities.

It is important to talk to your doctor about the choice of medication, how often it is taken, and any side effects. There are many medications available. Some of them work better for one type of epilepsy than another. Side effects, if any, may vary from one person to another. It is also very important to keep in touch with the doctor who prescribes the medicine. Your doctor will make sure that the medication is working as well as possible.

Many people with epilepsy must take their drugs for the rest of their lives to prevent further seizures. If a person, especially a child, has been free of seizures for a few years, the doctor may suggest trying to end the medications.

Surgery to remove injured brain tissue may be an alternative if drugs fail to stop the seizures. Specialized tests, including recording of the seizures with video electroencephalography (EEG), are needed to see if this type of treatment can possibly help a person.

Another type of surgery now available involves implanting a vagus nerve stimulator. This is done for people who have partial seizures that remain unbearable in spite of the use of medications.

Epilepsy treatment should include discussions about any social, emotional, and personality changes that can come with the disorder. Some of these changes may be due to the medications. Others may be due to the illness. Your neurologist will help you understand the differences and suggest proper action. You may need to let schools, employers, and friends know about your illness.

Women with epilepsy should seek advice from their doctors before and during pregnancy. They should not stop their medications if they become pregnant without talking to their doctors first.

Reporting regulations for seizures
California law requires physicians to report any medical condition that may affect ability to maintain control of a car, truck, or motorcycle. As seizures commonly can result in periods of altered consciousness, we will report seizures to the Public Health Dept. and Dept. of Motor Vehicles. This could result in temporary or permanent suspension of your driverís license. After a seizure, a person must not drive for 1 to 12 months, depending on circumstances. Sometimes, a doctorís approval is needed to be able to drive again.