Early beliefs about epilepsy included the idea that seizures resulted from demons, spirits and angry gods. Unfortunately, despite advances in modern medicine, epilepsy continues to be misunderstood. This lack of understanding leads to discrimination and social stigmas that, in addition to an increased risk of injury and economic instability, create significant burdens on those with epilepsy. Fear of people finding out about the disorder results in suffering from not seeking treatment, children facing psychological problems caused by bullying and teasing, and restrictions placed on driving and employment opportunities limiting independence.
Epilepsy affects all races, ages and genders. It is most frequently diagnosed in children, adolescents and older adults. Although epilepsy has no cure, treatments are available, and people with epilepsy can lead normal productive lives.
In March 2012, the Institute of Medicine (IOM) presented a report to the Senate titled Epilepsy Across the Spectrum: Promoting Health and Understanding. Composed by professionals and organizations who work in this specialty, this comprehensive report provides recommendations aimed at improving the lives of people with epilepsy. Keck Medicine of USC physician. Christianne Heck, MD, served as an IOM committee board member.
The brain controls all functions of the body.
Two types of cells make up the brain – neurons and glial cells. Neurons are nerve cells that communicate messages from the body about functions, senses and emotions. Glial cells support and protect neurons. Messages are sent through specialized networks of neurons using chemical and electrical signals.
Chemical signals are dispatched by substances known as neurotransmitters. They are released by neurons and target receptors in other cells or neurons. Electrical messages are conveyed when the voltage of the neuron is altered by ions such as calcium, potassium and sodium. Any disruption in these pathways will lead to abnormal brain activity.
A seizure results when abnormal electrical activity of the brain temporarily alters behavior.
Seizures can occur for many different reasons and can vary greatly in their appearance. Two or more unprovoked seizures can suggest epilepsy. A diagnosis is made by a physician based on many factors, such as results of diagnostic tests, symptoms and cause of seizures.
The location of abnormal activity in the brain and how it spreads will determine the features of the seizure. A seizure can affect functions such as movements, thoughts and consciousness; as a result, many types of seizures exist.
Seizure types have been categorized by the International League Against Epilepsy (ILAE) into two groups, based upon where the seizures start in the brain and if consciousness is impaired.
Partial seizures begin in a single area of the brain and are subdivided further into simple partial and complex partial, according to how much consciousness is impaired during the seizure. During a simple partial seizure, the person’s awareness remains intact. During a complex partial seizure, consciousness is altered. Both of these seizure types can progress to generalized seizures, also referred as secondary generalized seizures.
Generalized seizures begin in both sides of the brain and quickly spread; consciousness is lost at the beginning of the seizure. These seizures are also subdivided into several types. See ILAE.org for more details about seizure classifications.
Usually seizures last from a few seconds to minutes. Seizures that do not stop are known as status epilepticus. It is a very serious condition requiring immediate medical attention. If you see someone enduring a seizure lasting longer than a few minutes, you should call 911 for emergency assistance.
Seizures are caused by abnormal brain activity, which is diagnosed by an EEG. Non-epileptic seizures physically look like seizures but do not show abnormal brain activity on an EEG. These are known as pseudo seizures.
Causes of epileptic and non-epileptic seizures
The majority of epilepsy cases diagnosed are classified as idiopathic or primary epilepsy, which means no known cause can be found. If a cause for seizures can be identified, this is known as symptomatic or secondary epilepsy.
Specific conditions known to cause damage to the brain have been identified as risk factors to developing epilepsy.
- Congenital birth defects
- Birthing difficulties
- Head traumas
- Infections affecting the brain
- Tumors affecting the brain
- Cerebral vascular disease
Genetic links have been identified with some types of epilepsy, and a family history of epilepsy also has been identified as a risk factor.
Seizures can occur either at the time of an injury, or months or even years after the injury. Seizures that take place at the onset of injury are known as acute symptomatic seizures. Those that start after a period of time are known as remote symptomatic seizures.
Types of Epilepsy
An epilepsy syndrome refers to a specific diagnosis determined by various details. Information required for this diagnosis includes not only seizure types but also severity, time of day of occurrence, age of onset, causes and seizure triggers. Clinical data from EEGs, results of diagnostic tests and full medical history prove valuable as well. It is important to find the right diagnosis to ensure that correct treatment is established.
In addition, determining the type of syndrome can provide useful information about the characteristics of the disorder, such as if seizures will lessen or not, and what treatments will work best. Genetic links also can be identified in certain epilepsy syndromes.