Epilepsy

Epilepsy: A tendency to recurrent seizures or temporary alteration in one or
more brain functions.

Seizures are defined as transient neurological abnormalities caused by
abnormal electrical activity in the brain. Human activities, thoughts,
perceptions, and emotions are normally the result of the regulated and
orderly electrical excitation of nerve cells in the brain. During a seizure,
a chaotic and unregulated electrical discharge occurs. In some cases, a
stimulus such as a flashing light sets off this abnormal sequence, but
offten seizures appear spontaneously.

Causes

Seizures are a symptom of brain dysfunction and, like symptoms in other
parts of the body, can result from a wide variety of disease or injury.
Seizures may occur in association with head injury, birth trauma, brain
infection (such as meningitis or encephalitis), brain tumor, stroke, drug
intoxication, drug or alcohol withdrawal states, or metabolic imbalance in
the body. A tendency to seizures may develop for no obvious reason or there
may be an inherited predisposition.

Incidence

About one person in 200 suffers from epilepsy. The number of epileptics in
the US is estimated to be close to 1 million. The disorder usually starts in
childhood or adolescence. Many people outgrow epilepsy and do not require
medication.

Types and Symptoms

Epileptic seizures can be classified into two broad groups - generalized and
partial seizures. The form a seizure takes depends on the part of the brain
in which it arises and on how widely and rapidly it fans out from its point
of origin. Generalized seizures, which cause loss of consciousness, affect
the whole body and may arise over a wide area of the brain. Temporal lobe
epilepsy* is a type of partial seizure. Partial seizures, in which
consciousness may be retained, are usually caused by damage to a more
limited area of the brain. Though partial seizures begin in a limited area,
the electrical disturbance may spread and affect the whole brain, causing a
generalized seizure.

Many people with epilepsy lead normal lives and have no symptoms between
seizures. Some can tell when an attack is imminent by experiencing an aura
(a restless, irritable, or uncomfortable feeling).

Generalized Seizures

There are two main types of generalized seizure - grand mal and petit mal
(absence) seizures.

Grand Mal

Duraing a grand mal seizure the person falls down unconscious and the entire
body stiffens and then twitches or jerks uncontrollably. There may be an
initial cry; breathing is then absent or very irregular during the seizure.
Following the seizure, the muscles relax, and bowel and bladder control may
be lost. The person may feel confused and disoriented and perhaps have a
headache; often he or she will want to sleep. These effects usually clear in
several hours. The person usually has no memory of the event. Prolonged
seizures, referred to as status epilepticus, can be fatal without emergency
treatment.

Absence Seizures

These seizures, in which there is a momentary loss of consciousness without
abnormal movements, occur mainly in children. There is a blank period
lasting from a few seconds to up to half a minute or so, during which the
sufferer is unaware of anything. To the onlooker, it may appear that the
person is simply daydreaming or inattentive, and the attack may even pass
unnoticed. Absence seizures may occur hundreds of times daily and can
markedly impair school performance.

Partial Seizures

Partial seizures are divided into simple seizures (in which consciousness is
maintained) and complex seizures (in which it is lost). In simpile partial
seizures and abnormal twitching movement, tingling sensation, or even
hallucination of smell, vision, or taste, occurs without warning and lasts
several minutes. When the twitching occurs and spreads slowly from one part
of the body to another on the same side, it is referred to as jacksonian
epilepsy. Sufferers retain awareness during the event and can recall the
details.

During complex partial seizures, the person becomes dazed and may not
respond if addressed. Sometimes involuntary actions, such as fumbling with
buttons or lip smacking, occur. These actions are called automatisms and can
(rarely) take more bizarre forms. The person typically remembers little, if
any, of the event.

Both types of partial seizure can sometimes spread to involve the entire
brain, in which case generalization is said to have occurred. The symptoms
then become the same as those of a grand mal seizure.

Prevention

Many epileptics experience seizures at times of extreme fatigue or stress.
Infectious illnesses, especially if fever is present, also lower the seizure
threshold. By avoiding these situations and taking prescribed medication
regularly, epileptics can reduce seizure frequency. Occasionally, epileptics
discover a distracting technique that can abort a seizure once the aura has
begun.

Diagnosis

In making the diagnosis, the physician seeks as much information as possible
about the attacks. Since patients frequently do not have recall, information
may be obtained from witnesses. After a complete neurological examination,
the physician usually orders an EEG to help with the diagnosis. It is
important to realize that the EEG cannot always absolutely confirm or refute
the diagnosis of seizures, and that the results must be weighed in light of
other clinical findings. Sometimes tests of heart function (such as an ECG
or Holter monitor) are obtained to exclude cardiac irregularities as a cause
of loss of consciousness in an adult. Patients thought to have seizures are
usually given CT scanning of the brain and blood tests to check for the
conditions associated with epilepsy. Opinion is divided on whether a single
seizure should be treated; physicians agree that people with recurrent
seizures should take anticonvulsant drugs.

Treatment

anticonvulsant drugs are the first line of treatment for epilepsy, and, in
almost all cases, they lessen the frequency of seizures. The drugs may have
unpleasant side effects, including drowsiness and impaired concentration.
The physician will attempt to find the one drug that works best, but, with
very severe epilepsy, a combination may be needed to control seizures. If no
seizures occur for two to three years (depending on their cause), the
physician may suggest reducing or stopping drug treatment.

Rarely, surgery may be considered if it is thought that a single area of
brain damage (usually in the temporal lobe) is causing the seizures and
medication is ineffective.

Outlook

If epilepsy develops during childhood and there is a strong family history
of the disease, the chances are good that the problem will descrease after
adolescence; it may even disappear altogether. However, seizure control is
likely to be more difficult in temporal lobe epilepsy or if the disorder has
been brought about by severe brain damage.

One third of those in whom epilepsy develops eventually grow out of the
condition and experience no further seizures. Another third find that the
seizures become less frequent in response to drug treatment. The conditions
of the remaining third remain the same.

Sufferers from epilepsy usually are able to work, but the disorder may limit
their choice of jobs. There are restrictions on obtaining a driver's license
(generally an applicant is required to have been seizure-free for several
years). It is advisable, unless the seizures are very well controlled, to
avoid high-risk jobs involving heights or dangerous machinery and sports
such as skiing.

Many epileptics carry a special card, tag, or bracelet that states they have
epilepsy. Epileptics are recommended to advice colleagues on what to do if a
seizure occurs.

Dealing with an Epileptic Seizure

Most major epileptic seizures last only a minute or two and demand little of
the bystander. All that is necessary is to let the attack run its course and
to ensure that the person is in no physical danger and can breathe while he
or she is unconscious.

The person should not be held down, nor should hir or her movements be
restrained. Any tight clothing around the neck should be loosened and
something soft should be placed beneath the head. The mouth should not be
forced open and no object should be wedged between the teeth. Once the
convulsions have ceased, the victim should be put into the recovery
position**.

An ambulance should be called if the seizure continues for more than five
minutes, if another seizure immediately follows the first one, or if
consciousness is not regained a few minutes after the epileptic seizure has
come to end.

*Temporal Lobe Epilepsy

A form of epilepsy in which abnormal electrical discharges in the brain are
confined to a localized region on one side, the temporal lobe. The seizures
therefore differ from the generalized disturbances that occur in a grand mal
seizure or in an absence seizure (petit mal).

Cause

There is usually an area of damage within one of the temporal lobes that
acts as a focus for the abnormal development of electrical discharges in
attacks. Damage may be caused by a birth injury, head injury, brain tumor,
brain abscess, or stroke. The temporal lobes are concerned with such
functions as smell, taste, hearing, visual associations, and some aspects of
memory. Abnormal electrical activity in a lobe may thus cause peculiarities
in any of these functions.

Symptoms and Signs

People affected by temporal lobe epilepsy suffer dreamlike states that range
from partial loss of awareness to total disregard. The person may have
unpleasant hallucinations of smell or taste. Also common during attacks is
the perception of an illusory scene or the phenomenon of deja vu. There may
also be facial grimacing, rotation of the head and eyes, and often sucking
and chewing movements.

The affected person may perform tasks with no memory of them after the
attack. An attack may last for minutes or hours before full consciousness
returns.

In some cases a temporal lobe seizure progresses after several seconds or
minutes to a generalized grand mal seizure.

Diagnosis and Treatment

The principles of investigation and drug treatment for temporal lobe
epilepsy are the same as for other types of epilepsy. Surgery has been used
with success in some cases of temporal lobe epilepsy. The operation is
designed to remove the part of the lobe containing the irritating focus for
the attacks. Operations are performed only in severe cases that have not
responded to drug treatment because of the possible effects on other
important functions of the brain.

**Recovery position

The correct position in which to place a casualty who is breathing, while
waiting for help to arrive.

Do not:
+ Leave an unconscious victim alone.
+ Put the victim into the recovery position if you suspect fractures to the
neck or spine.

Steps:
1. Turn the victim's head toward you, tilting it back, to open the airway.
2. Put the arm nearest you by the victim's side and slide it under his or
hut buttock.
3. Lay the other arm across the chest and cross the leg farthest from you
over the one at the ankle.
4. Grasp clothing at the hip farthest from you with one hand and support the
head with the other. Pull the victim toward you to rest against your knees.
5. Bend the uppermost arm and leg to support the body and stop the victim
from rolling onto his or her face. The other arm should now be free.
Readjust the head to make sure it is tilted well back and check to see if
the airway is clear.

(I hope this information comes in handy! All of the material above is from a
legitimate source, the AMA home med.encyc. - though I had to type it all in,
so please forgive the occasional typos in the text. Sean)