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EPILEPSY FAQ


What is Epilepsy?
Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior or sometimes convulsions, muscle spasms, and loss of consciousness. Epilepsy is a disorder with many possible causes. Anything that disturbs the normal pattern of neuron activity — from illness to brain damage to abnormal brain development — can lead to seizures. Epilepsy may develop because of an abnormality in brain wiring, an imbalance of nerve signaling chemicals called neurotransmitters, or some combination of these factors. Having a seizure does not necessarily mean that a person has epilepsy. Only when a person has had two or more seizures is he or she considered to have epilepsy. EEGs and brain scans are common diagnostic test for epilepsy.

How long does a seizures last?
Depending on the type of seizure, they can last anywhere from a few seconds to several minutes. In rare cases, seizures can last many hours. For example, a tonic-clonic seizure typically lasts 1-7 minutes. Absence seizures may only last a few seconds,
while complex partial seizures range from 30 seconds to 2-3 minutes. "Status Epilepticus" refers to prolonged seizures that can last for many hours, and this can be a serious medical condition. In most cases, however, seizures are fairly short and little first aid is required.

Common Types of Seizures

Generalised Seizures
Absence seizures are not dramatic - in fact, they may not even be noticed at first. This form of epilepsy was previously known as "petit mal", (from French, meaning "little sickness"), and begins in childhood, between the ages of 5 and 10. It may cease at puberty, or continue throughout adult life. Typically, the child may be seen to stare vacantly for a few seconds, often fluttering the eyelids briefly, and seeming to be out of contact with surroundings. The child does not fall to the ground, and recovery is prompt, although the attacks may recur repeatedly, up to many times in the same day. The school work then suffers, and the child may be accused wrongly of "daydreaming".

Tonic-clonic seizures were previously called "grand mal" attacks (from French, meaning "big sickness"). The episodes are dramatic. There may be a brief warning consisting of a feeling of sinking or rising in the pit of the stomach, or the person may cry out or groan before losing consciousness completely. The limbs become stiff and rigid, and breathing stops, causing the lips to go blue. The eyes are rolled upward, and the jaws are clenched - if the tongue or lips are in the way, they will be bitten. This "tonic phase" is followed, within 30 to 60 seconds by the "clonic phase", in which the body is shaken by a series of violent, rhythmic jerkings of the limbs.
These usually cease after a couple of minutes. The person then recovers consciousness, but may be confused for several minutes, and wishes to sleep for an hour or two afterward. Headache and soreness of the muscles which have contracted so violently are commonly experienced for a day or more after the attack.

Myoclonic seizures where there may be sudden, symmetrical, shock-like contractions
of the limbs, which may or may not be followed by loss of consciousness.

Other varieties of generalised epilepsy are uncommon.
They include:
Atonic seizures, in which there is momentary loss of tone in the muscles of the limbs, leading to sudden falling to the ground or dropping of the head. The pattern is most often seen in children who have suffered injury to the brain, through lack of oxygen at birth, meningitis in infancy, etc.
Tonic seizures, where stiffening of the abody (arching the back) is the predominant feature. This type of attack may or may not be followed by loss of consciousness. It too is most commonly seen in children who have suffered some form of major insult to the brain.

Is there any treatment?
Once epilepsy is diagnosed, it is important to begin treatment as soon as possible. For about 80 percent of those diagnosed with epilepsy, seizures can be controlled with modern medicines and surgical techniques. Some antiepiletic drugs can interfere with the effectiveness of oral contraceptives. In 1997, the FDA approved the vagus nerve stimulator for use in people with seizures that are not well-controlled by medication.

What is the prognosis?
Most people with epilepsy lead outwardly normal lives. While epilepsy cannot currently be cured, for some people it does eventually go away. Most seizures do not cause brain damage. It is not uncommon for people with epilepsy, especially children, to develop behavioral and emotional problems, sometimes the consequence of embarrassment and frustration or bullying, teasing, or avoidance in school and other social setting. For many people with epilepsy, the risk of seizures restricts their independence ( states refuse drivers licenses to people with epilepsy) and recreational activities. People with epilepsy are at special risk for two life-threatening conditions: status epilepticus and sudden unexplained death. Most women with epilepsy can become pregnant, but they should discuss their epilepsy and the medications they are taking with their doctors. Women with epilepsy have a 90 percent or better chance of having a normal, healthy baby.

The Causes of Epilepsy
What is it that makes neurones of the brain discharge abnormally?
An inherited instability in the functioning of neurones seems to be responsible for the common forms of generalised epilepsy, especially absence attacks, myoclonic and tonic-clonic seizures where there is a family history of similar disorder. How this genetic defect operates has yet to be established!

Injury to the brain may certainly cause epilepsy. This includes deprivation of oxygen at birth, trauma to the head at any time of life, and stroke (injury to part of the brain caused by blockage or haemorrhage of one of its blood vessels).

Metabolic disturbance can produce generalised seizures through disturbing the normal functioning of neurones.This may occur when there is severe lowering of blood glucose levels, and when there is severe malfunctioning of the liver or kidneys.

Alcohol and drug abuse may cause seizures during intoxication, or when the offending substance is being withdrawn. Withdrawal of certain medications, such as barbiturates and other sedatives, can cause epileptic seizures in those who have taken them for long periods.

Brain tumour is, fortunately, a relatively uncommon cause of epilepsy, but it must be excluded in all patients who develop epilepsy for the first time during adult life. Tumour should also be excluded in children and adolescents in whom the appearances of the EEG test (see below) are not typical of genetic epilepsy, or where these does not seem to be an adequate alternative explanation (such as birth injury).

What research is being done?
Scientists are studying potential antiepileptic drugs with goal of enhancing treatment for epilepsy. Scientists continue to study how neurotransmitters interact with brain cells to control nerve firing and how non-neuronal cells in the brain contribute to seizures. One of the most-studied neurotransmitters is GABA, or gamma-aninobutryic acid. Researchers are working to identify genes that may influence epilepsy. This information may allow doctors to prevent epilepsy or to predict which treatments will be most beneficial. Doctors are now experimenting with several new types of therapies for epilepsy, including transplanting fetal pig neurons into the brains of patients to learn whether cell transplants can help control seizures, transplanting stem cells, and using a device that could predict seizures up to 3 minutes before they begin. Researchers are continually improving MRI and other brain scans. Studies have show that in some case, children may experience fewer seizures if they maintain a strict diet - called the ketogenic diet - rich in fats and low in carbohydrates.

 

Organizations

Epilepsy Foundation
4351 Garden City Drive
Suite 406
Landover, MD 20785-2267
postmaster@efa.org
http://www.epilepsyfoundation.org
Tel: 301-459-3700 800-EFA-1000 (332-1000)
Fax: 301-577-2684

Epilepsy Institute
257 Park Avenue South
New York, NY 10010
website@epilepsyinstitute.org
http://www.epilepsyinstitute.org
Tel: 212-677-8550
Fax: 212-677-5825

Epilepsy Self Help Group
R. Madhavan Nair Centre For Comprehensive Epilepsy Care
Sree Chitra Tirunal Institute For Medical Sciences And Technology
Thiruvananathapuram, Kerala
cec@sctimst.ac.in
http://sctimst.ker.nic.in/
Tel: +91-0471-524282
Fax: +91-047-443152


Material for Additional Information

  • Febrile Seizures Fact Sheet
    Febrile seizures fact sheet compiled by the National Institute of Neurological Disorders and Stroke (NINDS).
  • Infantile Spasms
    Infantile spasms (West Syndrome) information sheet compiled by NINDS.
 
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