Definition and Overview
Epilepsy is a neurological disorder characterized by recurrent, sudden, or unprovoked seizure due to the disrupted electrical activity of the brain. Some of its hallmark symptoms are seizures, loss of consciousness, and convulsions.
The brain is referred to as the command center of the body. It is composed of millions of neurons that send messages to various parts, instructing them how to move or react to certain situations. Simply put, without them, a person would not be able to know how to eat, walk, and breathe, to name a few.
In order to communicate, the brain delivers electric signals through the nerves that are bundled together in the spine. Epilepsy occurs when the transport of these signals is disturbed or there is a massive amount of electrical information being sent.
According to the Epilepsy Foundation, the disorder is the fourth most common neurological problem in the United States following Alzheimer’s disease. At least 1 in every 26 people will develop the disorder, which is more common among older adults and children. Epilepsy should not be confused with other types of seizures, aptly called non-epileptic seizures (NES). At least 20% of people who believe they have epilepsy actually have NES.
Although epilepsy and NES share similar characteristics, such as seizures, they differ in terms of the cause. Epilepsy is always caused by disruptions of brain activity. NES, on the other hand, can be either organic (e.g., metabolic processes) or psychogenic (seizures caused by certain emotional or mental processes such as panic attacks).
Causes of Condition
It is understood that epilepsy occurs due to the disturbance in the electrical activity of the brain. What is not clear, however, is why this happens in the first place.
Doctors generally classify epilepsy in two ways: idiopathic or symptomatic. It is considered idiopathic when no known cause can be attributed to the seizures. Most of the reported cases of epilepsy are idiopathic.
However, recent studies are now looking into the possibility that this has a genetic factor. In one study by the National Center for Biotechnology Information, gene changes are linked to at least ten specific types of epilepsy. One of these is the EPM2A gene mutation that occurs with people who have LaFora Disease.
When epilepsy is associated with a particular health problem, it is called symptomatic, wherein epilepsy is part of the symptom. These health problems, which affect the brain, include the growth of tumors, which could be benign or malignant, and diseases affecting the blood vessels connected to the brain like a stroke. Symptomatic epilepsy may also be induced by environmental factors such as abuse of alcohol and drugs, or injuries that severely affect the head, especially the brain.
There are also infections that can have an impact on the nervous system. One of these is meningitis, which may be caused by either a virus or bacteria. Meningitis is a medical condition characterized by the swelling of the meninges, which are connective tissues in the spinal cord and brain.
Epilepsy among children may be caused by poor or delayed development of the brain during fetal growth or problematic birth wherein the supply of oxygen to the brain may have been reduced or cut off due to the umbilical cord being twisted around the neck.
Seizures, on the other hand, can be categorized in many ways. If it affects a focus of the brain, such as one area or hemisphere, it is called focal or partial. It is considered generalized if it affects the entire brain. A petit mal seizure is a mild type that involves loss of consciousness for only a short period of time.
- Repeated and usually sudden seizures
- Sudden intense emotion such as sadness, fear, or happiness
- Unusual feeling in the gut
- Sense of déjà vu
- Uncontrollable movements of the limbs
- Loss of consciousness and/or awareness
- Tingling in the entire body
- Visual disturbances (e.g., flashing lights)
- Staring into space
- Stiffening of the muscles
- Loss of muscle control
- Biting of the tongue
Who to See and Treatments Available
It usually takes some time before a patient can be diagnosed with epilepsy especially if other obvious symptoms such as convulsions or jerky movements are missing. The symptoms may be similar to those of other health problems such as panic attack.
Nevertheless, a neurologist can correctly diagnose the problem. It begins with a consultation and a physical examination where the doctor allows the patient to describe the episodes such as the possible triggers, the reaction of the body following the seizure, and other symptoms. The doctor will also look into the patient’s medical records and family history.
The doctor may then request for a more comprehensive test such as MRI scan, which can detect any lesions or changes in the brain structure. An EEG (electroencephalogram) can be helpful in assessing the electrical activity of the brain. Electrode pads are attached to the scalp while the patient is exposed to flashing light, which affects at least 5% of people with epilepsy.
As for the treatment, the most common approach is medication. At least 65% of patients respond to anti-epilepsy drugs such as sodium valproate, topiramate, and lamotrigine. These medications are typically given in progressive doses, depending on how the body responds to them.
In very rare cases, brain surgery becomes an option but only if the treatment will not have any major impact on the body and other parts of the brain.
Patients are also often advised to maintain a seizure journal. It will be useful in determining if there are potential triggers to the seizures such as flashing lights, stress, alcohol use, illegal drug use, and lack of sleep.
Since the condition can occur at any time, it may also be necessary for the patient to wear a medical bracelet. This bracelet indicates the kind of condition the patient has, what types of first aid procedures can be carried out, and who to call in case of emergency.
Abou-Khalil BW, Gallagher MJ, Macdonald RL. Epilepsies. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 67.
Foreman B, Hirsch LJ. Epilepsy emergencies: diagnosis and management. Neurol Clin. 2012;30:11-41.
Morris GL 3rd, Gloss D, Buchhalter J, Mack KJ, Nickels K, Harden C. Evidence-based guideline update: vagus nerve stimulation for the treatment of epilepsy: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2013;81:1453-1459. PMID: 23986299 www.ncbi.nlm.nih.gov/pubmed/23986299.
Werz MA. Epilepsy Syndromes. Philadelphia, PA: Elsevier Saunders; 2010.