Epilepsy

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Epilepsy

Epilepsy, from the Greek word for seizure, is a recurrent demonstration of a brain malfunction. The outward signs of epilepsy may range from only a slight smacking of the lips or staring into space to a generalized convulsion. It is a condition that can affect anyone, from the very young to adult ages, of both sexes and any race. Epilepsy was described by Greek physician Hippocrates (c. 460–c. 377 BC). The incidence of epilepsy, that is, how many people have it, is not known. Some authorities say that up to one-half of 1% of the population are epileptic, but others believe this estimate to be too low. Some authorities state that about 40 to 50 million people worldwide are afflicted with epilepsy. This figure is a rough estimate at best. Many cases of epilepsy, those with very subtle symptoms, are not reported. The most serious form of epilepsy is not considered an inherited disease, though parents with epilepsy are more prone to have children with the disease. On the other hand, an epileptic child may have parents that show no sign of the condition, though they will have some abnormal brain waves.

Though the cause of epilepsy remains unknown, the manner in which the condition is demonstrated indicates the area of the brain that is affected. Jacksonian seizures, for example, which are localized twitching of muscles, originate in the frontal lobe of the brain in the motor cortex. A localized numbness or tingling indicates an origin in the parietal lobe on the side of the brain in the sensory cortex.

The recurrent symptoms, then, are the result of localized, excessive discharges of brain cells or neurons. These can be seen on the standard brain test called the electroencephalogram (EEG). For this test electrodes are applied to specific areas of the head to pick up the electrical waves generated by the brain. If the patient experiences an epileptic episode while he/she is wired to the EEG, the abnormal brain waves can easily be seen and the determination made as to their origin in the brain. Usually, however, if the patient is not experiencing a seizure no abnormalities will be found in the EEG.

Grand mal seizures

Grand mal seizures are those that are characteristic of epilepsy in most people’s mind. Immediately prior to the seizure, the patient may have some indication that a seizure is immanent. This feeling is called an aura. Very soon after he/she has the aura the patient will lapse into unconsciousness and experience generalized muscle contractions that may distort the body position; these are clonic seizures. The thrashing movements of the limbs that ensue in a short time are caused by opposing sets of muscles alternating in contractions (hence, the other name for grand mal seizures: tonic-clonic seizures). The patient may also lose control of the bladder. When the seizures cease, usually after three to five minutes, the patient may remain unconscious for up to half an hour. Upon awakening, the patient may not remember having had a seizure and may be confused for a time.

Petit mal seizures

In contrast to the drama of the grand mal seizure, the petit mal may seem inconsequential. The patient interrupts whatever he/she is doing and for up to about 30 seconds may show subtle outward signs such as blinking his eyes, staring into space, or pausing in conversation. After the seizure he/she resumes previous activity. Petit mal seizures are associated with heredity and they rarely occur in people over the age of 20 years. Oddly, though the seizures may occur several times a day, they do so usually when the patient is quiet and not during periods of activity. After puberty, these seizures may disappear or they may be replaced by the grand mal type of seizure.

Status epilepticus

A serious form of seizure, status epilepticus indicates a state in which grand mal seizures occur in rapid succession with no period of recovery between them. This can be a life-threatening event because the patient has difficulty breathing and may experience a dangerous rise in blood pressure. This form of seizure is very rare, but can be brought on if someone abruptly stops taking the medication prescribed for his/her epilepsy. It may also occur in alcohol withdrawal.

KEY TERMS

Cortex— The outer layer of the brain.

Motor cortex— Part of the cortex that controls the actions of the extremities, such as moving one’s hand away from a heat source.

Sensory cortex— Part of the cortex that receives signals from peripheral nerves to indicate the presence of excessive heat, for example, and the need to move.

Treatment

A number of drugs are available for the treatment of epilepsy. The oldest is phenobarbital, which has the unfortunate side effect of being addictive. Other drugs currently on the market are less addictive, but all have the possibility of causing untoward side effects such as drowsiness, nausea, or dizziness.

The epileptic patient needs to be protected from injuring himself/herself during an attack. Usually for the patient having a petit mal seizure, little needs to be done. Occasionally these individuals may lose their balance and need to be helped to the ground to avoid hitting their head, but otherwise need little attention. The individual in a grand mal seizure should not be restrained, but may need to have some help to avoid his/her striking limbs or head on the floor or nearby obstruction. If possible, roll the patient onto his/her side. This will maintain an open airway for the patient to breathe by allowing the tongue to fall to one side.

Epilepsy is a recurrent, lifelong condition that must be reckoned with. Medication can control seizures in a substantial percentage of patients, perhaps up to 85% of those with grand mal manifestations. Some patients will experience seizures even with maximum dosages of medication. These individuals need to wear an identification bracelet to let others know of their condition. Epilepsy is not a reflection of insanity or mental retardation in any way. In fact, many who experience petit mal seizures are of above-average intelligence.

See also Anticonvulsants.