EPILEPSY - AN OVERVIEW

by Epilepsy Association of Scotland

The following are some basic facts about epilepsy:

• about 420,000 people in the UK (1 in 130) have some form of epilepsy
• around 30,000 new cases are diagnosed each year, with about three-quarters being young people under the age of 20
• epilepsy affects people of both sexes, of all levels of intelligence, and from different racial origins and social backgrounds
• epilepsy is not a disease, nor is it a mental illness
• there are different forms of epilepsy and types of seizures
• some people's seizures follow a definite pattern, whereas other people have unpredictable seizures
• some people get a warning a seizure is coming on
• most seizures are quickly over and easily dealt with
• in most cases, epilepsy can be effectively controlled with medication
• epilepsy is common in childhood and adolescence, but can start at any age
• anyone can develop epilepsy after a head injury (e.g. playing sport, or in a road accident)
• epilepsy can develop in the elderly when the blood supply to the brain diminishes because of ageing
• photosensitive epilepsy is rare
• boredom can be a trigger of seizures, so that the more people are stimulated in the home, school or work environment, the less likely seizures will occur
• for most people with epilepsy, the attitude of others towards them is a much greater handicap than the epilepsy itself
• what people with epilepsy most need is understanding and acceptance from the public

Definition

Epilepsy is a tendency to recurrent seizures. Such seizures occur as a result of disturbances in the electrical activity of certain brain cells. There are several kinds of epilepsy, and over 20 classified types of seizure. The nature of the seizure depends on both the part of the brain first affected, and where and how quickly the disturbance spreads to other areas of the brain (see classification of seizures below).

Causes

One cause of epilepsy is brain damage, for example:

• birth injury
• accidental injury (e.g. road, industrial, domestic)
• non-accidental injury (e.g. child battering, mugging)
• alcohol, drug, solvent, and substance abuse

Another cause is infections and fevers, for example meningitis, encephalitis, and some prolonged and severe high temperature convulsions. Primary and secondary tumours can lead to epileptic fits, as can biochemical abnormalities (for example, low levels of glucose, calcium, and magnesium). Other causes are:

• hormonal imbalance
• a low convulsive threshold (a combination of a highly sensitive brain with other causes)
• idiopathic epilepsy, for which no cause is identified

Classification of seizures

The following is a classification of seizures, as recommended by the International League Against Epilepsy (Gastaut, 1969) and other international bodies. Generalised seizures are triggered by an abnormal electrical discharge starting deep in the mid-brain and spreading to the rest of the brain (i.e. no local onset). They include:

• absences
• myoclonic
• infantile spasms
• clonic
• tonic
• tonic-clonic
• atonic
• akinetic

Partial seizures are triggered by an abnormal electrical discharge confined to a localised area of the brain (i.e. local onset). They are further broken down into simple partial seizures:

• motor
• sensory
• atonomic
• compound or complex partial seizures
• with impaired consciousness alone
• with cognitive symptomatology (forced thinking)
• with affective symptomatology (disturbance of emotions)
• with psychosensory symptomatology (disturbance of sensory emotions)
• with psychomotor symptomatology (automatisms)

Partial seizures secondarily generalised are triggered by an abnormal electrical discharge starting in a localised area of the brain, then spreading into the mid-brain. Finally, there are unclassified seizures. This category includes all those seizures that cannot be classified due to inadequate or incomplete data. Possible triggers of seizures It is not always possible to determine what triggers a seizure at a particular time, but some factors which make seizures more likely can sometimes be identified in individual cases. They may include:

• lack of food
• lack of sleep
• excessive heat
• constipation
• menstruation
• too much liquid
• alcohol
• sudden loud noises
• flashing or flickering lights
• failure to take medication
• too much medication (causing toxicity)
• anxiety
• stress
• boredom and inactivity

Reflex epilepsies (i.e. caused by sudden loud noises, or flashing or flickering lights) are rare.

Medication

The first line of management for nearly all cases of epilepsy is anti-epileptic medication, although in a very few cases surgery may be appropriate or a specific diet recommended. Medication is prescribed to control epilepsy, i.e. to reduce incidence of seizures, it does not normally cure epilepsy. Nowadays, the emphasis of treatment is on:

• monotherapy (control of seizures by means of one drug wherever possible)
• blood level monitoring (the testing of drug serum levels in the blood to ascertain the critical dosage for each individual, i.e. the amount which controls seizures but does not lead to adverse side-effects)

The majority of people with epilepsy do not suffer severe side-effects, provided they take their prescribed medication regularly and have good on-going medical supervision Anti-epileptic drugs are not addictive, but they may have some side-effects, especially in the elderly and in those taking several anti-epileptic drugs. Problems faced by people with epilepsy The neurological implications of a diagnosis of epilepsy are:

• possible underlying brain damage
• sub-clinical epileptic discharges
• prodromes and auras
• behaviour disturbances as part of the seizure pattern
• long-term and often erratic course of the condition. The problems which may arise as a result of seizures are:
• embarrassment (e.g. loss of control, incontinence)
• unpredictability
• fear of injury to self and others
• fear of intellectual impairment
• fear of choking and death
• fear of the seizure worsening
• fear of how others (family, relatives, friends, colleagues) view the seizures The problems associated with medication are that:
• it is difficult for some people to accept taking drugs
• some people may experience side-effects from anti-epileptic drugs Problems that the individual may experience include:
• a lowering of self-image, leading to lack of self-confidence
• a lowering of aspirations
• difficulty in establishing new relationships
• having to cope with the label of "epilepsy"
• having to decide whether to conceal the condition, and the tension and anxiety resulting from this
• a possible change of appearance Problems that may be experienced within the family include:
• difficulty of all members of the family accepting the fact of epilepsy
• coping with feelings of alienation or guilt, or being "hard done by"
• keeping the needs of all members of the family in mind
• being aware of the teasing which the person with epilepsy may undergo
• striking the balance between reasonable safety measures and over-protection
• possible genetic implications
• being prepared for possible intensification of conflict in teenage years
• coming to terms with the possibility of the individual with epilepsy never leaving home for a more independent life
• child bearing (a possible danger to the unborn child from the anti-epileptic drugs taken by the mother, and from falls and loss of oxygen during seizures)
• child rearing (if the mother has seizures) Problems that the individual may experience in the community include:
• employment (many jobs are closed to people with epilepsy; unnecessary job discrimination)
• leisure and recreation (the need for extra care, e.g. swimming, cycling, climbing, etc.) * travel (may need extra precautions)
• alcohol (the need for self-regulation, and an awareness of what level of alcohol triggers seizures)
• driving a car (not possible for at least two years)
• insurance is not easy to get (e.g. car, house, and life insurance cover)
• the overwhelming problem of social stigma, ignorance, and prejudice