EPILEPSY (SEIZURE DISORDER)

Definition

Epilepsy (also known as seizure disorder) is a neurological condition with symptoms which vary from a momentary lapse of attention to convulsions.

Damage to brain cells can disrupt the normally smooth-running pattern of electrical activity in the brain by causing an electrical overload. This can create a seizure, which causes a sudden change in the individual's consciousness and/or change in motor activity.

Facts

Epilepsy affects people of all ages, races and nationalities. According to the Epilepsy Foundation of America, about two and a half million people in the United States have a seizure disorder. It can develop at any time in life. Approximately two-thirds of the 125,000 persons who are newly diagnosed each year are adults.

The symptoms, frequency, intensity and types of seizures vary greatly from person to person.

Those whose condition is controlled by medication may not experience seizures at all.

In many cases, the cause of epilepsy is unknown. It can occur as a result of an infection, head injury, brain tumour, hydrocephalus, toxic reaction to drugs and alcohol, or other conditions which injure the brain and damage brain cells. Genetic factors may contribute to the development of a seizure disorder, but are not a primary cause. It may also be associated with other neurological conditions such as cerebral palsy.

Symptoms

There are two basic types of seizures: generalised and partial. These refer to how much of the brain experiences the abnormal electrical activity. The form, intensity and duration of the seizures are related to the number and type of brain cells which are affected. In a Generalised (or Grand Mal) Seizure the whole brain is affected. The individual may experience lapse of consciousness and convulsions. Motor function and bladder or bowel control may also be affected.

In a Partial Seizure, abnormal electrical activity occurs in only a part of the brain. There is a loss of consciousness, although with "simple partial" seizures there is usually a decrease in consciousness. However, specific effects depend on the part of the brain involved. Common effects may include: a dazed state, automatic, purposeless behaviour such as lip-smacking, or jerking movements in a certain part of the body.

Seizure activity is sometimes preceded by sensations involving the five senses, such as a sound, an unpleasant odour or taste, a sinking or rising feeling in the stomach or head, or spots before the eyes. This is referred to as the "aura." Some people may be able to train themselves to recognise the aura as a warning sign and prepare themselves for the oncoming seizure by taking preventative measures to protect themselves from possible injury.

Diagnosis

Diagnostic examinations will vary according to the needs of each individual. Diagnosis usually involves a thorough physical and neurological examination, a detailed medical history, analysis of blood and other bodily fluids, an electroencephalogram (EEG), and a computerised tomography (CT) or magnetic resonance imaging (MRI) scan. The pattern of seizures must be measured, including types, frequency and duration.

Treatment

There is no known cure for epilepsy. According to the Epilepsy Foundation of America, in about 85% of the cases, seizures can be successfully controlled by appropriate medication and treatment. Drugs that are used to treat seizures are called anti-epileptics or anti-convulsants. They act by minimising or blocking the spread of excess electrical discharge to other parts of the brain.

Treatment methods may also consist of surgery or a special diet.

Treatment of epilepsy is aimed at controlling seizures as well as treating their underlying cause if it is known. Certain types of seizures are difficult to control even with medication. In some cases, surgery may be indicated in order to remove the epileptic focus, or that part of the brain which produces the seizures.

A person with epilepsy can potentially be seizure-free, work and participate in most activities.

Since stress or emotional upset may lower the seizure threshold or raise the risk of experiencing seizures, treatment should include attention to social, emotional, psychological and vocational needs.

If a person has a generalised (Grand Mal) seizure, the following guidelines should be remembered:

• Remain calm.
• Remove sharp objects from the area.
• Loosen clothing around the neck to help the person breathe.
• Place something soft under the person's head.
• Turn the person on his/her side to keep air passage clear. Do not attempt to force open the person's mouth or to insert any objects into the mouth.
• Do not try to hold the person down or stop his/her movements.
• Do not attempt CPR, unless the person does not start breathing again after the seizure has stopped.
• Remain with the person until the seizure has ended.
• Reassure the person as consciousness returns.
• Offer to call a friend, relative or taxi to help the person get home if he/she seems confused.