Epilepsy
EPILEPSY (SEIZURES)
The term epilepsy refers to recurrent seizures or “convulsions.” Rarely do we experience such dramatic symptoms as with certain types of seizures, and throughout history, a broad body of superstition, misunderstanding, and unfounded fear have arisen around the diagnosis. Even today, sufferers are faced with many obstacles to their daily activities which are related more to these misconceptions than to their usually well- controlled disease.
Seizures are episodes of spontaneous discharge of groups of nerve cells in the brain. This may arise for unknown reasons, or may result from some physical or chemical injury to the brain. They area affected determines the type of seizure which occurs, but often the seizure will spread beyond the area of injury to produce a generalized seizure.
SYMPTOMS
Seizures can conveniently be divided into several categories, depending largely upon the type of symptoms they cause. Tonic-Clonic, or Grand Mal– refers to the most widely recognized type, where muscle groups rapidly contract and release in a jerking motion, eventually involving many or all major groups, impairing consciousness, and leading to coma during and following the seizure. Vocalizations, urinary incontinence, irregular breathing and tongue biting may occur. Usually the seizure lasts but a few seconds or minutes.
Absence Spells–refers to brief periods of loss of awareness, sometimes with exaggerated blinking movements. Occasionally loss of muscle tone may produce falling, although the patient appears to be alert and conscious.
Partial Seizures–refer to seizures which are limited in effect to a single region of the brain. This may result in muscle contraction seizures limited to one part of the body, e.g. the arm, or in sometimes bizarre symptoms such as perception of unusual odors, strange repetitive movements such as lip-smacking, or even unusual behavior patterns of an inappropriate nature. The fictional crime committed as a result of a complex seizure is just that–fiction; the behavioral manifestations are almost always far too simplistic to result in such a complex behavioral act. Awareness and consciousness during partial seizures may be either normal or impaired.
Petit Mal–refers to childhood seizures manifesting as brief periods of unawareness, while an appearance of full consciousness persists; the patient may not be aware of their occurrence, and they may be very frequent during the day, resulting in school and developmental problems until recognized and treated.
CAUSES
When the onset of recurrent seizures is in childhood and not associated with some obvious facto, most cases are “idiopathic”–of unknown cause. A slight family tendency is noted, but this is inconsistent.
High fevers can cause seizures especially in children. These are usually isolated events, and very few such victims who are otherwise medically normal develop recurrences (fewer than 3%). Whether treatment with anti- seizure medications is warranted is controversial, and depends on a variety of medical and philosophical factors.
Many diverse brain injuries can result in seizure disorders by injuring the nerves of the brain, rendering them unstable. These include infections (encephalitis, meningitis), alcohol, stroke, trauma, tumors, and others.
DIAGNOSIS
The history, physical exam and brain wave test (electroencephalogram or EEG) are the mainstays of diagnosis. A judgment is important in many cases, since the EEG is not a totally sensitive test, and some people without seizures may have an abnormal EEG.
If the onset of seizures is in adulthood, a CAT scan x-ray of the brain may be considered, since the likelihood of finding some anatomic abnormality such as tumors or areas of stroke is much greater than in childhood. Ordinarily the above tests are adequate for diagnosis, assuming other general screening blood tests are normal. Any detected abnormalities may require more extensive evaluation.
TREATMENT
Isolated seizures of obvious cause may require no specific treatment. Most cases of recurrent seizures or idiopathic seizures will require treatment with medications to reduce the risk of recurrences. The drugs used, their doses, side-effects, and efficacy are highly complex, and should be under the management of an experienced physician.
Often, a single drug is used first, and pushed upward in dose until seizures are controlled or