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EPILEPSY

What is Epilepsy ?

Epilepsy means a recurring tendency to have fits, also called seizures. It is not a disease but it can occur as a result of many brain disorders. It is common, affecting about 1% of the population. The first stage in diagnosis is to obtain a good description of the fits or seizures. Seizures are disorders of brain function caused by abnormal electrical activity in the brain. If they start in a small part of the brain, they are called partial seizures. These may start with a strange smell, a rising feeling in the stomach, or jerking of one part of the body. If most or all of the brain is disturbed at the onset, causing loss of consciousness, the fits are called generalised seizures. Generalised convulsions, (jerking all over the body) are sometimes called grand mal seizures. Partial seizures may become generalised. An absence is one type of generalised seizure causing temporary loss of attention and responsiveness usually without any convulsive movements of the limbs and without collapse to the floor. Such attacks are common in children who may look vacant perhaps with some facial movements such as blinking or licking of their lips. It may be thought that the child is daydreaming and the attacks may interfere with learning at school. These may be called petit mal attacks. Other types of generalised seizures may result in tonic-clonic convulsions in which the whole body stiffens and then violent jerks occur. In a third variety, limb jerks occur sometimes appearing just to be caused by clumsiness. Many different kinds of seizure occur, but many attacks of falling or even shaking are not caused by epilepsy.

How does Epilepsy occur ?

In everyone’s brain, there is continuous controlled electrical activity in nerve circuits. In a seizure, this seems to become uncontrolled and to spread through the brain disrupting normal function until it eventually subsides as the attack settles. It is not clear why someone may go for years without an attack and then have one for no obvious reason.

Why does Epilepsy occur ?

Many generalised seizure disorders are the result of a genetic disorder inherited from parents. Other types of epilepsy result from diseases of the brain of almost any type. Some are caused by injuries, infections or even tumours but others follow a disturbance of brain chemistry or toxins such as alcohol or drugs. Some babies who have seizures when they have a fever may go on to have epilepsy as a result of damage to the temporal lobes of the brain. In many cases, no cause can be identified. A small number of people have fits provoked by flickering screens or other stimuli but this is not the cause of the seizures in most people with epilepsy.

Treatment Involved for Epilepsy

The doctor will want to talk to somebody who can describe the seizures and the effect they have on the patient. Tests are required to look for particular causes of epilepsy. Brain waves can be recorded from the scalp while the patient is asked to close his eyes or breathe deeply. This test is called an electroencephalograph (EEG). A brain scan (MRI) is sometimes done to look for any abnormality in a particular part of the brain. Blood tests may be needed to look for disturbed chemistry in the blood. When the diagnosis is clear, suitable drugs may be prescribed to control the seizures. There are many different drugs which may be used. Some are more suitable for certain kinds of epilepsy. The drugs have to be taken regularly if they are to work, but they are not addictive. It is important to have your full cooperation and to keep a record of any attacks and details of treatment.

During Treatment for Epilepsy

Many kinds of epilepsy which come on in childhood settle as the young person grows up. After a period free of seizures, treatment can sometimes be withdrawn. If treatment does not control the seizures, other drugs may be tried or further investigations may be done. Some drugs cause side effects such as drowsiness or a skin rash. It is important to try to allow a child to grow up as normally as possible allowing for the additional hazards caused by seizures. Relations and friends should know what to do when a seizure occurs. Some people like to carry a special card or wear a bracelet to give information about their condition in case they have a seizure. Women with epilepsy should discuss contraception and pregnancy with their doctor or with an epilepsy support nurse.

After Treatment for Epilepsy

Sometimes seizures recur later in life or different kinds of attacks may start. Changes in behaviour or new types of seizure may prompt new treatments or further investigations.

If Epilepsy is Left Untreated

Seizures may settle without any treatment but there is some danger if seizures are allowed to continue uncontrolled. Absence seizures interfere with concentration and learning during important school years.

Effects on Family of Epilepsy

It is important to allow young people to grow up normally without being stigmatised. The family should find out about epilepsy and how to deal with attacks. The person with epilepsy needs to be encouraged to take treatment reliably and to report seizures and side effects. They should talk to their doctor or an epilepsy nurse about adolescence and issues to do with parenting and employment. Other family members may also be affected and may benefit from advice and treatment.