What is Epilepsy: A complete guide to this chronic disorder
We’ve all heard of people who can’t be around flashing lights because of their epilepsy, but what is epilepsy? In this article, we will look at what is epilepsy, the symptoms, causes, types, and treatments of epilepsy as well as how it affects our body.
What is epilepsy?
Epilepsy is a chronic disorder that means the same thing as seizure disorders. It’s known for its unpredictable and unprovoked seizures. It comes in a wide range of types and varies from person to person. The word epilepsy itself doesn’t indicate anything about the cause or severity of someone’s seizures. Epilepsy is found in more than 50 million people worldwide. Of those 50 million, 80% live in developing countries and 6-10 million with epilepsy live in India.
Epilepsy can be traced back to Assyrian texts in 2,000 B.C. However, there are multiple references to epileptic-like happenings throughout many ancient texts, especially in ancient Greek medical texts. Hippocrates, a famous Greek physician, includes tons of neurological things within his book On Sacred Disease. For example, he included the first known neurosurgery procedure that refers that the craniotomy should be performed on the opposite side of the brain as the seizures in order to spare the patients from the “phlegma” that in theory caused the disease.
In the 18th and 19th centuries is when medicine began to make important advances and did more research on epilepsy. At the beginning of the 18th century, the belief that epilepsy was an idiopathic disease that derived from the brain and other organs became to come into view. William Cullen and Samuel A Tissot set out to accurately describe the various types of epilepsies. However, many people from The Church had religious superstitions and believed that epilepsy was a divine punishment or possession- the Grand Mal Seizures are the classic example of “possession”. The 19th century carries with it many advances in epilepsy form the French medical school. The 20th century is marked by the inventions of electroencephalography (EEG) and anti-epileptic drugs, advancement in neurosurgery, and the outline of underlying pathophysiological mechanisms. The most recent epileptic advances involve advanced imaging techniques, the development of microsurgery, and research connecting the genetic factors and epileptic seizures.
What is epilepsy: disease or disorder?
Epilepsy is a disorder due to the disturbance that is caused by neurons sending wrong messages to the brain. Unlike a disease, epilepsy can’t be caught.
What is epilepsy: symptoms
Epileptic seizures can affect any process your brain can coordinate and do. The symptoms will vary depending on the type of seizure. However, an epileptic person tends to have the same type of seizures every time so the symptoms will be similar to each epileptic episode. Some signs of seizures and symptoms can include:
- Temporary confusión
- Loss of consciousness and/or awareness
- A staring spell
- Psychic symptoms like anxiety, fear, or déjà vu
- Uncontrollable and jerking movements in the arms and legs
What is epilepsy: causes
Epilepsy has no known cause for about half of the people who suffer from it. However, the other half of the people can trace their epilepsy to several factors, including:
- Genetic influence. Sometimes epilepsy runs in the family. Researchers have linked some specific types of epilepsy to specific familiar genes. Other genes may make someone more sensitive to certain environmental conditions that can cause seizures.
- Brain conditions. Conditions such as a brain tumor, dementia, or stroke can cause epilepsy. The leading cause of epilepsy in people over the age of 35 is a stroke.
- Developmental disorders like autism or neurofibromatosis– a condition where tumors grow on the nervous system. About 3 in 10 kids with autism also have epilepsy.
- Head trauma. Something like a traumatic brain injury can easily cause epilepsy.
- Prenatal injury. Before we are born, we are incredibly sensitive to brain damage by things like infection, poor nutrition, or oxygen deficiencies. This brain damage may cause epilepsy or cerebral palsy.
- Infectious diseases like meningitis, viral encephalitis, and AIDS can cause epilepsy.
What is epilepsy: types
Based on how the abnormal brain activity begins, doctors will classify the seizures into two groups: focal or generalized.
Focal seizures show up when there is just one area of your brain with abnormal activity. Sometimes they are called partial seizures. Without a thorough examination, sometimes the symptoms of focal seizures are confused with other neurological disorders like narcolepsy or migraines. There are two types of focal seizures:
- Focal seizures without loss of consciousness, previously known as simple partial seizures, means that some senses are altered. For example, emotions and the way things look, smell, taste, sound, or feel may change. There can also be some involuntary jolting of a body part, like a leg or an arm, with sensory symptoms like tingling, flashing lights, or dizziness.
- Focal seizures with impaired awareness, once known as complex partial seizures, means that there is a change or loss of consciousness and/or awareness. Someone having a focal seizure with impaired awareness may stare into space and not respond normally to their environment. They may also use repetitive movements like chewing, swallowing, hand rubbing, or walking in circles.
Generalized seizures appear in all area of the brain. There are six types known today: absence, tonic, tonic, clonic, myoclonic, and tonic-clonic.
- Absence seizures, previously known as petit mal seizures, mean that the person stares into space or uses subtle movements like lip smacking and eye blinking. It can cause a brief loss of awareness. This type of seizure often occurs in children and can occur in clusters.
- Tonic seizures affect the muscles in your back, arms, and legs and can cause you to fall to the ground due to the stiffening of your muscles.
- Atonic seizures, also known as drop seizures, cause you to suddenly fall down due to a loss of muscle control.
- Clonic seizures affect the arms, neck, and face. They show up by repeated jerking muscle movements.
- Myoclonic seizures are little sudden twitches in your legs and arms.
- Tonic-Clonic seizures, also known as grand mal seizures, are the most dramatic type of epileptic seizure a person can have. They can cause immediate and abrupt loss of consciousness, stiffening and shaking of the whole body, and sometimes a lack of bladder control and tongue biting.
What is epilepsy: how epilepsy affects the brain
Neurons are nerve cells that control the way we feel, think and move. Our neurons typically communicate using chemical and electrical signs, signals, and messages to each other that cause depolarization. When the signals are disrupted, damaged, or there are too many messages sent at once, is when a seizure begins.
Sometimes these neurons send out abnormal messages. If only a single neuron acts abnormal and sends out an unusual message, nothing will happen. But if lots of neurons, from the same area of the brain, being to send out unusual and abnormal messages together, for example, to have a seizure, then seizures can happen. There are three requirements for the unusual message to cause a seizure. First, each neuron has to be excited. Second, the message must be long enough to cause the other neurons to act in an identical way. Third, all of the neurons must be connected to other neurons within a few synapses. Once these conditions are met, the unusual seizure message spreads quickly. If the unusual message causes disrupted activity, this affects only a part of the brain which makes it a focal seizure. If the disrupted activity speaks to the whole brain, it becomes a generalized seizure. The part of the brain where the disruption (the neurons giving unusual messages) begins is known as the epileptic focus and is what doctors look for when finding out the causes of the seizures.
Because our brain has many different functions- such as memory, movement, moods, and all of our senses, a seizure can temporarily or seriously affect each and every one of these.
What is epilepsy: how epilepsy affects the body
Epilepsy doesn’t just affect our brain, but also our body and organs. Some examples include:
- The heart is affected by an abnormal heartbeat. With enough seizures over time, people can develop regular abnormal heartbeats. Some doctors believe that sudden unexpected death in epilepsy (SUDEP) is actually caused by an irregular heartbeat.
- The lungs don’t always know how to keep rhythm and the breathing may become disrupted and labored. This is because the autonomic nervous system regulates our breathing. However, seizures disrupt this system and cause our breath to temporarily stop.
- The reproductive system. Those with epilepsy commonly have up to two to three times more reproductive problems than those without epilepsy.
- While epilepsy itself doesn’t weaken bones, the drugs many people take for epilepsy will weaken the skeletal system.
- The effects seizures on the digestive system can involve abdominal pain or irritable bowels as well as loss of bowel control.
- The entire muscular system can be affected because some seizures cause our muscles to tighten suddenly while others cause our muscles to go completely limp.
What is epilepsy: diagnosis of epilepsy
A person is diagnosed as epileptic when they have two unprovoked seizures that were not caused by a known and reversible medical condition like low blood sugar or alcohol withdrawal. Common ways a doctor diagnosis epilepsy after reviewing the symptoms and medical history is to run some tests. This may include:
- Blood tests to check for infections and genetic conditions.
- Lumbar puncture (spinal tap) is a needle that is placed into the lower back and spinal cord. The cerebral spinal fluid- the fluid that bathes the spinal cord and brain- that is removed is looked at for infections or any other problems.
- A neurological exam to test behavior, mental function, motor skills, and be able to diagnose and determine the type of epilepsy.
- Neuropsychological tests are tests given by doctors to look at your thinking, speech, and memory skills to see what areas of the brain are affected.
- An electroencephalography (EEG) is the most common test for diagnosing epilepsy because it records the electrical activity in our brains. The EEG is able to see the changes in our normal brain wave pattern.
- High-density EEG to see more precisely which areas of the brain are being affected by the seizures. A high-density EEG is the same as an EEG, but the electrodes are closer together, about half a centimeter apart than a normal EEG.
- Computerized tomography scan (CT scan) which uses X-rays to look at the cross-sectional images of the brain. It can show brain abnormalities that could be causing the seizures like tumors or cysts.
- Magnetic resonance imaging (MRI) uses powerful magnets and radio waves to show a highly detailed view of the brain. An MRI can detect brain lesions or abnormalities that could be the root cause of the seizures.
- Functional MRI (fMRI) involves measuring the blood flow to specific parts of the brain when they are working. For example, looking at the areas of speech and movement before surgery so doctors can avoid injuring those places of the brain while operating.
- Curry analysis takes the EEG data and puts it into an MRI of the brain to show where the seizures are taking place.
- Positron emission tomography scan (PET Scan) injects a small amount of low-dose radioactive material into a vein to help see the active areas of the brain and be able to see abnormalities.
- Single-photon emission computerized tomography scan (SPECT Scan) is used if the MRI and the EEG didn’t show the brain location where the seizures are originating. Like the PET Scan, it injects radioactive material into a vein to create a 3D map of the activity of the blood flow during seizures.
- Statistical parametric mapping (SPM) compares the areas of the brain that have an increased metabolism during seizures. This can tell doctors where seizures began, in theory.
- Magnetoencephalography (MEG) measures the magnetic fields that are produced by brain activity to help show possible areas of where the seizures start.
What is epilepsy: treatments
Typically, doctors begin to treat epilepsy with medication. If that doesn’t work, then they may try to fix epilepsy with surgery or therapy.
Many people can become one seizure-free by taking an anti-seizure/antiepileptic medication. Other people can have a decreased frequency or intensity of seizures by taking a combination of medications.
Epilepsy surgery involves removing the area of the brain that’s causing the seizures. Doctors will only perform the surgery if the area of the brain is small and well-defined, and if it doesn’t interfere with functions that we need every day like language, speech, motor, hearing, or vision. Even with surgery, many people will still need to take some sort of medication to prevent the seizures after a successful surgery.
There are some therapies that seem to work for some people, as well. The vagus nerve stimulation is like a little pacemaker that goes underneath the skin of the chest. The wires from the stimulator are connected to the vagus nerve in the neck. The idea is that it sends bursts of energy to our brain via the vagus nerve. Although it’s not clear how it stops seizures, it can usually reduce seizures by 20%-40%. Some younger people with epilepsy may be able to use the Ketogenic diet in order to reduce their seizures. It is a strict diet low in carbohydrates and high in fats.
What is epilepsy: Prognosis
Epilepsy is the fourth most common neurological disorder. However, the prognosis of it depends on each person and their seizures. Around 80% of people with epilepsy require ongoing treatment to prevent further seizures. Age, family history, infections, and other present disorders will affect how likely it is that the seizures will get better or even stop.
What is epilepsy: Social Stigma
What is the social stigma around epilepsy? Some people with epilepsy feel a social stigma, almost a shame, for having epilepsy because it leaves them out of certain things. Sometimes a child with epilepsy will be told they can’t participate in a school activity (which is illegal) or not invited to a birthday party. Furthermore, many healthcare and car insurance providers may not like to take on someone with epilepsy because they may not have the proper coverage, but they also pose a big risk factor. For example, there is a high risk of someone with epilepsy and frequent seizures crashing their car. However, that does not mean that they are a less safe driver than someone without epileptic seizures.
How to support someone with epilepsy
Make sure that someone with epilepsy:
- Takes their medication correctly.
- Getting enough sleep
- Wearing a medical alert bracelet in order to be treated correctly by medical personnel in case of emergency.
- Let them live as independently as possible. For example, continuing to work.
- Become educated about epilepsy!
- Find a doctor that everyone likes
- Find an epilepsy support group for both yourself and them.
Have you or anyone you know had epilepsy? How did they handle it? Let us know in the comments below!