Epilepsy is a chronic neurological disorder characterized by recurrent seizures that can range from brief lapses of attention or muscle jerks to severe and prolonged convulsions. About 50 million people worldwide have epilepsy and nearly 90 percent of those people live in developing regions, according to the World Health Organization. The Centers for Disease Control and Prevention estimates that 2 million people in the United States have epilepsy and nearly 140,000 Americans develop the disorder each year.
Symptoms & Causes
The most common type of seizure, called idiopathic epilepsy, is not associated with other neurologic disease, has no known cause and is not preventable, according to the WHO. This affects approximately six out of 10 people with the disorder. However, epilepsy can also arise from prenatal complications, traumatic brain injury, stroke, tumor and cerebrovascular diseases, according to the CDC. This is known as secondary epilepsy. In both cases, epileptic symptoms occur because the normal signaling between the nerve cells and the brain has been disrupted, possibly due to abnormality in brain wiring or imbalance of nerve-signaling chemicals called neurotransmitters, or a combination of the two.
While the predominant symptom of epilepsy is seizures, having a seizure doesn’t necessarily mean that a person has epilepsy. Epilepsy is defined by two or more unprovoked seizures, according to the National Institute of Neurological Disorders and Stroke. Spontaneous, temporary symptoms such as confusion, muscle jerks, staring spells, loss of awareness and disturbances in mood and mental functions can occur during seizures. Overall, seizures can be further classified to different subtypes, depending on where in the brain the disturbance first starts, how far it spreads and the severity of symptoms, according to the Mayo Clinic.
Diagnosis & Tests
Since people with epilepsy often display abnormal patterns of brain waves even when they are not experiencing a seizure, EEG monitoring within 24 hours of the first seizure can help detect abnormal brain activities, according to the NINDS. EEG monitoring, in conjunction with video surveillance over periods of wakefulness and sleep, can also help rule out other disorders such as narcolepsy, which may have similar symptoms as epilepsy. Brain scans such as PET, MRI, SPECT and CT scans are also useful for observing the structure of the brain and mapping out damaged areas or abnormalities, such as tumor and cysts, which can be the underlying origin of seizures, according to the Mayo Clinic.
Treatments & Medications
Anticonvulsant drugs are the most commonly prescribed treatment for epilepsy. There are more than 20 epileptic drugs available in the market right now, including carbamazepine (also known as Carbatrol, Equetro, Tegretol), gabapentin (Neurontin), lamotrigine (Lamictal), oxcarbazepine (Trileptal), oxcarbazepine (Trileptal), pregabalin (Lyrica), tiagabine (Gabitril), topiramate (Topamax), valproate (Depakote, Depakene) and more, according to the NINDS.
Most side effects of anticonvulsants are relatively minor, including fatigue, dizziness or weight gain. But starting in 2008, the Food and Drug Administration mandated all epilepsy medications to bear a label warning the increased risk of suicidal thoughts and behaviors. A 2010 study following 297,620 new patients treated with an anticonvulsant suggested that certain drugs, including gabapentin, lamotrigine, oxcarbazepine, and tiagabine, may be associated with a higher risk of suicidal acts or violent deaths.
Surgery might be a viable treatment option if the patient experiences a certain category of epilepsy, such as focal seizures, where seizures begin from a small, well-defined spot in the brain before spreading to the rest of the brain, according to the Mayo Clinic. In these cases, surgery can help relieve the symptoms by removing the parts of the brain that cause seizures. However, surgeons usually avoid operating in areas of the brain that are necessary for vital functions such as speech, language or hearing, according to the NINDS.
An FDA advisory panel recently recommended the approval of Deep Brain Stimulation therapy for patients who cannot control the frequency of their seizures through medication. Currently approved for managing Parkinson’s Diseases, the treatment uses a surgically implanted, battery-operated neurostimulator — similar to a heart pacemaker — to deliver electrical stimulation to targeted areas in the brain. The device is not yet officially approved by the FDA for managing epilepsy, though.
Coping & Management
Epilepsy patients might need to adjust certain elements of their lifestyle, such as recreational activities, education, occupation, transportation, in order to accommodate the unpredictable nature of their seizures, according to the Mayo Clinic. Nonetheless, many epilepsy patients can still lead healthy and socially active lives, especially by educating themselves and the people around them of the facts, misconceptions and stigma surrounding the disease.
When somebody is having a seizure with convulsions, it’s important to gently roll the person to his or her side to prevent choking and cushion the person’s head in order to prevent head trauma. Do not put anything into the person’s mouth since it could cause choking and do not restrict the person from moving unless there are dangerous sharp objects around, the NINDS advises. Help loosen any tight collars or neckties if necessary. It’s also important to record the duration and the symptoms of the seizure so the patient can provide those details to the doctor at a future appointment.