What is Epilepsy?

Epilepsy is a relatively common disorder which takes the form of recurring seizures.

 

A seizure occurs when there is a sudden, uncontrolled, surge in the normal electrical activity in all or part of the brain.

 

Epilepsy can affect anyone at any age but most people with epilepsy will experience their first seizure before the age of twenty.

 

It is estimated that more than 275,000 people throughout Australia have a diagnosis of epilepsy.

 

65 million people worldwide currently live with epilepsy. Each year at least 200,000 people are diagnosed with epilepsy. In two-thirds of patients diagnosed with epilepsy, the cause is unknown.

 

However, many people have epilepsy which can be controlled by taking medication and by adopting a sensible approach to their lifestyle.

  • In 50% of cases seizures are completely controlled.
  • 0–50% have their seizures significantly reduced.
  • And 20–40% do not attain adequate seizure control.

So, what is it?

Before answering this question, it’s necessary to look at the brain – and how it works.

 

The brain is made up of millions of tiny nerve cells called neurones, each of which can send and receive messages in a very similar way to one of the units in a computer or calculator. In the brain, messages are passed from cell to cell by various chemicals (known as neurotransmitters).

 

As a rule these messages are sent in an orderly way. If however, something unusual happens – if, for example, the ‘wrong’ message is passed or cells fail to respond to a message – an epileptic seizure may result.

 

An epileptic seizure can therefore be described as a “temporary breakdown” in the brain’s communication system.

 

Epilepsy is present when a person has established tendency to having recurrent seizures.

Anybody can have a seizure

The ‘temporary breakdown’ that causes a seizure can happen to anybody; it’s simply a matter of getting the necessary activator or stimulus to start it off. With the stimulus of an electric current, for example, everyone would have a seizure. Some people, however, require comparatively less of a stimulus than others, to trigger off a seizure. The likelihood of someone having an epileptic seizure is described as the ‘epileptic threshold’. People with epilepsy have a low epileptic threshold – which means they may have a seizure if the working of the b rain is only slightly upset. Others are able to withstand quite a strong stimulus to the brain without having a seizure; these people have a high threshold.

 

Thus having epilepsy can, in some ways, be compared to having an allergy. Some people clearly have a low allergy threshold – and only a slight amount of pollen in the air will make their eyes sore and make them start sneezing. With others, no amount of pollen seems to have any effect. The epileptic threshold.

 

The sorts of stimulus that triggers off seizures in different people, can vary enormously. In young children aged six months to three years, a high temperature can cause a seizure, known as a febrile convulsion. In women, for example, hormonal changes associated with the menstrual cycle, may lead to chemical changes which may, in turn, lead to chemical changes in the brain. In some people, these changes may be prompted by a visual stimulus, such as flashing lights. A change of daily routine or lack of sleep, or more emotional factors, such as stress and excitement, can all prompt seizures in some individuals. Very often however, it is impossible to say what exactly acted as a stimulus for a seizure; there is no cause that we can readily see.

What does an EEG show?

An EEG, or electroencephalogram, is a special recording of the tiny electric signals produced by the brain, that can provide important information about how the brain is working. It is a simple, harmless test, in which small discs are placed on the scalp and the activity of the brain is recorded. The EEG can help doctors in diagnosis, as it may show the sort of abnormal activity commonly found in epilepsy. The recording will show for example, a special pattern, known as a “spike” and “wave” pattern in many patients with a low epileptic threshold. However, a normal EEG does not exclude epilepsy as the electrical activity may only be abnormal during an attack. A doctor is certain to call for an EEG test if he/she suspects epilepsy.

Are epileptic seizures all the same?

No – there are a number of different types and patterns of epileptic seizures. The various names of the different seizures have often been a source of confusion in the past.

Seizures are divided into two main groups:

Partial seizures – only part of the brain is involved.

 

Generalized seizures – these involve most of the brain.

1) Partial seizures

About 60% of people with epilepsy have partial (focal) seizures. These seizures can often be subtle or unusual, and may go unnoticed or be mistaken for anything from intoxication to daydreaming. Seizure activity starts in one area of the brain and may spread to other regions of the brain.

 

Types of partial seizures are:

  • Simple partial seizure – awareness retained
  • Complex partial seizures – awareness altered
  • Secondarily generalised Tonic-Clonic (starting as partial and becoming generalised)

2) Generalised seizures

Generalised seizures are the result of abnormal activity in both hemispheres of the brain simultaneously. Because of this, consciousness is lost at the onset of the seizure.

 

There are many types of generalised seizures:

  • Tonic-clonic – characterised by alternative stiffness and jerking.
  • Myoclonic – characterised by muscular jerking.
  • Absence – in which the person loses awareness briefly.

What is involved in a seizure?

Is consciousness always lost? No, not necessarily. Complete loss of consciousness occurs in tonic–clonic seizures; these are major seizures. In some minor seizures, such as myoclonic jerks, there is no apparent loss of consciousness. In some seizures, e.g. absence, there may be a loss of awareness, although the person does not lose consciousness altogether. How long does a seizure last? This depends on the type of seizure. Myoclonic jerks last a second or so; absences usually last 5–10 seconds or sometimes up to a minute. A tonic–clonic and partial seizure lasts several minutes although recovery to full consciousness takes longer.

Is it possible to mistake an epileptic seizure?

Yes. The judgement that a seizure is epileptic is a matter for expert medical diagnosis. A severe faint or a panic attack may, at times, be mistaken for an epileptic seizure. Anybody witnessing a seizure should keep an accurate record of what took place, as this can provide essential clues in diagnosis.

Who gets epilepsy?

Anyone. Epilepsy can start without warning at anytime in a person’s life. There is, however, a tendency for epilepsy to start during childhood or adolescence and often to disappear by the time adult life is reached. Epilepsy is not a mental disease, although seizures may be a symptom of some underlying brain disease or damage – but certainly not always. The start of epilepsy in an adult is often a sign of some underlying disease, or the result of an injury affecting the brain (such as a road accident).

What’s the treatment like?

There have been important advances in anti-epileptic treatment over the past 25 years, with emphasis now on giving the patient a normal life. People with epilepsy need to discuss their medication requirements with their doctor or specialist – so that they get the full benefit from the treatment and risk or side effects is kept as low as possible. Pregnancy and epilepsy and medication during pregnancy are topics women need to discuss with their doctor. It’s very important for people taking anti–epileptic medication to keep their doctor informed of any other medication they are taking – the oral contraceptive pill, for example – because there can be an interaction between medication.

What does having epilepsy really mean?

With modern anti–epileptic treatment, many people with epilepsy can lead a normal life. Children with epilepsy can achieve the same educational standards as other children according to their inborn abilities. Certainly, there may be limitations with regard to recreational activities – children with epilepsy should always be supervised when swimming – but such restrictions should not take all the fun out of life.

 

For the school-leaver/adult – the question of employment can be a major hurdle as the workplace is more limited, as certain jobs and certain work environments (working with heavy machinery, for example) would present a risk. However, a wide range of job opportunities still remain. People with epilepsy are usually well able to live a normal everyday life – enjoying the family life, sexual relationships and recreational activities that most people take for granted. Epilepsy need not be an impairment to a normal life.

Overcoming the impairment of ignorance.

Through ignorance, which often leads to fear, many people have some funny ideas about epilepsy. And as those with epilepsy know only too well, it’s common for people to avoid them once they know they’ve got epilepsy. People with epilepsy are often treated with distrust and prejudice – and not infrequently, outright discrimination. It is far harder for someone with epilepsy to be accepted normally – to get a job, although perfectly well qualified – or to join a club or social grouping. Knowing the difficulties that are faced, the person with epilepsy often avoids the situation, shying away from social contact and thereby losing any confidence they may have had. It is sad and ironic that community acceptance is often exactly what is needed to give them the confidence to live a normal life. To break this vicious circle, we need better community understanding. Better information is the first step.

Facts and Statistics

  • Anyone can be affected by seizures at any age, but epilepsy is most frequently diagnosed in infancy, childhood, adolescence and old age.
  • According to the World Health Organisation, epilepsy is the world’s most common serious brain disorder.
  • Epilepsy is more than three times as common as multiple sclerosis, Parkinson’s disease and cerebral palsy.
  • Epilepsy is a condition of the brain, not a mental illness.
  • It is estimated that over 800,000 people in Australia will be diagnosed with epilepsy at some stage in life.
  • It is estimated that over 250,000 Australians are living with epilepsy. Approx 3% to 3.5% of Australians will experience epilepsy at some point in their lives.
  • Approximately 25,000 people in Australia are diagnosed with epilepsy each year.
  • An estimated 2.4 million new cases occur each year globally.
  • Around the world an estimated 50 million people have epilepsy at any given time.
  • seizure is an event – a disruption of the normal electrochemical activity of the brain – and epilepsy is the disease characterised by tendency to have recurrent epileptic seizures
  • Under certain circumstances anyone can have a seizure
  • Epilepsy is now considered “resolved” for people who have an age-dependent epilepsy syndrome but are now past the relevant age, or people who have been seizure-free for 10 years, with no anti-epileptic medication for 5 years.
  • It is commonly thought that epilepsy always involves convulsions. In fact there are
    around 40 different types of epilepsy and epilepsy syndromes.
  • Incidence of epilepsy in developing countries is almost double that of developed countries.
  • Up to 70% of people gain full seizure control with treatment but in developing countries, over 80% of people with epilepsy may not receive the treatment they need.
  • A small percentage of people may be eligible for surgery. Approximately 70% of people who have epilepsy surgery become seizure free.
  • Treatment options for people who cannot get seizure control with medications include Vagus Nerve Stimulation and the Ketogenic Diet.
  • Up to 15% of people referred to an epilepsy specialist centre do not actually have epilepsy and have been previously misdiagnosed.
  • People with epilepsy can obtain a driver’s licence if their seizures are controlled by medication or if they fulfil the guidelines set out by the driving authorities.
  • Many people outgrow or have a long term remission from seizures. Epilepsy is not necessarily a lifelong disorder.
  • Epilepsy can have profound social, physical and psychological consequences.
  • People with epilepsy can face social stigma and exclusion. A fundamental part of reducing this stigma is to raise public and professional awareness.

Epilepsy is associated with an increased risk of death, which may be related to:

  • An underlying brain disease, such as a tumour or infection.
  • Seizures in dangerous circumstances, leading to drowning, burns or head injury.
  • Prolonged or ongoing seizures (Status epilepticus).
  • Sudden and unexplained causes.
  • A possible respiratory or cardio-respiratory arrest during a seizure.
  • Suicide.

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