What is Epilepsy?
Epilepsy is a common neurological disorder affecting about two in 100 people. Three out of four cases of epilepsy begin in childhood.
A seizure is caused when more than the usual amount of electrical energy passes through the brain. The portion of the brain affected by this “overload” causes temporary changes in body movement, consciousness and behavior.
Epilepsy is not contagious, it is not a disease. It can be caused by head injury, auto accidents, severe illnesses, tumors and other health conditions.
Recognition of seizure disorders and knowledge of first aid is important because it is very easy to mistake some seizures for other conditions.
Could it be Epilepsy?
Only a physician can say for sure whether or not a person has epilepsy. But many people miss the more subtle signs of the condition and therefore also miss the opportunity for early diagnosis and treatment.
The symptoms listed below are not necessarily indicators of epilepsy, and may be caused by some other, unrelated condition. If one or more is present, however, a medical check-up is recommended:
- Periods of blackout or confused memory
- Occasional fainting spells in which bladder or bowel control is lost, followed by extreme fatigue
- Episodes of blank staring in children; brief periods when there is no response to questions or instructions
- Sudden falls for no apparent reason
- Episodes of blinking or chewing at inappropriate times
- A convulsion, with or without fever
- Frequent jerking movements in babies
How many are there?
There are over 30 types of seizures classified into three major categories:
- Partial – arise in a specific portion of the brain
- Generalized – both hemispheres of the brain
- Unclassified – inadequate/incomplete data available. The most common seizure types are generalized tonic-clonic, absence and complex partial seizure.
Formally known as the “grand mal” seizure, this is a convulsive seizure affecting the whole body. The seizure may start with a crying out. The person falls, becomes unconscious and his body stiffens, followed by jerking motions. The person slowly regains consciousness but is tired and confused. The seizure usually lasts 2-4 minutes.
Formally called “petit mal”, it is most common in children. There is no aura before the seizure. The seizure consists of brief loss of consciousness (10-20 seconds). Staring and blinking is associated with this type of seizure, dozens or even hundreds may occur each day. They may be mistaken for day dreaming.
Complex Partial Seizures
Formally known as “psychomotor” or “temporal lobe” seizure; it is accompanied by an aura or “warning.” During the seizure, a person may have a glassy stare give no response, move aimlessly, make lip smacking or chewing motions, may appear intoxicated, drugged or psychotic. There may be struggle or fighting of restraint.
Myths and Facts About Epilepsy
Epilepsy is a disease
|Epilepsy is a disorder in which a person has two or more seizures without clear cause.|
Epilepsy is inherited
|Most cases of epilepsy are not inherited. However, some types of epilepsy, most of them easily controlled with medication, are genetically transmitted, that is passed on through the family.|
People are epileptics
|The word “epileptic” should not be used to describe someone who has epilepsy, as it defines a person by one trait. A label is powerful and can create a limiting and negative stereotype. It is better to refer to someone as “a person with epilepsy”.|
Epilepsy is caused by a disease
|Epilepsy has no single cause. In approximately 70% of cases, the cause is unknown. Epilepsy may be caused by head trauma, brain tumor, poisoning, infection or maternal injury.|
Epilepsy only effects children
|Epilepsy can affect anyone at any age at any time. Some people are born with epilepsy; others develop it later in life.|
Epilepsy cannot be treated
|Epilepsy can be treated and most people who receive treatment lead active and productive lives. Treatments include drug therapy, surgery, and dietary therapy.|
People with epilepsy have
|This is untrue. People with epilepsy do not typically have developmental disabilities.|
Epilepsy is a life long disorder
|Epilepsy is not a life long disorder. Most persons with epilepsy do not have seizures or require medication all their lives. The majority of childhood forms of epilepsy are outgrown by adulthood.|
International Classification of Seizures
I. Partial Seizure (seizures which involve or begin in one area of the brain)
A. Partial seizures with elementary symptomatology (seizures that have relatively uncomplicated symptoms.) Usually the person remains conscious.
- With motor symptoms (symptoms affecting the muscles, includes Jacksonian seizures)
- With special sensory or somatosensory symptoms (symptoms affecting the senses)
- With autonomic symptoms (symptoms affecting the internal organs)
- Compound forms (symptoms of more than one of the above types)
B. Partial seizures with complex symptomatology (partial seizures with more complicated symptoms, generally with some loss of consciousness- includes temporal lobe or psychomotor seizures)
- With impairment of consciousness only
- With cognitive symptomatology (symptoms affecting thought)
- With affective symptomatology (symptoms affecting mood or emotion)
- With “psychosensory” symptomatology (symptoms affecting sense perception, such as illusions or hallucinations)
- With “psychomotor” symptomatology (symptoms such as movement and behavior inappropriate to the situation- automatisms)
- Compound forms (symptoms of more than one of the above types)
C. Partial seizures secondarily generalized (seizures that begin as partial seizures and then become generalized
II. Generalized Seizures (bilaterally symmetrical and without local onset- seizures that involve both sides of the brain)
- Absences (brief lapses of consciousness occurring without warning and unaccompanied by prominent movements, as in petit mal)
- Bilateral massive epileptic myoclonus (an involuntary jerking contraction of the major muscles)
- Infantile spasms (brief muscle spasms in young children)
- Clonic seizures (seizures consisting of jerking movements of the muscles)
- Tonic Seizures (seizures in which the muscles are rigid)
- Tonic-clonic seizures (seizures which begin with muscle rigidity and progress to jerking muscular movement, commonly known as “grand mal” seizures)
- Atonic seizures (seizures in which there is a loss of muscle tone and the person falls to the ground)
- Akinetic seizures (seizures in which there is a loss of muscle movement)
III. Unilateral Seizures (seizures involving one hemisphere, or half, of the brain and consequently affecting one side of the body)
IV. Unclassified Epileptic Seizures (seizures which, because of incomplete information, cannot be put in a category)
- A generalized seizure in which consciousness is altered, formerly called petit mal, a term now seldom used. It is usually brief; similar seizures occur many times in a day. The EEG pattern is three-per-second spikes and waves. Absence seizures are usually easily treated and usually outgrown.
- The use of a cassette-like tape recorder to monitor the EEG while an individual is awake, at work, school, or play. The ambulatory monitoring device permits up to seventy-two hours of recording on tape. However, the amount of information produced about specific parts of the brain is limited. Since either the child or another observer must mark events thought to be seizures, and because the amount of EEG information is limited, ambulatory monitoring is useful only in special stimulations where it is important to clarify the nature of the spell (i.e., faint vs. seizure) and where quantification of spells is important. The procedure is far less expensive than video-EEG monitoring, but also less definitive.
Antiepileptic drug (AED)
- Also called anticonvulsant drug. One of the drugs used to prevent recurrence of seizures. The particular drug chosen for a child depends on the type of seizures, the age of the child, and the type of side effect that might be expected.
- The part of the brain in the parietal lobe where vision, hearing, memories, and motor function come together and where associations occur between sensations, movements, and thoughts.
- A form of generalized seizure in which body tone is suddenly lost and the child slumps to the ground or his head slumps forward. These difficult to control seizures often occur in Lennox-Gastaut Syndrome (LGS). They may resemble the sudden seizure in which the child is thrown to the ground, often injuring his face or teeth. Atonic seizures and Myoclonic seizures often occur in the same child, and the terms are often used interchangeably.
Atypical absence seizure
- A staring spell similar to an absence seizure but often with an atypical EEG. It may last longer than the typical absence seizure and may have other additional features (movement, falling, etc). Atypical absence may be more difficult to control with medications than typical absence seizures.
- The start of a seizure. It is usually described as a warning – a peculiar feeling, a sense of fear, a funny sensation in one part of the body. The neural activity indicated by these sensations can spread to other areas of the brain. If the seizure does not spread, the aura would be referred to as a simple partial seizure.
- The complex and purposeless automatic movements that accompany a complex partial seizure. These movements often consist of smacking of the lips, chewing, picking at clothes, or wandering around in a confused fashion.
Autonomic nervous system
- The part of the brain that controls functions like heart rate, blood pressure, and skin temperature and color. Seizures from the temporal lobe can produce disturbances of autonomic function.
- The part of a neuron that resembles a telephone line and is responsible for the capacity of brain cells to communicate with one another.
Benign rolandic epilepsy
- A special form of seizures in children that starts after three years of age. The seizure often begins with a sensation in the corner of the mouth, followed by local jerking of the muscles; it spreads to one side of the face, or one side of the body, and may become a generalized seizure. It has a typical EEG. These seizures occur more commonly during certain stages of sleep. They are usually outgrown.
- An episode in which the child does not breathe, turns blue, and may lose consciousness. These spells may, on occasion, result in a seizure. Breathholding spells are not serious and are not epilepsy. There are two forms: cyanotic (blue) and pallid (white).
- The rhythmic jerking of an extremity or the whole body. Seizures that are only clonic are rare. Clonic seizures are usually the second component of tonic-clonic seizures.
Complex partial seizure
- A seizure that involves only part of the brain (usually the temporal or the frontal lobe) and that alters consciousness or awareness. It may be accompanied by automatisms. Complex partial seizure and partial complex seizure mean the same thing.
- Alertness or awareness, the ability to interact normally with the environment. Consciousness is altered in generalized seizures or complex partial seizures but is usually not affected in simple partial seizures.
- An older term for a seizure. It usually refers to seizures that have a motor component – jerking or stiffening. Other old terms for convulsion include spell or fit.
Convulsive syncope (pron: sing-co-pee)
- A seizure that occurs in association with a fainting spell. The child experiences sweatiness, pallor, dizziness, and faints and loses consciousness. A small percentage of people who faint will then have a brief tonic-clonic seizure. The fainting spell is termed syncope; when a tonic-clonic seizure is associated with it, it is called a convulsive syncope. The convulsion is a benign seizure and does not require treatment.
CT or CAT scan
- Computerized tomography, or computerized axial tomography, uses small doses of x-rays and computer analysis to produce a picture of the brain and allow the physician to see certain abnormalities.
Cyanotic breathholding spells
- Breathholding spells in which the child starts to cry, then holds his breath and turns blue before losing consciousness. A seizure occasionally follows a breathholding spell.
- An infection of the brain in which cysts within the brain become calcified and cause seizures. It is more common in underdeveloped than in developed countries.
- A sensation that you have seen something or someone before, whether or not you have. This sensation is normal and common, but when it occurs repeatedly, it can be a manifestation of complex partial seizures emanating from the temporal lobe.
Previously known as severe myoclonic epilepsy of infancy (SMEI), is a catastrophic type of epilepsy with prolonged seizures that are often triggered by hot temperatures or fever. It is intractable, and hard to treat with anticonvulsant medications.
- The electroencephalogram records the electrical activity of the brain, or “brain waves.” The EEG does not provide a diagnosis of epilepsy, but it assists physicians in clarifying the type or origin of seizures.
- Inflammation of the brain substance itself, due to bacterial or viral infection.
- Seizure patterns whose clinical manifestations and EEG’s are sufficiently characteristic for a physician to be able to predict a patient’s future course and to recommend specific medications. The term “the epilepsies” is also used to indicate that there are diverse forms of repeated seizures (epilepsy), not just one single type.
- Recurrent (two or more) seizures not provoked by specific events such as trauma, infection, fever, or chemical changes. Seizures may take many forms. Patterns of epilepsy that are similar and have a predictable outcome are termed epileptic syndromes.
- The headache that follows some seizures. Seizures increase blood vessels may cause a post seizure headache. Migraine headaches can be mistaken for epileptic cephalalgia.
- A pattern defined by seizure type, age at onset, characteristic EEG, and an expected outcome. Certain epileptic syndromes respond better to particular types of medications. Epileptic syndromes include infantile spasms, the Lennox-Gastaut Syndrome (LGS), benign rolandic epilepsy, and others. The various epileptic syndromes make up the epilepsies.
- A seizure caused by fever. Febrile seizures are common in young children of six months to three or four years old. Resulting from the lower seizure threshold of the young brain, only rarely are they associated with later epilepsy. While frightening, they appear to cause little harm. They tend to occur in families. Physicians generally do not prescribe anticonvulsants to try to prevent these seizures.
- A term still often used in England to refer to a seizure. Most American physicians prefer to avoid using that term to describe seizure episodes.
- Surgical removal of one area or region of the brain.
- See simple partial seizures.
- A local area of abnormality in the brain. These local abnormalities may be seen as spikes, or sharp waves, or as slowing on an EEG.
- A seizure involving the whole brain. It may involve alterations of alertness or awareness, as during absence or complex partial seizures, or tonic-clonic seizure.
Grand mal seizure
- The old term for generalized tonic-clonic seizure.
- Surgical removal of one-half of the brain. There are several different types of hemisherectomy being performed.
- The detailed medical story of previous events. The history establishes exactly what happened to the patient and explores the general state of a person’s health.
- To over-breathe. A physician may instruct your child to take a number of deep breaths for two to four minutes. This over-ventilation may cause an absence or complex partial seizure, which can then be observed by your doctor. Rapid breathing during exercise is rarely associated with a seizure. Anxiety may cause an individual to hyperventilate.
- A Latin term for “stroke” or “event”. A seizure, of whatever type, is referred to as an ictus.
- Of unknown cause. Seizures are called idiopathic seizures if no cause can be found. Causes cannot be found in more than half of the children experiencing seizures. Idiopathic seizures often have a better outcome than those that are symptomatic, that is, for which a cause can be found.
- A special form of epilepsy that can occur in the first two years of life from multiple causes. The seizures consist of repeated episodes of flexion of the head onto the chest, the knees coming up, and the arms extending. Each episode lasts one to two seconds; episodes occur in a series of five to fifty, with a brief pause between each. The child may have many such series during each day. This form of epilepsy is commonly associated with significant developmental disabilities and requires prompt diagnosis and treatment with specific medication.
- Monitoring, using modern technology, of the characteristics of an individual’s seizures and their correlation with an EEG. Monitoring may include ambulatory monitoring, prolonged EEG’s, prolonged video-EEG monitoring, and use of depth electrodes and the grid.
- The period between episodes or seizures. (See ictus.)
Janz, juvenile Myoclonic epilepsy or (JME)
- A newly recognized syndrome that begins in late childhood with mild myoclonic jerks on going to sleep or awakening. This jerking may precede or be associated with absence seizures or generalized tonic-clonic seizures. It is often produced by sleep deprivation and commonly runs in families. The characteristic EEG and history make diagnosis of this condition easy, and treatment is usually very effective.
Lennox-Gastaut Syndrome (LGS)
- A condition that includes two or more types of seizures, one of which is of the akinetic, atonic, falling-down type. Absence seizures and generalized tonic-clonic seizures, occurring particularly at night, are common. The EEG shows generalized slow spike or poly-spike and slow wave abnormalities. Developmental disability is common and often progressive. This is a severe seizure-type and one that is difficult to control.
- Functional parts of the brain. The principal lobes are the frontal lobes, important for personality and memory; the temporal lobes, which are responsible for speech, memory, and emotion; the parietal lobes, which integrate sensory function; and the occipital lobes, which are the site of vision.
- Inflammation of the coverings of the brain, caused by bacteria or viral infections, meningitis may be accompanied by inflammation of the brain itself (encephalitis), resulting, on occasion, in seizures or brain damage.
- Migraine headaches, caused by changes within the blood vessels of the brain, are characteristically accompanied by paleness, vomiting, and sleep. They often last more than an hour. On rare occasions they can be confused with or associated with seizures. They tend to run in families.
Minor motor seizure
- An old term, not part of the new classification, previously used to describe multiple types of spells, including both atonic and Myoclonic varieties. Children with the Lennox-Gastaut Syndrome generally experience multiple types of seizures, many of which are minor motor.
- Magnetic resonance imaging scans, like CT sans. Are used to identify structure and abnormalities within the brain. This new technique uses no x-rays and gives a clearer picture of brain structure than does the CT scan. It is more expensive and takes longer to do than the CT scan.
- Sudden movements of arms or legs, most commonly occurring when the child is falling asleep. Myoclonic jerks during the day may be normal but, if frequent, could be part of one of the epilepsies.
- An inherited condition characterized by brown (café-au-lait or coffee-colored) spots, mild mental retardation, and seizures. Small tumors on many nerves may compress surrounding tissue causing pain, weakness, etc.
- The nerve cells of the brain.
- The chemicals released by the end (terminal) of an axon, they float across the space between cells and affect the “firing” of the next cell. Neurotransmitters may be excitatory or inhibitory to the next cell.
Pallid breathholding spell
- Not true breathholding, but a sudden loss of consciousness due to slowing of the heart, usually occurring after mild trauma. It may, on occasion, result in a seizure. It is not epilepsy and rarely requires treatment.
Partial complex seizure
- Another name for a complex partial seizure.
- A focal or local seizure in the brain.
Petit mal seizure
- The old term for “little spell,” now known as an absence seizure. These spells usually include starring. Many kinds of seizures include starring and respond to different medications.
Photic sensitive seizure
- A seizure caused by flashing lights, such as strobe lights or light shinning through trees or a fence. In some “photic sensitive” individuals these stimuli may produce seizures.
- A Latin term meaning “after the seizure” (see ictus). Confusion, sleepiness, or weakness after the seizure is termed post-ictal since it occurs after the event.
- Outcome or outlook of a medical condition.
PNES (Pshycogenic Non-Epileptic Seizures)
- Events that resemble seizures but are not caused, as an epileptic seizure is, by electrical abnormalities in the brain. PNES may be subconscious. PNES can occur, symultaneously, in persons who also have epileptic seizures and may be difficult to differentiate. Only a neurologist can determine the difference. PNES is sometimes exhibited by those with any form of PTSD. Treatment is done in conjunction with a neurologist and mental health professional for optimal results.
- A rare, progressive condition that is characterized by unilateral seizures and progressive one-sided paralysis. Of unknown cause, this condition is best treated with hemispherectomy.
- In physiologic terms, or in regard to epilepsy, recruitment refers to an enlisting of surrounding brain cells to fire simultaneously. Only when a certain number a cells are recruited to fire together will sufficient electrical activity be generated to appear as a spike on the EEG or as a clinical seizure.
- A paroxysmal (episodic) electrical discharge of nerve cells in the brain (neurons) resulting in alteration of function or behavior. There are many different forms of seizures, depending on where in the brain the electrical activity starts and on the direction and rapidity of its spread in the brain.
Simple partial seizure
- A focal or local seizure involving a single area of the brain. Since each are has particular functions, there are many kinds of simple partial seizures depending on which region is affected. Some are motor, involving the face, hand, or leg; some sensory, with individual sensations in a part of the body; some, involving a temporal lobe produce smells, tastes, fears, or memories. Unlike a complex partial seizure, consciousness is not altered in a simple partial seizure.
- Sudden massive jerks of the body, often as someone is going to sleep. These are normal and are not epilepsy.
- A term used to describe a seizure. The term is vague and is often used to refer to a seizure or a pseudo seizure if the nature of that episode is unknown.
- A sharp abnormality on an EEG, it indicates an electrical discharge of a small number of neighboring brain cells. Recurrent spikes are electrical seizures and may spread to involve sufficient brain cells to cause a true change in function or behavior, that is, a clinical seizure.
- One of the metabolic diseases in which some material, usually a breakdown product of normal tissue, cannot be further metabolized and is stored within nerve cells of the brain. This storage produces malfunction of the cells; it is commonly associated with progressive intellectual and neurologic deterioration and with seizures. Each of the various diseases has a name.
- Characterized by a birthmark (hemangioma or port wine stain) involving the forehead and variable parts of the face, often associated with vascular abnormality of the brain, seizures, progressive one-sided weakness, and progressive developmental disabilities.
- Indicating a defined cause. Seizures due to fever, meningitis chemical abnormalities, or head trauma are called symptomatic seizures, or provoked seizures.
- The tiny space between the end of the axon and the body of the next neuron.
- The characteristics include a feeling of dizziness associated with pallor and sweatiness, followed by loss of consciousness. When this benign condition is followed by a brief tonic-clonic seizure it is termed convulsive syncope.
- A collection of signs or symptoms that together form a condition with a known outcome, or which requires special treatment.
- The susceptibility of a single neuron to fire or of the brain to have a seizure. Many factors may lower the brain threshold and precipitate a seizure. Anticonvulsant drugs raise the threshold and make seizures less likely.
- A sudden, episodic, repetitive movement, most commonly involving eye-blinking or movements of the face and head, but sometimes of other parts of the body. These complex movements are not associated with alterations in consciousness, and they can usually be stopped consciously for periods of time. They are not associated with EEG abnormalities and are not seizures.
- Weakness occurring in one limb or one side of the body after a focal or unilateral seizure. This paralysis, while often thought of as exhaustion of the brain, actually results from inhibition of the seizures and of the normal function of the brain on that side. Todd’s paralysis after a seizure is usually resolved in one to two hours but may, on occasion, continue for several days. It always disappears completely.
- The generalized seizures people often think of when they think of epilepsy, formerly called grand mal seizures. They are characterized by stiffening and then rhythmic jerking movements of the body.
- A seizure that involves stiffening of the arms, legs, and back and loss of consciousness. The stiffening may last several seconds to a minute. Most tonic seizures go on to a clonic component. Tonic seizures are uncommon, except as the first part of the tonic-clonic seizure.
- A chronic infection, often acquired by a fetus in utero, that affects multiple organ systems. It can cause developmental disabilities, scarring of the brain, and seizures.
- A disease characterized by skin lesions (white spots, thickened patches, etc.) seizures, and developmental disabilities. Because it is caused by abnormal development of cells, many other organs of the body (e.g., eyes, heart, kidneys) experience changes or tumors.
- A seizure involving one side of the body, usually the face, arm, or leg. A unilateral seizure involves or spreads through a single half of the brain.
- The use of video cameras to capture visually the onset and characteristics of seizures or episodes while simultaneously monitoring the EEG to see electrical changes. Video-EEG monitoring permits a physician to identify whether a seizure is associated with an EEG change, that is, whether it is a real seizure or a pseudo-seizure (PNES). It will often allow physicians to identify the areas in the brain where the seizures begin.