Epilepsy is the
tendency to have repeated seizures that originate within the brain.
Many people have a single seizure at some point in their lives, but
this does not mean that they have epilepsy. If a person has a tendency
to experience repeated seizures which originate in the brain, then
they may be diagnosed as having epilepsy.
Unlike most other
neurological conditions, there may be no physical sign that a person
has epilepsy when they are not having a seizure. Therefore the diagnosis
is based on a history of more than one epileptic seizure.
A number of investigations
may provide additional information, although they cannot completely
confirm or rule out a diagnosis of epilepsy. These include:
Blood tests
Electroencephalogram (EEG)
Scans such as Computerised Tomography (CT) or Magnetic Resonance
Imaging (MRI).
Epilepsy can be
divided into different categories by possible cause, each including
a number of different types of seizure.
Idiopathic Epilepsy:
In this group
there is no clear cause for the epilepsy and genetic factors may be
responsible. The person usually has no other disabilities and the
EEG recording is often normal between seizures. There is usually a
good response to drug treatment.
Symptomatic Epilepsy:
This usually develops
as a result of a structural abnormality in the brain, either present
at birth or occurring later in life. EEG tests and brain scans may
show what the abnormality is. The response to drug treatment may vary
from one person to another.
Cryptogenic epilepsy:
In this type of
epilepsy, no cause can be found, but one is suspected.
Associated
Feature
Psychiatric
Disturbances.
Depressive
Episodes
Panic
Disorder
Anxiety
Disorder
Differential
Diagnosis
Some disorders have similar symptoms. The clinician, therefore, in
his diagnostic attempt has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis.
Episodic and
paroxysmal symptoms that resemble epilepsy.
Gastroesophageal reflux in infants and young children.
Apnea and Cyanosis.
Breath-Holding spells and Pallid Infantile Syncope.
Migraine.
Transient Ischemic Attacks.
Transient Global Amnesia.
Cause:
Any person's brain
has the capacity to produce a seizure under certain conditions, but
most are not likely to do this spontaneously. The reasons why some
people develop epilepsy are not straightforward and there are many
possible causes. Each
individual has a 'seizure threshold' or level of resistance to seizures.
This threshold varies from person to person and is probably part of
their genetic make-up; that is, how traits are passed from one generation
to another.
A person with
a low seizure threshold might develop epilepsy spontaneously without
other factors being involved. Having a low threshold and a condition
such as cerebral palsy may also be the cause of epilepsy. Sometimes
a tendency to have seizures can be seen in families where several
members have epilepsy.
The genetics of
epilepsy are complex. In some people the seizure threshold may be
lowered if the brain is injured. If the injury is severe, perhaps
due to a road traffic accident, tumor, stroke or trauma at birth,
then epilepsy may develop as a result.
Some people develop
epilepsy following an infection that affects the brain, such as meningitis
or encephalitis.
Many people believe
that the onset of their seizures was due to stress or periods of emotional
upset, or to a relatively minor blow to the head. Although this type
of factor may trigger individual seizures, it is not the underlying
cause of the epilepsy. In these cases it is likely that a family tendency
to have seizures plays an important role.
Treatment:
Success of treatment depends
on many factors. These include; the type of epilepsy, how accurate
the diagnosis is, whether the right type of treatment is being taken,
and if it is being taken correctly and whether the person has any
other associated disability.
Some people continue
to have seizures despite treatment. A small proportion of these people
may benefit from neurosurgery.. However this is only considered in
people whose seizures have been shown to arise from activity in one
single area of the brain.
Many people are
able to keep their seizures to a minimum by avoiding situations which
they know can trigger a seizure. These triggers may include lack of
sleep, too much alcohol, emotional upsets or missing medication. Practicing
such 'self care' is an important part of epilepsy treatment.
If a person continues
to have seizures, then this may affect some parts of their daily living.
In this situation, they can try to minimize any problems that occur
by taking practical steps to reduce possible risks.
Counseling
and Psychotherapy [ See
Therapy Section ]:
Careful counselling
and health education can help to reduce anxiety for the person as
well as for their family and friends.
Pharmacotherapy
[ See Psychopharmacology
Section ] :
With the appropriate
drug treatment, seizures can be completely controlled in up to 80%
of people. In some people the tendency to have seizures decreases
with time. For others it may be necessary to take antiepileptic drugs
for a period of years, even if seizures have stopped, as the underlying
cause of the seizures may still be there.
The vast majority
of people with epilepsy take daily medication - anti-epileptic drugs
(AEDs). For many of us, these drugs will successfully control our
seizures or at least reduce the number and severity of our seizures.
However, when we are newly diagnosed as having epilepsy, it can be
difficult adjusting to the need to take drugs every day. Understanding
how the drugs work and why we need to take them often helps that adjustment.
