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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.

 


DSM Code

None

G40.4 Epilepsy

Disorder Sheets

Epilepsy Action

New Anstey House
Gate Way Drive
Yeadon
Leeds
LS19 7XY
UK
Tel: 0113 210 8800
Fax: 0113 391 0300
Email: Click Here
Web: Click Here

The National Society for Epilepsy
Chesham Lane
Chalfont St Peter
Bucks
SL9 0RJ
UK
Tel: 01494 601300
Helpline: 01494 601400
Web: Click Here

Recommended Book

The Neuropsychiatry of Epilepsy - Click Here to View

 

Epilepsy

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For more information on epilespy and downloadable information leaflet please see http://www.epilepsynse.org