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.
