Epilepsy is a neurological condition, which affects the nervous system. Epilepsy is also known as a seizure disorder. It is usually diagnosed after a person has had at least two seizures that were not caused by some known medical condition like alcohol withdrawal or extremely low blood sugar. Sometimes, according to the International League Against Epilepsy, it can be diagnosed after one seizure, if a person has a condition that places them at high risk for having another.
The seizures in epilepsy may be related to a brain injury or a family tendency, but most of the time the cause is unknown. The word "epilepsy" does not indicate anything about the cause of the person's seizures, what type they are, or how severe they are.
A seizure is a sudden surge of electrical activity in the brain that usually affects how a person feels or acts for a short time. Seizures are not a disease in themselves. Instead, they are a symptom of many different disorders that can affect the brain. Some seizures can hardly be noticed, while others are totally disabling.
There are so many kinds of seizures that neurologists who specialize in epilepsy are still updating their thinking about how to classify them. Usually, they classify seizures into two types, primary generalized seizures and partial seizures. The difference between these types is in how they begin:
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Primary generalized seizures begin with a widespread electrical discharge that involves both sides of the brain at once. Hereditary factors are important in many of these seizures.
Primary generalized seizures
Partial seizures begin with an electrical discharge in one limited area of the brain. Some are related to head injury, brain infection, stroke, or tumor, but in most cases the cause is unknown.
One question that is used to further classify partial seizures is whether consciousness (the ability to respond and remember) is "impaired" or "preserved." The difference may seem obvious, but really there are many degrees of impairment or preservation of consciousness.
Identifying certain seizure types and other characteristics of a person's epilepsy like the age at which it begins, for instance, allows doctors to classify some cases into epilepsy syndromes. This kind of classification helps us to know how long the epilepsy will last and the best way to treat it.
There is a fine balance in the brain between factors that begin electrical activity and factors that restrict it, and there are also systems that limit the spread of electrical activity. During a seizure, these limits break down, and abnormal electrical discharges can occur and spread to whole groups of neighboring cells at once. This linkage of electrical discharges creates a "storm" of electrical activity in the brain. This is a seizure. When a person has had at least two of these seizures, that's called epilepsy.
The reasons why epilepsy begins are different for people of different ages. But what's true for every age is that the cause is unknown for about half of everyone with epilepsy.
Children may be born with a defect in the structure of their brain, or they may suffer a head injury or infection that causes their epilepsy. Severe head injury is the most common known cause in young adults. In middle age, strokes, tumors, and injuries are more frequent. In people over 65, stroke is the most common known cause, followed by degenerative conditions such as Alzheimer's disease.
How does epilepsy begin?
Often seizures do not begin immediately after a person has an injury to the brain. Instead, a seizure may happen many months later. We do not have a good explanation for this common observation, but scientists are actively researching this subject.
The overall life expectancy of people who have epilepsy is the same as for anybody else if they are otherwise pretty healthy. Some people whose epilepsy is caused by things like a stroke or a brain tumor may die sooner from those conditions, of course.
A long-lasting convulsive seizure (called "tonic-clonic status epilepticus") is a medical emergency. If not stopped within about 30 minutes, it may cause permanent injury or death. In addition, people with epilepsy can also die from inhaling vomit during or just after a seizure. This can be prevented if someone will turn the person onto one side when the seizure begins and ensures that the vomit completely comes out of the mouth. In general, seizures are hardly ever fatal, even if the person loses consciousness.
People who are not seizure-free need to be careful about possible accidents during a seizure. Death from drowning is more common among people with epilepsy. It can even occur in a tub with only a few inches of water, so people who have seizures probably should stick to showers instead of baths. If you have epilepsy, your doctoróand the agency in your state or province responsible for licensing driversówill help you decide whether it is safe and legal for you to drive. You should also be careful on train or subway platforms and when walking near busy streets. However,with some planning, you should be able to lead a life that is both active and safe.
Why does it sometimes take years before someone with a brain injury experiences a seizure?
SUDEP is a rare condition in which people with epilepsy die without a clear cause. It accounts for less than 2% of deaths among people with epilepsy. The risk is about 1 in 3,000 per year for all people with epilepsy. It can be as high as 1 in 300 for those who have frequent, uncontrollable seizures and take high doses of seizure medicines. SUDEP is extremely rare in children.
The person is often found dead in bed and doesn't appear to have had a convulsive seizure. About a third of them do show evidence of a seizure close to the time of death. They are often found lying face down.
No one is sure about the cause of death in SUDEP. Some researchers think that a seizure causes an irregular heart rhythm. More recent studies have suggested that the person may suffocate from impaired breathing, fluid in the lungs, and being face down on the bedding.
What about Sudden Unexplained Death in Epilepsy (SUDEP)?
Knowing what to do when a person is having a seizure is an important part of treatment. But taking a longer view, the real objective of treating epilepsy is to stop seizures or control them as best as possible, and to help people with seizures to lead a full and unrestricted life according to their own wishes.
"No seizures, no side effects" is the motto for epilepsy treatment. Not every person will achieve that goal right now, but with more research more will achieve it each year. Many people may have the possibility of achieving better seizure control right now, but haven't gotten the help they need. While seizure medicines are the mainstay of epilepsy treatment, there are other approaches to think about too.
Here you'll find information about treating seizures and epilepsy. Start with the sections on Quality Measures, which gives an overview of what you can expect from your primary care physician or general neurologist when you have just been diagnosed or after you have already started treatment.
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