Epilepsy is a condition that affects an estimated
2.7 million Americans, 50,000,000 worldwide, and impacts millions more One in three adults reported that they know someone with the disorder
and/or have witnessed a seizure. Approximately 200,000 new cases
of epilepsy are diagnosed each year. Of the major chronic medical conditions, epilepsy is among the least understood. Epilepsy strikes most often among the very young and the very old. The number of cases in the elderly are beginning to soar as the baby boomers approach retirement, although anyone can get epilepsy at any time.
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PHYSIOLOGY
Epilepsy is a disorder that briefly interrupts the
normal electrical activity of the brain. Normally, neurons, which
are cells that carry electrical impulses, form a network, allowing
communication between the brain and rest of the body. Neurons "fire"
or send electrical impulses toward surrounding cells, stimulating
neighboring cells to fire at one time, causing an "electrical
storm" within the brain, which results in physical changes
called seizures.
For the person experiencing the seizure, this sudden change may
alter the way everything looks, or may make the person's body move
involuntarily. Sometimes it may even cause a convulsion, a more
severe series of uncontrolled movements. Seizures usually last from
a few seconds to one or two minutes, and then end gradually as brain
cell activity returns to normal.
In addition, the association between epilepsy and depression is strong. More than one of every three persons with epilepsy are also affected by depression, and, people with a history of depression have a 3 to 7 times higher risk of developing epilepsy.
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CAUSES
The cause of epilepsy cannot be identified in 70
percent of all cases. The remaining cases are most frequently caused
by head injuries, strokes, brain tumors, infections such as meningitis,
lead poisoning or injury during childbirth. Genetics is assumed
to play a role when no specific cause can be identified.
There is some evidence of heredity with epilepsy,
but it is minor. A child with a parent who has epilepsy is at a
greater chance of developing the condition than the rest of the
population, but that doesn't mean that he or she will.
Scientists believe that everyone inherits some susceptibility
to seizures, however many people with high susceptibility may never
develop the condition unless something happens to injure the brain.
Unlike some other medical conditions, epilepsy
has no identifiable or consistent "triggers" which can
bring on a seizure. However, some environmental and internal factors
that may initiate seizures in a susceptible person include:
- alcohol
- strong emotion
- intense exercise
- flashing lights or loud music
- illness or fever
- lack of sleep
- stress
- menstrual period
- hormonal changes
- drug use
- missed medication
- poor nutrition
- emotional stress
- extreme fatigue
- low blood sugar
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EPILEPSY SYMPTOMS
Many symptoms may indicate that a person has developed
epilepsy. However, only a physician can diagnose the condition.
Symptoms may include:
- short 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
- brief periods of no response to questions or instructions
- sudden falls in children for no apparent reason
- episodes of blinking or chewing at inappropriate times
- a convulsion, with or without fever
Some people with epilepsy experience an aura, an
unusual sensation that often acts as a warning device, signaling
the onset of a seizure. It is characterized by a feeling of fear
or sickness or an odd smell or taste.
Sometimes the more severe seizure does not follow,
and only the aura sensation occurs.
Aura is actually often beneficial. It can serve as a "warning"
giving the affected person time to move away from potentially dangerous
obstacles or environments that might be hazardous during a seizure.
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TYPES OF SEIZURES
Scientists have more than 20 different types of seizures.
They are classified as either partial or generalized with subdivisions
in each category. Sixty-five percent of people with epilepsy experience
partial seizures and thirty-five percent have generalized seizures.
Partial Seizures
Partial seizures happen when the disturbances occur
in just one part of the brain, affecting whatever physical or mental
activity that area controls. They are divided into simple, complex
and secondarily generalized seizures.
A simple partial seizure takes place during a conscious
state. Symptoms vary depending on the area of the brain involved,
and can include a change in muscle activity, abnormal functioning
of the five senses, rapid heartbeat or breathing rate and/or affected
perception and memory.
A complex partial seizure is accompanied by impaired
consciousness and recall. It may also involve staring, automatic
behavior such as lip smacking, chewing, tumbling, walking, grunting,
repetition of words or phrases, or other symptoms and signs.
A secondarily generalized seizure begins as a partial
seizure and then spreads. If the whole brain is affected, it causes
a generalized convulsion, or fall.
Generalized Seizures
Generalized seizures happen when the electrical disturbance
sweeps through the whole brain at once, causing loss of consciousness,
falls, convulsions, or massive muscle spasms. Types of generalized
seizures include Tonic-clonic, absence and myoclonic.
Tonic-clonic seizures, previously referred to as
"grand mal," begin with simultaneous loss of consciousness
and the tonic phase (stiffening of the body). The person falls to
the ground and often emits a loud cry as the chest muscles stiffen.
Next comes the clonic clonic phase, during which the muscles rhythmically
jerk.
Abscence Seizures
Absence seizures, previously referred to as "petit
mal," result in brief episodes of impaired awareness. There
also may be small motor movements, changes in muscle tone, or automatic
behaviors. Abscence seizures are mostly seen in children 5-12 years
of age and often stopping spontaneously in the teens. Loss of consciousness
is so brief that the child usually does not change position. They
last 10 seconds or less.
Myoclonic Seizures
A myoclonic seizure produces a sudden shock-like
jolt to one or more muscles which increases muscle tone and causes
movement. These sudden jerks are like those that occur in healthy
people as they fall asleep. They are so brief that they may go unnoticed
as sudden muscle contractions (often confused as tics) that occur
at any age and are associated with epileptic syndromes such as West
and Lennox-Gastaut.
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DIAGNOSIS
To properly diagnose epilepsy, the physician takes
a careful medical history to obtain descriptive information about
the seizures and what the individual experienced just before the
seizure occurred. In addition, physicians use the electoencephalograph
(EEG) which shows special brain wave patterns enabling the doctor
to diagnose whether or not the person experienced a seizure. CT
scans or MRI machines are also used to show an image of the brain
to determine whether growths, scar tissue or other physical conditions
are causing seizures.
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RESEARCH/TREATMENT
Although medical science has made significant strides
in recent years in understanding epilepsy, a cure does not yet exist.
However, effective treatment options are available, which may enable
those with epilepsy to live richer, fuller lives.
Most physicians prefer use of anti-epilepsy drugs
(AEDs) long-term over any other treatment. Single drug therapy is
often effective for seizure control, however, nearly 30 percent
of all patient treatments involve multiple drug therapies.
Among the 2.7 million affected by the disorder, an
estimated 30 percent are patients with refractory epilepsy, or those
who will experience seizures with their current therapy. In addition,
some people with epilepsy are under reasonable control but suffer
disabling side effects from their medication. Some side effects,
which may include feeling tired or nauseated, are more likely to
happen when a person starts a new epilepsy drug. The side effects
may go away once the person becomes used to the drug.
Brain surgery is considered as a treatment for epilepsy
only when medication fails, and the tissue causing the seizures
is confined to one area of the brain, If the brain tissue can be
safely removed without damaging personality or function, surgery
may be an option.
For research and current clinical trials Click Here.
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EPILEPSY PATIENT PROFILE
Epilepsy can develop at any age and at any time. However, 70 percent
of epilepsy cases are in adults over the age of 18 and an estimated
21 percent are age 65 and older. Twenty percent of epilepsy cases
develop before the age of five. Epilepsy affects both genders equally.
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IMPACT
According to experts, despite the large number of
people affected/impacted, epilepsy is a misunderstood condition
that continues to attract prejudice and is the source of many social
and psychological problems for patients.
In a national survey conducted by National Family
Opinion Research, Inc. (NFO), a total of 331respondents with epilepsy
(including 100 patients with refractory epilepsy) and 1,000 members
of the general public were interviewed about their perceptions of
people with epilepsy.
Although public perceptions about epilepsy were closer
to the views of patients with refractory , in general, the survey
found that the general public overestimated the extent to which
people with epilepsy have to limit their activities in several areas:
- Forty-nine percent of the public reported that people with epilepsy
have to limit their sports and fitness activities compared to
30% of people with epilepsy and 34% of patients with refractory
epilepsy who reported this
- Sixty-four percent of the public reported that people with epilepsy
had to limit their social drinking compared to 46% of people with
epilepsy and 59% of patients with refractory epilepsy who reported
this.
- It was also reported that 55% of the general public surveyed
are employed full-time and make an average of $36,000 a year,
compared to 39% of people with epilepsy who reported they are
employed full-time and make an average income of $27,008 a year.
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