Normal brain functioning is the result of millions of tiny electrical signals working together to enable movement, sensation, memory, emotion, behavior and consciousness. A seizure is the result of a sudden, irregular discharge of electrical signals.A convulsive seizure is characterized by shaking of the body and a period of decreased mental awareness. Other, less apparent forms of seizures may affect a personÕs awareness, muscle control or sensory perception.
People with epilepsy have repeated episodes of seizures. One seizure episode does not mean a diagnosis of epilepsy. A child with febrile seizures, an adult with a series of convulsions following alcohol withdrawal or a person with low blood sugar from insulin shock does not necessarily have epilepsy.
Epilepsy affects people of all ages, races and ethnic backgrounds. There are more than 20 different seizure disorders. Once epilepsy is diagnosed, 80 percent of cases can be managed either with medications or surgery.
Description: There are more than 20 different seizure disorders. One in ten Americans will have a seizure at some time, and at least 200,000 have at least one seizure a month.
Epilepsy affects 1-2% of the population of the United States. Although epilepsy is as common in adults over 60 as in children under 10, 25% of all cases develop before the age of five. One in every two cases develops before the age of 25. About 125,000 new cases of epilepsy are diagnosed each year, and a significant number of children and adults that have not been diagnosed or treated have epilepsy.
Most seizures are benign, but a seizure that lasts a long time can lead to status epilepticus, a life-threatening condition characterized by continuous seizures, sustained loss of consciousness, and respiratory distress. Non-convulsive epilepsy can impair physical coordination, vision, and other senses. Undiagnosed seizures can lead to conditions that are more serious and more difficult to manage.
Types of seizures: Generalized epileptic seizures occur when electrical abnormalities exist throughout the brain. A partial seizure does not involve the entire brain. A partial seizure begins in an area called an epileptic focus, but may spread to other parts of the brain and cause a generalized seizure. Some people who have epilepsy have more than one type of seizure.Motor attacks cause parts of the body to jerk repeatedly. A motor attack usually lasts less than an hour and may last only a few minutes. Sensory seizures begin with numbness or tingling in one area. The sensation may move along one side of the body or the back before subsiding. Visual seizures, which affect the area of the brain that controls sight, cause people to see things that are not there. Auditory seizures affect the part of the brain that controls hearing and cause the patient to imagine voices, music, and other sounds. Other types of seizures can cause confusion, upset stomach, or emotional distress.
GENERALIZED SEIZURES: A generalized tonic-clonic (grand-mal) seizure begins with a loud cry before the person having the seizure loses consciousness and falls to the ground. The muscles become rigid for about 30 seconds during the tonic phase of the seizure and alternately contract and relax during the clonic phase, which lasts 30-60 seconds. The skin sometimes acquires a bluish tint and the person may bite his tongue, lose bowel or bladder control, or have trouble breathing.
A grand mal seizure lasts between two and five minutes, and the person may be confused or have trouble talking when he regains consciousness (post-ictal state). He may complain of head or muscle aches, or weakness in his arms or legs before falling into a deep sleep.
PRIMARY GENERALIZED SEIZURES: A primary generalized seizure occurs when electrical discharges begin in both halves (hemispheres) of the brain at the same time. Primary generalized seizures are more likely to be major motor attacks than to be absence seizures.
ABSENCE SEIZURES: Absence (petit mal) seizures generally begin at about the age of four and stop by the time the child becomes an adolescent.
Absence seizures usually begin with a brief loss of consciousness and last between one and 10 seconds. A person having a petit mal seizure becomes very quiet and may blink, stare blankly, roll his eyes, or move his lips. A petit mal seizure lasts 15-20 seconds. When it ends, the person who had the seizure resumes whatever he was doing before the seizure began. He will not remember the seizure and may not realize that anything unusual has happened. Untreated, petit mal seizures can recur as many as 100 times a day and may progress to grand mal seizures.
MYOCLONIC SEIZURES: Myoclonic seizures are characterized by brief, involuntary spasms of the tongue or muscles of the face, arms, or legs. Myoclonic seizures are most apt to occur when waking after a nightÕs sleep. A jacksonian seizure is a partial seizure characterized by tingling, stiffening, or jerking of an arm or leg. Loss of consciousness is rare. The seizure may progress in characteristic fashion along the limb.
Limp posture and a brief period of unconsciousness are features of akinetic seizures, which occur in young children. Akinetic seizures, which cause the child to fall, also are called drop attacks.
PARTIAL SEIZURES: Simple partial seizures do not spread from the focal area where they arise. Symptoms are determined by the part of the brain affected. The patient usually remains conscious during the seizure and can later describe it in detail. In 2003, it was reported that people who experience partial seizures are twice as likely to have sleep disturbances as people their same age and gender.
COMPLEX PARTIAL SEIZURES: A distinctive smell, taste, or other unusual sensation (aura) may signal the start of a complex partial seizure.
Complex partial seizures start as simple partial seizures, but move beyond the focal area and cause loss of consciousness. Complex partial seizures can become major motor seizures. Although a person having a complex partial seizure may not seem to be unconscious, he does not know what is happening and may behave inappropriately. He will not remember the seizure, but may seem confused or intoxicated for a few minutes after it ends.
Causes and symptoms: The origin of 50-70% of all cases of epilepsy is unknown. Epilepsy sometimes is the result of trauma at birth. Such causes include insufficient oxygen to the brain; head injury; heavy bleeding or incompatibility between a womanÕs blood and the blood of her newborn baby; and infection immediately before, after, or at the time of birth.
Other causes of epilepsy include:
* head trauma resulting from a car accident, gunshot wound, or other injury.
* brain abscess or inflammation of membranes covering the brain or spinal cord
* phenylketonuria (PKU, a disease that is present at birth, often is characterized by seizures, and can result in mental retardation) and other inherited disorders
* infectious diseases like measles, mumps, and diphtheria
* degenerative disease
* lead poisoning, mercury poisoning, carbon monoxide poisoning, or ingestion of some other poisonous substance
* genetic factors
Status epilepticus, a condition in which a person suffers from continuous seizures and may have trouble breathing, can be caused by:
* suddenly discontinuing anti-seizure medication
* hypoxic or metabolic encephalopathy (brain disease resulting from lack of oxygen or malfunctioning of other physical or chemical processes)
* acute head injury
* blood infection caused by inflammation of the brain or the membranes that cover it
Diagnosis: Personal and family medical history, description of seizure activity, and physical and neurological examinations help primary care physicians, neurologists, and epileptologists diagnose this disorder. Doctors rule out conditions that cause symptoms that resemble epilepsy, including small strokes (transient ischemic attacks, or TIAs), fainting, (syncope), pseudoseizures, and sleep attacks (narcolepsy.)
Neuropsychological testing uncovers learning or memory problems. Neuroimaging provides views of brain areas involved in seizure activity.
The electroencephalogram (EEG) is the main test used to diagnose epilepsy. EEGs use electrodes placed on or within the skull to record the brainÕs electrical activity and pinpoint the exact location of abnormal discharges. The patient may be asked to remain motionless during a short-term EEG or to go about his normal activities during extended monitoring. Some patients are deprived of sleep or exposed to seizure triggers, such as rapid, deep breathing (hyperventilation) or flashing lights (photic stimulation). In some cases, people may be hospitalized for EEG monitorings that can last as long as two weeks. Video EEGs also document what the patient was doing when the seizure occurred and how the seizure changed his behavior.
Other techniques used to diagnose epilepsy include:
* Magnetic resonance imaging (MRI), which provides clear, detailed images of the brain. Functional MRI (fMRI), performed while the patient does various tasks, can measure shifts in electrical intensity and blood flow and indicate which brain region each activity affects.
* Positron emission tomography (PET) and single photon emission tomography (SPECT) monitor blood flow and chemical activity in the brain
Source: The News, 10/5/2008