Epilepsy is a seizure disorder that affects nearly 3 million Americans, according to the Epilepsy Foundation. During an epileptic seizure, neurons (nerve cells) that normally send messages to and from the brain misfire and send the wrong signals. There are many different types of epilepsy, each with its own distinguishing symptoms. Though epilepsy is most commonly diagnosed during childhood, it can occur for a variety of different reasons at any stage of life.
Types
There are many different types of seizures, but they all fall into one of two general categories. Primary generalized seizures occur in both sides of the brain at the same time. These include myoclonic, atonic, tonic, clonic, tonic-clonic and absence (petit mal) seizures. Partial seizures occur only in one small area of the brain. The three types of partial seizures are simple, complex and secondarily generalized seizures.
Causes
In some cases, there may be a genetic predisposition to epilepsy or to a sensitivity to certain conditions that cause epileptic seizures. In other cases, medical conditions such as a traumatic head injury from a fall or accident, a prenatal brain injury, dementia, heart attack, stroke or brain infections such as meningitis can lead to epilepsy.
Symptoms
Symptoms of seizures can occur during wakening and sleep. Symptoms of one type of seizure can occur individually and in combination with symptoms of other types of seizures. Absence seizures are mild, begin and end abruptly and usually last only a few seconds. They usually begin in childhood, are characterized by staring spells and may also involve some movement of the face or limbs, such as chewing motion or flicking of the hands. Myoclonic seizures involve brief jerking or twitching of muscles. Atonic seizures last less than 15 seconds, but during that time, muscles in the body suddenly lose their strength, often causing the entire body to drop to the ground. In a tonic seizure, the body and limbs suddenly stiffen up, while in a clonic seizure the limbs jerk uncontrollably. The symptoms of a tonic-clonic (grand mal) seizure, which can last several minutes, are essentially a combination of tonic and clonic seizure symptoms, with stiffening, unconscious collapse and jerking limbs. The symptoms of simple partial seizures vary greatly, depending on where they originate in the brain. They may include jerking or stiffening of limbs, changes in the senses that are usually hallucinations or delusions, physical discomfort in the head or body, memory or speech problems and sudden change in emotional state. Complex partial seizures, which sometimes begin as simple partial seizures, involve staring, memory lapses and lack of awareness. Dangerous and embarrassing behavior sometimes occur as a result of the lack of awareness.
Secondary generalized seizures start with the symptoms of a partial seizure, but then the seizure spreads through the brain and take on the symptoms of a tonic-clonic or other type of generalized seizure.
Treatment
Anti-seizure mediation is usually the first line of conventional treatment for epilepsy. Because anti-epilepsy drugs can have both mild and serious physical and psychological side effects, doctors usually begin by prescribing a single medication at a low dose and work up from there, if necessary, by increasing the dose or prescribing a combination of drugs. Other treatment options to discuss with a physician include a ketogenic (high-protein, low-glycemic) diet, brain surgery and vagus nerve stimulation to reduce the number and severity of seizures.
Remission
Although it is difficult to predict remission and may depend on the type of epilepsy involved, many children and adults eventually discontinue medication and live without seizures. One Canadian study, published in the journal 'Neurology', followed children who were diagnosed with absence epilepsy at ages from 1 to 14 until they ranged in age from 12 to 31 years. At the time of follow-up, he researchers found that 65% of these children were in remission at follow-up. Eighteen percent were taking anti-epilepsy drugs to control seizures. Seventeen percent were having seizures but did not take medication. Fifteen percent of the group had developed myoclonic epilepsy.
