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Epilepsy Overview
What is Epilepsy?
Epilepsy is a well-recognized brain (neurological) disorder in which a person experiences recurring seizures. It is often simply referred to as a “seizure disorder.”
Epilepsy is not...
- A mental illness
- Contagious, you can't catch it from anyone
- A symptom of intellectual weakness
- A reason for shame or embarrassment
Epileptic seizures may involve brief periods of unconsciousness, distortions of the senses (taste, smell, sight), loss of control over body movements, or convulsions. A person can have only one type of seizure, or more than one type.
The good news today is that epilepsy is understood as a physical illness and your doctor is an excellent source for information about seizures and epilepsy.
Who Can it Affect?
Epilepsy can affect any person of any age.
About 2,500,000 people in the US have some form of epilepsy. Half of all epilepsy develops before age 25, but it is increasingly common in the young and the elderly. There are as many cases of epilepsy in those 60 years of age and older as in children 10 and younger.
Actually, 25 million Americans (one in every ten) have had or will have a seizure at some point in their lives. However, epilepsy is characterized by seizures that occur more than once because of an underlying condition of the brain. About 125,000 new cases of epilepsy are diagnosed each year.
How does epilepsy develop?
In about 70% of cases, no obvious reason for epilepsy can be found. When a cause is found it may include:
- Head injury from an accident or other trauma
- Brain tumors or strokes
- Certain genetic conditions, or problems in brain development before birth
- After effects of brain infections like encephalitis or meningitis, or severe cases of measles
- Changes in metabolism preventing vital nutrients from feeding the brain
Generally speaking, epilepsy can be caused by many things that affect the brain. However, it is not a condition that gets worse with time, and most people who have it—children or adults—can expect to live a normal life span.
Understanding Seizures
There are numerous reasons why disruptions to the electrical circuitry in the brain can produce a seizure. Head injuries, tumors, infections, high fevers, and certain illnesses or medications are among the things that can cause seizures.
Seizures result from disturbances in the activity of nerve cells in the brain called neurons. Normal electrical signals moving between neurons make the brain and body function. The neurons act like switches, automatically turning on and off the electrical charges.
During a seizure, there are glitches in the brain's operation—the neuron cell-switches seem to get stuck in the on position. This produces a flood of electrical signals that can spread and stimulate various parts of the brain to cause changes in the way the person feels or acts.
What happens during a seizure depends on where the glitches occur in the brain and how widespread they are. If only a small part of the brain is affected, the person may notice only an odd smell or taste. More extensive brain disturbances may block the person's awareness or cause confusion for a brief time.
Large groups of nerve cells controlling muscle activity may be affected causing uncontrolled body movements or convulsions—shaking, violent spasms, or jerking motions.
Seizures can last a few seconds or a few minutes. They usually end naturally as the bursts of electrical brain cell activity calm down and return to normal. After the seizure has ended, the person may have a headache or unusual sensations, or feel confused or tired.
Two thirds of adults who have a seizure never experience another one. However, some may develop repeated seizures, a condition called epilepsy. The occurrence of a single seizure does not necessarily mean that a person has epilepsy.
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Types of Seizures
There are several kinds of epileptic seizures depending on where the bursts of electrical activity occur in the brain and how much of the brain is affected. A person can have one or more types of seizures. Seizures are generally classified as generalized if they affect the entire brain, or partial if they affect only a particular area within the brain. Furthermore, they are considered simple if the patient remains conscious or complex if the patient loses consciousness.
Generalized seizures
Tonic-clonic seizures, sometimes called grand mal seizures occur when waves of electrical activity flood the whole brain at once. Such episodes can be frightening to those witnessing one.
The person having a grand mal seizure may fall to the ground unconscious as the body briefly stiffens and starts jerking. Bladder or bowel control is sometimes lost. The person's breathing may slow or even momentarily stop, and skin turns a bluish color.
Usually, the seizure ends on its own and the person regains consciousness, but may feel tired and confused.
Absence seizures or petit mal are another form of seizures. The person appears to be daydreaming or blankly staring and last only a few seconds, but there may also be blinking or facial twitching, and head, arm, or chewing movements. Petit mal seizures are most often seen in children, usually beginning before age 5. The child and others may not even notice these “little” seizures.
Partial seizures
These happen when only a specific part of the brain is affected. Depending on where the electrical discharges take place, partial seizures may produce changes in sensation, movement, or emotions.
Simple partial seizures involve specific changes in feelings, or in the way things sound, look, feel, taste, or smell. The person remains fully conscious during these episodes.
Complex partial seizures involve a loss of consciousness. The person may stare, make chewing movements or mumble, pick at clothing, or do the same action repeatedly. These seizures may last for a minute or two, during which the person seems in a dreamlike state, and full awareness may not return for some time after the episode ends.
A partial seizure may spread, affecting enough brain cells to become a generalized seizure. When this regularly happens the person may first experience certain recognizable sensations—such as an odd smell or taste, or feelings of fear or sickness—that act as a warning signal. This warning, called an aura, allows time for the person to move away from potentially harmful situations.
Seizure similarities
Although there are different types of seizures, they are all similar in some ways:
- They normally don't last long and end on their own. The brain has its own way of restoring electrical balance and ending a seizure
- Seizures are usually not life-threatening and people experiencing them don't feel pain during an episode
- Persons having seizures are not dangerous to others. Even if they become agitated, their movements are too uncoordinated to harm anyone else
DEPAKOTE ER is indicated as monotherapy and adjunctive therapy in the treatment of adult patients or children 10 years of age and older with complex partial seizures that occur in isolation or in association with other types of seizures.
DEPAKOTE ER is also indicated as sole and adjunctive therapy in the treatment of simple and complex seizures in adult patients or children 10 years of age and older, and adjunctively in adult patients or children 10 years of age and older with multiple seizure types that include absence seizures.
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What To Do If Someone Is Having A Seizure
Helping the person
What can you do for the person having a seizure? Here are suggestions from the Epilepsy Foundation of America:
- Ease the person to the ground or flat surface and put something soft under the head. Clear the area of any hard or sharp objects
- Turn the person on one side to prevent choking and keep the airway clear. Loosen anything around the neck that might hinder breathing
- Don't try to hold down the person to prevent jerking movements. This could injure the person
- Don't force anything into the person's mouth. Contrary to popular myth, seizures do not cause people to swallow their tongues
- Keep the person out of harm's way, guiding them away from possible danger such as a busy street or steep stairs
- Stay with the person until full awareness returns and offer help in returning home or to some other destination
Calling for help
You should call for medical assistance if:
- Convulsive shaking and jerking lasts longer than five minutes, or starts again shortly after stopping
- Breathing is difficult or there is unusual pain in the chest or other body area
- The person having the seizure seems ill, injured, or appears to be pregnant
If you are living with a person who has a seizure disorder, ask the doctor about how you should respond to the particular seizures and when to call for medical help.
Living with Epilepsy
If you have epilepsy, here are some suggestions from the Epilepsy Foundation for living with this disorder:
- Educate yourself and others about epilepsy to dispel any misunderstandings about this medical condition
- Take all medications as directed by your doctor. Never miss a dose or take more or less than prescribed
- Tell your doctor if you are having any side effects from medications or if there is a change in your seizures
- Learn what may trigger your seizures and do what you can to avoid those things
- Limit or avoid alcohol, since it can interact with medicines you are taking and/or trigger seizures
- Lead an active life, however, precautions are needed for activities that might be hazardous if you were to suddenly lose consciousness or be unable to control your movements. Discuss your activities with your doctor
- Most states allow people with epilepsy to drive if they have not had seizures for a certain length of time. Your doctor can advise you on qualifications
- Fight off feelings of sadness, or depression. They may be related to your seizures or medication, so talk to your doctor rather than remaining silent
- Overall, try to live as independently and actively as you can. Try not to let concerns about having a seizure keep you at home. Wear a medical identification bracelet and carry a first aid card, so if you have a seizure, people will know what to do
Epilepsy is a medical condition. There is no such person as an “epileptic.”
Epilepsy may be a part of your life, but it is not your entire life. This disorder doesn't have to make your life different in any major way.
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What a Doctor Can Do
Doctors use several approaches to determine if a person has a seizure disorder, the type, and its extent.
Gathering information
An important tool for the doctor is gathering as much information as possible about what the seizures looked like and what happened just before they started. Sometimes other people—family, friends, or coworkers—can better describe what happened after the seizure started, since the person who had the episode often cannot.
Testing
EEG—A doctor also diagnoses epilepsy using an electroencephalogram (EEG), a painless test that measures electrical activity in the brain. Electrical signals from brain cells are picked up by small wires placed on the head and recorded as wavy lines by a special machine. The brain waves may show patterns that are typical of certain seizure types.
CT/MRI—once epilepsy is suspected, computed tomography (CT) or magnetic resonance imaging (MRI) scans of the brain may help pinpoint a cause. These record pictures of the brain to see if there are any growths, scars, damage from injury or stroke, or other physical conditions that might be producing seizure activity.
Other tests—the doctor may order blood tests, liver and kidney function studies, an electrocardiogram (ECG) measuring heart function, and other tests to find other possibly treatable causes of seizures.
Treating Epilepsy
Epilepsy is typically treated with medicines, a special diet, lifestyle changes, or in some severe cases, surgery. If you experience seizures, your doctor can help determine which treatment is right for you.
Drug therapy—Treatment with medicines is most common and is usually tried first. There are different drugs that can be used, depending on the type of seizures, and doctors often attempt to use one drug at a time if possible. No single drug can control all types of seizures. Some people have their seizures controlled with a single drug others must take several.
Medications that are prescribed for seizures should be taken regularly as prescribed.
Diet—A special diet very high in fats—called a ketogenic diet—sometimes helps prevent seizures, especially in children. It must be prescribed and monitored by a doctor, and is usually tried only if medications and other treatments do not work effectively.
Surgery—If medication fails to control the seizures, or if epilepsy is caused by a brain tumor, surgery might be recommended. It is usually tried only if seizures begin in a small area of the brain. Treating that small portion may stop the seizures or greatly reduce them, without damaging the patient's ability to function in other ways. Surgeons will operate only when the possible benefits outweigh the risks.
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