Q: What does “Epilepsy” mean?
A: The word “Epilepsy” is derived from a Greek word meaning “a condition of being overcome, seized, or attacked.” People used to believe seizures were caused by a demon and epilepsy became known as a sacred disease. Unfortunately, myths and fears still surround epilepsy, resulting in misconceptions about the disorder. Unaddressed, these concerns make the goal of living a normal life with epilepsy far more difficult than it needs to be. Simply put, the word “Epilepsy” means nothing more than the tendency to have seizures.
Q: Is epilepsy a disease?
A: Epilepsy is not a disease. It is a sign or symptom of an underlying neurological disorder.
Q: What is a seizure?
A: The brain is a highly complex and sensitive organ. It controls and regulates all our actions. It controls motor movements, sensations, thoughts, and emotions. It regulates the involuntary inner workings of the body such as the function of the heart or lungs.
Brain cells work together communicating by means of electrical signals. Occasionally, there is an abnormal electrical discharge from a group of cells, and the result is a seizure. The type of seizure will depend upon the part of the brain where the abnormal electrical discharge arises.
Q: What is an aura?
A: Before the onset of a seizure some people experience a sensation or warning called an “aura.” An aura may occur far enough in advance to give the person time to avoid possible injury. The type of aura experienced varies from person to person. Some feel a change in body temperature while others may experience a feeling of tension or anxiety. In some cases, the epileptic aura will be apparent to the person as a musical sound, a strange taste, or even a particular curious odor. If the person is able to give the physician a good description of this aura, it may provide a clue to the part of the brain where the initial discharges originate. An aura could occur without being followed by a seizure and, in some cases, can by itself be called a type of simple partial seizure.
Q: When was epilepsy discovered?
A: Epilepsy is the oldest known brain disorder. It was mentioned more than 2,000 years before Christ. References can be found in ancient Greek texts and in the Bible. It wasn’t until the mid 1800s, however, that epilepsy was given serious study. In 1857, Sir Charles Locock was the first to introduce a sedative that aided in controlling seizures. In 1870, John Hughlings Jackson identified the brain’s outer layer, the cerebral cortex, as the part involved in epilepsy. In 1929, Hans Berger demonstrated that the electrical impulses of the human brain could be recorded.
People with Epilepsy
Q: What kind of people have epilepsy?
A: Given the right circumstances, virtually anyone can have a seizure. Each of us has a brain seizure threshold which makes us more or less resistant to seizures. Seizures can have many causes, including brain injury, poisoning, head trauma, or stroke; and these factors are not restricted to any age group, sex, or race–nor is epilepsy.
Q: How many people have epilepsy?
A: Epilepsy is far more common than most of us realize. Current estimates indicate that 1 in 26 persons will have some form of epilepsy in their lifetime.
Q: Does epilepsy strike at any particular age?
A: Epilepsy can strike anyone at any age. However, most persons who develop seizures during their formative years tend to experience a reduction in the intensity and frequency of their seizures as they grow older. In many cases, the epilepsy will disappear completely. Fifty percent of all cases develop before 10 years of age.
Q: Does epilepsy occur more in some cultures?
A: Epilepsy occurs more frequently in some cultures. For example, in Tanzania, 4% of the population experiences severe seizure disorders. In this case, genetic predisposition to lower seizure thresholds is known to exist. In Canada, 1-2% of the population has epilepsy.
Types of Seizures
Q: Are there different types of seizures?
A: Many varieties of epileptic seizures occur, and frequency and form of attacks vary greatly from person to person. With modern methods of treatment, however, most cases can be fully controlled. Because there are so many nuances in epilepsy and so many different kinds of seizures, a specific classification system is being promoted by the International League Against Epilepsy. The International Classification of Epilepsy Seizures has been adopted by the medical community and is gradually replacing outdated seizure terminology including “grand mal” and “petit mal.”
The new classification scheme describes two major types of seizures: “partial” and “generalized.” It also divides each of these categories into subcategories including simple partial, complex-partial, absence, tonic-clonic, and other types.
Q: What is the difference between partial and general seizures?
A: The distinction between “partial” and “generalized” seizures is the most important feature of the new classification system. If the excessive electrical discharge in the brain is limited to one area, the seizure is partial. If the whole brain is involved, it is generalized. In all, there are over 30 different seizure types. Therefore, the new classification format subdivides the partial and generalized Epilepsies into a number of different categories.
Q: What are partial seizures?
A: Partial seizures (formerly known as focal seizures) with elementary symptomology are often referred to as “simple partial.” During this type of seizure the patient can experience a range of strange or unusual sensations including sudden, jerky movements of one body part, distortions in hearing or seeing, stomach discomfort, or a sudden sense of fear. Consciousness is not impaired. If another seizure type follows, these sensations may be referred to as an “aura.”
Q: What are complex-partial seizures?
A: Complex-partial seizures (formerly psychomotor or temporal lobe) are characterized by a complicated motor act involving impaired consciousness. During the seizure the patient appears dazed and confused. Purposeless behaviors such as random walking, mumbling, head turning, or pulling at clothing may be observed. Usually, these so-called “automatisms” cannot be recalled by the patient. In children this seizure may consist of staring or lip-smacking and, therefore, may be confused with the absence seizure described below.
Q: What are absence (petit mal) seizures?
A: Generalized absence seizures (formerly petit mal) are characterized by 5 to 15 second lapses in consciousness. During this time the patient appears to be staring into space and the eyes may roll upwards. Absences are not preceded by an aura and activity can be resumed immediately afterwards. Typically, they occur in children and disappear by adolescence. They may, however, evolve into other seizure types, such as complex-partial or tonic-clonic. The occurrence of absences in adulthood is rare.
Q: What are tonic-clonic (grand mal) seizures?
A: Tonic-clonic (formerly grand mal) seizures are generalized convulsions involving two phases. In the tonic phase, the individual loses consciousness and falls, and the body becomes rigid. In the clonic period, body extremities jerk and twitch. After the seizure, consciousness is regained slowly. If the tonic-clonic seizure begins locally (with a partial seizure) it may be preceded by an “aura.” These seizures are said to be secondarily generalized.
While the tonic-clonic seizure is the most visible, obvious type of epilepsy, it is not the most common. Partial seizures are more frequently encountered and occur in 62% of all epilepsy patients. Complex-partial seizures account for approximately 30% of all cases.
Q: What are other types of seizures?
A: Benign rolandic epilepsy is an epileptic syndrome occurring in young children that is age limited (you stop having seizures in the teen years). Salivation, twitching of the mouth or upper extremity on one side are typical manifestations. Seizures occur almost exclusively nocturnally.
Juvenile myoclonic epilepsy is epilepsy characterized by onset in childhood or adolescence and is associated with extremity jerking or generalized tonic-clonic seizures (grand mal) within an hour or two of wakening from sleep. Seizures which may be precipitated by sleep deprivation, alcohol or coffee tend to occur in the morning.
Other seizure terms include: Atonic (Drop Attacks), Myclonic, Infantile Spasms, Nocturnal, Photosensitive, Visual, Musicogenic, Jacksonian, Sensory, Bilateral Myclonus, Atkinetic, Autonomic, Prolonged seizures, and Ictal State.
Q: What are “status” seizures?
A: Status epilepticus is the term used to describe recurrent seizures without recovery of consciousness between attacks. This is a medical emergency and can be life threatening or cause brain damage. Immediate action should be taken to obtain necessary medical care.
Q: What are pseudo seizures?
A: Pseudo seizures (or psychogenic seizures) are quite common and can occur in people who have, or do not have epilepsy. The attacks are triggered by a conscious or unconscious desire for more care and attention. The seizures start with rapid breathing, triggered by mental stress, anxiety, or pain. As the person breathes rapidly, they build up carbon dioxide in their body and change their body chemistry. This can cause symptoms very much like epileptic seizures including prickling in the face, hands, and feet, stiffening, trembling, etc. The appropriate treatment for pseudo seizures is to calm the person and start them breathing at a normal rate. Treatment should also involve investigating the mental and emotional factors that led to the pseudo seizure.
Q: How do you distinguish epileptic seizures from pseudo seizures?
A: Epileptic seizures and pseudo seizures are distinguishable both by their nature and symptoms, but the diagnosis can be difficult. Epileptic seizures are caused by a change in how the brain cells send electrical signals to each other, while pseudo seizures are triggered by a conscious or unconscious desire for more care and attention. Thus, measuring brain activity with an EEG and video telemetry is important for distinguishing epileptic and pseudo seizures. Also, pseudo seizures often lack the exhaustion, confusion, and nausea that is associated with epileptic seizures. Psychogenic seizures can occur in people who also experience epileptic seizures.
Q: Can seizures occur if a person does not have epilepsy?
A: Epilepsy is a chronic condition of recurrent unprovoked seizures. Isolated seizures and provoked seizures (e.g., drug or alcohol induced) are not epilepsy even though the events are real seizures. There are many types of non-epileptic seizures. Non-epileptic seizures differ from epileptic seizures in that there is usually no evidence of abnormal electrical activity in the brain after the seizure, and they do not occur repeatedly. Some of the more common causes of non-epileptic seizures are low blood sugar, fainting, heart disease, stroke, migraine headaches, kinked blood vessels, narcolepsy, withdrawal, and extreme stress or anxiety.
Q: What are seizures like?
A: The nature of seizures varies depending on the type of epilepsy the individual has. Some seizures may be very noticeable while some may go completely unrecognized. With the most common types of seizures there is some loss of consciousness, but some seizures may only involve small movements of the body or strange feelings. The different seizure types have certain characteristics that accompany them.
Q: What does it feel like to have a seizure?
A: Common feelings associated with seizures include uncertainty, fear, physical and mental exhaustion, confusion, and memory loss. Some types of seizures can produce visual and auditory phenomena, while others can involve a “blank” feeling. If a person is unconscious during a seizure there may be no feeling at all.
Q: How long does a seizure last?
A: Depending on the type of seizure, it can last anywhere from a few seconds to several minutes. In rare cases, seizures can last many hours. For example, a tonic-clonic seizure typically lasts one to seven minutes. Absence seizures may only last a few seconds, while complex partial seizures range from 30 seconds to two to three minutes.
“Status Epilepticus” refers to prolonged seizures that can last for many hours, and this can be a serious medical condition. In most cases, however, seizures are fairly short and little first aid is required.
Q: Is there such a thing as a “minor” case of epilepsy?
A: There are over 30 types of seizures, and some types are more severe than others. Long tonic-clonic convulsions, for example, can produce more physical and mental effects than shorter partial seizures. Some people may experience very frequent seizures (every few hours), while others can go for months or years without a seizure. Also, some seizures are easily controlled by drug therapies while others may continue regardless of the medication that is tried.