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Epilepsy

And let that day be lost to us on which we did not dance once!

And let that wisdom be false to us that brought no laughter with it!
~Friedrich Nietzsche~

What is Epilepsy?

The word epilepsy is derived from the Greek epilepsia, which in turn can be broken in to epi- (upon) and lepsis (to take hold of, or seizure).

Epilepsy is a neurological condition which affects the nervous system, and is also known as a "seizure disorder".

The term epilepsy is used to denote a tendency to have recurrent seizures. Seizures (convulsions) occur when there are abnormal electrical impulses in the brain. These pulses occur in groups of nerve cells or neurons. Epilepsy may be triggered by chemical imbalance or a structural abnormality. The term epilepsy is used to cover a variety of seizure types. These differ in cause, nature, severity, management and long-term outcome.

What causes Epilepsy?

Most of the time the cause of epilepsy remains a mystery (Idiopathic Epilepsy). The person with idiopathic epilepsy is apparently healthy in every respect and there is no underlying disease or damage causing them to have seizures.

In some cases a cause is found (Symptomatic Epilepsy) and there may be several reasons why epilepsy is triggered:

• Damage to the brain with or without scarring as a result of injury to the head, infection of the brain (encephalitis) or brain linings (meningitis)

• Malformation of the brain

• Degeneration of the brain

• Metabolic (biochemical) disorder as a result of low blood glucose, low calcium or drugs, particularly alcohol

• Brain tumours

• Blood clots and brain haemorrhages

Some people with epilepsy may identify factors which bring on seizures. These could include stress, hormonal changes or illness. A particular type of epilepsy is triggered by visual stimulation such as flashing lights or flickering TV.

What is a seizure?

A seizure is a sudden surge of electrical activity in the brain that usually affects how a person feels or acts for a short time. Seizures are not a disease in themselves. Instead, they are a symptom of many different disorders that can affect the brain. Some seizures can hardly be noticed, while others are totally disabling.

The seizures in epilepsy may be related to a brain injury or a family tendency, but often the cause is completely unknown. The word "epilepsy" does not indicate anything about the cause or severity of the person's seizures.

Symptoms of a seizure

A seizure is usually defined as a sudden alteration of behaviour due to a temporary change in the electrical functioning of the brain, in particular the outside rim of the brain called the cortex. Below you will find some of the symptoms people with epilepsy may experience before, during and after a seizure. Seizures can take on many different forms and seizures affect different people in different ways. It is not implied that every person with seizures will experience every symptom described below.

Seizures have a beginning, a middle, and an end.

When an individual is aware of the beginning, it may be thought of as a warning or "aura". On the other hand, an individual may not be aware of the beginning and therefore have no warning.

Sometimes, the warning or aura is not followed by any other symptoms. It may be considered a simple partial seizure by the doctor.

The middle of the seizure may take several different forms. For people who have warnings, the aura may simply continue or it may turn into a complex partial seizure or a convulsion. For those who do not have a warning, the seizure may continue as a complex partial seizure or it may evolve into a convulsion.

The end to a seizure represents a transition from the seizure back to the individual’s normal state. This period is referred to as the “post-ictal period” (an ictus is a seizure) and signifies the recovery period for the brain. It may last from seconds to minutes to hours, depending on several factors including which part(s) of the brain were affected by the seizure and whether the individual was on anti-seizure medication. If a person has a complex partial seizure or a convulsion, their level of awareness gradually improves during the post-ictal period, much like a person waking up from anaesthesia after an operation. There are other symptoms that occur during the post-ictal period and are detailed below.

Please note: Below is only a partial list, some people may experience other symptoms not listed below. These lists are meant to help patients communicate with their physicians.

Early seizure symptoms (warnings)

Seizure symptoms

After-seizure symptoms (post-ictal)

Types of seizures

There are many types of seizures and a person may have more than one type. No two people will have the same symptoms.

The type of seizure depends on which part of the brain is affected. If the whole brain is affected then the seizure is known as "generalised" and there is a loss of consciousness, however brief.

If only part of the brain is affected, then it is known as "partial" or "focal" and consciousness, although affected, may not necessarily be lost.

Just as people's seizures vary, so do recovery times. This can be from seconds to minutes.

How to Recognise a Seizure and What To Do

The following table should be helpful in recognising seizures and assisting a person when a seizure occurs.

How is a diagnosis made?

The diagnosis of epilepsy is largely clinical, therefore an accurate description of the seizures and the circumstances in which they occur is most important.

These descriptions will probably be provided by friends or relatives who have witnessed the seizure. This will help in the diagnosis and may determine the need for further investigations such as:-

Blood Tests which will help the doctor assess the general health of the person and will eliminate other potential causes of seizures.

CAT Scans (Computerised Tomography) may be taken to determine whether or not there are any structural changes in the brain.

EEG (Electroencephalogram) will measure changes in the brain's functioning, detected by alterations in electrical activity. It is quite possible that any or all of these investigations will record "normal" results, but on the basis of observed symptoms, a diagnosis of epilepsy can still be made.

Living With Epilepsy

When you are first diagnosed with epilepsy you are likely to feel stunned and confused. You may need to make some small changes in your life. The most important thing is to know and understand as much as possible about epilepsy and how it affects you.

No matter how well controlled your epilepsy is, life with epilepsy can have its ups and downs. Accept the limitations it may impose on you from time to time and live life to the fullest. Living with epilepsy may have its problems but with the right attitude they can be overcome.

Medication

The majority of people with epilepsy have their seizures controlled by anti-epileptic medication. A great deal of progress has been made in this field over the years and now about 80% of people with epilepsy will have their seizures totally controlled or greatly reduced thanks to these drugs.

The choice of drug depends not only on the type of seizure but also on the individual and it may take some time to achieve the right dose for each person.

 Medication strengthens the resistance to seizures. It is most important to take the prescribed dose at the prescribed time. The aim is for the amount of medication in the bloodstream to be maintained at the level needed to prevent or reduce seizures.

Anti-epileptic drugs should not be stopped suddenly without medical advice. If a dose is forgotten, it is not advisable to "double dose". Any changes or side-effects which may result from your medication (though often minor and short-lived) should be noted and reported.

People who can help

• Family Doctor and Neurologist
  The person you see most often will be your GP, who together with you and your neurologist, will manage your epilepsy. You can help them to help you by keeping a record of your seizures, noting how you feel before a seizure and the circumstances surrounding it. Your neurologist will know most about your condition. Find out as much as you can, because understanding your epilepsy will help you explain it to others. You may find it useful to prepare a list of questions before you visit your doctor.
• Suggested Questions:-

°         Which type of epilepsy do I have?

°         Is there an identifiable cause?

°         Will I have to take medication?

°         How long will I have to take it?

°         What does the medication do?

°         Are there any side effects?

°         Is control possible?

°         How will it affect my life?

• Social Worker
  You can get practical advice from your clinic or hospital social worker. Advice and information about epilepsy is also available from EPILEPSY SOUTH AFRICA.
• Relatives and Friends
  Be as open as possible with people. The support and understanding of family and friends is invaluable. Make sure they have the correct facts about your condition. It is no disgrace to have epilepsy and it would be a tragedy to let it dominate your life. It is important that family and friends respect the independence of people with epilepsy and do not try to over-protect them.
• Employers
  Most people with epilepsy are successfully employed in a wide variety of jobs. Many people are afraid to disclose to their employers that they have epilepsy. This is not advisable. Employers and colleagues need to know about epilepsy and how it affects you and what to do should you have a seizure.
• Teachers
  Teachers can be very helpful to children with epilepsy. One cannot stress strongly enough the importance of regular and open communication between the teacher, the parents and the child with epilepsy.

Helping yourself

Safety is important. If you remember some basic, common sense rules, you will minimise the likelihood of injury should you have a seizure.

• Fires and Stoves: Never come too close to an open fire. Keep guards around hearth fires and Primus and gas stoves.

• Bathrooms: Doors should be left unlocked and if possible should open outwards. A shower is often preferable to a bath, but if not available, bath water should be kept shallow and the taps should be turned off before getting in. Avoid bathing while alone at home.

• Sleep: Some people have seizures during their sleep. Sleeping without a pillow may be advisable.

• Sports: With adequate precautions, no sport need be barred. When horse riding, always wear a helmet. Swimming, mountain climbing and sailing should not be done alone. Make sure that whoever is with you is aware of your condition and knows what to do if you have a seizure.

• Identity Discs: It is an excellent idea to wear a Medic Alert Identity Disc at all times. These are available from Medic Alert or through EPILEPSY SOUTH AFRICA. Its also a good idea to keep an Identity Card containing your name and address and your doctor's name and telephone number in your purse or wallet.

• Self-Help Groups: Some people find enormous support in belonging to Self-Help Groups.

Looking to the future

Thanks to better medical treatment and improved understanding of the condition, most people with epilepsy lead full and active lives. Yes, the diagnosis may come as a shock and you may have to make some changes as quickly as possible so that you can get on with your lifestyle. But try to come to terms with it as quickly as possible so that you can get on with your life!

If this seems difficult, the following tips should be helpful:

• Educate yourself and others about epilepsy and help to dispel the myths of the past.

• Find a doctor in whom you have confidence and follow his/her advice.

• Be open with others and try to ignore any negative reactions.

• Don't let the fear of having a seizure keep you at home.

• Remember that with the right approach, qualifications and skills, epilepsy need not be a major barrier to employment.

Possibilities for surgery, types of medication and research will be discussed in further postings on this website and/or on the blog.

There is not one big cosmic meaning for all,

there is only the meaning we each give to our life,

an individual meaning, an individual plot, like an individual novel,

 a book for each person.
~Anais Nin~

Eternal  Peace

Serenity

Links

Epilepsy South Africa

Irish Epilepsy Association

Epilepsy Society UK