People with epilepsy tend to have recurrent seizures (fits). The seizures occur because of a sudden surge of electrical activity in the brain - there is an overload of electrical activity in the brain. This causes a temporary disturbance in the messaging systems between brain cells. During a seizure the patient's brain becomes "halted" or "mixed up".
Every function in our bodies is triggered by messaging systems in our brain. What a patient with epilepsy experiences during a seizure will depend on what part of his/her brain that epileptic activity starts, and how widely and quickly it spreads from that area. Consequently, there are several types of seizures and each patient will have epilepsy in his/her own unique way.
The word "epilepsy" comes from the Greek word epi meaning "upon, at, close upon", and the Greek word Leptos meaning "seizure". From those roots we have the Old French word epilepsie, and Latin word epilepsia and the Greek words epilepsia and epilepsies.
How common is epilepsy?
Approximately 50 out of every 100,000 people develop epilepsy each year in industrialized nations.
About 50 million people worldwide are said to be affected by epilepsy and seizures.
Epilepsy in USA - according to The Epilepsy Foundation over 3 million Americans are affected by epilepsy and seizures. About 200,000 new cases of seizures and epilepsy occur in the USA each year. 10% of all Americans will experience a seizure some time during their lifetime.
Epilepsy in UK - according to Epilepsy Action 460,000 people in the United Kingdom have epilepsy.
Epilepsy worldwide - according to The National Society for Epilepsy (UK) about 50 million people have epilepsy globally.
Epilepsy and life expectancy
Researchers from the University of Oxford and University College London reported in The Lancet in 2013 that premature death is 11 times more common among people with epilepsy compared to the rest of the population. The authors added that the risk is even greater if a person with epilepsy also has a mental illness.
Suicides, accidents and assaults accounted for 15.8% of early deaths. Among these 15.8%, the majority had been diagnosed with a mental disorder.
Head researcher, Seena Fazel said:
"Our results have significant public health implications, as around 70 million people worldwide have epilepsy, and they emphasize that carefully assessing and treating psychiatric disorders as part of standard checks in persons with epilepsy could help reduce the risk of premature death in these patients. Our study also highlights the importance of suicide and non-vehicle accidents as major preventable causes of death in people with epilepsy."
A Swedish study found that young men who exercise vigorously may have a lower risk of epilepsy later in life.
Epilepsy in developing nations
There are twice as many people with epilepsy in developing nations than industrialized countries. Unfortunately, over 60% of people in poorer nations do not receive proper medical care for epilepsy, researchers from the University of Oxford reported in the journal The Lancet.
The authors added that the burden of epilepsy in developing countries is "under-acknowledged by health agencies", even though treatments for the disorder are very cost-effective.
Lead author, Charles Newton, of the Department of Psychiatry, said:
"Deriving accurate figures on the epidemiology of epilepsy in low- and lower-middle income countries is very difficult - there have been very few surveys to gather the sort of data we need, and such studies tend to be expensive, especially for countries whose health research funding is likely to be very limited.
However, the research we do have shows that the burden of epilepsy in these regions is at least double that found in high-income countries, and sadly, adequate facilities for diagnosis, treatment and ongoing management of epilepsy are virtually non-existent in many of the world's poorest regions. Many people with epilepsy or their families do not even know that they have a disorder that can be controlled with biomedical treatment, so it is vitally important that awareness is raised and medical care improved in these regions."
Types of seizures
There are three types of diagnoses a doctor might make when treating a patient with epilepsy:
- Idiopathic - this means there is no apparent cause.
- Cryptogenic - this means the doctor thinks there is most probably a cause, but cannot pinpoint it.
- Symptomatic - this means that the doctor knows what the cause is.
There are three descriptions of seizures, depending on what part of the brain the epileptic activity started:
A partial seizure means the epileptic activity took place in just part of the patient's brain. There are two types of partial seizure:
- Simple Partial Seizure - the patient is conscious during the seizure. In most cases the patient is also aware of his/her surroundings, even though the seizure is in progress.
- Complex Partial Seizure - the patient's consciousness is impaired. The patient will generally not remember the seizure, and if he/she does, the recollection of it will be vague.
A generalized seizure occurs when both halves of the brain have epileptic activity. The patient's consciousness is lost while the seizure is in progress.
Secondary Generalized Seizure
A secondary generalized seizure occurs when the epileptic activity starts as a partial seizure, but then spreads to both halves of the brain. As this development happens, the patient loses consciousness.
Symptoms of epilepsy
The main symptoms of epilepsy are repeated seizures. There are some symptoms which may indicate a person has epilepsy. If one or more of these symptoms are present a medical exam is advised, especially if they recur:
- A convulsion with no temperature (no fever).
- Short spells of blackout, or confused memory.
- Intermittent fainting spells, during which bowel or bladder control is lost. This is frequently followed by extreme tiredness.
- For a short period the person is unresponsive to instructions or questions.
- The person becomes stiff, suddenly, for no obvious reason
- The person suddenly falls for no clear reason
- Sudden bouts of blinking without apparent stimuli
- Sudden bouts of chewing, without any apparent reason
- For a short time the person seems dazed, and unable to communicate
- Repetitive movements that seem inappropriate
- The person becomes fearful for no apparent reason, he/she may even panic or become angry
- Peculiar changes in senses, such as smell, touch and sound
- The arms, legs, or body jerk, in babies these will appear as cluster of rapid jerking movements.
The following conditions need to be eliminated as they may present similar symptoms, and are sometimes misdiagnosed as epilepsy:
- A high fever with epilepsy-like symptoms
- Narcolepsy (recurring episodes of sleep during the day and often disrupted nocturnal sleep)
- Cataplexy (a transient attack of extreme generalized weakness, often precipitated by an emotional response, such as surprise, fear, or anger; one component of the narcolepsy quadrad)
- Sleep disorders
- Panic attacks
- Fugue states (a rare psychiatric disorder characterized by reversible amnesia for personal identity)
- Psychogenic seizures (a clinical episode that looks like an epileptic seizure, but is not due to epilepsy. The EEG is normal during an attack, and the behavior is often related to psychiatric disturbance, such as a conversion disorder)
- Breath-holding episodes (when a child responds to anger there may be vigorous crying and subsequent apnea and cyanosis - the child then stops breathing and skin color changes with loss of consciousness).
On the next page we take a close look at the treatments for epilepsy, including the possible development of a pill to suppress seizures and the latest research studies into fatty acids and therapies involving music.