Epilepsy: Causes, Symptoms and Treatments

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.

Epilepsy in UK - according to Epilepsy Action 460,000 people in the United Kingdom have epilepsy.

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 worldwide - according to The National Society for Epilepsy (UK)about 50 million people have epilepsy globally.

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
• Fainting
• 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
• Nightmares
• 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).

Treatments for epilepsy

When a diagnosis of seizures or epilepsy is made, the doctor will then discuss with the patient or the patient's family what the best treatment options are. If an underlying correctable brain condition was causing the seizures, sometimes surgery may stop them. If epilepsy is diagnosed (ongoing tendency to have seizures), the doctor will prescribe seizure-preventing drugs or anti-epileptic drugs.

If drugs do not work, the next option could be surgery, a special diet or VNS (vagus nerve stimulation). Trigeminal nerve stimulation may also be effective, according to this study.

The doctor's aim is to prevent further seizures from occurring, while at the same time avoiding side-effects so that the patient may lead a normal, active, and productive life.

Anti-epileptic drugs (AEDs)

The majority of AEDSs are taken orally. The type of seizure the patient is having will decide which drug the doctor may prescribe. We do not all react in the same way to drugs; while some of us may experience side effects from one type of medication, others will not. Some drugs effectively stop further seizures from occurring with one patient who has a certain type of epilepsy, while another patient with the same type will experience no benefit from that same drug. Even when the right drug is found, it could take some time to find the ideal dose.

Famous people who have/had epilepsy:

Agatha Christie (writer)
Alexander the Great (monarch)
Alfred Nobel (scientist)
Alfred the Great (monarch)
Aristotle (philosopher)
Bud Abbot (actor, comedian)
Charles Dickens (writer)
Charles V (Spanish monarch)
Danny Glover (actor)
Edgar Allen-Poe (writer)
George F. Handel (musician)
Hannibal (military commander)
Julius Caesar (emperor)
Leonardo da Vinci (artist)
Lewis Carroll (writer)
Lord Byron (writer)
Louis XIII (monarch)
Martin Luther (theologian)
Michelangelo (artist, sculptor)
Napoleon Bonaparte (Emperor)
Neil Young (musician)
Nicolo Paganini (musician)
Peter Tchaikovsky (musician)
Pythagoras (mathematician)
Richard Burton (actor)
Sir Isaac Newton (scientist)
T. Roosevelt (statesman)
Vincent Van Gogh (artist)

AEDs are aimed at modifying the structures and processes involved during the development of a seizure; including neurons, receptors, glia, ion channels and inhibitory or excitatory synapses. Inhibition is triggered to stop or prevent seizure activity.

Children take the same AEDs as adults. They may be present as tablets, capsules, syrups or sprinklers. As in the case of treating adults, AEDs are designed to prevent seizures. Some are effective with a limited number of types of seizure, while others may treat a broader range. Doctors will try to control seizures with just one drug, but some children may need to take more than one. The success of childhood AEDs also depends to a great extent on compliance - following instructions carefully (not forgetting to take them).

Here is a list of the most commonly prescribed anti-epileptic drugs (AEDs).

• acetazolamide (brand name Diamox)
• acetazolomide modified release (brand name Diamox SR)
• carbamazepine (brand name Tegretol)
• carbamazepine modified release (brand name Tegretol Retard)
• clobazam (brand name Frisium )
• clonazepam (brand name Rivotril)
• ethosuximide (brand names Emeside - Zarontin)
• gabapentin (brand name Neurontin)
• lacosamide (brand name Vimpat)
• lamotrigine (brand name Lamictal )
• levetiracetam (brand name Keppra)
• oxcarbazepine (brand name Trileptal phenobarbital)
• perampanel (brand name Fycompa) tablets as an adjunctive treatment for partial onset seizures in epilepsy were approved by the FDA on Monday 22nd October, 2012. Fycompa is already approved in the European Union (27 sovereign states), Norway and Iceland, and is made and marketed by Eisai.
• phenytoin (brand name Epanutin)
• pregabalin (brand name Lyrica)
• primidone (brand name Mysoline)
• rufinamide (brand name Inovelon)
• sodium valproate (brand names Epilim - Episenta)
• sodium valproate modified release (brand name Epilim Chrono)
• tiagabine (brand name Gabitril )
• topiramate (brand name Topamax)
• valproic acid (brand name Convulex)
• vigabatrin (brand name Sabril)
• zonisamide (brand name Zonegran)

The prognosis for epilepsy sufferers

Experts say that about 60% of people who are untreated have no further seizures during the 24 months following their first seizure. The outlook (prognosis) for most people with epilepsy is good. Approximately 70% go into remission for 5 years on or off treatment (no seizures for five years). About 20% to 30% develop chronic epilepsy (long term epilepsy) - these people are generally treated with AEDs.

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