What Is Epilepsy?

Epilepsy is a disorder of the nervous system, which consists of the brain and spinal cord. Together, they are called the Central Nervous System (CNS). Each cell in the CNS is called a neuron. There are over 10 billion of these neurons in the CNS. The job of the neuron is to receive information and transmit it to the brain. Epilepsy exists when some neurons malfunction – that is, they do not do their job properly. Scientists are not certain why this occurs.

It does not take much to cause an epileptic disturbance. If as few as seven of the ten billion neurons malfunction at the same time, a seizure may result.

When the brain is functioning as it should, it works at many levels at once. A person can simultaneously see, hear, smell, walk, and talk. This is because each part of the brain acts separately, and at the same time all the parts work together. In this way, the brain is like an orchestra in which each instrument plays independently yet all combine together to produce a harmonious pattern of sound. But suppose something goes wrong with one instrument, and it can now only sound one note. The rest of the orchestra momentarily loses track of the score, and for a moment the whole orchestra sounds the same one note. Something like that happens to the brain during an epileptic seizure. A small section of neurons takes over, and the brain – temporarily – can sound one note only. No other messages can get through, and the person experiences a seizure.

What happens during a seizure?

There are several different kinds of seizures. Two of the most common types of seizure are absence seizures (also known as petit mal seizures) and tonic-clonic seizures (also known as grand mal seizures).

Absence seizures usually begin during childhood. During an absence seizure the child temporarily "blacks out." The blackout is short (5-30 seconds) and has its onset without warning. The child will resume doing whatever he had been doing beforehand and will have no memory of what happened. There is no set rule about how often this sort of seizure occurs. A person may have as many as fifty or even a hundred a day, or as few as one or two a month.

The Tonic-Clonic seizure is what most people think epilepsy is all about. The seizure begins with a sudden loss of consciousness. The person falls stiffly to the ground, sometimes uttering a birdlike cry as he does so. Because his breathing is temporarily interrupted, his skin may turn a pale, bluish color. Then his whole body starts to jerk. Breathing resumes but is heavy and irregular. Soon the shaking stops, and the person relaxes. These seizures seldom last more than three minutes.

There are many other types of seizures, and several ways of classifying them. Most people have one type of seizure. There are some, though, who have two or more types, and some people have one type at one period and another later on.

What can I do to help someone who is having a tonic-clonic seizure?

Keep calm and let the seizure run its course. Do not try to hold the person down or restrain his movements in any way. Loosen tight clothing – undo his belt and tie. Clear the area around the epileptic so that he cannot hurt himself by slamming into hard objects. Place something soft under his head.

Do not try to open the victim's mouth or to force anything between his teeth. If his mouth is already open, you may place a soft object between his side teeth to keep him from biting his tongue.

There are two situations which call for medical attention immediately: if the seizure lasts more than ten minutes, or if there is a series of seizures, one following another in rapid succession. Either of these conditions is called "status epilepticus." This is a rare but dangerous condition. Long or repeated seizures become increasingly difficult to stop, and if allowed to go on indefinitely may lead to exhaustion and even death.

Who gets epilepsy?

Anyone at any time may sustain an injury or disease of the brain or CNS that may lead to epilepsy. This injury or disease can occur before birth by means of radiation, poisonous substances, or infectious diseases (such as measles); during birth as a result of a lack of oxygen; during childhood as a result of head injuries or childhood diseases; and during adulthood as a result of head injury, brain tumor, or blood circulation problems. (It is estimated that many thousands of people develop epilepsy each year after head injuries sustained in automobile accidents.)

Can epilepsy be outgrown?

Most children do outgrow epilepsy. However, it is difficult for doctors to predict which children will outgrow the condition. Children who respond well to antiepileptic drugs, have normal development, and have normal EEGs are most likely to outgrow their epilepsy by adolescence. Also, some forms of epilepsy are more likely to be outgrown than others.

On the other hand, for some people seizures intensify with age.

The picture is complicated, and what will happen in any case is hard to predict. But one thing seems certain – the sooner the diagnosis and the better the control, the greater is the chance of outgrowing the condition.

Is epilepsy inherited?

Certain forms of epilepsy tend to run in families, and some forms have even been associated with specific genes. But many people with epilepsy have no family history of the disorder.

Can epilepsy be prevented?

To quote Paul E. Funk, former Executive Vice President of the Epilepsy Foundation of America, "We are all potentially epileptic, and epilepsy can indeed touch the life of anyone at any time." However, although we cannot totally prevent epilepsy, we can greatly lessen our chances of getting it. Proper medical care in pregnancy and childbirth are important steps toward preventing epilepsy. Good nutrition also plays a part in epilepsy prevention, although as far as we know the role is a minor one. To guard against epilepsy we need not dose ourselves with vitamins as long as we eat a well-balanced diet. Our best protection against epilepsy is to prevent serious head injury. One of the best protective devices of all is a seat belt.

How is epilepsy treated?

There are many antiepileptic drugs which stop or reduce epileptic seizures. The main mechanism of action – in other words, how they do this – varies from one drug to another. Some drugs have more than one mechanism of action, while others have unknown mechanisms of action; scientists do not know how they work. All these drugs have side effects, the common ones being drowsiness, headaches, double or blurred vision, dizziness, and nausea.

For patients who are not responsive to antiepileptic drugs, epilepsy can sometimes be treated with surgery. The surgical treatment of epilepsy has advanced to a point where between 38 percent and 58 percent of carefully selected patients may be almost completely free of seizures after surgery. However, surgery can only be performed when the seizures cannot be controlled by drugs. Additionally, surgery is only an option for patients who have partial epilepsy arising from a part of the brain which can be removed without causing significant physical or intellectual loss.

In recent years dietary treatment of epilepsy has become more widespread. The most common diet used to control epileptic seizures is the ketogenic diet, a special diet very high in fat and very low in carbohydrates. This diet forces the body into a state of ketosis, where body fat is burned for fuel instead of carbohydrates. For reasons that are not yet completely clear to researchers, this produces an anticonvulsant effect. The ketogenic diet is extremely complex to administer and very restrictive to follow, and is therefore only recommended after several antiepileptic drugs have been tried without success.

Will epilepsy ever be cured?

Our understanding of the CNS is still incomplete. Research is progressing constantly. Discovering how the brain works will help scientists understand and hopefully cure epilepsy sometime in the near future.