Epilepsy
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What is Epilepsy and what are Seizures?
What Causes Epilepsy?
The Types of Seizures and Epilepsies
How is Epilepsy Treated?
Clinical Studies
Local Treatment and Support Services
Introduction
About 1% of persons in the United States have epilepsy. The disorder is not contagious but can strike anyone at any age. Many—but not all—patients achieve good control of their seizures. The following page is intended as a resource that provides links to unbiased information on seizures and epilepsy.
What is Epilepsy and what are Seizures?
Epilepsy is a long-term disorder in which persons suffer from repeated seizures. Seizures are sudden brain disturbances which are caused by abnormal nerve firing in brain cells. Seizures are almost always short events, lasting a few seconds to a few minutes. Seizures can be very different.
For example:
1) the patient may have abnormal jerking of a part of the body,
2) may have a simple staring spell,
3) may have an alteration of consciousness with temporary confusion,
4) or may have a full “grand mal” attack—which includes falling down, stiffness and jerking
The various types of seizures will be explained in more detail below. If a person has had more than one or two seizures, we usually say that the person has epilepsy.
- A good overview of epilepsy is available here.
- For a summary in Spanish (Espanol) see this link.
- Publications in Spanish can also be found here.
- Other Non-English Resources (currently being researched and reviewed)
What Causes Epilepsy?
Epilepsy begins most often during childhood or after the age of 65, but can begin at any age. Almost any kind of injury to the brain can cause epilepsy. Epilepsy can be caused by abnormal genes in the brain. Other common causes are head injury, infection, stroke, and brain tumors.
For more information about the causes of epilepsy:
For Medical professionals:
eHealthMD
Stanford Epilepsy Center (PDF, causes begin on page 4)
Stanford Epilepsy Center (HTML)
The Types of Seizures and Epilepsies
Finding out the type of seizure that the patient has is the first step (after establishing the cause—see above) in the diagnosis and treatment of the disorder.
The type of seizures helps define the kinds of epilepsy the patient has. To learn more about the types of epilepsy, use this site where the types of epilepsy are reviewed in detail. A good description of Lennox-Gastaut epilepsy syndrome can be found right here and infantile spasms syndrome is described quite well here.
Medical Professionals, here are the very latest and very detailed considerations.
The original classifications (still widely used) are available in the following references and links:
- Seizure Classificaton: Commission on Classification and Terminology of the International League Against Epilepsy (1981) Proposal for revised clinical and electrographic classification of epileptic seizures. Epilepsia. 22: 489-501. Click here.
- Epilepsy Classification: Commission on Classification and Terminology of the International League Against Epilepsy (1989) Proposal for revised classification of epilepsies and epileptic syndromes. Epilepsia. 30: 389-399. Click here.
Seizures are divided into two groups: FOCAL (PARTIAL) or GENERALIZED.
Focal Seizures
Focal (partial) seizures are those which begin in a part of the brain. There are three types of focal seizures:
Focal seizures without losing consciousness/awareness (simple partial seizures): The attacks begin in one part of in the brain and do not usually spread to other parts of the brain. For example, the patient may have a sudden onset of jerking of an arm lasting 60–90 seconds. The patient is aware of the seizure and can describe it.
Focal seizures with loss of consciousness/awareness (complex partial seizures) also begin in one part of the brain, but the abnormal electrical discharge spreads further in the brain. The patient may have a brief warning and then cannot respond. Some patients may stare and others may stagger or even fall. Patients may uncontrolled movements that we call automatisms. Typical automatisms are lip smacking, swallowing, fumbling, scratching, or even walking about. After 30–120 seconds, the patient makes a gradual recovery to normal awareness but may feel tired or ill for several hours after the attack. The patient has no memory of these events.
Focal seizures evolving to a bilateral, convulsive seizure (secondarily generalized partial seizures) are those focal seizures which progress from the focal stage to a grand mal seizure. This seizure type is described below.
Generalized Seizures
Generalized seizures are those in which we cannot find where in the brain it begins.
Generalized tonic-clonic (convulsive, “grand mal”) seizures are the most dramatic of all epileptic seizures. The patient has:
1) stiffness in all extremities
2) then has massive jerking of the body.
3) The jerking (called clonic jerking) slows
4) The patient is usually unresponsive.
5) The tongue or cheek may be bitten and loss of bladder function is common.
6) Death during a grand mal seizure is quite uncommon; usually the patient makes a gradual recovery and complains of headache.
Absence (petit mal) seizures begin and end suddenly. These seizures are often referred to as the “staring spell” of childhood. The attack usually lasts less than 10 seconds and rarely more than 45 seconds. The patient usually has no memory for the seizure. Absence attacks usually begin in childhood or adolescence and may occur up to hundreds of times per day.
Myoclonic jerking is a lightning-like muscle movement of any part of the body. Usually it is significant enough that there is visible movement of the body part. This can happen repetetively, and there is no loss of awareness. Myoclonus is seen in some patients as an independent seizure type and in others as part of their usual seizure. Knowing the cause of the myclonus will help your doctor make the right diagnosis. There are many kinds of myoclonus.
For Medical Professionals:
National Institute of Neurological Disorders and Stroke
Atonic seizures are those in which the patient goes limp.
Tonic seizures are those in which the patient has sudden muscle stiffness. In either case, if standing, the patient typically falls suddenly to the floor and may be injured. If seated, the head and chest may suddenly drop forward. Although most often seen in children, this seizure type may occur in adults. Many patients with these seizures wear helmets to prevent head injury.
Infantile spasms usually begin before the age of one year. The seizures have jerking of the arms and legs. Click here to read more.
How is Epilepsy Treated?
Medication
Most patients with epilepsy are treated with anti-seizure medications to reduce their seizures. These drugs work in about 2/3 of patients. But 1/3 of patients continue to have uncontrolled seizures. The doctor usually chooses the medications based on the patient’s seizure type (see seizure classification above). Some of the newer drugs have fewer side effects compared to the older ones. Some drugs are used mostly for special epileptic conditions such as status epilepticus. For more about status epilepticus, go here.
Neurologists and other specialized physicians are expert in choosing (and sometimes combining) anti-seizure drugs to stop the seizures.
More information about anti-seizure drugs:
Visit MINCEP Epilepsy Care
For medical professionals:
Epilepsy.com
Stanford Epilepsy Center (PDF, (medications are discussed on pages 10-30)
Stanford Epilepsy Center (HTML)
Hard-To-Treat Seizures
Although most patients seizures can be controlled with medications, some can not be controlled with any medication. Neurologists are typically the physicians who are trained to treat epilepsy, and most patients should start with their local neurologist before seeking advanced care.
The doctor will ask about what happens during a seizure and will examine the patient.
The patient will also be tested with an EEG and perhaps other tests for diagnosis such as a CT or MRI. To learn more about these tests, use the following links
Some advanced centers also use magnetoencephalography (MEG) for diagnosis—see this link for more details.
One of the more important advances in understanding hard-to-treat seizure disorders has been the development of intensive video/EEG monitoring. Studies using this technique date at least to 1977. Intensive monitoring is used to make the correct diagnosis and, if possible, to find the part of the brain where the seizure begins. Some patients may then be treated by surgery. To see videos that can help you recognize seizures, go here.
To see a site for teens with epilepsy, try this link.
All advanced epilepsy programs have intensive video/EEG monitoring available for patient evaluation.
Surgical Therapy
For patients with seizures that do not respond to medications, surgical therapy may be possible. The most widely used treatment is to find the part of the brain where the seizure starts and to remove, if possible, that part of the brain. This process uses intensive video/EEG monitoring described above.
For patients who do not respond to medications and are not candidates for the more common surgical approaches, a number of new devices are under study. One of these, the vagal nerve stimulator, is approved by the FDA for use in epilepsy. Use this link for a detailed description of the device and the surgical process.
The National Association of Epilepsy Centers provides a list of many of specialized centers nationwide. See this link for a list of all US centers that are members of this organization (some very good centers may not be members).
Clinical Studies
Hard-to-treat patients can often participate in clinical studies of new drugs or of new devices. For one list of available studies, go to this link. If you have seizures which are not controlled, you may wish to discuss these studies with your doctor. Before you consider clinical trials, find out if they’re right for you.
Local Treatment and Support Services
Philadelphia has many excellent local centers available for the specialized evaluation and treatment of epilepsy. These are not listed in the text above to avoid the appearance of preferential treatment in this document. In alphabetical order:
1. Children’s Hospital of Philadelphia
2. Hahnemann Hospital (Part of Drexel University)
3. Jefferson University Hospital
4. St. Christopher’s Hospital for Children
5. Temple University
6. University of Pennsylvania Hospital
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PhillyHealthInfo.org is here to help you find epilepsy treatment and support groups in Bucks, Chester, Delaware, Montgomery, or Philadelphia Counties. Our Local Health Services and Local Health Events right side of the PhillyHealthInfo.org Epilepsy Homepage are a great place to start.
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Locally, the hands-on organization is the Epilepsy Foundation of Eastern Pennsylvania (EFEPA). Patients and relatives with questions about health and legal support, education, family and school services, local conferences and workshops, and issues such as employment and insurance should contact EFEPA.
The national organization that offers support services is the Epilepsy Foundation, located in Landover, Maryland.
The international consumer organization is the International Bureau for Epilepsy (IBE).
Other resources, including research resources are listed at Citizens United for Research in Epilepsy (CURE).
For medical professionals: the American Epilepsy Society (AES) is a vibrant scientific organization dedicated to finding medical and surgical remedies for patients with epilepsy. The international medical and scientific organization is the International League Against Epilepsy (ILAE).
Jacqueline French, MD
Roger J. Porter, MD
Fellows, College of Physicians of Philadelphia
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