| The terms “seizure” and “epilepsy” | | | | patient is videotaped during the entire test to look |
| are used more or less interchangeably. Perhaps when | | | | for subtle clues to seizures. The other thing is that |
| the seizure is more visibly evident by muscle jerking | | | | some kinds of seizures, like partial seizures especially |
| and loss of consciousness, the more it might be said, | | | | of the frontal area, tend to occur during sleep. |
| “That person has epilepsy.” In any case, the | | | | Generalized seizures are more prone to occur in the |
| process is caused by repetitive and abnormal | | | | morning. The video camera might pick up subtle |
| electrical discharges in the brain. These can be | | | | changes, like appearing stunned, having rapid blinking, |
| mapped and recorded by the electroencephalogram, | | | | or inability to follow directions. |
| or EEG, which involves hooking a lot of wires to the | | | | It would seem obvious why seizures should be |
| scalp and recording where the abnormal activity is | | | | treated, that is, not to have them. But there are a |
| taking place. If the discharges are taking place in the | | | | lot of other issues which mandate treatment of |
| motor area of the brain, the typical jerking | | | | seizures. People with seizures don’t live as long. |
| movements are seen. If they are taking place in the | | | | The most extreme example of this is Sudden |
| temporal area, the patient might smell something | | | | Unexplained Death of Epilepsy (think of John |
| funny. Seizure activity in the occipital, or back area of | | | | Travolta’s tragic loss of his son). A person with |
| the brain, might cause odd things to be seen. The | | | | epilepsy is forty-two times more likely to die |
| abnormal activity can spread from one area to | | | | suddenly of unexplained causes than a person |
| another, causing combinations of these. When the | | | | without it. There is increased risk of cognitive |
| entire brain is discharging abnormally, this is called a | | | | impairment: epileptics often don’t finish school, |
| generalized seizure. There are other variations of | | | | often do not marry, and many have difficulty finding |
| seizures: ones that result in abnormal emotions, | | | | employment. Depression and suicidality are greatly |
| problems with learning, or dysfunctions in systems | | | | increased in epilepsy. |
| controlled by the autonomic nervous system. It | | | | The good news is that there are excellent |
| simply depends on where the abnormal discharge | | | | treatments for seizures. First-line drugs that have |
| activity is taking place. | | | | been around for a long time are Phenobarbital, |
| There were a lot of descriptive terms used in the | | | | valproic acid, and carbamazepine, though these can |
| past to try and classify seizures. This has been | | | | have side effects like sleepiness which may make |
| simplified into two specific types and seems to work | | | | them less desirable. There are at least nine new |
| well. The first group is “partial” or | | | | “second generation antiepilepsy drugs |
| “focal” onset seizures. They start in one | | | | (AED’s) which have become available since 1993. |
| specific area. The second type is | | | | These often work as single agents, though |
| “generalized” or “distributed” seizures | | | | sometimes they have to be combined. They have to |
| which start in all areas of the brain cortex at once. In | | | | be carefully chosen and tailored to the seizure patient |
| simple partial seizures there is no loss of | | | | based on other drugs taken and the condition of the |
| consciousness; in complex partial seizures there is a | | | | liver and bone marrow. Blood levels of the drugs |
| loss of consciousness. There is a loss of | | | | sometimes require careful monitoring. Some of these |
| consciousness in all generalized seizures. The | | | | newer drugs include gabapentin, lamotrigine, and |
| generalized seizures are further classified according to | | | | topiramate. |
| their effect on the body, and may include absence | | | | Here’s the downside, though. In up to one-third |
| seizures, myoclonic, clonic and atonic seizures. These | | | | of cases, the drugs simply do not bring complete |
| two main types of seizures (partial and generalized) | | | | control. It used to be that people were walking |
| are called primary epilepsy. Secondary epilepsy might | | | | around for years and years on three or four drugs |
| include alcohol withdrawal seizures, drug overdose | | | | which were not working. Current thinking now is that |
| seizures, and the seizures of brain infections such as | | | | if three drugs have been given in sufficient doses |
| meningitis. | | | | over a sufficient length of treatment, it’s time to |
| It can be a challenge at times to diagnose a seizure | | | | refer for epilepsy surgery evaluation. This type of |
| condition. One interesting side note is that if a person | | | | treatment is bringing complete control in over 80% |
| has bite lacerations to the tongue after a seizure-like | | | | of those treated, and over half of those referred are |
| episode, it is 99% certain that he indeed had a | | | | surgical candidates. The numbers are that there are a |
| seizure; only 24% of people having true seizures | | | | hundred-thousand people out there right now who |
| actually bite their tongues, however, so you | | | | would benefit from surgery. |
| can’t say they don’t have seizures because | | | | So, in conclusion, epilepsy or seizure disorder, affects |
| the tongue wasn’t bitten. To proceed, however, | | | | over two and a half million Americans. There are |
| the usual first step in diagnosis is an MRI scan. The | | | | excellent drug treatments available after the diagnosis |
| purpose is to look for structural abnormalities like | | | | has been established. Drug treatment is demanding |
| tumors, enlarged blood vessels, or atrophic brain | | | | and exacting, and is probably best managed by |
| areas that might be the cause of seizures, and which | | | | physicians who deal in seizures all the time. If there is |
| might be potentially repairable. The next step is the | | | | a situation where drug therapy is proven to be |
| EEG, or brain wave test. It is usually done after a | | | | ineffective, referral to an epilepsy surgery center is |
| period of sleep deprivation, as this condition might | | | | warranted. There are numerous reasons why |
| elicit an otherwise quiet seizure. It is important that | | | | seizures should be completely managed; most of |
| the entire EEG be performed. It is done awake, | | | | them centered on longevity and quality of life issues. |
| during rapid- fire strobe lights, and asleep. Often the | | | | |