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Epilepsy

Epilepsy is a chronic condition of the brain. It is characterized by seizures that do not seem to have an obvious cause.[10][11] To the outside viewer, these seizures show as episodes of heavy shaking.[12] Depending on the seizure, the shaking may be short and difficult to detect or it may be longer.

Epilepsy
Other namesSeizure disorder
The electroencephalogram recording of a person with childhood absence epilepsy showing a seizure. The waves are black on a white background.
Generalized 3 Hz spike-and-wave discharges on an electroencephalogram
SymptomsPeriods of vigorous shaking, nearly undetectable spells[1]
DurationLong term[1]
CausesUnknown, brain injury, stroke, brain tumors, infections of the brain, birth defects[1][2][3]
Diagnostic methodElectroencephalogram, ruling out other possible causes[4]
Differential diagnosisFainting, alcohol withdrawal, electrolyte problems[4]
TreatmentMedication, surgery, neurostimulation, dietary changes[5][6]
PrognosisControllable in 69%[7]
Frequency39 million / 0.5% (2015)[8]
Deaths125,000 (2015)[9]
A video of a seizure
Someone who has bitten the tip of their tongue while having a seizure

People with epilepsy are sometimes called epileptic, but it is the fit or seizure that is "epileptic".

Many people have died from seizures.

Different forms

There are many different forms of seizures, and there are also many different forms of epilepsy. Most forms of epilepsy cannot be cured. In most cases, drugs can make life easier for those suffering from it. In very few cases, (which are difficult to treat), surgery may help. In some cases, only eating special things (called a diet) may help. A special diet has been developed; it is called Ketogenic diet. When it was developed, it was mainly used to treat certain children with epilepsy, before good drugs became available. Today, it is used to treat certain cases where drugs do not seem to help.

Certain forms of the disease disappear after a time, they do for example only occur in childhood. Epilepsy is not one condition. Rather, it stands for a number of health problems that all show in the same ways.

Occurrence

The condition is very common; about one percent of people worldwide (65 million) have epilepsy.[13] Nearly eighty percent of all cases occur in developing countries.[12] Epilepsy becomes more common as people age.[14][15] In the developed world, onset of new cases occurs most frequently in infants and the elderly.[16] In the developing world this is in older children and young adults.[17] Between five and ten percent of all people will have an unprovoked seizure by the age of eighty.[18] The chance of having a second seizure is between forty and fifty percent.[19]

Common things

The condition has many forms, but generally the following is true:

  • People get muscular seizures or convulsions.
  • People lose control over their body. Feces may be released in the process. They may fall to the floor and hurt themselves when they are standing or walking.
  • People may become unconscious.
  • Those affected are not aware of the seizure going on. People do not remember or know what happened to them.
  • In some cases, people may sense that a seizure is about to occur. This special feeling is called aura. Afterwards, people may remember the aura, but not the seizure itself.
  • Most seizures only last a short time, the exception to this is called status epilepticus. Such a status epilepticus can last over five minutes.
  • Reflexes do not work while people are having a seizure; they may also stop breathing.
  • People are tired after a seizure. They may be confused.
  • Epilepsy is not a mental illness.

Treatment

The condition is very common, and has been studied a lot. Doctors only say someone has epilepsy, if that person has had at least two seizures, for which the immediate cause cannot be seen. There are also seizures which are not caused by epilepsy. There are drugs for many forms of epilepsy that make life better for those affected. In about two thirds of the cases, taking one drug alone can make the seizures go away. The remaining third is more difficult to treat, but in many cases, a combination of drugs can at least reduce the number of seizures.

In most cases, epilepsy is caused by scars in the brain. Some forms of the condition are caused by genetic disorders, which may be passed on from the parents to the children. Very often, the actual cause for an epileptic seizure is lack of sleep, too much alcohol, or other things that cause stress.

Many countries in the world say there are special rules for people who have epilepsy. They need to be without a seizure for some time before they may drive a car. They also need to take drugs to treat their illness. In many countries, such people may not drive buses, taxis or trucks.

Problems

People having an epileptic seizure face a number of problems. The most common ones are:

  • They hurt themselves during the seizure. This includes broken bones, and wounds resulting from biting or hitting an object.
  • They produce an accident during the seizure. This includes falling off a ladder, car accidents, and drowning while swimming.
  • In some cases, people stop breathing. In such cases, the brain will be damaged, if the seizure lasts for a longer time, or there are multiple such seizures in a row.
  • During the seizure, neurotransmitters are released in the brain. If their concentration is too high, the brain will take damage.

Risk factors

In many cases, risky behaviour can provoke seizures. Such risk factors include

In many cases,a person who is able to cope with stress, who sleeps enough, and who does not drink too much can reduce the risk of having a seizure.

Famous people with epilepsy

Epilepsy Media

  • A still image of a generalized seizure

  • An EEG can aid in locating the focus of the epileptic seizure.

  • Revised operational scheme of seizure classification, ILAE, 2017

  • Wristbands or bracelets denoting their condition are occasionally worn by people with epilepsy should they need medical assistance.

  • The anticonvulsant drugs sodium valproate, stiripentol, clobazam and midazolam.

  • Deaths due to epilepsy per million persons in 2012
         0–7     8–10     11–13     14–17     18–21     22–28     29–37     38–67     68–100     101–232

  • Hippocrates, 17th century engraving by Peter Paul Rubens of an antique bust

Notes

  1. ↑ 1.0 1.1 1.2 "Epilepsy Fact sheet". WHO. February 2016. Archived from the original on 11 March 2016. Retrieved 4 March 2016.
  2. ↑ McPhee SJ, Hammer GD (2010). "7". In Hammer GD, McPhee SJ (eds.). Pathophysiology of disease : an introduction to clinical medicine (6th ed.). New York: McGraw-Hill Medical. ISBN 978-0-07-162167-0.
  3. ↑ Goldberg EM, Coulter DA (May 2013). "Mechanisms of epileptogenesis: a convergence on neural circuit dysfunction". Nature Reviews. Neuroscience. 14 (5): 337–49. doi:10.1038/nrn3482. PMC 3982383. PMID 23595016.
  4. ↑ 4.0 4.1 Longo DL, Fauci AS, Harrison TR, Kasper DL, Hauser SL, Jameson JL, Loscalzo J (2012). "369 Seizures and Epilepsy". Harrison's principles of internal medicine (18th ed.). McGraw-Hill. p. 3258. ISBN 978-0-07-174887-2.
  5. ↑ Bergey GK (June 2013). "Neurostimulation in the treatment of epilepsy". Experimental Neurology. 244: 87–95. doi:10.1016/j.expneurol.2013.04.004. PMID 23583414. S2CID 45244964.
  6. ↑ Martin-McGill, Kirsty J.; Jackson, Cerian F.; Bresnahan, Rebecca; Levy, Robert G.; Cooper, Paul N. (7 November 2018). "Ketogenic diets for drug-resistant epilepsy". The Cochrane Database of Systematic Reviews. 11 (11): CD001903. doi:10.1002/14651858.CD001903.pub4. ISSN 1469-493X. PMC 6517043. PMID 30403286.
  7. ↑ Eadie MJ (December 2012). "Shortcomings in the current treatment of epilepsy". Expert Review of Neurotherapeutics. 12 (12): 1419–27. doi:10.1586/ern.12.129. PMID 23237349. S2CID 207221378.
  8. ↑ Vos, Theo; Allen, Christine; Arora, Megha; Barber, Ryan M.; Bhutta, Zulfiqar A.; Brown, Alexandria; Carter, Austin; Casey, Daniel C.; Charlson, Fiona J.; Chen, Alan Z.; Coggeshall, Megan; Cornaby, Leslie; Dandona, Lalit; Dicker, Daniel J.; Dilegge, Tina; Erskine, Holly E.; Ferrari, Alize J.; Fitzmaurice, Christina; Fleming, Tom; Forouzanfar, Mohammad H.; Fullman, Nancy; Gething, Peter W.; Goldberg, Ellen M.; Graetz, Nicholas; Haagsma, Juanita A.; Hay, Simon I.; Johnson, Catherine O.; Kassebaum, Nicholas J.; Kawashima, Toana; et al. (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  9. ↑ Wang, Haidong; Naghavi, Mohsen; Allen, Christine; Barber, Ryan M.; Bhutta, Zulfiqar A.; Carter, Austin; Casey, Daniel C.; Charlson, Fiona J.; Chen, Alan Zian; Coates, Matthew M.; Coggeshall, Megan; Dandona, Lalit; Dicker, Daniel J.; Erskine, Holly E.; Ferrari, Alize J.; Fitzmaurice, Christina; Foreman, Kyle; Forouzanfar, Mohammad H.; Fraser, Maya S.; Fullman, Nancy; Gething, Peter W.; Goldberg, Ellen M.; Graetz, Nicholas; Haagsma, Juanita A.; Hay, Simon I.; Huynh, Chantal; Johnson, Catherine O.; Kassebaum, Nicholas J.; Kinfu, Yohannes; et al. (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  10. ↑ Commission on Epidemiology and Prognosis, International League Against Epilepsy (1993). "Guidelines for epidemiologic studies on epilepsy. Commission on Epidemiology and Prognosis, International League Against Epilepsy". Epilepsia. 34 (4): 592–6. doi:10.1111/j.1528-1157.1993.tb00433.x. PMID 8330566. S2CID 3264819.
  11. ↑ Blume W, Lüders H, Mizrahi E, Tassinari C, van Emde Boas W, Engel J (2001). "Glossary of descriptive terminology for ictal semiology: report of the ILAE task force on classification and terminology". Epilepsia. 42 (9): 1212–8. doi:10.1046/j.1528-1157.2001.22001.x. PMID 11580774. S2CID 10894926.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  12. ↑ 12.0 12.1 "Epilepsy". Fact Sheets. World Health Organization. October 2012. Retrieved January 24, 2013.
  13. ↑ Thurman, David J.; Beghi, Ettore; Begley, Charles E.; Berg, Anne T.; Buchhalter, Jeffrey R.; Ding, Ding; Hesdorffer, Dale C.; Hauser, W. Allen; Kazis, Lewis; Kobau, Rosemarie; Kroner, Barbara; Labiner, David; Liow, Kore; Logroscino, Giancarlo; Medina, Marco T.; Newton, Charles R.; Parko, Karen; Paschal, Angelia; Preux, Pierre-Marie; Sander, Josemir W.; Selassie, Anbesaw; Theodore, William; Tomson, Torbjörn; Wiebe, Samuel; ILAE Commission on Epidemiology (September 2011). "Standards for epidemiologic studies and surveillance of epilepsy". Epilepsia. 52 Suppl 7: 2–26. doi:10.1111/j.1528-1167.2011.03121.x. PMID 21899536. S2CID 8505004.
  14. ↑ Brodie, Martin J.; Elder, Andrew T.; Kwan, Patrick (November 2009). "Epilepsy in later life". Lancet Neurology. 8 (11): 1019–30. doi:10.1016/S1474-4422(09)70240-6. PMID 19800848. S2CID 14318073.
  15. ↑ Browne, Thomas R.; Holmes, Gregory L. (2008). Handbook of epilepsy (4th ed.). Philadelphia: Lippincott Williams & Wilkins. p. 7. ISBN 978-0-7817-7397-3.
  16. ↑ Wyllie, Elaine; Cascino, Gregory D.; Gidal, Barry E. (2010). Wyllie's treatment of epilepsy : principles and practice (5th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. ISBN 978-1-58255-937-7.
  17. ↑ Newton, CR (29 September 2012). "Epilepsy in poor regions of the world". Lancet. 380 (9848): 1193–201. doi:10.1016/S0140-6736(12)61381-6. PMID 23021288. S2CID 13933909.
  18. ↑ Wilden, JA; Cohen-Gadol, AA (15 August 2012). "Evaluation of first nonfebrile seizures". American Family Physician. 86 (4): 334–40. PMID 22963022.
  19. ↑ Berg, AT (2008). "Risk of recurrence after a first unprovoked seizure". Epilepsia. 49 Suppl 1: 13–8. doi:10.1111/j.1528-1167.2008.01444.x. PMID 18184149. S2CID 28114460.
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