Epilepsy and Seizures.
Epilepsy is a condition which originates in the brain.
The first time a person either experiences or witnessess an epileptic seizure it is likely to be a dramatic which will remain in the memory for a long time.
Many people affected by epilepsy will have feelings of anxiety, fear, anger, and even helpless or guilt.
Many people who are affected by epilepsy will also sometimes replay in their minds prejudices which they have heard others expressing about people with epilepsy ("epileptics"). Are not these people somehow handicapped or perhaps even mentally ill? Will I now have to take some kind of medication for the rest of my life which would certainly also be damaging to my body?
Epilepsy is a condition which originates in the brain. It has nothing to do with mental illness and in the majority of cases it does not lead to a reduction in intelligence. Epilepsy can be treated and in a great many cases can be completely cured.
The Frequency of epilepsy in the community and of epileptic seizures in those affected by it.
Epileptic seizures are amongst the most common neurological disorders. Approximately 5% of the population will suffer isolated epileptic seizures without going on to develop full epilepsy (a chronic condition). Around 0.5 – 1 % of the population of the world as a whole suffers from some form of epilepsy.
In the Federal Republic of Germany around 200,000 children are affected by epilepsy. The following pages on the topic of epilepsy are intended to provide some objective and scientific information on the subject which is designed to counter some of the commonly held fears and misconceptions which many people have about people who suffer from epilepsy.
In addition, we should like to provide you with some information on the symptoms, causes, risks, diagnostic procedures and treatment options in relation to epilepsy.
We think that it is especially important in the cases of chronic conditions such as epilepsy that the patients (including children if they are old enough to understand!) are fully informed about the condition and about possible treatment options for it.
Epilepsy. Information from A-Z
Information. What exactly is epilepsy?
All types of epilepsy have in common that in them epileptic seizures may occur from time to time without any recognisable cause. These seizures are caused by functional disturbances in the brain which appear suddenly and are temporary and short in duration. 5% of all people experience an epileptic seizure at some point in their lives. For the most part these people do not have epilepsy but they have what is called an "occasional seizure" which is triggered by a particular circumstance (e.g. fever during childhood years, poisoning, inflammation or alcohol). We talk of people having epilepsy only when they have had at least two epileptic seizures which were not triggered by a recognisable and immediately preceding cause. 1% of all people have epilepsy. The condition may arise at any age in a person's life, it is found equally frequently in all races and cultures and affects people from all levels of society.
Types of Seizures and Forms of Epilepsy.
The epilepsies are a group of conditions which have varying symptoms. There is not a condition of epilepsy as such; but there are rather various epilepsy syndromes which differ from one another in significant ways. These therefore represent distinct clinical pictures which have particular types of epileptic seizures associated with them and they also each have other characteristic features. These characteristic features include, for example, particular changes in EEG (electroencephalogram or "brain activity") patterns, and different age groups at which the various types of seizure first appear or at which they may disappear of their own accord. To some extent we can think of an epilepsy syndrome as being a short-hand way of describing a particular form of manifestation of epilepsy.
What types of epileptic seizures are there?
In the human brain there are some 20,000,000,000 nerve cells which work together to control our thinking, movement, feeling and perception, e.g. of light and music. All of these functions of the brain may be impaired during an epileptic seizure, either individually or affecting various combinations of functions at the same time. During an epileptic seizure an outside observer may be able to observe only a characteristic type of physical movement (= "motor activity"). A disturbance in the sensory apparatus of consciousness may, in individual cases, be reported only by the person who is actually having the seizure. In the vast majority of cases epileptic seizures last for only a few seconds or minutes at most and will cease by themselves without any treatment being necessary. These are called "self-limiting" seizures. In some rare exceptions seizures may last for than 20 minutes. These are so-called "seizure states" which are also known by the terms "status epilepticus" or "continuous seizures."
The International League Against Epilepsy makes a fundamental distinction between two groups.
- Partial (or focal) seizures affect only a part of the brain and during them the person remains conscious.
- Generalised seizures, however, affect both halves of the brain and always result in a loss of consciousness.
It is possible for a seizure to begin in a particular region of the brain but for it then to progress across the entire brain. This is known as a secondarily generalised seizure. In such cases the person may often remember the beginning of the seizure. When faced with a seizure, in order to help the doctors make the right decisions about the therapy which is required, it is far more important for people to be able to observe and report accurately the symptoms and the course of the seizure than it is to be able to make (overhasty) use of technical language about seizures.
Symptoms. Signs of epilepsy
What epilepsy syndromes are there?
As in the descriptions of seizures, when describing the various types and syndromes of epilepsy a distinction is made between the focal and generalised forms. Focal epilepsy is also known as partial epilepsy.
Another criterion in the classification of epilepsy is a division into:
- and Cryptogenic epilepsies
Idiopathic epilepsy is a form of the condition for which there is no other cause than a certain inherited predisposition to it. Despite the amazing increase in knowledge in the field of genetics it has so far been possible to identify a specific disorder of a person's genes as being the cause of epilepsy in only a very small percentage of cases in which there is increased incidence of epilepsy within a family.
Symptomatic in this context means that the epilepsy is caused by a demonstrable pathological change in the brain, such as a brain tumour, the consequences of inflammations, severe head injuries, strokes or cortical dysgenesis, which is either congenital or which has arisen in the early stages of the brain's development. This change may affect only a very tiny region of the brain which may be possible to identify only with the aid of microscopic investigations. With the continued improvement of medical investigative and diagnostic techniques, in particular in the field of magnetic resonance imaging (also called nuclear magnetic resonance imaging), it is becoming increasingly often possible to demonstrate the presence of structural changes in the brain, especially in patients with focal epilepsy.
Epilepsies are described as being cryptogenic if it is thought that they are not idiopathic but symptomatic even though the actual cause of the seizures has not yet been identified.
Examples of various epilepsy syndromes.
|Idiopathic||- Benign childhood epilepsy with centrotemporal spikes" (BCECT) - Benign childhood epilepsy with occipital paroxysms||- Benign familial neonatal convulsions (BFNC) - Absence epilepsy in school-age children Juvenile myoclonic epilepsy|
|symptomatic||- Temporal lobe epilepsy with hippocampal sclerosis - Frontal lobe epilepsy with focal cortical dysplasia.||Epilepsy in lissencephalia (= developmental disorder affecting the entire cerebral cortex)|
|Cryptogenic||- West syndrome with a probable symptomatic cause||- Epilepsy with myoclonic astatic seizures|
At what age does epilepsy begin?
Epilepsy may appear for the first time in someone's life at any age, but it usually first manifest during childhood. Many childhood epilepsies stop of their own accord during puberty. These epilepsies are described as being "benign" (=good natured) and they are overwhelmingly epilepsies of the focal type. The most commonly found type of epilepsy in children is called "benign childhood epilepsy with centrotemporal spikes" (BCECT) which is also known as (benign) Rolando epilepsy. The development of children who have benign focal epilepsy cannot itself always be described as "benign" however. In addition to suffering so-called learning disabilities, some of these children also have disorders affecting their speech, behaviour or intelligence. As an example of these we may mention "epileptic aphasia" (loss of speech), the so-called "Landau-Kleffner syndrome".
Causes. What causes epilepsy?
How does epilepsy develop?
First of all we must make a distinction between epileptic seizures and epilepsy:
An epileptic seizure is an indication of a a short-lived functional disturbance in the brain. In principle any brain may produce a seizure in response to an intensive form of stimulation, such as a high fever, overtiredness or a brain injury. Not every seizure is an indication of the existence of epilepsy, however.
We speak of epilepsy when a person suffers repeated seizures without there being any recognisable triggers for them. Where seizures occur in response to identified triggers these are known as "occasional seizures." The causes of epilepsy include such things as injury to the brain in an accident or even inflammation of the brain. It can also be caused by problems with the development of a baby's brain while still in the womb or by complications during its birth. The primary causes of the development of epilepsy among teenagers and young adults are accidents and brain tumours. Amongst adults and the elderly, however, blood circulation disorders and strokes as well as the processes of degeneration in the brain all play a much greater role in the development of epilepsy. The causes of epilepsy are often also very hard to isolate.
Inheritance of the Condition.
An inherited predisposition to the condition may be one of the causes of epilepsy. So far science has been able to link spcific genes to only a few forms of epilepsy. Knowledge about how epilepsy is caused is increasing all the time, however. Research in this field will discover other correlations between the various causal factors.
Diagnostics, Therapy, Surgery
Once the treatment objectives have been determined, the therapy is planned. Various treatment options are available, depending on the ...
These clinics are specialized in the treatment of epilepsy and epileptic seizures.