The Facts about Epilepsy

When the human brain functions normally, millions of tiny electrical charges pass from nerve cells in the brain to all parts of the body. In people who have epilepsy, the normal patterns are interrupted by sudden and unusually intense bursts of electrical energy that can briefly affect consciousness, body movements and sensations. These physical changes are called epileptic seizures; epilepsy is therefore sometimes called a seizure disorder.

Epilepsy affects people in all nations and of all races. About two million Americans have epilepsy. Of the 125,000 new cases that develop each year, up to 50% occur among children and adolescents.

Causes
Epilepsy can result from a brain injury before, during or after birth; head trauma; poor nutrition; certain infectious diseases; brain tumors; and some poisons. However, in many cases the cause is unknown. Attacks of epilepsy might be preceded by a feeling of unease or sensory discomfort called an aura, which indicates the beginning of the seizure. Signs of an impending epileptic seizure, which vary among patients, might include visual phenomena such as flickering lights or "sunbursts."

Individuals predisposed to seizures may have an increased risk for having a seizure following stress, sleep deprivation, fatigue, insufficient food intake, or failure to take prescribed medications.

Some people can experience seizures but not have epilepsy. For example, many young children have convulsions from fevers. These febrile convulsions are one type of seizure. Other types of seizures not classified as epilepsy include those caused by an imbalance of body fluids or chemicals or by alcohol or drug withdrawal. A single seizure does not mean that the person has epilepsy.

Characteristics
Generalized seizures involve all the brain cells. One type of generalized seizure consists of a convulsion with a complete loss of consciousness. Another type looks like a brief period of fixed staring.

Partial seizures involve cells in only part of the brain. Such partial seizures may cause periods of "automatic behavior" and altered consciousness. This is typified by purposeful- looking behavior, such as buttoning or unbuttoning a shirt. Such behavior, however, is unconscious, may be repetitive, and is usually not remembered afterward by the person who experienced it.

Although the symptoms listed below are not always indicators of epilepsy, it is wise to consult a doctor if you or a member of your family experiences one or more of them:

• "Blackouts" or periods of confused memory
• Episodes of staring or unexplained periods of unresponsiveness
• Involuntary movement of arms and legs
• "Fainting spells" with incontinence or followed by excessive fatigue
• Odd sounds, distorted perceptions, or episodic feelings of fear that cannot be explained

Implications
Seizures might interfere with the child's ability to learn. If the student has the type of seizure characterized by a brief period of fixed staring, he or she may be missing parts of what the teacher is saying. It is important that the teacher observes and documents these episodes and report them promptly to parents and school nurses.

Students with epilepsy or seizure disorders are eligible for special education and related services under the Individuals with Disabilities Education Act (IDEA). Some students may have additional conditions such as learning disabilities along with the seizure disorders. Depending on the type of seizure or how often they occur, some children might need assistance to help them keep up with classmates. This might include adaptations in classroom instruction, first aid instruction on seizure management to the student's teachers, and counseling.

It is important that people with epilepsy tell the people they spend time about their condition. Friends, teachers, co-workers and others need to know what to do in case of a seizure and who to contact if one occurs. Even if seizures are largely controlled by medication, it is still best to notify others.

Patients, their friends or family, and their health care providers should work together to monitor the effectiveness of medication as well as any side effects. If a patient’s physical or intellectual skills seem to change, it is important to tell the doctor. There may also be associated hearing or perception problems caused by the brain changes. Written observations will be helpful in discussions with the health care provider.

People with epilepsy must also deal with the psychological and social aspects of the condition. These include public misperceptions and fear of seizures, uncertain occurrence, loss of self control during the seizure episode, and compliance with medications. To support people with epilepsy, schools and places of work can provide epilepsy education programs, including information on seizure recognition and first aid.

Treatment
The most common treatments for epilepsy are anticonvulsant medications that prevent or control seizures. With medication, most patients with epilepsy who are otherwise healthy are able to live full and productive lives. For some, other treatments may include a ketogenic diet (high in fats and oils, low in carbohydrates) and biofeedback.

Some patients' lives are devastated by frequent, uncontrollable seizures and/or associated disabilities. Surgery, which is another treatment option, is generally not performed unless drug treatment has failed.

This article includes information from the National Institutes of Health/National Institute of Neurological Disorders and Stroke and the National Information Center for Children and Youth with Disabilities

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.