SYS PELIP - Epilepsy Foundation Of Northern California

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EPILEPSYQuestionsand AnswersAbout Seizure Disorders

EPILEPSYQ. What is epilepsy?Epilepsy is a neurological disorder that produces sudden, brief changes in how brain cells(neurons) function. When brain cells are notworking properly, a person’s consciousness,movements or actions may be altered for ashort time. Those physical changes are calledseizures. Epilepsy is sometimes called a seizuredisorder. It affects people in all nations and ofall races.Q. usuallyWhen does epilepsydevelop?Epilepsy can begin at any time of life. One in fourof the 200,000 new cases of seizures and epilepsy diagnosed each year in the U.S. begin underthe age of 14; one in three begin in people overthe age of 65. The remaining 41 percent of newcases start between the ages of 15 and 64.Q. U.S.How many people in thehave epilepsy?Almost one percent of the population, or nearly 3 million people, have epilepsy.Q. toWhatcauses a persondevelop epilepsy?This pamphlet is designed to provide generalinformation about epilepsy to the public. It does notinclude medical advice. People with epilepsy should notmake changes in treatment or activities based on thisinformation without first consulting a physician.In more than 70 percent of all cases, no causecan be found. Among the rest, epilepsy may be 2008 Epilepsy Foundation of America, Inc.E P I L E P S Y:Q U E S T I O N SA N DA N S W E R S1

caused by head injuries, strokes, brain tumors,genetic conditions (such as tuberous sclerosis),lead poisoning, problems in brain developmentbefore birth, illnesses that affect the brain likemeningitis or encephalitis, or even severe casesof measles.Q. prevented?Can epilepsy beEpilepsy can be prevented by reducing risks ofhead injury and stroke, or by developing newvaccines to prevent seizure-producing illnesses.For example, safety belts and air bags, motorcycle helmets, and safety seats for infants inautomobiles protect against epilepsy as a resultof auto accidents.Q. Iscontagious?epilepsy everNo, you cannot catch epilepsy from anotherperson.Q. Iscondition?epilepsy an inherited2Some types of epilepsy are definitely associated with genetic factors. At the same time,epilepsy usually develops with no family historyof the condition at all. It may be that all of usinherit some susceptibility to seizures, but thatmany people with a high susceptibility neverdevelop the condition unless something happens to injure the brain. Children of a parentwith epilepsy have a slightly greater probabilityof developing the condition than the rest ofthe population, but it is still much more likelythat they will not.E P I L E P S Y:Q U E S T I O N SA N DA N S W E R SSEIZURESQ. seizures?What causes epilepsy orThe brain is the control center for the body.Normal electrical signals between cells makethe brain and body work correctly. The cellswork like little switches, turning electricalcharges on and off automatically. But sometimes it is as if some cells get stuck in the "on"position, and keep firing. This continuous firingaffects neighboring cells and spreads to otherparts of the brain, or throughout the brain. Theexcessive electrical charges prevent those cellsfrom performing their normal functions. It maychange the way the world looks, or may makeour bodies move automatically. Sometimesthey may cause a convulsion. Seizures usuallylast a short time (a matter of seconds or aminute or two), and then end naturally as braincell activity returns to normal.Q. peopleWhat kinds of seizures dowith epilepsyhave?Several different kinds of seizures may occur.Generalized tonic clonic seizures (also calledgrand mal or convulsions) are the most noticeable kind. They happen when the whole brainis suddenly swamped with electrical energy.The seizure often starts with a cry causedby air being suddenly forced out of the lungs.The person falls to the ground, unconscious.The body stiffens, and then begins to jerk. Thetongue may be bitten. A frothy saliva mayappear around the mouth. Breathing may getE P I L E P S Y:Q U E S T I O N SA N DA N S W E R S3

very shallow and even stop for a few moments,causing the skin to turn a bluish color. The jerking movements then slow down, and the seizureends naturally after a minute or two. Bladder orbowel control is sometimes lost. When consciousness returns the person who had theseizure may feel confused and sleepy. In somecases only a very short recovery period isrequired, after which people can go back to theirnormal activities. If the seizure is prolonged, orthe person is injured, medical attention is essential.Absence seizures (also called petit mal) look likedaydreaming or blank staring. They begin andend abruptly, last only a few seconds, and aremost often seen in children. A child having thiskind of seizure is unaware of people and thingsaround him for a few seconds, but quicklyreturns to full awareness. These "little” seizureshappen so quickly that the child (and sometimesother people around him) may not notice them.Sometimes these seizures also produce blinkingor chewing movements, turning of the head, orwaving of the arms.Atonic seizures, or drop attacks, cause suddenfalls. Myoclonic seizures produce massive muscle jerks. And infantile spasms are characterizedby head drops or body spasms.4Simple partial seizures produce changes in sensation, movement or feeling without alterationof consciousness. Sometimes the movementsstart in one area of the body and then slowlyprogress upwards to involve one whole side. Theseizure may make things look strange, or theperson may see people or things that are notreally there. He or she may hear strange soundsor have a feeling that what is happening aroundhim or her has somehow happened before (dejavu). He or she may feel strange sensations onone side of the body or a rising felling in theE P I L E P S Y:Q U E S T I O N SA N DA N S W E R Sabdomen. These feelings may last several seconds up to a minute or so. The cause of thesedisturbances (which may be frightening andupsetting to someone who doesn’t know what iscausing them) is seizure activity taking place inparts of the brain that control movement, seeing, hearing. memory, or feeling.Complex partial seizures (sometimes calledpsychomotor or temporal lobe seizures) affectawareness. A complex partial seizure makes aperson appear to be in a trance and go througha series of movements over which he has nocontrol. Although the kind of movements mayvary from individual to individual, there may be adistinctive pattern of actions that each personfollows every time a seizure happens.A seizure of this type may start with a warning, termed the aura, which is actually the simple partial seizure that precedes impairment ofconsciousness: a strange sensation, a feeling offear, perhaps, or a sudden sick feeling in thestomach, or even seeing or hearing somethingthat is not really there. The person stares blankly,and may make chewing movements with themouth. He or she may move an arm, pull atclothing, get up and walk around, all the timelooking dazed and out of touch with the environment. Although not completely aware ofthings and people around him, a person havingthis kind of seizure, may follow simple directionsif they are given in a calm, friendly voice.Sometimes complex partial seizures producemore dramatic changes in behavior, includingscreaming, crying, moaning, laughing, disrobing,running, or apparent fear.Although most seizures last for only aminute or two, full awareness may not returnfor some time afterwards. Confusion and irritability may follow, and the person will notE P I L E P S Y:Q U E S T I O N SA N DA N S W E R S5

remember what happened or what he or she didwhile the seizure was going on.Both simple or complex partial seizures mayaffect enough brain cells to spread and becomea generalized tonic clonic (grand mal) seizure.Doctors describe these as partial seizures secondarily generalized.Q. What is an aura?An aura is a feeling or experience that may warnthe person that a more severe seizure is about tobegin. The aura is, in fact, the start of a simplepartial seizure before it spreads to other areas(see above). Examples include a feeling of fear orsickness or an odd smell or taste, as describedabove. People who have this warning may havetime to move away from possible hazards.Sometimes the expected seizure does not followand all that happens is the aura.Q. Doseizures injure thebrain?6The average seizure does not seem to have anylasting effect on the brain. Many people withepilepsy have had dozens or even hundreds ofseizures in their lives without noticeable changesin intelligence or alertness; others say that lots ofseizures over time do have some negativeeffects. Seizures which last an unusually longtime may injure the brain.Q. personIs there any danger of adying during aseizure?A seizure is seldom a cause of death, but it canhappen. There is a chance of accidental death ifsomeone has a seizure in water, or near heights,E P I L E P S Y:Q U E S T I O N SA N DA N S W E R Sor while driving a car. Occasionally, a person mayfall in such a way that breathing is blocked, ormay suffer a heart attack as a result of the stressof the seizure. In rare cases, breathing may notstart again when a convulsive seizure is over, inwhich case artificial respiration should be given.Death may also occur as a result of a series ofnon-stop seizures that may last for hours if nottreated in a hospital. People suffering more thanone convulsive seizure in a short period shouldalso receive immediate medical care. Youngadults with hard-to-control seizures may be athigher risk of sudden, unexplained death. Thisrare but troubling phenomenon is not yet wellunderstood.Q. Coulda person withepilepsy harm someoneelse during a seizure?A person who is having a seizure cannot controlhis or her actions and is therefore not capable ofcarrying out a planned attack on someone whileit is going on. If a person having a seizure isgrabbed or held down during an episode ofautomatic behavior, the person might lash outinstinctively at whoever is restraining him or her.Q. Areseizures with feverrelated to epilepsy?In most cases, infants and children who havefever-triggered (febrile) seizures do not go on todevelop epilepsy. Although you can’t always prevent seizures with fever in very young children,there may be some things that will help and thatyou should ask your doctor about. Parentsshould get medical attention immediately if ababy has a convulsion.E P I L E P S Y:Q U E S T I O N SA N DA N S W E R S7

FIRST AIDQ. ifWhatshould you dosomeone has ageneralized tonic clonic(grand mal) seizure?First aid for epilepsy is basically very simple. Itkeeps the person safe until the seizure stops naturally by itself.8These are the key things to remember: Keep calm and reassure other people whomay be nearby. Don’t hold the person down or try to stop hisor her movements. Time the seizure with your watch. Clear the area around the person of any-thinghard or sharp. Loosen ties or anything around the neck thatmay make breathing difficult. Put something flat and soft, like a folded jacket, under the head. Turn him or her gently onto one side. This willhelp keep the airway clear. Do not try to forcethe mouth open with any hard implement orwith fingers. It is not true that a person havinga seizure can swallow his or her tongue.Efforts to hold the tongue down can injureteeth or jaw. Don’t attempt artificial respiration except inthe unlikely event that a person does not startbreathing again after the seizure has stopped. Stay with the person until the seizure endsnaturally. Be friendly and reassuring as consciousnessreturns. Offer to call a taxi, friend or relative to helpthe person get home if he or she seems con-E P I L E P S Y:Q U E S T I O N SA N DA N S W E R Sfused or seems unable to get home alone.Q. beShould an ambulancecalled?If you know someone has epilepsy, it is usuallynot necessary to call an ambulance unless theseizure lasts longer than five minutes, or anotherseizure begins soon after the first, or the personcannot be awakened after the jerking movements have stopped. If someone having a convulsive seizure seems ill, injured, is pregnant orhas diabetes or the seizure happened in water anambulance should be called.Q. someoneWhat should you do ifhas one of theother types of seizures?You don't have to do anything if a person hasbrief periods of staring or shaking of the limbs.If someone has the kind of seizure that produces a dazed state and automatic behavior, thebest thing to do is: Watch the person carefully and explain toothers what is happening. Often people whodon't recognize this kind of behavior as aseizure think that the dazed person is drunkor on drugs. Speak quietly and calmly in a friendly way. Guide the person gently away from any danger, such as a steep flight of steps, a busyhighway, or a hot stove. Do not grab hold,however, unless some immediate dangerthreatens. People having this kind of seizureare an "automatic pilot" so far as their movements are concerned. Instinct may makethem struggle or lash out at the person whois trying to hold them. Stay with the person until full consciousnessreturns, and offer help in returning home.E P I L E P S Y:Q U E S T I O N SA N DA N S W E R S9

TREATMENTQ. medicalWhere can a person getcare for epilepsy?Neurologists, pediatric neurologists, pediatricians, internists and family physicians all provide treatment for epilepsy. Specialized care forpeople whose seizures are difficult to control isavailable in large medical centers, neurologicalclinics, at university and other hospitals, andfrom neurological specialists in private practice.Q. usedWhat kinds of tests arein the evaluation ofa person who may haveepilepsy?10The doctor’ s main tool in diagnosing epilepsy isa careful medical history and as much information as he or she can get about what theseizures looked like and what happened justbefore they began. A second major tool is anelectroencephalograph (EEG). This is a test thatrecords brain waves picked up by tiny wires(electrodes) pasted on the scalp. The brainwaves may show special patterns which help thedoctor identify epilepsy. CT or MRI machinestake pictures of the inside of the brain to see ifthere are any growths, scars, or other physicalconditions that may be causing the seizures.Q. normalCan a person whose EEG isstill have epilepsy?Yes. Electrical changes may be taking place sodeep in the brain that the electrodes on thescalp don't pick them up. Second, there may nothave been any unusual activity while the EEGrecording was being made. Twenty-four hourrecordings with a home monitor may pick upE P I L E P S Y:Q U E S T I O N SA N DA N S W E R Ssigns of epilepsy that would not be found duringthe half-hour or so that is usually recorded aspart of a routine EEG study. Sometimes, patientsare admitted to an epilepsy monitoring unit foreven more prolonged recording, during whichmedication doses may be reduced.Q. How is epilepsy treated?Epilepsy treatment is designed to preventseizures. It includes medication, surgery, vagusnerve stimulation or special diet. Of these treatments, regular use of seizure-preventing drugs isby far the most common, and the first to betried. Different drugs control different types ofseizures. A medication that helps one personmay not be effective for someone else.Whenever possible, doctors try to controlseizures with just one drug.Q. Do drugs cure epilepsy?Not in the same sense that penicillin can curean infection. But for many people with epilepsy, the drugs will prevent seizures so long asthey are taken regularly. After someone hasbeen free of seizures for a few years, thephysician may recommend a slow withdrawalfrom the medication to see whether he or shewill remain seizure free without medication.For many people with epilepsy, however, takingantiepileptic medication will be something that 11has to continue over many years.Q. treatment?How successful isOf the 200,000 new cases of seizures andepilepsy that occur each year in the UnitedStates, about 2/3 will achieve seizure remission,and many of these people will be able to with-E P I L E P S Y:Q U E S T I O N SA N DA N S W E R S

draw from medication at some point. Theremaining one-third will continue to haveseizures, despite treatment. Currently, more than2.7 million Americans are living with seizures.Hopefully, research will develop new ways ofcontrolling seizures so that all Americans withepilepsy will be able to live seizure-free.Q. addictedCan a person becometo antiepilepticdrugs?This is unlikely to happen. A person takingdrugs for epilepsy depends on them to preventseizures. If he or she stops taking them suddenly, a seizure or a series of seizures is thelikely result. These medications are not prescribed in quantities to produce a high, and areseldom abused in the sense that more than theprescribed dose is taken.Q. byWhen is epilepsy treatedsurgery?12Surgery may be considered if medication fails tocontrol the seizures and if the seizures arecaused by an abnormality in a limited part of thebrain. If such an area can be found and taken outsafely, the surgeon will remove it. In many casesthe seizures will then stop, or be greatlyreduced. Surgeons will only operate when thepossible benefits outweigh the risks, other typesof surgery may be considered in some cases.Q. toWhatsort of diet is usedtreat epilepsy?The diet is called a ketogenic diet. It is a strictdiet, very high in fats and very low in carbohydrates, with restricted calories. It produces achemical change in the body, called ketosis,E P I L E P S Y:Q U E S T I O N SA N DA N S W E R Swhich in some people, especially children, prevents seizures. A ketogenic diet is usually triedafter medications have failed to stop theseizures. Like other treatments for epilepsy, itmust be prescribed and monitored by a physician. There’s no evidence that any other type ofspecial diet is of benefit to people with epilepsy,although some that require milder forms of carbohydrate restriction than the ketogenic diet arebeing studied.Q. stimulationWhat is the vagus nervetreatment?Vagus nerve stimulation (VNS) is a type oftreatment in which short bursts of electricalenergy are directed into the brain via the vagusnerve, a large nerve in the neck. The energycomes from a battery, about the size of a silverdollar, which is surgically implanted under theskin, usually on the chest. Leads are threadedunder the skin and attached to the vagus nervein the same procedure. The physician programsthe device to deliver small bursts of electricalstimulation every few minutes. This is a relatively new type of treatment. It may be tried whenother treatment is not effective. Just how itworks to prevent seizures is still being studied.Q. mineralsCan extra vitamins andprevent seizures?Lack of vitamin B and magnesium can lead toseizures in rare cases, but it is unwise to try toself-medicate with high dose vitamins without aphysician's advice. However, a daily multiple vitamin with folic acid may be taken. Sometimessupplemental vitamins will be prescribed by thedoctor, but these are usually used to make up forvitamins lost through the effect of the seizuredrugs rather than to prevent seizures.E P I L E P S Y:Q U E S T I O N SA N DA N S W E R S13

DAILY LIFEQ. Doesepilepsy affectmental ability?Intelligence tests of people with epilepsy generally show a normal range of intelligence.Some people with epilepsy are very intelligent,some are not, and most rank somewhere inthe middle. At the same time, some childrenwith epilepsy who are of normal intelligence donot perform in school as well as expected.There is also a higher frequency of epilepsy inpeople with other neurological disorders, suchas some forms of developmental delay or cerebral palsy, that may have associated cognitivelimitations. This may be due to a number offactors. Some brain processes may be affectedby the medication. Sometimes these childrenmay be having small seizures that interruptattentio

EPILEPSY: QUESTIONS AND ANSWERS 1 . information about epilepsy to the public. It does not include medical advice. People with epilepsy should not make changes in treatment or activities based on this . hearing. memory, or feeling. Complex partial seizures (sometimes called psychomotor or temporal lobe seizures) affect .

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