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Epilepsy is a general term that refers to a tendency to have recurrent seizures. A seizure is a temporary disturbance in brain function in which groups of nerve cells in the brain signal abnormally, usually excessively. Nerve cells or neurons normally produce electrical impulses that act on other nerve cells, muscles, or glands to create awareness, thought, sensations, actions, and control of internal body functions. During a seizure, disturbances of normal nerve cell activity produce symptoms that vary depending on which part and how much of the brain is affected. Seizures may produce changes in awareness or sensation, involuntary movements, or other changes in behavior. Usually, a seizure lasts from a few seconds to a few minutes.
There are many types of seizures, but they can be classified into two broad groups:
Some people have seizures that are hardly noticeable to others. Sometimes, the only clue that someone is having a petit mal or absence seizure is rapid blinking or a few seconds of staring into space. In contrast, someone having a complex partial seizure may appear confused or dazed and will not be able to respond to questions or direction for up to a few minutes. And someone having a generalized tonic-clonic seizure, sometimes called grand mal, may cry out, lose consciousness, fall to the ground and have rigidity and muscle jerks lasting up to a few minutes, with an extended period of confusion and fatigue afterward.
Not necessarily. In general, seizures do not indicate epilepsy if they only occur as a result of a temporary medical condition such as a high fever, low blood sugar, alcohol or drug withdrawal, or immediately following a brain concussion. Among people who experience a seizure under such circumstances, without a history of seizures at other times, there is usually no need for ongoing treatment for epilepsy, only a need to treat the underlying medical condition.
Based on recent surveys, the CDC estimates that nearly 2.5 million people in the United States have epilepsy. A more conservative estimate suggests that about 2.1 million people currently have epilepsy, with 150,000 developing the condition each year. New cases of epilepsy are most common among children and older adults.
Epilepsy may arise when there are disruptions to the normal connections between nerve cells in the brain. Much like disruptions in wiring of complex electrical circuit, imbalances of natural chemicals or neurotransmitters or changes in the membranes of nerve cells alter these connections, causing seizures. Some of these disruptions, imbalances and changes may develop early in life, related to hereditary factors or early exposures and events. Others may be acquired later. Known conditions and events that may lead to epilepsy include:
In nearly two-thirds of the cases of epilepsy, a specific underlying cause cannot be identified, and the focus remains on developing the most effective treatment.
Sometimes epilepsy may be preventable. Some of the most important opportunities for prevention are:
Before you begin treatment, the first step is to ensure that the diagnosis of epilepsy is correct and to determine, if possible, the type of epilepsy and whether there are any underlying conditions that also need treatment. This will require a careful review of your medical history and a neurological examination along with any other recommended tests. The plan of care for treating your epilepsy is based on this evaluation, and it may include:
Doctors from several medical specialties may treat people with epilepsy. Primary care doctors such as family physicians, pediatricians and internists are often the first doctors to see a patient with new seizures. They may make the initial diagnosis of epilepsy or they may consult with a neurologist, a specialist in the brain and nervous system, to confirm the diagnosis and recommend treatment. Primary care doctors sometimes provide follow-up care for patients with epilepsy, but when problems arise such as medication side effects or recurring seizures, you may be referred to a neurologist or pediatric neurologist for consultation or continuing care.
Some neurologists with advanced training specialize in the diagnosing and treating epilepsy. People whose seizures are difficult to control or who need specialized or intensive care for epilepsy may be referred to specialized epilepsy centers, which have advanced diagnostic and treatment capabilities and are staffed by physicians, neurosurgeons, psychologists, nurses and technicians specializing in epilepsy care.
Women with epilepsy can experience difficulties arising from hormonal changes during their reproductive cycle that sometimes can affect the tendency to have seizures. Pregnancy brings special considerations for women with epilepsy, because seizure occurrence and certain drugs taken during this time may sometimes carry a risk of harm to the developing fetus. Usually these risks can be minimized by several precautions women can take before and during pregnancy.
Most people with epilepsy live a full life span. Nevertheless, the risk of premature death is increased for some, depending on several factors:
Source: Centers for Disease Control