What is Epilepsy? Well, the first thing that comes to mind when someone hears the word “seizure”, is convulsive seizures like Grand Mal Seizures or Tonic- Clonic Seizures. There are about forty different types of seizures that can affect the way a person moves and that affect his or her awareness.
Epilepsy is a chronic neurological condition in which a person has at least two unprovoked seizures. What I mean by “unprovoked”, is that the seizure isn’t caused by any existing medical conditions such as diabetes. Epilepsy is separated into two categories: Generalized Seizures and Partial Seizures. Generalized Seizures are seizures that affect the whole brain. These seizures include Grand Mal (Tonic- Clonic) Seizures, Petit Mal (Absence) Seizures, Atypical Absence Seizures, Tonic Seizures, Clonic Seizures, Myoclonic Seizures, and Atonic Seizures. Partial Seizures are seizures that affect only a limited area of the brain, mainly the temporal lobe and frontal lobe. These seizures include Simple Partial Seizures and Complex Partial Seizures. There are some times where a Partial Seizure can go into a Generalized Seizure, these are called Secondary Generalization.
Grand Mal (Tonic- Clonic) Seizures: During these seizures, the person briefly stiffens and loses consciousness, falls, and often cries out. These seizures usually last one to two minutes. There may be excessive saliva that is described as “foaming” at the mouth. There can also be loss of urine and biting of the tongue or cheek. Afterwards, the person is tired and confused for a period of time and often goes to sleep.
Petit Mal (Absence) Seizures: These are brief episodes of staring with impairment of awareness and responsiveness. These seizures usually last less than ten seconds. They begin and end suddenly and there is no warning before the seizure starts. Afterwards, the person is alert and attentive.
Atypical Absence Seizures: These seizures begin before 6 years old and often begin and end gradually over seconds. They often last more than ten seconds. The person stares but has a partial reduction in responsiveness. Eye blinking or movement of the lips may occur.
Tonic Seizures: These seizures are characterized by sudden stiffening movements of the body, arms, or legs, and involve both sides of the body. They are more common in sleep or the transition into and out of sleep. The person will fall if the seizure happens while standing. They usually last less than twenty seconds.
Clonic Seizures: These seizures are rare but consist of rhythmic jerking movements of the arms and legs. They are not followed by a prolonged period of confusion or tiredness.
Myoclonic Seizures: These seizures are characterized by brief, shock- like jerks of a muscle or group of muscles. They usually cause abnormal movements on both sides of the body at the same time. The neck, shoulders, upper arms, body, and upper legs are usually involved. Juvenile Myoclonic Seizures most often involve the neck, shoulders, and upper arms. The seizures occur one hour after waking up. These seizures are usually well controlled.
Atonic Seizures: During these seizures, the person suddenly loses muscle strength. The eyelids may droop, the head may nod, objects may be dropped, or the person may fall to the ground. These usually begin in childhood. Atonic Seizures last less than fifteen seconds.
Simple Partial Seizures: These seizures are characterized by four seizure types: Motor Seizures, Sensory Seizures, Autonomic Seizures, and Psychic Seizures. Motor Seizures affect muscle activity. The body stiffens or the muscles begin to jerk in one area of the body. The jerking may stay in the same place or it can spread. Sensory Seizures cause changes in sensation. For example, the person may have hallucinations such as the feeling of pins and needles, tasting something bitter, or seeing a colored pinwheel. Autonomic Seizures change automatically bodily functions such as someone’s heart rate or breathing. Psychic Seizures cause sudden and often intense emotions such as fear, anxiety, depression, or happiness.
Complex Partial Seizures: During these seizures, the person stares but cannot respond to questions or commands, or responds incompletely and inaccurately. These seizures usually involve automatisms which can include lip smacking, chewing movements, tasting movements, swallowing movements, grunts, tapping, picking at clothing, and fumbling. Auras are usually common. They act as a warning and is a form of Simple Partial Seizures. These seizures usually last twenty seconds to two minutes.
Secondary Generalization: This happens when the seizure begins in a limited area of the brain and then spreads to both sides of the brain. These seizures are common and occur in more than 30% of children and adults with Partial Epilepsy.
Anti- Epileptic Drugs (AEDs): Anti- Epileptic drugs are used as a treatment to keep the electrical activity in the brain from going out of control. They are very effective in treating Epilepsy most of the time.
Ketogenic Diet: The Ketogenic diet is a special high fat, low carbohydrate diet that is prescribed to some patients with Epilepsy. This diet is carefully monitored by a dietician and a neurologist.
Surgery: Surgery is usually the last option. Someone who is a candidate for Epilepsy surgery is someone who has not responded well to AEDs or who cannot tolerate the side effects from the medication. Some of the types of Epilepsy surgery include Vagus Nerve Stimulation (VNS), Hemispherectomy, Corpus Callosotomy, and Temporal Lobectomy. Vagus Nerve Stimulation happens when the surgeon inserts a device that acts like a pacemaker under the skin in the chest wall and it runs from the brainstem through the neck and into the chest and abdomen. A Hemispherectomy is when the surgeon takes out one half of the brain’s hemisphere that is causing seizures. Corpus Callosotomy cuts the large fiber bundle that connects the two hemispheres of the brain. This surgery does not remove brain tissue. A Temporal Lobectomy involves the removal of some part of the temporal lobe in which seizures are starting.
Source: “Epilepsy: Patient and Family Guide” by Orrin Devinsky, MD
I hope you guys enjoy learning about Epilepsy and the treatments that are available for it.