Before answering this question, it’s necessary to look at the brain – and how it works. The brain is made up of millions of tiny nerve cells called neurones, each of which can send and receive messages in a very similar way to one of the units in a computer or calculator. In the brain, messages are passed from cell to cell by various chemicals (known as neurotransmitters). As a rule these messages are sent in an orderly way. If however, something unusual happens – if, for example, the ‘wrong’ message is passed or cells fail to respond to a message - an epileptic seizure may result. An epileptic seizure can therefore be described as a “temporary breakdown” in the brain’s communication system.
Epilepsy is present when a person has established tendency to having recurrent seizures.
Anybody
can have a seizure.
The ‘temporary breakdown’ that causes a seizure
can happen to anybody; it’s simply a matter of getting
the necessary activator or stimulus to start it off. With
the stimulus of an electric current, for example, everyone
would have a seizure. Some people, however, require comparatively
less of a stimulus than others, to trigger off a seizure.
The likelihood of someone having an epileptic seizure is described
as the ‘epileptic threshold’. People with epilepsy
have a low epileptic threshold - which means they may have
a seizure if the working of the b rain is only slightly upset.
Others are able to withstand quite a strong stimulus to the
brain without having a seizure; these people have a high threshold.
Thus having epilepsy can, in some ways, be compared to having an allergy. Some people clearly have a low allergy threshold – and only a slight amount of pollen in the air will make their eyes sore and make them start sneezing. With others, no amount of pollen seems to have any effect.
The
epileptic threshold.
The sorts of stimulus that triggers off seizures in different
people, can vary enormously. In young children aged six months
to three years, a high temperature can cause a seizure, known
as a febrile convulsion. In women, for example, hormonal changes
associated with the menstrual cycle, may lead to chemical
changes which may, in turn, lead to chemical changes in the
brain. In some people, these changes may be prompted by a
visual stimulus, such as flashing lights. A change of daily
routine or lack of sleep, or more emotional factors, such
as stress and excitement, can all prompt seizures in some
individuals. Very often however, it is impossible to say what
exactly acted as a stimulus for a seizure; there is no cause
that we can readily see.
What
does an EEG show?
An EEG, or electroencephalogram, is a special recording
of the tiny electric signals produced by the brain, that can
provide important information about how the brain is working.
It is a simple, harmless test, in which small discs are placed
on the scalp and the activity of the brain is recorded. The
EEG can help doctors in diagnosis, as it may show the sort
of abnormal activity commonly found in epilepsy. The recording
will show for example, a special pattern, known as a “spike”
and “wave” pattern in many patients with a low
epileptic threshold. However, a normal EEG does not exclude
epilepsy as the electrical activity may only be abnormal during
an attack. A doctor is certain to call for an EEG test if
he suspects epilepsy.
Are
epileptic seizures all the same?
No - there are a number of different types and patterns
of epileptic seizures. The various names of the different
seizures have often been a source of confusion in the past.
Medical authorities are now becoming more uniform in the names
of seizures.
SEIZURES
ARE DIVIDED INTO TWO MAIN GROUPS:
Generalized seizures – these involve most of the
brain.
Partial seizures – only part of the brain is involved.
GENERALISED
SEIZURES MAY BE;
Tonic-clonic – characterised by alternative stiffness
and jerking.
Myoclonic – characterised by muscular jerking.
Absence – in which the person loses awareness briefly.
With partial seizures, the disturbance often effects involuntary
movement or sensation in a particular part of the body. It
is not uncommon for a person to have more than one type of
seizure.
What
is involved in a seizure?
Is consciousness always lost? No, not necessarily. Complete
loss of consciousness occurs in tonic–clonic seizures;
these are major seizures. In some minor seizures, such as
myoclonic jerks, there is no apparent loss of consciousness.
In some seizures, e.g. absence, there may be a loss of awareness,
although the person does not lose consciousness altogether.
How long does a seizure last? This depends on the type of
seizure. Myoclonic jerks last a second or so; absences usually
last 5–10 seconds or sometimes up to a minute. A tonic–clonic
and partial seizure lasts several minutes although recovery
to full consciousness takes longer.
Is
it possible to mistake an epileptic seizure?
Yes. The judgement that a seizure is epileptic is a matter
for expert medical diagnosis. A severe faint or a panic attack
may, at times, be mistaken for an epileptic seizure. Anybody
witnessing a seizure should keep an accurate record of what
took place, as this can provide essential clues in diagnosis.
Who
gets epilepsy?
Anyone. Epilepsy can start without warning at anytime
in a person’s life. There is, however, a tendency for
epilepsy to start during childhood or adolescence and often
to disappear by the time adult life is reached. Epilepsy is
not a mental disease, although seizures may be a symptom of
some underlying brain disease or damage – but certainly
not always. The start of epilepsy in an adult is often a sign
of some underlying disease, or the result of an injury affecting
the brain (such as a road accident).
What's
the treatment like?
There have been important advances in anti-epileptic
treatment over the past 25 years, with emphasis now on giving
the patient a normal life. People with epilepsy need to discuss
their medication requirements with their doctor or specialist
– so that they get the full benefit from the treatment
and risk or side effects is kept as low as possible. Pregnancy
and epilepsy and medication during pregnancy are topics women
need to discuss with their doctor. It’s very important
for people taking anti–epileptic medication to keep
their doctor informed of any other medication they are taking
– the oral contraceptive pill, for example - because
there can be an interaction between medication.
What
does having epilepsy really mean?
With modern anti–epileptic treatment, many people
with epilepsy can lead a normal life. Children with epilepsy
can achieve the same educational standards as other children
according to their inborn abilities. Certainly, there may
be limitations with regard to recreational activities –
children with epilepsy should always be supervised when swimming
- but such restrictions should not take all the fun out of
life.
For the school-leaver/adult – the question of employment
can be a major hurdle as the workplace is more limited, as
certain jobs and certain work environments (working with heavy
machinery, for example) would present a risk. However, a wide
range of job opportunities still remain. People with epilepsy
are usually well able to live a normal everyday life –
enjoying the family life, sexual relationships and recreational
activities that most people take for granted. Epilepsy need
not be an impairment to a normal life.
Overcoming
the impairment of ignorance.
Through ignorance, which often leads to fear, many people
have some funny ideas about epilepsy. And as those with epilepsy
know only too well, it’s common for people to avoid
them once they know they've got epilepsy. People with epilepsy
are often treated with distrust and prejudice – and
not infrequently, outright discrimination. It is far harder
for someone with epilepsy to be accepted normally –
to get a job, although perfectly well qualified - or to join
a club or social grouping. Knowing the difficulties that are
faced, the person with epilepsy often avoids the situation,
shying away from social contact and thereby losing any confidence
they may have had. It is sad and ironic that community acceptance
is often exactly what is needed to give them the confidence
to live a normal life.
To break this vicious circle, we need better community understanding. Better information is the first step.
Edited
from: “Understanding Epilepsy”
Produced by: Reckitt & Colman
Updated April 2002
This information provided by the Epilepsy Association of South Australia and Northern Territory Inc on the Internet is designed to provide basic information about epilepsy. It is not intended, nor does it constitute medical or other professional advice. Diagnosis and advice on medical care or other assessments should be sought from a medical practitioner or suitably qualified professional.
