What is Epilepsy?
Epilepsy comes from the Greek word epilepsia, meaning seizure. The complaint was known even in the days of the ancients and readily recognised. Sometimes it was put down to evil spirits. Strange to say, in our world of sophisticated medicine, in many cases, we are still unable to say why these attacks occur. But they are said to occur in about one person per 200. Some claim it is much more common than this. How many different types are there? Doctors speak of a great many different forms. But for practical purposes, we’ll stick to the two most common. In recent years, however, there has been a great deal of reassessing of epilepsy and the different types.
Traditionally, and over the years, the first is a fairly mild form called “petit mal,” now called “absence attack.” Often symptoms are barely noticeable. The child might stare into space for a few seconds or minutes, seemingly unaware of the surroundings. There may be a few odd movements, such as blinking the eyes. Then just as suddenly the child comes back to planet Earth. There is no adverse aftermath. Activities are continued where they left off; there is no falling about or tiredness afterwards. Some may suffer from many bouts in a day. They are common.
A severe type referred to as “grand mar” is usually more dramatic and may be terrifying, especially when encountered for the first time.
This is a generalised convulsion. The child may have strange actions, such as staring into space, with the eyes moving in a peculiar manner. A sudden loss of consciousness occurs. Simultaneously strange, abnormal jerking movements occur, often the limbs and body shaking violently. The patient will probably fall, mouth salivating, eyes closed or maybe staring with a glassy look. There may be urination or a spontaneous uncontrollable bowel action. Afterwards, the child may feel strange, may fall asleep or be generally confused.
Epilepsy is considered to be a symptom rather than a disease. The word, referring to the general persistent nature of the disorder, has been handed down from ancient Greece. It is commonly referred to as a “fit.” There are many manifestations of epilepsy, but generally, it is seen as the sudden onset of usually transient symptoms.
These involve a change in consciousness, and are often associated with sensory, motor and psychic changes. It is believed that these changes are associated with the sudden release of electrical discharges in the brain. For this reason they are more likely to occur in patients with some underlying organic brain lesion than in those without any underlying disorder.
So-called symptomatic epilepsy may follow on from any number of well-established brain disorders. Anything that may damage the brain, either from without (e.g. injury) or within (infections, tumours, blood-vessel disorders etc.) may produce an epileptic seizure. This usually occurs in patients 30 years of age or over.
Idiopathic epilepsy occurs when there is no demonstrable brain disorder. The attacks may occur over a long period of time, and usually symptoms come on early in life, almost always under the age of 30, and frequently in childhood. Just why the nerve cells of the brain are subject to this sudden violent discharge of impulses, resulting in the abnormal movements, is unknown.
About 70 per cent of cases give rise to symptoms by the age of 20 years, and 85 per cent by the age of 25. Often children starting to have fits in adolescence have had convulsions in infancy. For this reason, any fit in childhood (particularly if it recurs or continues) must have adequate medical investigation.
The tendency for seizures appears to be inherited. This may be masked, but can be aggravated later on by general constitutional factors. Recurrent illnesses, particularly those involving elevated temperatures, exhaustion, worry, frustration, and any psychological disorder, may play a part. So may general bodily health, mental acuity and alertness, although it is not clear to what extent.
More than half of the attacks occur during sleep. The next most common time is during the first hour after wakening in the morning. However, they may occur at any time. If the patient is intent on ordinary activities, attacks are more unlikely than when that person is inattentive or relaxing. Relaxing just before bedtime is a period of increased risk.
It is worth mentioning here that during this time, watching TV is a common habit with many people. With the epileptic, fits are more likely at this time, particularly if the sufferer has a maladjusted TV set, producing much flashing or bizarre lines on the screen. Epileptics are cautioned to avoid this as much as possible. Also, if bored or inattentive, there is an increase in the risk of fits. The person is much better advised to switch the set off and go to bed. Video games may also start attacks.
With women, menstruation is a much more common time, particularly the five days before the onset, and continuing till about 48 hours after its termination. In some women with mild epilepsy, attacks may occur only at such times.
Physical upsets such as injury, nausea, vertigo and vomiting may precipitate turns. General anaesthesia increases the risk. Excess amounts of fluid in the body (for example too much beer) may bring them on. This is a salutary warning for the heavy beer drinker!
Increase in tensions, and virtually any psychological abnormality, may precipitate an attack. Some epileptics who have a low mentality rating, and who do not have adequate care available to them may be best cared for in an institution.
Surgical intervention is sometimes talked about, but at present, it has no place in the treatment of the epileptic. (This does not include measures that are invaluable in pinpointing a diagnosis and in excluding other possible serious causes.)
In recent times there has been an increasing volume of material in the medical journals concerning the possible risk of epileptic women producing congenital malformations due to medical treatment. At present this information is incomplete.
Some claim the medication may be responsible, while others say it is the intrinsic nature of the disease itself. The most important factor is that any epileptic woman anticipating pregnancy must seek the advice of a competent obstetrician well tuned in to the current side of medicine, and perhaps in consultation with a neurologist.
Many preparations are now available that assist the epileptic to live a relatively normal life.
Most epileptics will be under medical treatment, and their doctor will prescribe a regimen well suited to their care. When the optimum routine has been worked out, this is best continued on a perpetual basis.
Phenobarbital, even after 50 years of constant prescribing, is still widely used. Thirty to 100 mg tablets three times a day is a common dose. Individuals vary a lot in the way they can tolerate this anticonvulsant. Primidone is similarly very useful, and 250 mg are given one to six times a daN.
Phenytoin sodium is also given in doses ranging from 300 to 400 mg a day. It comes in capsules of either 30 or 100 mg strength. Supervision is essential, for overdose can lead to irreversible abnormalities of the nervous system. These drugs are often given in combination, but usually no more than two at any time.
Many other drugs have been developed, such as sulthiame and valproate, especially for children. Phenytoin, phenobarbital, primidone, carbamazepine, ethosuximide, trimethadone, clonazepam and valproate are now the most widely used drugs. Often a patient will require more than one form of medication. The patient must be under adequate medical care. Complex cases are often treated by neurologists who specialise in the nervous system and its disorders, or it may be started with a consultant, and then continued under the everyday care of the family doctor.
Each case has medication specially prescribed for the specific type of epilepsy, and this may remain the same for many years, or it may be altered. It depends on the patient response, and the general nature of the condition. No two cases will be identical. The parent must supervise therapy, carefully watch the patient (in the case of children) and give as much support as possible. In most states and countries, epilepsy support groups are in operation and give a great deal of assistance to families of epileptics. It is worth becoming associated with such groups.
In women whose attacks are principally premenstrual, the oral diuretics (fluid pills) often assist for short bouts. Many of the tranquillisers (such as diazepam) can act as mild anticonvulsants, and are often prescribed.
Status epileptics become a matter for urgent treatment, and require immediate transfer of the patient to a centre where this is available.
The outlook for the epileptic is a variable one. Many go through life relatively normally and, with treatment, can live peaceably and find a useful function. Others are dogged by misfortune, ill health and frequency of attacks, all of which are aggravated by undercurrent illness and psychological hazards. Only a small number of epileptics meet their death by accident or misadventure. Recovery occasionally occurs, and this is more likely, it seems, when the patient can live a life as near to normal as possible. Self-help community organisations are very useful.
In conclusion it is again emphasised that epileptics must be under continuous medical care and treatment. Self-medication is certainly not advised, and at all times it must be under the direction of the medical experts. This rather lengthy section has been included in such detail so that those suffering from this disorder or those coming into their immediate contact may have a better appreciation of it, and understand how treatment fits into the pattern. It is not meant to be a self-guide do-it-yourself kit, and should be utilised in the way described.
Epilepsy occurs for no obvious reason. Or, certain events may precede an attack, such as looking at flashing lights, especially the television. This is more probable if there are zigzagging movements on it, or the strange fuzzy signs when the station is off the air. It is more likely if tired, or there has been an emotional upset, arguments, or over breathing for any reasons.
It seems to have a genetic predisposition, for a check will often indicate a near relative with the same disorder. But sometimes it may follow a head injury in which there has been scarring of the surface of the brain.
Treatment is excellent, and has removed many of the problems once associated with the disease. But first, diagnosis is essential. This is often assisted by a special investigation called the EEG – short for electroencephalograph. This may show typical abnormal tracing indicating epilepsy. Sometimes X-rays or a CT picture (once called a CAT scan) will be obtained. It depends on what the physician (often a specialist in this field called a neurophysician) thinks about the particular case. Certain basic causes must first be eliminated.
Medication keeps the person fit-free for as long as possible. A wide range of drugs has been developed over the past few years. However, some of the original ones such as phenytoin (“Dilantin”), phenobarbital and methylphenobarbitone (“Prominal”) are still used with a good deal of success. But there are several newer ones; a product called sodium valproate (“Epilim”) seems very suitable for children and is widely prescribed. But this will be worked out on an individual basis by the physician. Be totally guided by this expert advice. The period of which patients should stay on particular medications is variable, but only after several years, and the patient has been fit-free for several in succession will any alteration be considered. Once more this is a personalised arrangement.
If you see a person having a fit, make every effort to ensure that the patient does as little as possible. Also, if on the street it is important that the face is not submerged in a puddle of water. This could cause the patient to suffocate. Do not try to open the jaw. Lift it forward to facilitate breathing if necessary and push the patient onto the side. There will be a spontaneous recovery, whether you offer help or not, however.
Anything known to cause or increase the risk of an attack should be avoided as much as possible. Fluorescent lights, flickering lights, overtiredness, jumpy TV sets, may all be known hazards that are better avoided if possible
Fortunately there has been a marked reduction in recent years as the community in general has become better informed about the disorder. In fact right now there are some very important figures in the business world that are known epileptics, also sportsmen who have overcome this and are living a fairly normal, energetic, fulfilling life. They are an excellent example for others with the same disability, and parents should not be too dismayed if their child is an epileptic.