The Shock Behind Epilepsy and Other Seizure Disorders

Symptoms and diagnosis
Neurology 2

By Neurosurgery Singapore

What is Epilepsy?

Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness.

Anyone can develop epilepsy. Epilepsy affects both males and females of all races, ethnic backgrounds and ages.

Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others repeatedly twitch their arms or legs. Having a single seizure doesn’t mean you have epilepsy. At least two unprovoked seizures are generally required for an epilepsy diagnosis.

Treatment with medications or sometimes surgery can control seizures for the majority of people with epilepsy. Some people require lifelong treatment to control seizures, but for others, the seizures eventually go away. Some children with epilepsy may outgrow the condition with age.

What are some symptoms of Epilepsy?

Because epilepsy is caused by abnormal activity in the brain, seizures can affect any process your brain coordinates. Seizure signs and symptoms may include:

  • Temporary confusion
  • A staring spell
  • Uncontrollable jerking movements of the arms and legs
  • Loss of consciousness or awareness
  • Psychic symptoms such as fear, anxiety or deja vu

Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode.

Doctors generally classify seizures as either focal or generalized, based on how the abnormal brain activity begins.

Focal seizures

When seizures appear to result from abnormal activity in just one area of your brain, they’re called focal (partial) seizures. These seizures fall into two categories:

  • Focal seizures without loss of consciousness. Once called simple partial seizures, these seizures don’t cause a loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste or sound. They may also result in involuntary jerking of a body part, such as an arm or leg, and spontaneous sensory symptoms such as tingling, dizziness and flashing lights.
  • Focal seizures with impaired awareness. Once called complex partial seizures, these seizures involve a change or loss of consciousness or awareness. During a complex partial seizure, you may stare into space and not respond normally to your environment or perform repetitive movements, such as hand rubbing, chewing, swallowing or walking in circles.

Symptoms of focal seizures may be confused with other neurological disorders, such as migraine, narcolepsy or mental illness. A thorough examination and testing are needed to distinguish epilepsy from other disorders.

Generalized seizures

Seizures that appear to involve all areas of the brain are called generalized seizures. Six types of generalized seizures exist.

  • Absence seizures. Absence seizures, previously known as petit mal seizures, often occur in children and are characterized by staring into space or subtle body movements such as eye blinking or lip smacking. These seizures may occur in clusters and cause a brief loss of awareness.
  • Tonic seizures. Tonic seizures cause stiffening of your muscles. These seizures usually affect muscles in your back, arms and legs and may cause you to fall to the ground.
  • Atonic seizures. Atonic seizures, also known as drop seizures, cause a loss of muscle control, which may cause you to suddenly collapse or fall down.
  • Clonic seizures. Clonic seizures are associated with repeated or rhythmic, jerking muscle movements. These seizures usually affect the neck, face and arms.
  • Myoclonic seizures. Myoclonic seizures usually appear as sudden brief jerks or twitches of your arms and legs.
  • Tonic-clonic seizures. Tonic-clonic seizures, previously known as grand mal seizures, are the most dramatic type of epileptic seizure and can cause an abrupt loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control or biting your tongue.

“You can’t catch Epilepsy from another person. However, anyone can develop epilepsy. Elderly people over the age of 65 often begin having seizures for the first time as they age. There is also no cure for epilepsy.”

What types of diagnosis?

  • In addition to conducting a physical examination, a physician will typically perform an EEG (electroencephalogram) to check the electrical activity of the brain. Imaging tests may also be performed to find the cause and location of foci causing seizures. These include:

    • CT imaging of the head: Computed tomography (CT) scanning combines special x-ray equipment with sophisticated computers to produce multiple cross-sectional images or pictures of the skull and brain.
    • MRI of the head: Magnetic resonance imaging (MRI). uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. This is the best available imaging examination to obtain pictures of the structure and sometimes even function of the brain.
    • Lumbar puncture (also called a spinal tap): This diagnostic test involves removing and analyzing a small amount of cerebrospinal fluid—the fluid that surrounds the brain and spinal cord — from the lumbar (or lower) region of the spinal column. Physicians use a lumbar puncture to help diagnose infections, bleeding around the brain, cancers involving the brain and spinal cord, and inflammatory conditions of the nervous system. Lumbar punctures can be performed at the bedside or with imaging guidance.
    • Magnetoencephalography (MEG): MEG is a non-invasive medical test that measures the magnetic fields produced by your brain’s electrical currents to identify the exact location of the source of epileptic seizures.

Difference between an Epilepsy and a Seizure 

  • Epilepsy is a term that encompasses recurring seizures. Seizures can be different, but all of them include abnormal electrical activity in the brain. This electrical activity changes body movements. Groups of cells and neurons in the brain produce impulses that control body movements, thoughts and sensations. When these impulses occur excessively, a seizure is produced. When someone has recurring seizures, more than likely they will have the same type of seizure each time. Seizures are stereotypic. An epilepsy diagnosis comes when a person has had two seizures that are unrelated to any other condition.

  • You can have a seizure without having epilepsy, but you can’t have epilepsy without having seizures. Seizures can last anywhere from a few seconds to a few minutes.

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