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Epilepsy And Seizure Disorders

  • Epilepsy is a neurological disorder that makes people prone to seizures. A seizure is a change in sensation, awareness, or behavior brought about by a brief electrical disturbance in the brain.
  • There are many different types of epilepsy with different causes; there are also many different types of seizures (see below). Those affected may have one or more types of seizures, which may vary in severity and frequency.
  • "Generalized seizures" affect both sides of the brain.
  • "Localized seizures" or "partial seizures" affect one part of the brain. Partial seizures are the most common form of seizure in adults, affecting 6 out of 10 people with epilepsy.
  • Epilepsy is NOT a "mental illness."
  • Approximately 2.3 million Americans, half of whom are female, have epilepsy.
  • According to the Epilepsy Foundation, nearly half of those affected get inadequate relief from their seizures.
  • According to the Epilepsy Foundation, among those over 65 years of age, more than 60,000 new cases of epilepsy are diagnosed each year.
  • Among those over 65, epilepsy may be caused by stroke, cardiovascular disease, Alzheimer's disease, or brain tumors.
  • There are reproductive health problems in women with epilepsy, including:
    • Infertility and difficulty becoming pregnant
    • Increased risk of having children with birth defects
    • Menstrual irregularities
    • Polycystic ovary syndrome
  • There are many different medications used either alone or in combination to control epilepsy and other seizure disorders. There are 26 drugs that are FDA approved for the treatment of seizures either alone or in combination. Single AED (anti-epilepsy drug) use is generally preferred because it may offer improved tolerance and decreased side effects or complications from drug interactions. The goal of treatment is to prevent or control seizures with the minimal amount of side effects.
  • While these medications are usually very effective, they have significant side effects that should be discussed with your doctor, especially if you are planning to become pregnant or if you are using birth control pills.
  • Some AEDs, for example, may decrease the effectiveness of birth control pills.
  • Some AEDs may increase bone loss, contributing to osteoporosis.
  • Common side effects of AEDs include impaired cognitive function, dizziness, and sedation. These may lead to impaired ability to carry out daily activities.
  • Drug interactions are also common with AEDs and other medications, particularly in those over 65 or those taking several medications.
  • Female hormones play a significant role in influencing seizures:
    • Seizure frequency and severity can change at puberty, over the menstrual cycle, with pregnancy and at menopause.
    • 30% to 50% of women with epilepsy have menstrual cycle-related seizures.
  • Fertility rates among women with epilepsy are about one third lower than women in general. This may be partly attributed to reluctance among these women to get pregnant. It may also be related to increased rates of menstrual irregularities, polycystic ovarian syndrome (PCOS), obesity, and other reproductive problems which have been both linked to the seizure disorder itself and the side effects of some AED's.

    Types of Seizures

    A. Generalized Seizures
    are seizures that begin in both halves of the brain.

    • Tonic Seizures: patient becomes stiff and may let out a high pitched cry.
    • Clonic Seizures: patient falls and may turn blue; arms and legs will jerk rhythmically.
    • Tonic-Clonic Seizures: begins with rigidity, may have a sudden fall or cry, followed by muscle jerks (convulsions), shallow breathing or temporarily suspended breathing, bluish skin, and possible loss of bowel or bladder control. The patient is unconscious during seizures that usually last one to two minutes, after which normal breathing resumes. The patient may be confused or tired afterwards and fall into a deep sleep.
    • Absence Seizures: these occur most often in children and are characterized by a blank stare; they usually only last a few seconds and may be accompanied by rapid blinking or some chewing mouth movements. The patient is unaware of what is occurring during the seizure, but quickly returns to full awareness afterwards. This may result in learning difficulties if not recognized and treated.
    • Myoclonic seizures: sudden brief, massive muscle jerks that may involve the whole body or parts of the body.
    • Atonic seizures: (also called "Drop Attacks") patient suddenly collapses and falls, recovering after 10 seconds to a minute.

B. Partial Seizures are localized seizures that occur when a disturbance comes from just one part of the brain, affecting whatever physical or mental activity is controlled by that area.

    • Simple Partial seizures: no loss of consciousness during the seizure but movement, emotion, sensations and feelings may be affected in unusual and sometimes frightening ways.
    • Complex Partial Seizures: (also called "psychomotor" or "Temporal Lobe" seizures) consciousness is altered and the person is not aware of her actions or surroundings. Movements or speech also cannot be controlled; the person often cannot remember afterwards what happened during the seizure.
    • Secondary Generalized Seizures: begin as partial seizures, but then the patient has a loss of consciousness as the seizure spreads throughout both sides of the brain.

C. Status Epilepticus: This is an emergency condition in which a prolonged (or multiple clusters) seizure develops into a non-stop seizure. It requires hospital treatment to control the seizure with intravenous medication.

Created: 12/11/2001  -  Donnica Moore, M.D.

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