Controlling Epilepsy

by Food and Drug Administration (FDA)

The sight of someone having a severe epileptic seizure is hard to forget. The person suddenly cries out, loses consciousness, falls to the ground, and foams at the mouth. Arms and legs jerk convulsively for several minutes.

It's no wonder such high drama has inspired supernatural interpretations of epilepsy in the past. During ancient times, most Greeks thought seizures were brief visits from the gods and called epilepsy "the sacred disease." During the Renaissance, in contrast, many people believed demons were behind seizures, and those with epilepsy were burned to death as sorcerers, according to Richard Restak, M.D., author of The Brain.

Today science has replaced superstition, and we realize that epilepsy is simply a common neurological disorder that can be diagnosed and treated with devices and drugs regulated by the Food and Drug Administration.

One out of every hundred people in this country has epilepsy. Their seizures stem from overly active nerve cells (neurons) in the brain. The strong and rapid bursts of electrical signals emitted from these hyperactive neurons temporarily disrupt normal functioning, much as a lightning storm can disrupt electrical power in a neighborhood.

The hallmark of epilepsy is recurring seizures — sometimes as many as several hundred a day — under normal circumstances. Anyone can develop a seizure if given the right bodily insult, such as poisoning or a lack of sugar in the brain brought on by diabetes. But in people with epilepsy, seizures can be triggered by something as minor as lack of sleep or the flickering of a light.

What causes epilepsy in all cases is not known. In some people it results from brain damage from head injuries, brain tumors, lead poisoning, meningitis, encephalitis, or measles. Lack of oxygen to the fetus during pregnancy, labor or delivery may cause epilepsy to develop during childhood. Brain damage incurred by a stroke is a common cause of epilepsy in people over 65.

Epilepsy can first appear at any age, although three-quarters of all cases surface during childhood. Epilepsy sometimes runs in families, but a genetic predisposition alone probably cannot cause most forms of the disorder; usually other factors, such as a head injury, must also be present.

Types of Seizures

There are more than 20 different types of epileptic seizures, ranging from the dramatic "grand mal" seizure described at the beginning of this article to the slight few-seconds loss of consciousness (known as an absence seizure) that often goes unnoticed. A person with epilepsy can have more than one type of seizure. Accurate diagnosis of the specific types of seizures is critical to determining appropriate therapy.

The kind of seizure depends on where in the brain the electrical signaling has gone awry, and how far that "brainstorm" has spread. If only the portion of the brain controlling movement of a limb is involved, that limb may tremble or jerk uncontrollably. If the affected brain area spreads, more of the body may begin to move erratically.

If the brain section governing hearing or vision is involved, the person may experience auditory or visual hallucinations. Sometimes the emotional centers of the brain are the hardest hit during a seizure and a person starts to cry for no apparent reason, or becomes angry or afraid. These seizures are termed partial because only part of the brain is involved.

Many people mistake a person undergoing a partial seizure as drunk or mentally ill. A complex partial seizure, for example, may cause the person to be dazed, unresponsive and clumsy, and to mumble, pick at clothing, or make chewing movements.

In contrast, during a generalized seizure such as a grand mal seizure (also known as a generalized tonic clonic seizure), the whole brain is suddenly swamped with extra electrical energy so the entire body undergoes convulsions and the person loses consciousness. Another type of generalized seizure called atonic causes abrupt loss of muscle tone, and the person falls to the ground.

Sometimes people, particularly those with complex partial seizures, experience a distinctive warning sign before a seizure, called an aura. The aura is itself a form of partial seizure, but one in which the patient retains awareness. It may be a peculiar odor, "butterflies" in the stomach, or a sound. One man with epilepsy, an ardent racetrack gambler, always hears the roar of a crowd followed by the name of a favorite racehorse just before falling unconscious. Another person hears rock music.

Although the average individual seizure doesn't appear to have any lasting effects, repeated seizures may be associated with damage such as memory loss. "There's growing evidence that seizures are not good for the brain," says Roger J. Porter, M.D., deputy director of the National Institute of Neurological Disorders and Stroke in Bethesda, Md.

A person may also be injured in a seizure-induced fall. Rarely, a person who has had a convulsive seizure may need resuscitation if breathing does not resume automatically.

Although seizures rarely cause death, they can be life-threatening if they occur in hazardous situations, such as while driving or swimming. Most cases of death from epilepsy stem from a series of seizures in a short span of time, or a seizure that lasts longer than a half hour. Both conditions can deprive the brain of oxygen or cause heart or kidney failure. People experiencing such seizures should receive immediate hospital care.

The diagnosis of epilepsy, clarification of the type of seizures, and determination of possible causes, are based on laboratory tests (see accompanying article) and a detailed medical history.

About the Author

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FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.