After a first-observed
convulsion causing loss of consciousness with falling and shaking, it is
natural to wonder, will the person have another convulsion? If so, when? Why
did it happen? Is this epilepsy or just a seizure? These are questions
patients, families and doctors must deal with.
Epilepsy is diagnosed
when more than one seizure occurs if the seizure is not a “reactive”
seizure. Reactive seizure are caused by some transient medical condition
that can disappear such as infections, toxins and drugs, or temporary loss of a
body organ function (e.g., liver, kidney, lung, etc.) that then heal and
further seizures do not occur. When a second convulsion occurs, even if the
first and this second seizure are separated by years, epilepsy is diagnosed.
Epilepsy means recurrent seizures.
Epilepsy can be caused
by brain injuries, strokes, tumors, infections, degenerative diseases such as Alzheimer’s
disease, Multiple Sclerosis, Parkinson’s Disease, inherited conditions, and
other diseases. Recognition of genetic causes of epilepsy is rising as science
improves to identify abnormal genes. However, epilepsy is not common in
families. Causes for approximately 50% of epilepsy cases are never found.
Currently, onset of epilepsy is no longer most common in children, rather, it
most commonly occurs in those over age 60. This is because we are living longer
and we are susceptible to more insults to our brains.
One percent of the world-wide
population has epilepsy. Approximately half of all people with epilepsy have
their seizures controlled; these people can remain seizure-free if they are on
the “best” anti-epilepsy drug (AED) at the “best” dosage for that individual. They
must continue this medication as they are not cures. Finding this medication is
a trial-and-error process of the patient working with doctors and the AEDs.
Another 30% of epilepsy patients will have a seizure every few weeks to months;
they have “incomplete” control. The remaining 20% of patients have “uncontrolled”
epilepsy; they experience seizures each day or every few days despite taking
AEDs. Epilepsy brain surgery is the most effective treatment to decrease or
even cure epilepsy for people in whom no AED works. If the brain focus causing
the epilepsy can be identified on various tests then attempting its surgical removal
is deemed promising for marked improvement in epilepsy control or even cure.
Brain scans (to search
for abnormal areas) and electroencephalograms (EEG) may identify a seizure-causing
focus. Spinal taps (if infection or other brain conditions are suspected) and
blood and urine tests to screen for other conditions also help doctors identify
epilepsy causes.
EEGs are normal in half
of all people with epilepsy because the test of multiple wires on the scalp is
done for just an hour or so and the EEG abnormalities do not always occur
during that time. Ambulatory EEGs (the person has EEG wires pasted on the scalp
connected to a small recording device on their body as they carry out daily
activities over 24 hours) may pick up abnormalities. More sophisticated testing
in special labs can be done where EEGs and video cameras are used to capture
abnormalities as the monitored-person lies in bed.
Pseudoseizures-involuntary, psychological, causes of
“seizures”-are
not rare and can complicate epilepsy diagnosis and treatment. See my past blogs
on this subject at LanceFogan.com:
blog #10 (March 23, 2011); Blog#49 (August 27, 2014); Blog #99 (October 26, 2018).
The diagnosis of
epilepsy depends on the clinical history of searching for, and characterizing, “spells” patients complain of along with the
above testing which commonly are all normal. Ultimately, clinical judgment and
the experience of your physician are crucial.
Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.
