Driving with Epilepsy
-EPILEPSY is a disorder characterized by recurring seizures, also known as “seizure disorder. A SEIZURE is a brief, temporary disturbance in the electrical activity of the brain. A SEIZURE is a SYMPTOM of EPILEPSY.
There are many forms of Epilepsy that affect the person in different ways. Ranging from frequent and violent to infrequent and mild, we will introduce you to the many varieties of this disorder.
Who Has Epilepsy?
About 3 million Americans have epilepsy
- There are roughly 200,000+ NEW cases of seizure disorders and epilepsy each year.
- 50% of people with epilepsy develop seizures by the age of 25; HOWEVER, anyone can get epilepsy at any time
- Now, there are as many people with epilepsy who are age 60 or older as children age 10 or younger.
- About 1% of the general population develops epilepsy.
- The risk is higher in people with certain medical conditions such as:
- Mental retardation
- Cerebral palsy
- Alzheimer’s disease
What Causes Epilepsy?
For about 70% of people with epilepsy, the cause is not known. In the remaining 30%, the most common causes are:
- Head Trauma
- Brain tumor
- Lead poisoning
- Infection of brain tissue
- Prenatal disturbance of brain development
What is the source of the Seizures?
The brain is the source of epilepsy. All brain functions — including feeling, seeing, thinking and moving muscles — depend on electrical signals passed between nerve cells in the brain. A seizure occurs when too many nerve cells in the brain “fire” too quickly causing as “electrical storm.”
Types of Seizures
There are many types of seizures and some people experience more than one type throughout their lifetime. Seizures are usually described by physicians in two groups: Primary Generalized and Partial Seizures.
Primary Generalized Seizures:
Begin with a widespread electrical discharge that involves both sides of the brain at once.
- Absence seizures
- Atypical absence seizures
- Myoclonic seizures
- Atonic seizures
- Tonic seizures
- Clonic seizures
- Tonic-clonic seizures
Begin with an electrical discharge in one specific area of the brain. Some causes for these types of seizures can be a head trauma, brain infection, stroke, tumor or the way the brain was formed during pregnancy. Most of these types of seizures are usually found on an EEG scan of the brain done by a neurologist. Some may need further medical diagnosis.
- Simple partial seizures
- Complex partial seizures
- Secondarily generalized seizures
Absence seizures are brief episodes of staring. During the seizure a person’s awareness and responsiveness are impaired. Usually they occur without any warning and the person experiencing them is unaware that they are having one. They usually last less than 10 seconds but can last longer. Many people mistake absence seizures for episodes of daydreaming or the child being inattentive.
Who gets them? Children between the ages of 4 and 14.
What is the prognosis? In about 70% of cases, absence seizures stop by the age of 18. Children that begin to have absence seizure before the age of 9 are more likely to outgrow them than children that begin to have absence seizures after the age of 10. Children with absence seizures have normal intelligence.
Atypical Absence Seizures
Atypical Absence Seizures present themselves like absence seizures however the person is often somewhat responsive. You may notice eye blinking or slight jerking movements of the lips. Unlike absence seizures, these seizures usually can’t be produced by rapid breathing.
Who gets them? Children before the age of 6. Many children with Atypical Absence seizures have below-average intelligence and other more difficult to control seizures. Many have Lennox-Gastaut syndrome.
What is the prognosis? Atypical absence seizures will usually continue into adulthood. These types of seizures are also commonly mistaken for daydreaming and inattentiveness.
It is important to let your child’s teacher know how to identify both absence and atypical seizures so they don’t assume your child is ignoring them.
Myoclonic Seizures are generally very brief jerk like a movement of a muscle or a group of muscles. They usually cause abnormal movements on both sides of the body at the same time. Myoclonic seizures present more commonly when a person has Juvenile myoclonic epilepsy, Lennox-Gastaut Syndrome, and Progressive myoclonic epilepsy.
Who gets them? The seizures can occur at any age, but the epileptic syndromes that most commonly included myoclonic seizures usually begin in childhood.
What is the prognosis? The outlook for people with myoclonic seizures can vary widely depending on the type of epileptic syndrome they are diagnosed
Atonic seizures are sometimes referred to as “drop seizures”. During an atonic seizure muscles suddenly lose strength. Their eyelids may droop, their head may nod and the person usually falls to the ground. When this type of seizure occurs the person remains conscious. Atonic seizures last usually less than 15 seconds.
Who gets them? Children
What is the prognosis? Atonic seizures often last into adulthood. Special protection is often advised like a helmet since many people get hurt when they experience an atonic seizure.
Tonic seizures are usually identified by sudden stiffening in the body, arms or legs and generally last less than 20 seconds. A person is usually conscious during this type of seizure but they usually occur when a person is asleep. Tonic seizures involve both sides of the brain which will cause both sides of the body to stiffen.
Who gets them? People that have Lennox-Gastaut syndrome commonly have tonic seizures.
What is the prognosis? Tonic seizures in Lennox-Gastaut syndrome are more difficult to control over time, however, some people are able to manage their symptoms with their physician’s help.
Clonic seizures consist of rhythmic jerking movements of the arms and legs. The length of these seizures varies. The jerking movements cannot be restrained nor should a person attempt to try and restrict a person while having a clonic seizure.
Who gets them? Clonic seizures are not very common. People at any age can get this type of seizure. Some parents mistake the common constant movement of a newborn for a clonic seizure.
What is the prognosis? Infants that experience clonic seizures usually outgrow them. Others may need prolonged treatment.
Tonic-Clonic Seizures is probably one of the most common types of seizures people experience. Tonic-clonic seizures used to be known as “grand mal” seizures. This type of seizure combines both characteristics of tonic seizures and clonic seizures. First comes the tonic phase when all the muscles in the body stiffen. A person may make a groan or crying sound as air is being forced past the vocal cords. The person will lose consciousness and usually falls to the floor. Sometimes the person may bite their tongue or cheek so you may see blood in their saliva. The person may turn a little blue in the face as oxygen is lost during the seizure. The next phase is the clonic phase when the arms and legs will begin to jerk rapidly and rhythmically. You will notice some bending and relaxing at the elbows, hips, and knees. The jerking will slow and stop as the seizure subsides. Sometimes a person will lose control of their bladder or bowels as their body begins to relax after the seizure. Usually, consciousness returns slowly and the person will appear drowsy, confused, agitated or depressed post-seizure.
Who gets them? Children and adults at any age.
What is the prognosis? Some children outgrow these seizures. Usually, tonic-clonic seizures are controlled by anti-epileptic seizure drugs (AED’s). Many patients that remain seizure free for a year or two while on AED’s will remain seizure free if the medicine is gradually weaned off. Children with no epilepsy waves on their EEG test and have a normal exam, 70% of them that had tonic-clonic seizures will stay seizure-free without medication. Children with epilepsy waves and an abnormal exam only 30% are able to stay seizure-free without medication.
Simple Partial Seizures
Simple Partial Seizures usually last less than 2 minutes. These can be classified into categories depending on the type of symptoms the person experiences.
- Motor seizures: These seizures will cause a change in muscle activity. Muscle jerking in one or multiple parts of the body. Speech may be impaired. A person may have uncontrolled laughter or automatic hand movements.
- Sensory seizures: A person may smell or taste things that aren’t there; hear a clicking, ringing or a person’s voice when it is not present; or feel a sensation of “pins and needles” or numbness. Some may hallucinate or experience an illusion.
- Psychic seizures: These types of seizures change how a person thinks feels or experiences things. They may have memory problems, slurred/garbled speech, an inability to find the right word, or trouble understanding spoken or written language. They may suddenly experience depression, fear, or happiness for no reason. Some people describe a feeling of deja vu.
Who gets them? Anyone at any time. They are more common in people that have had a head injury, brain infection, stroke or brain tumor but most of the time the cause is unknown.
What is the prognosis? Very often these seizures can be controlled by Anti-epileptic drugs. A complete medical history and exam is needed to help identify these types of seizures.
Complex Partial Seizures
Complex Partial Seizures usually begin in a small area of the temporal lobe or frontal lobe of the brain. Then they quickly involve other areas of the brain that affect alertness and awareness. Sometimes people appear to be awake but they are not aware of what is happening. Many people experience an aura or warning just before the seizure occurs. Some feel sick to their stomach or are dizzy. Then the person begins to stare blankly like an absence seizure. However many people will move their mouth, pick at the air or their clothing, or perform other purposeless actions. These movements are called automatisms. On a few occasions, a person may repeat words, laugh, scream or cry. Some people may wander about which can be very dangerous and should be monitored closely.
Who gets them? Anyone. These are more commonly found in people that have had a head trauma, brain infection, stroke or brain tumor. Like other seizures, the cause is usually not known.
What’s the prognosis? It depends on if the cause is known. Some people outgrow these seizures or are able to control them with medication. Sometimes epilepsy surgery can be an option to alleviate the seizures.
Secondarily Generalized Seizures
Secondarily Generalized Seizures these seizures are called “secondarily generalized because they become generalized after the initial event, a partial seizure has already begun. They usually last no more than a few minutes. The preceding partial seizure is usually not very long which makes this part so hard to detect.
Who gets them? These seizures occur in more than 30% of people with partial epilepsy.
What’s the prognosis? Most seizures of this type can be controlled with medication. If they are not controlled with medication then your physician should investigate to see whether they might be secondarily generalized seizures that begin in a limited area of the brain. Then surgery may be an option.
-This information was adapted from the Epilepsy Foundation site.