A seizure attack occurs when there is an acute abnormality in the electrical activity in the brain. To be classified as an epileptic, a person must have experienced either a minimum of two seizures that are at least 24 hours apart and not incited by a known medical disorder or one seizure and a high risk for subsequent convulsions.
Epilepsy is a common worldwide neurological disorder that afflicts both sexes, all ages and every socioeconomic class.
In the United States, 3.4 million people live with the disease; one in 26 will develop the malady at some point in their lifetime.
The infirmity is characterized by unforeseeable, unprovoked recurrent seizures that trigger a variety of abnormal mental and physical functions. With appropriate pharmaceutical management, prolonged remission can be achieved for up to 70% of those with the illness.
A 2020 report in “Neuroepidemiology” notes that “the global burden of epilepsy has a decreasing trend with a significant reduction in mortality and a progressive decline of the disease in the youngest age-group and a corresponding increase in the elderly.”
The authors of “The History of Epilepsy,” in the medical journal “Cureus,” note that for millennia the malady has “fascinated and frightened scientists and layman alike.” Despite the more recent positive trend, there are still many misconceptions about the ailment.
While all those with epilepsy undergo seizures, not everyone with seizures has epilepsy.
A seizure attack occurs when there is an acute abnormality in the electrical activity in the brain. To be classified as an epileptic, a person must have experienced either a minimum of two seizures that are at least 24 hours apart and not incited by a known medical disorder or one seizure and a high risk for subsequent convulsions.
There are three major groups of epileptic seizures.
In “generalized onset seizures” there is a broad electrical discharge affecting both sides of the brain simultaneously. If there is abnormal activity in a limited area or group of cells in one hemisphere of the brain, it is called a “focal onset seizure.” When it is impossible to classify the attack, it is labeled an “unknown onset seizure.”
Depending on the type, age of onset and cause, different kinds of symptoms can occur; those stricken with the illness usually have the same clinical manifestations with each recurring seizure episode. The bodily expressions can include uncontrolled jerking movement of extremities, muscle twitching, staring spells, spasms, confusion, loss of consciousness or awareness and psychological abnormalities.
When a characteristic pattern of clinical features is grouped together, the individual affected may be classified as having a specific epileptic syndrome. This designation can be useful in the prognosis and management of the disorder.
In some instances, a potentially life-threatening emergency occurs when there is an acute prolonged epileptic crisis; this is called a status epilepticus. It requires immediate treatment. The mortality from this type of seizure has decreased over the last half century secondary to faster diagnosis and more aggressive therapy.
A cause for epilepsy is identifiable in only about half of those suffering with the infirmity. A 2022 article in the “Journal of the American Medical Association” delineates six etiological categories:
- Structural: congenital abnormalities, strokes, brain tumors and head trauma
- Infectious: certain inflammations
- Genetic: either inherited or acquired
- Metabolic: secondary to disruption of how the body uses food
- Immune: defects in immune system leading to brain infections
- Unknown
Confirming the diagnosis of epilepsy can be challenging because other conditions have similar presentations.
An accurate detailed narrative of the symptoms associated with the individual’s seizures is vital. In addition, blood tests, electroencephalograms, computed tomography and magnetic resonance imaging are obtained. The diagnostic goal is to clearly define the epileptic convulsion episodes so that an effective treatment plan can be constructed.
Since ancient times, humans have lived with epilepsy.
In 1000 B.C. in ancient Babylonia, a cuneiform clay tablet chronicled a person with “his neck turning left, hands and feet are tense, and his eyes wide open, and from his mouth froth is flowing without him having any consciousness.” The doctors of that era attributed these physical displays secondary to evil spirts, demons and gods invading the body.
The ethereal realm associated with epilepsy remained unchallenged until the Greek physician Hippocrates in the 5th century B.C. postulated that the brain may be the mainspring of the disorder. The term “epilepsy” is derived from the Greek word meaning to attack or seize.
For multiple centuries Hippocrates’ hypothesis held little credence with those who continued to support the supernatural origin of the malady. During this long unscientific period, people with seizures faced dreadful social ostracism and prejudice. In America, as late as the mid 1900s, some states prohibited those with epilepsy to get married.
The knowledge-based era for epilepsy began in the mid-19th century when doctors identified “electrical discharges” in the brain may be the reason for the disorder. In 1912, the pharmacological basis for modern epileptic therapy began with the recognition of the anticonvulsant features of phenobarbital. It continues to be one of the most commonly prescribed medication for epilepsy worldwide.
Today, there are 26 approved anti-seizure drugs (ASDs).
They are the cornerstone therapeutics that control seizures in two-thirds of epileptic patients. ASDs treat the symptoms but do not cure the underlying disorder. Which specific pharmaceutical to use is based upon the individual’s seizure type, as well as other medical conditions, age, sex and potential interaction with other medications.
While drugs are the centerpiece for epileptic treatment, other modalities are available particularly for those who are medically resistant to ASDs. These methods include specialized dietary therapy, neurostimulation and in some cases, brain surgery.
Since the early documentation of convulsions 3,000 years ago in ancient Babylonia, the understanding of epilepsy has evolved. In the 21st century the disease can be successfully treated so that most of those stricken can have full and normal lives.
Source: dailypress.com, Dr. Jonathan L. Stolz
