Part 1: General Information
Part 2: Self-Help
Part 3: Further Information
Febrile Seizures. Febrile seizures are caused by high fever and usually occur between the ages of three months and five years. They are quite common and occur in about 3% of all children under five years old. Nearly all febrile seizures are brief and have no long-lasting effect.
Vaccinations. Some controversy arose a few years ago over the possibility that the DTP (diphtheria-tetanus-pertussis) vaccine might trigger epilepsy or other neurologic diseases. In young children, high fever from a vaccination can, in rare instances, trigger seizures, which are almost always temporary and have no serious consequences. Some experts suggest that children who have neurologic events following their DTP shot may already have a preexisting impairment, such as epilepsy or abnormal brain development, which is revealed but not caused by the vaccine. Children with epilepsy may be at risk for an outbreak of symptoms two or three days after the vaccination. Such a temporary worsening of their disease does not appear to pose a danger to the child. In general, for infants with suspected neurologic problems, a decision to vaccinate may be delayed until their neurologic situation is clarified (but no later than their first birthday).
Television-Induced Seizures. Certain patterns of rapidly flashing colors have triggered seizures in hundreds of television watchers, most recently in Japanese children who watched cartoons with rapid fluctuating colors. (It appears that the color variations -- not the light -- caused the seizures.
Other Causes. Seizures in infants and children may also be due to birth defects, difficulties during delivery, infections, poisoning, or head injuries. Melatonin, an herbal remedy available over the counter for sleep disorders, has been found to cause seizures in children who have existing neurologic problems.
If epilepsy first appears in teenage or adult years, the known major causes tend to be drug or alcohol abuse, withdrawal from certain antianxiety or antidepressant drugs, cancer, disorders of blood vessels, infections, or diabetes. Occupational exposure to certain chemicals can also cause epilepsy. One study found an association between epileptic seizures and herpes simplex virus infections that occur in the central nervous system. More research is needed before any causative role can be proved. In the elderly, epilepsy is often due to degenerative diseases of the brain. Small strokes, called transient ischemic attacks, are often difficult to distinguish from mild epileptic seizures, and in fact, a first seizure in adults might be a precursor to stroke.
Head Injuries. Head injuries can cause seizures, with the risk highest in severe head trauma. In such cases, a first seizure related to the injury can occur even years later. People with mild head injuries, which involve loss of consciousness for less than 30 minutes, have only a slight risk that lasts up to five years after the injury.
Genetic Factors. Some forms of epilepsy are inherited. Researchers have recently identified genetic mutations that affect the channels in nerve cells that carry calcium, potassium, and sodium back and forth. Sodium, potassium, and calcium serve the brain as ions and produce electric charges that must fire regularly in order for a steady current to pass from one nerve cell to another. If the channels that carry them are genetically damaged, an imbalance occurs that can cause misfire and seizures. One gene, known as Cacng2 or stargazer, impairs ion channels that regulate sodium and calcium and may be responsible for an inherited form of absence epilepsy. Others known as KCNQ2 and KCNQ3 affect potassium channels and are found in families with a rare form of generalized seizures that occur in infancy called benign familial neonatal convulsions.
Brain Tumors. Both cancerous and noncancerous brain tumors can cause seizures in children and adults.
Pseudoepilepsy. In many cases, a seizure can be caused by psychologic stresses, which is known as pseudoepilepsy. It can usually be distinguished from true epilepsy using electroencephalogram (EEG), which measures brain waves.
SYMPTOMS. The manifestations of epilepsy depend on the area of
the brain where the abnormal discharge occurs. Elementary partial seizures,
called also simple or focal seizures, result from a localized cortical
discharge. The symptoms may be either motor, sensory, or autonomic, or
any combination of the three. Complex partial seizures, called also psychomotor
or temporal lobe seizures, usually, but not always, originate in the temporal
lobe of the brain. There may be an aura before the seizure. As the name
implies, there are many different cognitive, affective, and psychomotor
symptoms. There is either loss or alteration of consciousness when the
seizure begins; after the attack the patient may feel drowsy or confused.
Absence or petit mal
seizures last only a few seconds. There is a sudden onset with no aura
or warning and no postictal symptoms. Seizures of this type usually affect
children between the ages of 5 and 12 years and may disappear during puberty,
but they can continue throughout life. There typically is a twitching about
the eyes or mouth, the patient remains sitting or standing, and appears
to have had no more than a lapse of attention or a moment of absent-mindedness.
Grand mal or tonic-clonic
seizures usually begin with bilateral jerks of the extremities or focal
seizure activity. There is loss of consciousness and both tonic and clonic
type convulsions. The patient may be incontinent during the attack and
there is danger of tongue biting. In the postictal phase the patient is
confused and drowsy.
Atonic or akinetic seizures are characterized by loss of body tone
that can produce nodding of the head, weakness of the knees, or total collapse
and falling. The patient usually remains conscious during the attack.
West syndrome affects children within the first
year, usually beginning between four and eight months. The infant experiences
spasms and developmental delay. Lennox-Gastaut syndrome is a severe form
of epilepsy in young children, which causes multiple seizures and some
developmental retardation.
Myoclonic epilepsy is a rare genetic seizure that
can be mild and cause brief periods of jerkiness in limited parts of the
body, such as the face or trunk, or it may be severe, with grand mal seizures,
hearing loss, mental damage, and heart problems.
DIAGNOSIS. A complete assessment of the patient's status is necessary, including a medical history, physical and neurological examination, and laboratory studies of the blood and spinal fluid. The latter are especially useful in determining whether an infection is the cause of the seizures. A CT scan may demonstrate a causative lesion. The diagnosis is confirmed by ELECTROENCEPHALOGRAM and ECHOENCEPHALOGRAM, which are helpful in locating the site and possibly the cause of the seizures.
TREATMENT. Medical management with anticonvulsant drugs is the preferred
therapy for about 95 per cent of patients with epilepsy. Surgical intervention
for the remaining 5 per cent involves removal of the portion of brain tissue
believed to be responsible for the seizures. Because of the dangers inherent
in the surgery, this mode of therapy is reserved for those patients who
do not respond to medical management and in whom the focus of seizure
activity is accessible.
The major antiepileptic
drugs are phenytoin, which is usually the drug of choice, phenobarbital,
primidone, carbamazepine for complex partial tonic-clonic seizures, and
ethosuximide and clonazepam for absence seizures. Valproic acid is also
used in the treatment of absence seizures. The choice of drug and calculation
of optimal dosage is very difficult and highly individualized.
All of the anticonvulsant
drugs can produce unpleasant side effects. They include gingival hyperplasia,
rash, and, in the case of Dilantin, fever and leukopenia. Physical dependence
can become a problem in patients taking phenobarbital or primidone, which
is largely converted to phenobarbital in the bloodstream. Toxic side effects
are also common and include drowsiness, ataxia, nausea, sedation, and dizziness.
The untoward effects of anticonvulsant drug therapy require close monitoring
of the patient's response to therapy and regulation of dosage as indicated.
In July 1997 FDA approved the first medical device for hard-to-control
partial seizures. Cyberonics' NeuroCybernetic Prosthesis (NCP) system or
vagus nerve stimulator, approved for adult and adolescent patients, is
surgically implanted on the left side of the chest with a lead running
under the skin to the vagus nerve on the side of the neck. The flat,
round, thin device, which includes a battery pack and computer chip, is
set by a neurologist to discharge in bursts of about 30 seconds each, every
five minutes a day, 24 hours a day. The stimulation has the effect of preventing
seizures in some people. People generally must continue to take medications
as well.
Another, more debated type of treatment is the ketogenic
diet, a special high fat, low carbohydrate diet used mainly in children
and sometimes prescribed as a treatment option for those with intractable
epilepsy. The diet results in ketosis, a condition in which excessive amounts
of ketones (substances chemically akin to acetone) are produced, resulting
in an anti-epileptic effect.
PATIENT CARE. Emergency care of the patient having a seizure includes
clearing the immediate area to protect the
patient and others, administering 100 per cent oxygen by face mask, and
intravenous administration of antiepileptic medication. No one should force
an object into the patient's mouth to hold it open (such as a comb, bite
block, or wallet), as such objects might obstruct the airway. Do not attempt
to restrain the patient, as that may cause harm to both the rescuer and
the patient.
Until a diagnosis of epilepsy
is confirmed, observations made before, during, and after each of the seizures
can provide important information to the diagnostician. Such data also
can help prepare an effective plan of care for managing the seizures once
a definitive diagnosis is made.
Just before a seizure (the
preictal stage) the patient may experience an abnormal somatic, visceral,
or psychic sensation called an aura. The presence or absence of the aura
and its nature (if it is present) should be noted and recorded. If a patient
does experience a particular kind of aura just before each seizure, this
information can be useful when planning care for prevention of injury.
It also is helpful to note what the patient was doing just before the seizure
began. If a particular emotional event or environmental or physiologic
condition is found to trigger the seizures, the patient might be
able to use this information to avoid or minimize the recurrence of seizures.
During the interictal stage
(while the seizure is occurring) significant data include the time the
seizure begins and its duration; where in the body the seizure begins and
what parts of the body are involved; whether the head or eyes turn to one
side and, if so, to which side; whether there is incontinence of urine
or stool, bleeding, or foaming or frothing at the mouth; effects of the
seizure on the vital signs; and changes in skin color or profuse perspiration.
During the postictal period
the patient is assessed for lethargy, confusion, impaired
speech, and reports of headache or muscle soreness.
The successful long-term
management of epilepsy requires coordinated effort on the part of the patient,
family, and health care professionals. Patient and family education and
support are essential components of any plan of care. Epileptic patients
must take their prescribed medications on their own and actively participate
in the management of their illness. They and those upon whom they are dependent
(as in the case of children) must know the nature of the illness, the purpose
and expected effects of treatment, the side effects of the drug they are
taking and its potential for interaction with other drugs that could inhibit
or enhance its anticonvulsant action, and the signs and symptoms of drug
intolerance that should be reported to the physician or nurse.
Education should also include
information about possible seizure triggers and ways in
which they might be avoided. Alcohol is especially dangerous for epileptic
persons because most antiepileptic drugs are sedatives and cardiopulmonary
depressants. The combination of drug and alcohol could cause loss of consciousness
or even death. Moreover, alcohol acts as a seizure trigger in some
persons.
RESEARCH: The Epilepsy Foundation is excited about efforts in the area
of genetic research.
"It is very likely that we will find that a lot of epilepsy has a genetic
basis -- not necessarily that a person has inherited it but that within
their physiology there has been a new mutation," he explains. "In July
1998 the British journal Nature published an article based on finding a
gene in a mouse model for a common form of epilepsy, absence or petit mal
epilepsy. It's called the stargazer gene -- after the mouse's name, Stargazer
-- and the study is considered a breakthrough."
Van Hazerbeke says the new study may lead to a test
to determine if an individual has a particular form of epilepsy and that
may eventually lead to reversal, prevention, or a cure.
SUPPORT. It is important that patients with epilepsy wear some form
of medical identification. In spite of efforts to educate the general public
about the nature of epilepsy and its effects on those who have it, there
remains some social stigma attached to epilepsy. Therefore, many patients
do not want their friends, classmates, or employers to know they have the
disease. Efforts must be made to improve the self-esteem of these people.
Local chapters of the Epilepsy Association of America offer programs and
opportunities for social interaction and group support to help persons
with epilepsy and their families deal with the psychosocial effects of
the disease. Information and guidance to a local chapter can be obtained
by contacting the Epilepsy Association of America, 111 W. 55th St., New
York, NY 10019.
The Epilepsy Foundation of America, 4351 Garden City Dr., Suite 406,
Landover, MD 20785, supplies information on all aspects of epilepsy and
can refer patients and their families to specialists and clinics in their
locality. View their web site at
www.efa.org
The National Society for Epilepsy is located in the UK. Web site at http://www.erg.ion.ucl.ac.uk/NSEhome/open.html
The Epilepsy Foundation of Colorado has a web page at bcn.boulder.co.us/human-social/agency/a98.
The Epilepsy Foundation of Hawaii page at
www.maui.net/~randm/efh.html.
The Epilepsy Foundation of the Saint Louis Region web page can be found at www.neuro.wustl.edu/epilepsy/.
Epilepsy Foundation of Northwest Florida webpage is at
www.cil.gulf.net/epil.html.
The Society:
http://www.cil.gulf.net/epil.html
The Society helps people with Epilepsy achieve maximum seizure control,to
become self-sufficient, and to have their rightful place in the community.
Epilepsy International: The World-Wide Resource Center for Epilepsy
Information
In English | En Español
http://www.epilepsy-international.com/
The UAB Epilepsy Center
http://www.neuro.uab.edu/UABEC.html
EFNJ - Epilepsy Foundation of New Jersey
http://www.efnj.com/
The Epilepsy Foundation of Michigan is the only organization in the
state totally dedicated to helping people affected by seizure disorders.
The site includes epilepsy information and how to get involved.
http://www.epilepsymichigan.org/news.html
People With Epilepsy, Inc. A self-help website devoted to People with Epilepsy http://www.o-c-s.com/epilepsy/index2.htm
Johns Hopkins--The Epilepsy Center
http://hopkins.med.jhu.edu/HealthcarePros/neuro/epilepsy/epilepsy.html
The Texas Tech Epilepsy Program is a multi-disciplinary organization
which aims to provide comprehensive diagnostic and therapeutic modalities
for epilepsy patients.
http://www.ttuhsc.edu/pages/neuro/ttep.htm
The SIU Center for Epilepsy, located in Illinois, provides comprehensive
care for persons with all types of epilepsy, through advanced diagnositc
techniques, specialized pharmacologic therapy, new investigational drugs
and devices, and epilepsy surgery. Web site is at siumed.edu/neuro/epilepsy.html
The Epilepsy and Brain Mapping Program is a comprehensive healthcare
center for treating adult and pediatric epilepsy.
www.epipro.com/
Epilepsy Ontario Home Page:
http://epilepsyontario.org/
for Women Living With Epilepsy Career Opportunities for People with
Disabilities
Miami Children's Hospital Comprehensive Epilepsy Program is a recognized
leader for the diagnosis and medical and surgical treatment of pediatric
epilepsy. http://www.mch.com/dnnc2.htm
LHSC's Epilepsy Unit is one of the two largest centres for the treatment
of epilepsy in Canada. It is renowned throughout the world for its highly
qualified team of professionals dedicated to the management of epilepsy.
http://www.lhsc.on.ca/eeg/epiu.htm
Yale Epilepsy Surgery Program
http://info.med.yale.edu/surgery/neurosur/episurg.html
This program is designed to provide comprehensive and innovative clinical
care for patients suffering from medically intractable epilepsy.
The Presbyterian Epilepsy Program's goal is to provide comprehensive
services for patients with epilepsy.
http://www.presbyterian.org/epilepsy.html
Educational resources and treatment information from the Epilepsy
Foundation of Victoria (Australia).
www.epinet.org.au
Comprehensive resources and information on epilepsy by Washington University
www.neuro.wustl.edu/epilepsy/
Epilepsy Information and FAQ:
debra.dgbt.doc.ca/~andrew/epilepsy/
Contains Frequently Asked Questions about Epilepsy
Plain Text Version Translations: Japanese; Portuguese.
Epilepsy Menu:
dem0nmac.mgh.harvard.edu/neurowebforum/EpilepsyMenu.html
Articles related to Epilepsy issues.
Comprehensive Epilepsy Center
http://neuro.med.cornell.edu/NYH-CMC/res19a.html
Explains how epilepsy causes seizures and lists the different treatment
options available. Affiliated with the Cornell Medical Center in New York
City.
Canine Epilepsy
http://www.k9web.com/dog-faqs/medical/epilepsy.html
British Epilepsy Association Web Site
http://www.epilepsy.org.uk/
The Web Site of the British Epilepsy Association featuring advice,
news, reference and support for people with Epilepsy.
Pregnancy and Epilepsy (Full Text Version)
http://www.seizures.com/doc/Epil%26Preg_text.html
Mark Yerby, M.D., M.P.H., of the North Pacific Epilepsy Research Center
discusses epilepsy, with emphasis on women and pregnancy, infant mortality,
and health policy issues
Epilepsy Research, Third Faculty of Medicine, Charles Univ., Praha
http://rfyzio.lf3.cuni.cz/
Mental Health Net -- Epilepsy Resources
http://www.cmhc.com/guide/epilepsy.htm
Mental HealthNet's list of epilepsy resources.
Epilepsy: Social Consequences and Economic Aspects
http://www.who.int/inf-fs/en/fact166.html
Explaining Epilepsy
http://bay.erg.ion.ucl.ac.uk/NSEhome/explain.html
Books for Readers Interested in Epilepsy
http://www.mediconsult.com/associations/epilepsy/books/index.html
Oxfordshire Epilepsy Network http://ourworld.compuserve.com/homepages/nse_oxfordshire_epilepsy_network/index.html
New Guidelines for Women With Epilepsy
http://www.medscape.com/MedscapeWire/1998/10.98/medwire1020.guidelines.html
New guidelines may help women with epilepsy make decisions about contraception,
pregnancy and breast-feeding while managing the disease.
EPILEPSY, Surgical Therapy
http://moe.med.yale.edu/reference/bibliography/snacc/Epilepsy4.html
An Epilepsy Education
http://www.kidshealth.org/kid/normal/epilepsy.html
Napoleon, Vincent van Gogh, Danny Glover, and Marion Clignet…
Epilepsy Focus - Fall 1996 - by the Cleveland Clinic Foundation
http://www.medhelp.org/ccf/effall00.htm
Neuroimaging in the Epilepsies: Modern neuroimaging technology now
allows noninvasive diagnosis of a wide spectrum of brain lesions which
may cause epilepsy.
The Epilepsy Connection
http://people.goplay.com/cyberpause/ewebpg03.htm