What is Epilepsy
by Dr. John Rees
Epilepsy was recorded as far back as the ancient Egyptians, who like the Aztecs, used to bore holes in the skull to let out ‘evil spirits’. Dr Rees gives us an insight into this condition that affects about 1 in 200-400 of the population.
Epilepsy is due to the normal electrical activity of brain cells becoming excessive and abnormal throughout the brain, which is known as generalised epilepsy, or in a localised part of the brain called focal epilepsy.
Petit Mal is a disorder of childhood; it is a generalised epilepsy and one that most children grow out of as their brain matures. It is characterised by little episodes of altered awareness (absences), lasting some seconds, eyelid flickering and occasionally by limb or body jerks. The brain wave test (EEG) is usually characteristically abnormal and responds well to medication.
Grand mal is also a generalised epilepsy which is characterised by loss of consciousness and a convulsion (fit), which looks very alarming but only rarely causes the patient damage.
A fit (seizure/epileptic attack) may last a few minutes following which the patient is often confused for some time. Tongue biting and incontinence sometimes accompany an attack. If you witness an attack simply ensure that the patient is on their side, is safe and has a good airway by bending the head backwards, never put your fingers in their mouth! Rarely, a fit may be prolonged requiring hospital admission. Most fits occur while awake but a minority occur during sleep.
The cause of generalised epilepsy is not fully understood but may arise during the brain’s development inside the mother, it may be due to birth difficulties and sometimes how the cerebral cortex (brain surface), develops.
The focal epilepsies arise in a part of the brain and so cause symptoms relevant to its function, i.e. a localised fit affecting a limb or one side of the body, odd inappropriate tastes, smells, sensations, memories or occasionally visual hallucinations. Very rarely a focal fit can become generalised. They indicate that there is a local problem in the brain which could be due to infection, tumour, trauma or most commonly the result of birth difficulty or prolonged febrile seizures. The latter are the commonest form of epilepsy and are the child’s brain response to a fever. They are usually easily treated by lowering temperature and occasionally drugs to control epilepsy (anticonvulsants). Nearly all children grow out of these fits as their brain matures, by age 5-6. Problems may arise if a febrile fit goes on for more than 10-15 minutes, causing part of the brain to suffer a relative lack of oxygen leading in later life to a focal epilepsy.
The majority of patients with epilepsy are well controlled on anticonvulsant medication, experience no fits with few or no side effects from the drugs, allowing them with attention to lifestyle, to live full lives including driving. However, there remain some patients for whom control of their epilepsy remains very difficult.
The diagnosis of epilepsy requires two or more seizures. There are obvious potential limitations when epilepsy is diagnosed in relation to school, employment, some sports, driving etc. (DVLA must be informed by the patient). Epilepsy should therefore be fully investigated by a specialist including EEG, CT/MRI imaging studies where necessary and a precise diagnosis reached with appropriate treatment whenever possible. Nearly all neurology departments run epilepsy clinics with specialist nurses on hand and the epilepsy charities are extremely active and useful for patients and their families. Surgery is only relevant to the treatment of a very few patients with focal epilepsy.