Epilepsy is a disorder in which a person has two or more unprovoked seizures. Unprovoked means that the seizures are not brought on by a clear cause such as alcohol withdrawal, heart problems, or extremely low blood sugar. In other words, epilepsy is a condition of recurrent, unprovoked seizures. The seizures may result from a hereditary tendency or a brain injury, but often the cause is unknown. Many use the term “seizure disorder” instead because “epilepsy” seems more serious or stigmatized. However, almost all seizure disorders are epilepsy.
Epilepsy is a seizure disorder

A person with epilepsy has had two or more unprovoked seizures, regardless of seizure type. There are many types of epilepsy, depending on age of onset, seizure type(s), EEG findings, family history, and neurological history, among other factors.

Types of Epilepsy

There are many different types of epilepsy. In fact, we commonly refer to different types of epilepsy as epileptic syndromes, defined by a cluster of features including:

• Seizure types
• Age when seizures begin
• Electroencephalogram (EEG) findings
• Brain structure (usually assessed with a brain MRI scan)
• Family history of epilepsy or genetic disorder
• Prognosis (future outlook)

There are many epileptic syndromes specific to both adults and children. At the NYU Comprehensive Epilepsy Center (CEC) we see patients of all ages. This section explores the most common epilepsy syndromes in both adults and children.
Epilepsy Syndromes

• Temporal Lobe Epilepsy
• Frontal Lobe Epilepsy
• Parietal Lobe Epilepsy
• Occipital Lobe Epilepsy
• Primary Generalized Epilepsy
• Idiopathic Partial Epilepsy
• Symptomatic Generalized Epilepsy
• Progressive Myoclonic Epilepsy
• Reflex Epilepsy

Epilepsy Syndromes in Children

• Febrile Seizures
• Benign Rolandic Epilepsy
• Juvenile Myoclonic Epilepsy
• Infantile Spasms
• Lennox-Gastaut Syndrome
• Childhood Absence Epilepsy
• Benign Occipital Epilepsy
• Mitochondrial Disorders
• Landau-Kleffner Syndrome
• Rasmussen Syndrome
• Hypothalamic Hamartoma & Epilepsy


Epilepsy and Seniors

Epilepsy spares no age group. Although epilepsy is often considered a disorder of childhood, it can begin at any age, and in some people it persists from childhood to old age. The rate of newly diagnosed epilepsy is actually higher in elderly people than in middle-aged adults. In fact, as we get older, the possibility of having seizures continues to increase. An 85 year old person is almost three times more likely than a 70 year old to develop seizures.
As with younger people, the cause of epilepsy in an elderly person cannot be determined in about half of cases. Of those in whom the cause can be determined, the largest number of cases (about 33%) are caused by stroke, often a small stroke that did not cause other symptoms.

Other causes of epilepsy in the elderly are degenerative disorders, such as Alzheimer’s disease (11%), tumors, either benign or malignant (5%), head injury (2%), and infection (1%).

The elderly are more sensitive than younger people to a variety of mental, physical, and environmental stressors. They are also more likely to develop many medical, neurological, and psychiatric disorders, some of which can increase the chance of developing seizures. Such disorders include metabolic changes such as very high or very low blood sugar, very low sodium levels, and endocrine disorders (e.g., thyroid or parathyroid disorders, diabetes). Elderly persons are also prone to falls. Approximately one-third of those over age 65 years will fall at least once each year. Many of these falls are associated with head injury, which can make seizures more likely and contribute to cognitive and behavioral problems.

Epilepsy and the Developmentally Disabled

All developmental disabilities and many epilepsy syndromes begin in childhood. However, both often persist into adolescence and adulthood. Among patients with epilepsy, the presence of a developmental disability predicts a more difficult road for the patient, the patient’s family and caregivers. Sixty-nine percent of children with epilepsy and mental handicap have at least one additional diagnosis:

• Cerebral palsy (CP)
• Autism
• Visual impairment

Individuals with developmental disabilities and epilepsy have:
• higher rates of seizure recurrence after a first seizure
• lower rates of “outgrowing” epilepsy
• higher rates of sudden unexpected death after adolescence and possibly in childhood

Causes of Developmental Disabilities and Epilepsy

The range of metabolic, genetic, and acquired causes of developmental disabilities is vast. The relationship between the etiology of the disability and epilepsy may be complex, although in most cases, a single underlying brain abnormality or insult to the brain causes both disorders.

Epilepsy and Lifestyle

People with epilepsy are often subject to depression, anxiety,irritability, and other serious mental disorders. The psychological and psychiatricdisturbances may be unrelated to epilepsy or may be related to the person’s emotional reactions to having epilepsy, the effect of medications, or the epilepsy itself. These mental disorders may also result from the same thing that causes the person’s epilepsy.

• Anxiety and Epilepsy
• Sleep and Epilepsy
• Psychosis and Epilepsy
• Sports & Physical Activities
• Depression and Epilepsy
• Smoking and Epilepsy
• Relationships & Epilepsy
• Sex & Epilepsy
• Employment & Epilepsy
• Driving & Epilepsy
• Health Insurance & Epilepsy

Sudden Unexplained Death in Epilepsy (SUDEP)

What is SUDEP?

Sudden unexplained death in epilepsy is a mysterious, rare condition, better known as SUDEP, in which typically young or middle-aged people with epilepsy die without a clearly defined cause. By definition, (1) death is sudden and unexpected, (2) a clear cause of death must be absent, and (3) victims must have had epilepsy. Victims are often found in bed with or without signs of having had a convulsive seizure, but were otherwise in a reasonable state of health at the time of death. Although seizures are suspected to have occurred prior to death, there should be no evidence of seizure as the direct cause of death.

What causes SUDEP?

Although the cause of death is unknown, some researchers suggest that a seizure causes an irregularity in the heart rhythm. More recent studies have suggested that a combination of impaired breathing (apnea), increased fluid in the lungs (impairing the exchange of oxygen and carbon dioxide), and being face down on the bed all combine to cause death due to impaired respiration. In many cases, death probably occurs after a seizure has ended.

How common is SUDEP?

The risk of SUDEP for a person with epilepsy is about 1 in 3000 per year. The risk for people with severe, intractable epilepsy who have frequent seizures and take large doses of many antiepileptic drugs is much higher at about 1 in 300 per year. Among all patients with epilepsy, SUDEP accounts for less than 2% of deaths. The risk is highest in young male adults (ages 20-40), with frequent convulsive seizures, taking several antiepileptic medications.
What are the risk factors for SUDEP?

SUDEP rates are highest in young people aged 20-40, and greater in men than women. Another major risk factor for SUDEP appears to relate to the severity of the epilepsy, as SUDEP is more common in people with:

• frequent convulsive seizures
• early age of onset of epilepsy
• long duration of epilepsy
• higher number of antiepileptic medications, and at high doses
• frequent medication changes

On the other hand, SUDEP is rare in patients with new onset epilepsy, in patients without convulsive seizures as a seizure type, and in patients with well controlled seizures.

Safety Precaution Tips

A few safety precautions can minimize the chances of SUDEP:

1. Patients should make sure to take the medications prescribed for them.
2. Patients should visit with their doctor regularly, especially if convulsive seizures are not completely controlled.
3. Adult patients with a high likelihood of tonic-clonic seizures in sleep should be supervised whenever possible. (SUDEP is extremely rare in children with epilepsy and in other patients who are well monitored. In fact, supervision has emerged as a protective factor for SUDEP, independent of seizure control.)
4. Basic first aid should be provided during a seizure, including rolling the person onto one side, checking respiration and avoiding putting any object in the patient’s mouth.
5. Family members and/or caregivers of patients with uncontrolled convulsive seizures should learn cardiopulmonary resuscitation.

Seizures

What is a Seizure?

A seizure is an excessive surge of electrical activity in the brain thatusually lasts from a few seconds up to a few minutes. Seizures can cause a wide range of symptoms or effects, depending on which parts of the brain are involved in the abnormal electrical activity. A sudden andinvoluntary jerk of a hand, arm or whole body can be a seizure, as can asmell of burnt rubber, a strange feeling in the belly, a ringing sound that keeps increasing in volume, staring into space, or convulsive movements.

Many people think that a seizure must be a tonic-clonic or “grand-mal” convulsion, but even very “minor” and subtle symptoms can be seizures if they are due to abnormal electrical activity in the brain.

Psychogenic Non Epileptic Seizures

What is a nonepileptic seizure?

A nonepileptic seizure is the result of subconscious mental activity or distress. It is not the result of abnormal brain electrical activity. Doctors consider most of these episodes psychological in nature, but not purposely produced. Therefore, the older term “pseudoseizures” has fallen out of favor. The person is usually unaware that the seizures are not epileptic. Nonepileptic seizures most often resemble complex partial or tonic-clonic seizures. The degree of resemblance varies considerably, often making diagnosis difficult.

How common are nonepileptic seziures?

Nonepileptic seizures are most common in adolescents and adults but also can occur in children and the elderly. They are three times more likely in females. These episodes have been more widely recognized during the past several decades. In comprehensive epilepsy centers, where video-electroencephalogram (video-EEG) monitoring is performed, approximately 20% of referred patients are found to have nonepileptic seizures.

How are nonepileptic seizures diagnosed?

The diagnosis of nonepileptic seizures is most often made with video-EEG monitoring. Doctors often try to have a family member or friend observe the recorded event to ensure that it is identical or nearly identical to the usual episodes. Certain tests may be safely used to help provoke a seizure of this kind.
How are nonepileptic seizures treated?

The treatment of nonepileptic seizures varies. In some cases the episodes subside when the patient learns that they are not epileptic seizures and are not due to a serious neurological disorder. Nonepileptic seizures are not necessarily an indication of a serious psychiatric disorder, but the underlying problem needs to be addressed and, in most cases, treated. There may be coexisting depression or anxiety that can be helped with medication. The prognosis for control of these episodes and for the patient’s psychological well-being varies. Counseling with a psychologist, psychiatrist, or clinical social worker for some period of time after the diagnosis is a mainstay to successful treatment. Accepting the diagnosis, at least as a real possibility, and following through with therapy are essential for a successful outcome.

Is it dangerous to treat nonepileptic seizures as if they are epileptic?

Absolutely! It is very important to diagnose whether seizures are epileptic or nonepileptic, as the treatments vary widely. Why expose a patient with nonepileptic seizures to antiepileptic medications with their associated risks and side effects? As importantly, repetitive non-epileptic seizures in a patient may mimic a very serious and dangerous condition, status epilepticus, for which doctors would administer sedating intravenous medications, often requiring intubation (putting a tube in the patient’s throat to help with breathing), thus exposing the patient to unnecessary invasive procedures.

Can a patient with nonepileptic seizures also have epileptic seizures?

Patients with nonepileptic seizures may also have epileptic seizures. As a matter of fact, epilepsy centers have shown that anywhere from 10-40% of patients with nonepileptic seizures also have epileptic seizures. This makes diagnosis of the different spells very important, as treatment for each type is so different.

TO BE CONTD.

Brb

Wow,dis is really eye opening. A friend of mine strted havin convulsions in second sch.she's graduated from uni now and it still occurs.its really embarrassing and she feels sad abt it.she does not foam from d mouth jst continuos jerking after which she becomes vey weak.she's presently on epilim and she wnts to stop it against doctor's advice cos she believes God will heal her. We are all scared but she is very stubborn. Pls ow wil dis affect her, is it really a good option for her.

Please tell your friend to carry on her meds. if they are not working then she should get the doctor to change it for her to something that will work better.

As per giving up the drugs totally, the way I look at it is that God who created all things created these drugs. He gave some people intelligence to be able to come up with the medical knowledge to create these drugs. Her own is to pray that the drugs agree with her system and to lead her to the right doctors. Of course she should pray for healing too, but she should be wise. God gave us wisdom too.

if her faith in being healed can carry her then she can stop but she better build that faith up oh

She's the one bearing this so who are we to tell her not to.

sebi if her faith no reach she go go back to the drugs.

I doubt she's there yet or she would not tell you what she's considering sef.
There will come a time in everyones life when all human effort is futile and faith is it.