November is National Epilepsy Awareness month. The international color for epilepsy is lavender, which is a color symbolizing solitude.
What is Epilepsy?
International League Against Epilepsy (ILAE) defines epilepsy as a disease of the brain defined by any of the following conditions:
At least two unprovoked (or reflex) seizures occurring more than 24 hours apart
One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10 years
Diagnosis of an epilepsy syndrome
Epilepsy is considered to be resolved for individuals who had an age-dependent self-limited epilepsy syndrome but who are now past the applicable age, or for those who have remained seizure-free for the last 10 years, with no seizure medication for the last 5 years.
Classification of epilepsy
Epilepsy classification is undertaken after the criteria for diagnosing epilepsy are met (definition above). Classification is undertaken using a multi-level classification framework, involving classification at three levels - the seizure type, epilepsy type and epilepsy syndrome. Imaging, EEG and other investigations, where available, contribute to optimized classification at all three levels. Where possible, a diagnosis at all three levels should be established. The etiology of the epilepsy should be considered from the outset, and at each step along the diagnostic pathway. Knowing the etiology can inform optimized classification and has important treatment implications for the patient.
Epilepsies are classified as:
Generalized epilepsy- when all areas of the brain are affected by an abnormal electrical impulse.
Focal epilepsy- seizures arising from a specific part (lobe) of the brain.
Combined generalized and focal epilepsy- Patients may have both generalized and focal seizure types, with interictal and/or ictal EEG findings that accompany both seizure types.
Unknown epilepsy- used to denote where it is understood that the patient has epilepsy, but it is not possible to denote whether it is focal, generalized, or combined focal and generalized. This may occur due to insufficient information to classify the epilepsy, for example if the EEG is normal/uninformative.
Who does it affect?
Epilepsy foundation says anyone can develop epilepsy. Seizures start for the first time in people over age 65 almost as often as it does in children. Seizures in the elderly are often the after effect of other health problems like stroke and heart disease.
Causes
Causes of epilepsy are different for each person, and some people have no identifiable cause. In others, doctors can trace epilepsy directly to genetics, brain trauma, autoimmune disorders, metabolic issues, or infectious diseases. Each cause has different signs, diagnoses, and treatment options.
Effects on life
Most people with epilepsy CAN DO the same things that people without epilepsy can do. However, some people with frequent seizures may not be able to work, drive, or may have problems in other parts of their life. People with epilepsy CAN handle jobs with responsibility and stress. People with seizure disorders are found in all walks of life. They may work in business, government, the arts, and all sorts of professions. If stress bothers their seizures, they may need to learn ways to manage stress. But everyone needs to learn how to cope with stress! There may be some types of jobs that people with epilepsy can’t do because of possible safety problems. Otherwise, having epilepsy should not affect the type of job or responsibility that a person has.
Common misunderstandings
All seizures are the same. Different types of seizures present differently.
People think it’s easy to tell when a seizure is about to happen, this is not often the case.
You can’t swallow your tongue during a seizure. It's physically impossible.
You should NEVER force something into the mouth of someone having a seizure. Absolutely not! Forcing something into the mouth of someone having a seizure is a good way to chip teeth, cut gums, or even break someone's jaw.
DON'T restrain someone having a seizure. Most seizures end in seconds or a few minutes and will end on their own.
Flashing lights do not affect every person diagnosed with epilepsy. It is actually only a small percentage of diagnosed epileptic patients that have photosensitivity.
What is NOT epilepsy?
What are provoked seizures?
A person can have a seizure from a physical cause. This could be an acute medical illness or trauma that begins before the seizure. It could also be related to a substance or event their body is responding to or withdrawing from. In these cases, seizures are called “provoked.” The provoking cause has had an effect on the brain that leads to a seizure. These seizures are not diagnosed as epilepsy. Treatment for provoked seizure should address the underlying cause.
Common causes of provoked seizures include
An acute medical illness (for example, infection)
A metabolic cause, such as an abnormality in blood sugar
Fever
Head injury or brain trauma
Stroke or transient ischemic attack (TIA)
Withdrawal from drugs or alcohol
A reaction to a prescribed or over-the-counter medication
In Conclusion
A patient has to meet certain criteria to be given an epilepsy diagnosis. There are multiple types of epilepsy. People of any age can be diagnosed with epilepsy. Not all times of seizures have the same presentation, so don't believe what you have seen on television. Know proper seizure safety and don't stick anything in a person's mouth or restrain them. Just because a person has seizures does not mean they have epilepsy.
Resources
International League Against Epilepsy- https://www.epilepsydiagnosis.org/epilepsy/epilepsy-classification-groupoverview.html
Epilepsy Foundation-
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