Epilepsy is a disease of the nervous system that can strike people of any age and in perfect health. It is marked by sudden, unexpected, brief episodes of various kinds. These episodes may involve loss of consciousness, or they may occur without any change in awareness. To understand how such an event happens, we need to look at how our brain normally works. The most advanced part of the brain is the cerebral cortex—a complex set of cells that, depending on the region or lobe involved, controls the different functions of our body. Movement, sight, hearing, taste, language, memory, thought—all depend on the cerebral cortex functioning correctly.
A temporary and abnormal functioning of certain zones, brought on by a sudden excitation of their cells, can produce a symptom closely tied to the specific function that those cells control. An epileptic seizure, then, is a temporary and brief malfunction of the nervous system.
Epilepsy is the tendency for these malfunctions to happen repeatedly. The likelihood of seizures depends on what is called the "convulsive threshold"—in simpler terms, how sensitive the nervous system is to stimuli from outside or within the body.
Most people never experience a seizure in their lifetime because their convulsive threshold is particularly high; their nervous system has strong enough safeguards against abnormal excitation. In young children, the risk is often higher because these protections are less developed.
Epilepsy is not a mysterious disease, and those who have it are not "different"
Epilepsy is not a mysterious disease, and those who have it are not "different." The prejudices that have long surrounded this condition arose from medical ignorance across the centuries, from people's difficulty in accepting and understanding a disorder of consciousness, and from fear—fear rooted in the false connection made between losing consciousness and dying.Types of Epileptic Seizures
Seizures fall into two main categories: partial seizures and generalized seizures.
Partial seizures involve only part of the nervous system. Depending on whether consciousness is affected, they are divided into simple partial seizures or complex partial seizures. Someone might experience sudden movements of a limb, face, or head, or strange sensations in one part of the body, speech disturbances, brief hallucinations, or memory lapses—all while remaining fully conscious. In other cases, confusion appears, along with automatic movements such as buttoning or unbuttoning clothes, touching oneself or objects, or speaking meaningless or inappropriate words and phrases. These seizures typically last only seconds, especially the simple kind, or a few minutes for complex ones. Because they are so brief, they may go unnoticed.
Generalized seizures, by contrast, involve a sudden, widespread disruption of the entire nervous system and always include loss of consciousness. They are divided into non-convulsive and convulsive seizures.
Non-convulsive seizures, which are more common in children, are called "absences." They involve a suspension of consciousness lasting fractions of a second or a few seconds. The person stops abruptly, stands motionless with a blank stare, apparently unaware of their surroundings.
Convulsive seizures are the most dramatic and widely recognized form of the illness. They typically begin with an abrupt loss of consciousness and a fall to the ground, followed by rigid tensing of all muscles, including those of the face. This gives way to repeated, rhythmic jerking movements (convulsions) that eventually lead to complete muscle relaxation. These main symptoms may be accompanied by drooling, tongue biting if it is clenched between the teeth, or loss of bladder control. A seizure usually lasts one to two minutes and typically ends in prolonged sleep afterward.
A single person may experience more than one type of seizure. Often, partial seizures can be followed by a generalized seizure.
Onset and Treatment
Epilepsy most often appears in childhood and adolescence, though it can develop in adulthood. How often seizures occur varies greatly from person to person—they might happen several times a day, for example in absence seizures, or monthly, yearly, or even more rarely.
A specialist, ideally one experienced in epilepsy, should make the diagnosis based on symptoms reported by the patient or family members. An electroencephalogram (EEG) is essential; it reveals nervous system dysfunction better than any other test. Brain imaging may also help rule out other conditions that might be present at the same time.
Anyone can develop epilepsy, just as anyone can develop any other illness
Anyone can develop epilepsy, just as anyone can develop any other illnessTreatment also demands experience and thorough knowledge of the condition. It must be tailored to the type of epilepsy, the frequency of seizures, and the risks the seizures pose to the patient. Today, several highly effective medications are available. The choice of which one depends on the form of epilepsy and how the patient responds. Usually, treatment begins with a single drug; combinations of two or at most three are used only when necessary.
It is possible to measure regularly the amount of medication in the body, to determine whether the patient is taking too little (ineffective), the right amount, or too much (toxic).
Treatment must continue for an extended period and may be lifelong.
Only a specialist should decide whether to stop medication, and only after years have passed without seizures.
For therapy to work well, taking medication correctly and consistently is crucial—no arbitrary dose reductions or missed doses.
Under these conditions, epilepsy today is a treatable disease, with about 70 percent of patients either fully free of seizures or experiencing significant improvement.
Treatment failures usually result from poor medication adherence or the presence of other nervous system damage—severe brain injury, degenerative diseases, trauma, and the like. When epilepsy occurs alongside such conditions, it is called secondary epilepsy; it is either caused by them or is one of their symptoms.
It is also worth noting that epilepsy is sometimes overdiagnosed, leading to unnecessary treatment in people who have simply had a single episode of lost consciousness from a sudden drop in blood pressure or blood sugar, or from an incidental abnormality on an EEG.
In the end, anyone can develop epilepsy, just as anyone can develop any other illness.
Prejudice against this disease can be overcome if people update their understanding to match current medical knowledge, and if, instead of turning to superstition, they turn to a capable, knowledgeable doctor who can explain the condition clearly.
- by Giulio Sideri, Associate Professor of Neurophysiopathology, Sapienza University of Rome, 1985
===FINE===