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Epilepsy FAQ |
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Archive-name: medicine/epilepsy-faq
Posting-Frequency: monthly
Last-modified: 1996/07/15
Version: 4.3
URL: http://debra.dgbt.doc.ca/~andrew/epilepsy/
Epilepsy FAQ
Frequently Asked Questions about Epilepsy
Version 4.3 -- 96/07/15
Maintained by Andrew Patrick (andrew@calvin.dgbt.doc.ca). New material and
suggestions are always welcome.
URL for this FAQ and other information:
http://debra.dgbt.doc.ca/~andrew/epilepsy/
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NOTES
Please note that this Epilepsy information MAY NOT BE ACCURATE OR
COMPLETE. Anyone with serious questions about Epilepsy should
consult their doctor. Some of this material was prepared by
Epilepsy Ottawa-Carleton and Epilepsy Ontario, and it is used with
permission. Please contact me before you use any of this material
in other information products.
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Questions Covered in this Document
* Basic Information
o What does "Epilepsy" mean?
o Is Epilepsy a disease?
o What is a seizure?
o What is an aura?
o When was Epilepsy discovered?
* People with Epilepsy
o What kind of people have Epilepsy?
o How many people have Epilepsy?
o Does Epilepsy strike at any particular age?
o Does Epilepsy occur more in some cultures?
* Types of Seizures
o Are there different types of seizures?
o What is the difference between partial and general seizures?
o What are partial seizures?
o What are complex partial seizures?
o What are absence (petit mal) seizures?
o What are tonic-clonic (grand mal) seizures?
o What are other types of seizures?
o What are "status" seizures?
o What are pseudoseizures?
o How do you distinguish epileptic seizures from pseudoseizures?
o Can seizures occur if a person does not have Epilepsy?
o What are the seizures like?
o What does it feel like to have a seizure?
o How long do the seizures last?
o Is there such a thing as a "minor" case of Epilepsy?
* Causes and Triggers
o What causes Epilepsy?
o Is Epilepsy inherited?
o Is Epilepsy contagious?
o Is it caused by a virus?
o Can certain things trigger seizures?
o Can seizures be triggered by flashing lights?
o Can certain foods or drinks cause seizures?
o Can lack of sleep cause seizures?
o Can low blood sugar trigger seizures?
o Can Nutrasweet (Aspartame) trigger seizures?
o Does alcohol affect seizures?
* First Aid for Seizures
o How can I help someone who is having a seizure?
o What if my child has a seizure during his sleep?
* Diagnosis
o How is Epilepsy diagnosed?
o What types of doctors can diagnose and treat Epilepsy?
o Can a person with Epilepsy have a false negative EEG?
o Can a person have a false positive EEG for Epilepsy.
o Is my child having absence seizures or just day dreaming?
o What conditions are sometimes mis-diagnosed as Epilepsy?
o Can seizures go un-noticed?
* Treatments
o Is there a cure for Epilepsy?
o Is it fatal?
o What kinds of treatments are available?
o Are there drug treatments for Epilepsy?
o How do drugs work to control seizures?
o What drugs are used to treat Epilepsy?
o How effective are the drug treatments?
o Do these drugs have side effects?
o What is a "blood level"?
o What are the symptoms of too high a drug level?
o How much do the drugs cost?
o Is it necessary for all people with Epilepsy to be on medication?
o When is surgery used to treat Epilepsy?
o What is the likelihood that my child will outgrow a seizure
disorder?
o Do non-traditional approaches help?
o Does transcendental meditation have any effect on Epilepsy?
o Does biofeedback help?
o Is there a special diet for people with Epilepsy?
o What is a ketogenic diet?
* Living with Epilepsy
o Can people living with Epilepsy lead normal lives?
o What can people with Epilepsy do to help their health?
o Who should know that I have Epilepsy?
o Is there prejudice against people with Epilepsy?
o Are there any problems having children?
o Can medications for controlling Epilepsy harm a nursing baby?
o Can people living with Epilepsy drive a car?
o Can people living with Epilepsy go swimming?
o Can Epilepsy lead to problems at school?
o Can Epilepsy cause emotional problems?
o Can Epilepsy lead to problems with self-esteem?
* Working With Epilepsy
o What occupations are not appropriate for people with Epilepsy?
o Can people with Epilepsy fly a plane?
o Is there a problem with job safety?
o Can an employer ask about Epilepsy on a job application?
o Can an employer ask about Epilepsy during a job interview?
o Can I be fired because I have Epilepsy?
o Can people with Epilepsy get social assistance?
* Epilepsy and Other Disorders
o Is Epilepsy related to other neurological problems?
o Is Epilepsy related to mental illness?
o Can Epilepsy affect intelligence?
o Is there a link between memory loss and Epilepsy?
o Is Epilepsy related to asthma?
o Are there any diseases that persons with Epilepsy more prone to?
* Miscellaneous
o Do animals get Epilepsy?
o Can dogs sense a seizure in humans before it strikes?
* More Information
o Where can I get more information about Epilepsy?
o What books are available on Epilepsy?
o Where can I find information on the Internet about Epilepsy?
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Topic: Basic Information
Q: What does "Epilepsy" mean?
The word "Epilepsy" is derived from a Greek word meaning "a condition
of being overcome, seized, or attacked." People used to believe that
the seizure was caused by a demon, and Epilepsy became known as a
sacred disease. This is the background to the myths and fears that
surround Epilepsy; myths that colour people's attitudes and make the
goal of a normal life more difficult than it needs to be be for people
who have Epilepsy. The word "Epilepsy" means nothing more than the
tendency to have seizures.
Q: Is Epilepsy a disease?
Epilepsy is not a disease. It is a sign or symptom of an underlying
neurological disorder.
Q: What is a seizure?
The brain is a highly complex and sensitive organ. It controls and
regulates all our actions. It controls motor movements, sensations,
thoughts, and emotions. It is the seat of memory, and it regulates the
involuntary inner workings of the body such as the function of the
heart and the lungs.
The brain cells work together, communicating by means of electric
signals. Occasionally there is an abnormal electrical discharge from a
group of cells, and the result is a seizure. The type of seizure will
depend upon the part of the brain where the abnormal electrical
discharge arises.
Q: What is an aura?
Before the onset of a seizure some people experience a sensation or
warning called an "aura". The aura may occur far enough in advance to
give the person time to avoid possible injury. The type of aura
experienced varies from person to person. Some people feel a change in
body temperature, others experience a feeling of tension or anxiety. In
some cases, the epileptic aura will be apparent to the person as a
musical sound, a strange taste, or even a particular curious odour. If
the person is able to give the physician a good description of this
aura, it may provide a clue to the part of the brain where the initial
discharges originate. An aura could occur without being followed by a
seizure, and in some cases can by itself be called a type of simple
partial seizure.
Q: When was Epilepsy discovered?
Epilepsy is the oldest known brain disorder. It was mentioned more than
2,000 years before Christ. References can be found in ancient Greek
texts and in The Bible. It wasn't until the mid 1800's, however, that
Epilepsy was given serious study. Sir Charles Locock was the first to
introduce a sedative that aided in controlling seizures in 1857. In
1870, John Hughlings Jackson identified the brain's outer layer, the
cerebral cortex, as the part involved in Epilepsy. Hans Berger
demonstrated that the electrical impulses of the human brain could be
recorded in 1929.
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Topic: People with Epilepsy
Q: What kind of people have Epilepsy?
Virtually everyone can have a seizure under the right circumstances.
Each of us has a brain seizure threshold which makes us more or less
resistant to seizures. Seizures can have many causes, including brain
injury, poisoning, head trauma, or stroke; and these factors are not
restricted to any age group, sex, or race and neither is Epilepsy.
Q: How many people have Epilepsy?
Epilepsy is far more common than most of us realize. Current estimates
indicate that more than one per cent of the population have had, or
will have, some form of Epilepsy in their lifetime.
Q: Does Epilepsy strike at any particular age?
Epilepsy can strike anyone at any age. However, most persons who
develop seizures during their formative years tend to experience a
reduction in the intensity and frequency of their seizures as they grow
older. In many cases the Epilepsy will disappear completely. 50% of all
cases develop before 10 years of age.
Q: Does Epilepsy occur more in some cultures?
Epilepsy occurs more frequently in some cultures. In Tanzania, 4% of
the population experiences severe seizure disorders. In this case,
genetic predisposition to lower seizure thresholds is known to exist.
In Canada, 1-2% of the population has Epilepsy.
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Topic: Types of Seizures
Q: Are there different types of seizures?
Many varieties of epileptic seizures occur, and frequency and form of
attacks vary greatly from person to person. With modern methods of
treatment, however, most cases can be fully controlled. Because there
are so many nuances in Epilepsy and so many different kinds of
seizures, a specific classification system is being promoted by the
International League Against Epilepsy. The International Classification
of Epilepsy Seizures has been adopted by the medical community and is
gradually replacing outdated seizure terminology including "grand mal"
and "petit mal".
The new classification scheme describes two major types of seizures:
"partial" and "generalized". It also divides each of these categories
into subcategories including simple partial, complex-partial, absence,
tonic-clonic, and other types.
Q: What is the difference between partial and general seizures?
The distinction between "partial" and "generalized" seizures is the
most important feature of the new classifcation system. If the
excessive electrical discharge in the brain is limited to one area, the
seizure is partial. If the whole brain is involved, it is generalized.
In all, there are over 30 different seizure types. Therefore, the new
classification format subdivides the partial and generalized Epilepsies
into a number of different categories.
Q: What are partial seizures?
Partial seizures (formerly known as focal seizures) with elementary
symptomology are often referred to a simple partial. During this type
of seizure the patient can experience a range of strange or unusual
sensations including sudden, jerky movements of one body part,
distortions in hearing or seeing, stomach discomfort, or a sudden sense
of fear. Consciousness is not impaired. If another seizure type
follows, these sensations may be referred to as an "aura".
Q: What are complex partial seizures?
Complex-partial seizures (formerly psychomotor or temporal lobe
Epilepsy) are characterized by a complicated motor act involving
impaired consciousness. During the seizure the patient appears dazed
and confused. Purposeless behaviours such as random walking, mumbling,
head turning, or pulling at clothing may be observed. Usually, these
so-called "automatisms" cannot be recalled by the patient. In children
this seizure may consist of staring or lip-smacking, and therefore may
be confused with the absence seizure described below.
Q: What are absence (petit mal) seizures?
Generalized absence seizures (formerly petit mal) are characterized by
5 to 15 second lapses in consciousness. During this time the patient
appears to be staring into space and the eyes may roll upwards.
Absences are not preceded by an aura and activity can be resumed
immediately afterwards. Typically, they occur in children and disappear
by adolescence. They may, however, evolve into other seizure types,
such as complex-partial or tonic-clonic. The occurrence of absences in
adulthood are rare.
Q: What are tonic-clonic (grand mal) seizures?
The tonic-clonic (formerly grand mal) seizure is a generalized
convulsion involving two phases. In the tonic phase, the individual
loses consciousness and falls, and the body becomes rigid. In the
clonic period, the body extremities jerk and twitch. After the seizure,
consciousness is regained slowly. If the tonic-clonic seizure begins
locally (with a partial seizure) it may be preceded by an "aura". These
seizures are said to be secondarily generalized.
While the tonic-clonic seizure is the most visible, obvious type of
Epilepsy, it is not the most common. Partial seizures are more
frequently encountered and occur in 62% of all Epilepsy patients.
Complex-partial seizures account for approximately 30% all cases.
Q: What are other types of seizures?
Benign rolandic epilepsy is an epileptic syndrome occurring in young
children that is age limited (you stop having seizures in the teen
years) . Salivation, twitching of the mouth or upper extremity on one
side are typical manifestations. Seizures occur almost exclusively
nocturnally.
Juvenile myoclonic epilepsy is an epilepsy characterized by onset in
childhood or adolescence and is associated with extremity jerking or
generalized tonic clonic seizures ('grand mal') within an hour or two
of wakening from sleep. Seizures which may be precipitated by sleep
deprivation, alcohol intake or coffee (strange) tend to occur in the
morning.
Pleases contact your local Epilepsy association or clinic for
additional information. Other seizure terms include: Atonic (Drop
Attacks), Myclonic, Infantile Spasms, Nocturnal, Photosensitive,
Visual, Musicogenic, Jacksonian, Sensory, Bilateral Myclonus,
Atkinetic, Autonomic, Prolonged seizures, and Ictal State.
Q: What are "status" seizures?
Status epilepticus is the term used to describe recurrent seizures
without recovery of consciousness between attacks. This is a medical
emergency and can be life threatening, or cause brain damage. Immediate
action to get the necessary medical care should be taken.
Q: What are pseudoseizures?
Psuedoseizures (or psychogenic seizures) are quite common and can occur
in people who have, or do not have, Epilepsy. The attacks are triggered
by a conscious or unconscious desire for more care and attention. The
seizures start with rapid breathing, triggered by mental stress,
anxiety, or pain. As the person breaths rapidly, they build up carbon
dioxide in their body and change their chemistry. This can cause
symptoms very much like Epileptic seizures: prickling in the face,
hands, and feet, stiffening, trembling, etc. The appropriate treatment
for pseudoseizures is to calm the person and start them breathing at a
normal rate. Treatment should also involve investigating the mental and
emotional factors that led to the psuedoseizure.
Q: How do you distinguish epileptic seizures from pseudoseizures?
Epileptic seizures and pseudoseizures are distinguishable both by their
nature and symptoms, but the diagnosis can be difficult. Epileptic
seizures are caused by a change in how the brain cells send electrical
signals to each other, while pseudoseizures are triggered by a
conscious or unconscious desire for more care and attention. Thus,
measuring brain activity with an EEG and video telmetry is important
for distinguishing epileptic and pseudoseizures. Also, pseudoseizures
often lack the exhaustion, confusion, and nausea that is associated
with epileptic seizures. Psychogenic seizures can occur in people who
also experience epileptic seizures.
Q: Can seizures occur if a person does not have Epilepsy?
Epilepsy is a chronic condition of recurrent unprovoked seizures.
Isolated seizures and provoked seizures (e.g., drug or alcohol induced)
are not Epilepsy even though the events are real seizures. There are
many types of non-epileptic seizures. Non-epileptic seizures differ
from epileptic seizures in that there is usually no evidence of
abnormal electrical activity in the brain after the seizure, and they
do not occur repeatedly. Some of the more common causes of
non-epileptic seizures are: low blood sugar, fainting, heart disease,
stroke, migraine headaches, kinked blood vessels, narcolepsy,
withdrawal, and extreme stress or anxiety.
Q: What are the seizures like?
The nature of the seizures varies depending upon the type of Epilepsy
the individual has. Some seizures may be very noticeable while some may
go completely unrecognized. With the most common types of seizures
there is some loss of consciousness, but some seizures may only involve
small movements of the body or strange feelings. The different seizures
types have certain characteristics that accompany them.
Q: What does it feel like to have a seizure?
Epilepsy is a broad classification for a wide variety of seizures, so
different people's seizures can be very different. Common feelings
associated with seizures include uncertainty, fear, physical and mental
exhaustion, confusion, and memory loss. Some types of seizures can
produce visual and auditory phenomena, while others can involve a
"blank" feeling. If a person is unconscious during a seizure there may
be no feeling at all. Many people also experience an "aura" before the
seizure itself.
Q: How long do the seizures last?
Depending on the type of seizure, they can last anywhere from a few
seconds to several minutes. In rare cases, seizures can last many
hours. For example, a tonic-clonic seizure typically lasts 1-7 minutes.
Absence seizures may only last a few seconds, while complex partial
seizures range from 30 seconds to 2-3 minutes. "Status Epilepticus"
refers to prolonged seizures that can last for many hours, and this can
be a serious medical condition. In most cases, however, seizures are
fairly short and little first aid is required.
Q: Is there such a thing as a "minor" case of Epilepsy?
There are over 30 types of seizures, and some types are more severe
than others. Long tonic-clonic convulsions, for example, can produce
more physical and mental effects than shorter partial seizures. Some
people may experience very frequent seizures (every few hours), while
others can go for months or years without a seizure. Also, some
seizures are easily controlled by drug therapies, while others may
continue regardless of the medication that is tried.
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Topic: Causes and Triggers
Q: What causes Epilepsy?
There is no single cause of Epilepsy. Many factors can injure the nerve
cells in the brain or the way the nerve cells communicate with each
other. In approximately 65% of all cases there is NO known cause. The
following are some of the most frequently identified causes:
o Head injury that causes scaring of the brain tissue.
o Trauma at birth, or high fever.
o Excessively rough handling or shaking of infants.
o Certain drugs or toxic substances when administered in large
doses.
o Interruption of blood flow to the brain caused by stroke, tumour,
or certain cardiovascular problems.
o Diseases which alter the balance of blood or its chemical
structure, or diseases that damage the nerve cells in the brain.
When physicians can identify the underlying disorder, such as those
mentioned above, the condition is referred to as "Symptomatic"
Epilepsy. In some cases, however, the underlying disorder can't be
identified and this is called "Idiopathic" Epilepsy.
Q: Is Epilepsy inherited?
In most cases Epilepsy is not inherited. In a few cases the tendency
towards Epilepsy might be inherited, but even with this tendency
certain conditions must exist in the brain before a person will
experience epileptic seizures. It is most unlikely that children will
inherit the disorder.
Q: Is Epilepsy contagious?
Epilepsy is in no way contagious. No one can get the disorder by
talking to, kissing, or touching somebody with Epilepsy. Epilepsy can
only be transmitted through hereditary transfer. Epilepsy that runs in
families suggests an underlying metabolic or genetic etiology, and this
is the least common of all Epilepsy causes.
Q: Is it caused by a virus?
Epilepsy can be the result of an infection or disease. Some conditions
known to have a risk of resulting in Epilepsy are meningitis, viral
encephalitis, and less frequently mumps, measles, diphtheria, and
abscesses.
Q: Can certain things trigger seizures?
In some cases, epileptic seizures can be triggered by things that
happen in the environment. Seizures can be triggered by flashing lights
or sudden changes from dark to light (or vice versa). Other people can
react to loud noises or monotonous sounds, or even certain musical
notes. It is important for people with Epilepsy to learn what kinds of
events can trigger seizures for them.
Q: Can seizures be triggered by flashing lights?
"Photosensitive Epilepsy" is the name given to a form of the disorder
where seizures are triggered by flickering or flashing lights. Though
it occurs more frequently in girls aged 6-12, it can occur at any age
and regardless of gender.
Q: Can certain foods or drinks cause seizures?
People with Epilepsy should have regular meals at regular intervals and
pay attention to what they eat and drink. Prescription and
non-prescription drugs, as well as food additives, may interact with
anti-convulsant drugs. Alcohol can lower seizure thresholds.
Q: Can lack of sleep cause seizures?
Excessive sleep deprivation can lower seizure thresholds and possibly
result in a seizure. Lack of sleep is known to be an important
precipitating factor in causing seizures. Other factors that can lower
seizure thresholds are high fever, increased excitement, and changes in
body chemistry. It is important for people with Epilepsy to learn what
kinds of events can trigger seizures for them.
Q: Can low blood sugar trigger seizures?
Hypoglycemia (low blood sugar) can induce epileptic-type seizures. This
condition can be caused by diet or by drugs such as insulin. This is
not really Epilepsy since it is not recurrent seizures that are due to
abnormal brain activity. Here the seizures are directly caused by the
blood sugar levels.
Q: Can Nutrasweet (Aspartame) trigger seizures?
In 1984, there were 3 reports about large amounts of Aspartame causing
a lowering of the seizure threshold and therefore increasing seizure
activity. The Centre for Disease Control in Atlanta did a review of
this and were unable to find any cause or effect relationship at normal
doses. More recently, Aspartame has been found to be unsuitable for
some children with generalized absence Epilepsy. A Queen's University
study looked at the brain-wave patterns in 10 children and the effects
of the artificial sweetener "Nutrasweet". A 40% increase in abnormal
brain-wave activity associated with absence seizures was found in this
study. However, there was no effect on the actual number of seizures.
Research on this topic is continuing.
Q: Does alcohol affect seizures?
Alcohol can raise and then lower the seizure threshold, and thus
increases the tendency to have a seizure. More important are
interactions between alcohol and seizure medicines. Also, some drugs of
abuse, especially cocaine and amphetamines, can cause seizures. Some
prescription medications when taken in large doses can also bring on
seizures.
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Topic: First Aid for Seizures
Q: How can I help someone who is having a seizure?
The appropriate behaviour for helping someone who has a seizure depends
on the type of seizure it is. While a person experiencing a
tonic-clonic seizure may require some first aid, in most cases there is
little that can be done.
Tonic-Clonic (Grand Mal)
This type of seizure is often the most dramatic and frightening, but it
is important to realize that a person undergoing an epileptic seizure
is usually unconscious and feels no pain. The seizure usually lasts
only a few minutes, and the person does not need medical care. These
simple procedures should be followed:
1. Keep calm. You cannot stop a seizure once it has started. Let the
seizure run its course. Do not try to revive the person.
2. Ease the person to the floor and loosen clothing.
3. Try to remove any hard, sharp, or hot objects that might injure
the person. It may be necessary to place a cushion or soft item
under their head.
4. Turn the person on his or her side, so that the saliva can flow
from the mouth.
5. Do NOT put anything in the person's mouth.
6. After the seizure the person should be allowed to rest or to sleep
if necessary.
7. After resting most people carry on as before. If the person is not
at home and still seems groggy, weak, or confused, it may be
better to accompany them home.
8. In the case of a child having a seizure, contact a parent or
guardian.
9. If the person undergoes a series of convulsions, with each
successive one occurring before he or she has fully recovered
consciousness, or a single seizure lasting longer than 10 minutes,
you should immediately seek medical assistance.
Absence (Petit Mal)
No first aid is required.
Complex-Partial (Psychomotor or Temporal Lobe)
1. Do NOT restrain the person. Protect him or her by moving sharp or
hot objects away.
2. If wandering occurs, stay with the person and talk quietly.
Simple-Partial (Focal)
No first aid is required.
Q: What if my child has a seizure during his sleep?
Children are usually awakened by seizures that occur while they sleep.
Thus, a parent of a child with a known seizure disorder is usually
aware when their child has seizures during the night. Only in those
rare cases where a child vomits or experiences other problems during a
seizure is there a need to worry.
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Topic: Diagnosis
Q: How is Epilepsy diagnosed?
The diagnosis and evaluation of Epilepsy requires the physician to know
all about the seizures - when they started, the patient's appearance
before, during, and after a seizure, and any unusual behavioural
occurrences. A background of the family's health history is also
useful. In addition, an electroencephalogram (EEG) may help detect
areas of increased nerve cell activity.
Q: What types of doctors can diagnose and treat Epilepsy?
Any licensed physician is qualified to treat Epilepsy. There are
doctors who specialize in neurological disorders, and these
neurologists can be found practicing in many hospitals and private
practices. Epileptologists may work in an Epilepsy clinic, as well as
in private practices. Usually a referral is required from another
physician in order to see a Neurologists and Epileptologists. Some
people also consult alternative health practitioners who specialize in
holistic healing, acupuncture, or chiropractic treatments.
Often, the first doctor to diagnose Epilepsy is the family doctor. Most
of them have had some experience with it, and will be the one to refer
a person with Epilepsy to a specialist initially. Pediatricians are
also well aware of Epilepsy, since about two-thirds of all Epilepsy
occurs before the age of 14. A neurologist has specialized training in
the disorders of the brain and nervous system. A neurosurgeon,
psychiatrist, or psychologist may also get involved if the
circumstances require them.
Q: Can a person with Epilepsy have a false negative EEG?
An EEG measures the electrical activity on the surface of the brain. An
EEG may appear to be normal if the abnormal electrical activity is
occurring deeper in the brain than the EEG is able to monitor.
Q: Can a person have a false positive EEG for Epilepsy.
Many people who do not have Epilepsy may have some "epileptiform"
activity on an EEG. However, this does not prove that they have a
seizure disorder. Reading EEG's is a highly skilled activity, and a
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