Parents Against Childhood Epilepsy, Inc.

Epilepsy is most commonly described as recurrent electrical discharges in the brain that disturb the normal functioning of the nervous system and can cause temporary loss of consciousness and/or temporary changes in behavior.

Epilepsy affects over three million Americans today. The number grows by 7½% annually. Each year 250,000 new cases are diagnosed, half of which begin in early childhood.

While epilepsy commonly starts in childhood, it can begin at any age -- it can strike any one of us at any time. Epilepsy affects more people than cystic fibrosis, multiple sclerosis, muscular dystrophy and tuberculosis combined. And yet, for more than 75% of the cases, we still cannot find a cause.

We do not know why most seizures occur, or why they occur so unexpectedly without pattern. While researchers continuously find new medications, each has its own harmful side effects and complete seizure control for many is difficult.

• GENERALIZED SEIZURES: happen when all or most of the brain is affected. So much of the brain is involved that people having generalized seizures "blank out" or lose awareness.
  • A generalized tonic clonic seizure is the kind that used to be called grand mal. The person blanks out, falls, stiffens, and then jerks uncontrollably for a minute or two. While it looks dramatic, this type of seizure is rarely a medical emergency.
  • A myoclonic seizure lasts a shorter time. It causes a massive muscle jerk that may throw the person who has it to the ground.
  • An atonic seizure causes sudden falls. It lasts only a few moments but can happen frequently.
  • An absence seizure is very brief, lasts only a few seconds, and looks like a blank stare, or daydreaming. While it is occurring, the person is completely unaware of his surroundings. It begins and ends suddenly.
  • Infantile spasms occur in babies. They are clusters of brief jerking or jackknife movements.
• PARTIAL SEIZURES: These happen when only part of the brain is affected, although they can spread to the whole brain and cause generalized tonic clonic seizures, described above. When the seizure activity remains in one area, the following seizures may occur:
  • Simple partial: Affects the senses, feeling, emotions, and movements. Things may look bigger or smaller: there may be hallucinations of sight or sound. People can feel unexplained pain, or fear, or anger. A hand or leg may shake. People do not lose awareness, however.
  • Complex partial: May start like a simple partial seizure, but progresses to cause loss of awareness and automatic movements that look like a trance-like state.

Causes

In about 75% of cases there is no known cause. Of the remaining 25%, the following are most frequent:

• Head Trauma of any type, especially from automobile accidents, gunshot wounds, sports accidents and falls and blows at work or in the home. The more severe the injury, the greater the chance of epilepsy developing.
• Brain Tumor and Stroke.
• Poisoning, such as lead poisoning. More than 5,000 persons are reported each year to suffer seizures caused by alcoholism.
• Infection: meningitis, viral encephalitis, lupus erythematosus and, less frequently, mumps, measles, diptheria and others.
• Maternal injury, infection or systemic illness affecting developing fetus during pregnancy.
• Heredity plays a role in some cases. All people inherit varying degrees of susceptibility to seizures. The genetic factor is assumed to be greater when no specific cause can be identified.

Treatment

Modern medical treatment methods can achieve full or partial control of seizures in 75% of cases. Some seizure disorders of infancy and early childhood are still highly resistant to current therapies.

• Medical - Major form of treatment is long-term anticonvulsant drug therapy. Some 20 antiepileptic drugs are currently in use. While multiple-drug therapy is sometimes necessary, single-drug therapy is more common.
• Surgical - Used only when medication fails. Most common form takes place when the brain tissue causing seizures is confined to a small focal area of the brain, which can be safely removed without damaging personality or function. Recently, hemispherectomies are being used to fight aggressive forms of epilepsy.
• Dietary - Doctor-monitored high fat, high caloric diet may succeed in some childhood cases when standard treatment fails.

Major Problems

Treatment

Despite available therapies, an estimated 25% of patients do not have complete seizure control and a similar proportion of cases are virtually resistant to current drug therapy. There are now medications with fewer side effects for cases resistant to treatment and for patients under multiple-drug therapy for whom monotherapy is not yet possible.

Diagnosis

There are more than 20 different seizure disorders. Recent international reclassification of systems, along with improved brain wave monitoring technology, new and efficient methods to precisely measure blood drug levels, non-invasive brain imaging and brain function measurement technologies, now permit the more specific diagnosis and treatment of epilepsy. Convulsive seizures are easily recognized. But there are other less apparent forms of epilepsy marked by non-convulsive seizure types. These seizures affect awareness, produce brief loss of muscle control and may involve sensory distortions. Early diagnosis is crucial.

Unemployment/Underemployment

20-30% of people with epilepsy who are physically able to work are unemployed. Many of those who are employed have been forced to accept positions far below their ability and educational achievement. For many people, having epilepsy has been less of a problem than overcoming negative attitudes about their intellectual and physical abilities. Changes in the law, especially provisions of the Americans with Disabilities Act, offer new hope in this area.

Impact on Children

The National Center for Health Statistics reports over half a million cases of epilepsy in children 18 years of age and under based on a National Health Interview Survey. Of these children, 65.5% or 327,500 have special needs.

Mortality

Epilepsy carries an increased risk of death from a variety of causes. Most seizures are benign, but a prolonged seizure can evolve into status epilepticus, a condition that sometimes leads to brain damage and, occasionally, death, especially by drowning.