What Is Epilepsy?

What Is Epilepsy?

Epilepsy is a chronic neurological disorder characterized by recurrent unprovoked seizures. If you have had more than one seizure without any identified provoking factor such as head trauma, fever, alcohol intake, illicit drug abuse, etc. you may have epilepsy. Between seizures, most people with epilepsy are completely normal.

Epilepsy can be inherited. Certain genes responsible for inherited epilepsy were identified. But there is still a lot to be discovered about genetic aspects of epilepsy. Some epilepsy cases are acquired. Certain conditions such as a birth defects and injuries, head trauma, brain infections, and brain tumors can result in epilepsy. In more than two thirds of cases there is no identified underlying etiology for epilepsy.

Not everyone who has had a seizure has epilepsy. About 10% of people will have a seizure during their lifetime; most of these are “provoked” seizures. These people may never have another seizure, and therefore do not have epilepsy.

What Kind of Epilepsy I have?

In addition to seizure classification, experts developed classification of epilepsy syndromes.

International Classification of Epilepsies

1. Localization-related (focal, local, partial)

  • Idiopathic
  • Symptomatic
  • Cryptogenic

2. Generalized

  • Idiopathic
  • Symptomatic
  • Cryptogenic

3. Undetermined epilepsies

  • With both generalized and focal seizures
  • Without unequivocal generalized or focal features

4. Special syndromes

With both localized or generalized epilepsies, idiopathic subdivision means there is no known cause of seizures, but causes can be genetic. Symptomatic means there is a known cause. Cryptogenic means there is no visible cause, but there is a suspected or hidden cause.

Temporal lobe epilepsy fits well into symptomatic localization related epilepsy if MRI Brain shows scar tissue in the temporal lobe.

Autosomal dominant frontal lobe epilepsy is classified as idiopathic localization related epilepsy.

If tumor, stroke, or trauma related injury seen in frontal lobe is the cause of seizure, it will be considered as symptomatic localization related epilepsy.

Localization related epilepsies are those with area of abnormality in the brain where seizures originate. These regions can be frontal, temporal, occipital, or parietal lobes.

Generalized epilepsy means the seizures originate from both hemispheres at the onset. Generalized epilepsies are classified as idiopathic, symptomatic or cryptogenic. Idiopathic generalized epilepsy syndrome include juvenile myoclonic epilepsy, childhood absence epilepsy, and juvenile absence epilepsy syndromes. Under symptomatic generalized epilepsy classification, Lenox- Gastaut syndrome and infantile spasms are well known.

Landau-Kleffner syndrome is classified as an uncommon epilepsy syndrome.

Special epilepsy syndromes include febrile seizure and reflex epilepsy such as photosensitive epilepsy, reading epilepsy, and others.

Why experts did classify seizures and epilepsy syndromes? What was the purpose?

Classification of the epilepsy syndrome is very important in determining further tests for evaluation and choosing the most appropriate medication to control seizures. For classification routine EEG and clinical and family history may not be adequate. Further tests such as video EEG monitoring is the gold standard test in determining type of epilepsy syndrome and seizures you have. If you have partial seizures, imaging techniques such as magnetic resonance imaging of brain, PET scan will be utilized to localize focus of seizures. Ictal SPECT is another way to find seizure focus and performed when clinical seizure is captured.

International classification of epilepsy syndromes and seizures are used by your doctor not just classifying what kind of epilepsy and seizure type you have, but also conducting the needed tests and determining type of treatment.

Why do I have epilepsy? Why me?

This is one of the most common questions the patients ask. There are many different underlying causes of epilepsy. Often the cause of your epilepsy can not be identified. Some of the known causes of epilepsy are as follows:

  • Head injuries: Concussion (brief loss of consciousness) is considered to be mild head trauma, and it may increase the risk of epilepsy slightly. Moderate or severe head injury with prolonged loss of consciousness or brain hemorrhage significantly increase the risk of epilepsy.
  • Brain infections such as meningitis, encephalitis, and brain abscess
  • Stroke: Ischemic (caused by lack of blood flow to parts of the brain) or hemorrhagic (bleeding into brain tissue) strokes increase the risk of epilepsy.
  • Alcohol: Heavy drinking (intoxication) or abrupt stopping of alcoholic beverages (“withdrawal” seizures) can cause an increased risk of epilepsy.
  • Brain tumors
  • Degenerative brain diseases, such as Alzheimer Disease and Parkinson Disease
  • Demyelinating diseases such as multiple sclerosis
  • Mental retardation and cerebral palsy
  • Cortical dysplasia and migration disorders: Here there is abnormality of brain growth, migration and maturation of the neuronal tissue. The neuronal tissue which migrated to inproper positions in brain result in “tangles” of neurons. These tangles have abnormal electrical connections, and therefore predispose brain to seizures.
  • Genetic predisposition: Some types of epilepsy run in families. If you have generalized epilepsy such as juvenile myoclonic epilepsy or childhood absence seizures, there is three to four fold increase in your first-degree relatives (parents, siblings, and children). First-degree relatives of patients with partial seizures have higher risk of developing epilepsy as the general population.
  • Age: The risk of seizures is highest in young children and in the elderly.
  • Gender: The incidence of epilepsy is higher in males than females. This may suggest that gender may be important in the development of epilepsy.
  • Febrile seizures during infancy increase the risk of epilepsy development later.
  • Connective tissue disorders, like vasculitis are associated with increased risk of epilepsy, if there is central nervous system involvement.
  • Cancer with spread to brain and side effects of chemotherapy
  • Some other disorders such as mitochondrial diseases, migraine, and psychiatric conditions are also associated with increased risk of epilepsy.

Leave a Reply

Your email address will not be published. Required fields are marked *

Copyright © 2011 Epilepsy Doctor. The contents of epilepsyphysician.com are for informational purposes only. The content of this website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You should always seek the advice of your physician or other qualified health provider with your questions regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the website.