February 25, 2011
MMS Physician Focus: February 2011
By Andrew Blum, M.D., Ph.D., and Catherine Phillips,
M.D.
Epilepsy is the third most common neurological disorder in the
United States, after Alzheimer's disease and stroke. Nearly three
million Americans have the condition, and 200,000 new cases are
diagnosed each year, according to The Epilepsy Foundation. Half of
all patients are children.
Yet as widespread as this condition may be, two characteristics
perhaps set it apart from others: it's still somewhat of a mystery
in the mind of the public, and the effects of this condition on the
patient go far beyond the physical. Here's some basic information
on this disorder.
Epilepsy is characterized by spontaneous, recurrent seizures
under conditions that would not normally cause seizures. The
seizures are caused by irregular brain activity - excessive
excitability of nerve cells in the brain resulting in neurons that
fire in an abnormal way.
This abnormal activity affects an individual's behavior, and
that behavior can vary considerably along a spectrum: A person may
fall to the ground and shake all over, or just stop and stare. Or
there may be some reaction in between. The seizures - which may
last from a few seconds to a few minutes and are followed by
confusion - can produce involuntary movements, changes in
awareness, altered behavior, or loss of consciousness. It can also
be life threatening.
Different types of seizures may occur, depending on which part
of the brain and how much of it is affected by the abnormal
activity. The origin of the activity may be due to any one of a
number of factors, among them head trauma, infections, sleep
deprivation, or genetics. And the condition can affect anyone, from
newborns to the elderly. A recent study by Columbia University
Medical Center in New York, in fact, suggests that older adults are
more at risk for developing epilepsy and that more people will
develop epilepsy in their lifetime than previously thought.
It's important to recognize that epilepsy is characterized by
spontaneous, recurrent seizures. Up to 10 percent of the population
may experience a seizure sometime in their lives (such as a febrile
seizure in infants, caused by fever), but to be epilepsy,
spontaneous, recurrent seizures -- under conditions that would not
normally cause seizures --must be present.
Epilepsy can be difficult to diagnose, as physicians must
distinguish the disorder from such conditions as migraine
headaches, fainting spells, or transient ischemic attacks (TIA),
the last of which produces stroke-like symptoms. The first step in
diagnosis, and perhaps the most crucial, is compiling an accurate
medical history of the patient. That often means getting
information from family members or witnesses who can describe the
seizures and what the patient actually experienced -- because many
times the patient will not even know they've had a seizure.
The history is then followed by medical tests, which include an
electroencephalogram (EEG, a test to detect problems in the
electrical activity of the brain), or imaging tests such as
Magnetic Resonance Imaging (MRI), or Computed Tomography (CT) to
see what is happening inside the brain and body. Treatment may
entail any one of a wide array of anti-convulsant medications (with
a careful eye to any side effects the patient may experience),
vagal or cranial nerve stimulation, special dietary approaches (the
"ketogenic diet") or in some special cases, surgery.
Epilepsy is a major chronic medical condition, similar to
arthritis, heart disease, diabetes or cancer. It can limit
activity, and cause pain, anxiety or depression. The impact of
epilepsy on the patient, however, goes far beyond the physical. The
emotional effects of epilepsy can be substantial, as the disorder
can mean problems with memory and learning, stress, depression, and
anxiety. Another major issue for epileptic patients is driving, as
patients are prohibited from operating a motor vehicle until they
can go six months without seizures.
Social stigma and discrimination, that might appear in
workplaces and schools, may occur as well, although we have made
progress in those areas; our culture is today much more attuned to
epilepsy representing a disorder of the brain, much as
diabetes is a disorder to the body.
For more information on epilepsy, including how to recognize
when someone is having a seizure and the key things to remember
when providing first aid for seizures, visit www.epilepsyfoundation.org.
For a video discussion on the topic, visit www.physicianfocus.org
Andrew S. Blum, M.D., Ph.D., Director of the Comprehensive
Epilepsy Program at Rhode Island Hospital in Providence, and
Catherine Phillips, M.D., Co-Director of the Comprehensive Epilepsy
Program at UMass Memorial Medical Center in Worcester, are Chairman
and Board Member, respectively, of The Epilepsy Foundation of
Massachusetts, Rhode Island, New Hampshire, and Maine.
Physician Focus is a public service of the Massachusetts Medical
Society. Readers should use their own judgment when seeking medical
care and consult with their physician for treatment. Send comments
to PhysicianFocus@mms.org
