| Epilepsy is the term used to describe any seizure disorder with repeated episodes of seizures (of any type) with no known cause. Information is transmitted from one nerve cell to another through an electrochemical process (electrical activity). Seizures are caused by a chaotic and unregulated disruption of the normal electrical activity of the brain as measured by an electroencephalogram (EEG).
Epileptic seizures are generally classified into generalized and partial seizures. Generalized seizures involve all or most of the brain, affecting the whole body and causing loss of consciousness. Partial seizures affect only a portion of the brain and may not result in loss of consciousness. Although partial seizures begin in a limited area of the brain, the electrical disturbance can spread and affect the whole brain, possibly evolving into a generalized seizure.
The most recognized type of seizure is the convulsive or generalized motor seizure. It is characterized by abnormal and sometimes violent movements of the whole body or only parts of the body. It can start out as a partial seizure and evolve into a generalized seizure. An example of a generalized motor seizure is the grand mal seizure.
The cognitive or absence seizure occurs when the individual does not respond in a normal manner to his or her surroundings for a brief period of time. There is no loss of consciousness. Absence seizures may also be referred to as petit mal seizures.
Sensory seizures can result in a wide and strange variety of reported symptoms, such as dizziness (vertigo) and tingling or numbness in a part of the body (paresthesias) or the perception of sounds, visions, and smells that do not really occur (auditory, visual, and olfactory hallucinations).
Seizures can result from various diseases or injuries. Epileptic seizures may be associated with birth trauma, head injury, central nervous system infections, brain tumor, stroke, ingestion of toxic substances, or metabolic imbalance. There may be an inherited tendency toward seizures.
Seizures with no apparent cause account for half of the cases in adults (Schachter). These seizures may actually result from microscopic brain lesions that occurred during birth or other trauma or from unexplained metabolic disturbances. A single seizure or episode of seizures does not necessarily mean that the individual has epilepsy.Risk: The number of men who develop epilepsy is slightly higher than the number of women. Children, the elderly, blacks, and those who are economically disadvantaged are more likely to develop epilepsy. The condition can appear at any time in an individual's life, especially during childhood and old age. Incidence and Prevalence: Approximately 2.5 million individuals in the US have been treated for epilepsy in the past five years. An estimated 0.5% to 2% will develop the condition during their lifetime (Schachter). There are approximately 50 million cases of epilepsy around the world; about 5% of the world's population will experience a seizure at some time during their lives (Schachter). |
Source: Medical Disability Advisor
| History: The type of symptoms and physical signs described by the individual or an observer depend on which part of the brain was affected. The history is very important in the diagnosis of epilepsy. A detailed description of the seizure from the individuals themselves or an observer is noted. Since individuals often do not remember the event, information obtained from someone who has witnessed the seizure is a valuable part of the history. If the individual is conscious throughout the seizure, he or she may be able to recall symptoms or other details. Many individuals with epilepsy have no symptoms between seizures (the inter-ictal phase). Others may have an aura characterized by restlessness, irritability, or an uncomfortable feeling that precedes a seizure (pre-ictal state).
The documented seizures must be recurrent and chronic in order to confirm a diagnosis of epilepsy. An isolated seizure episode of any type is not an epileptic seizure. In fact, if there is no history of seizures, a single seizure or repeated seizures in a short period of time may be a sign of a serious underlying disease, chemical imbalance, drug or alcohol use, stroke, or a tumor. Physical exam: The exam may be entirely normal. If the individual is examined immediately after the seizure, a complete neurological exam may be postponed if the individual lost consciousness or is not alert. The period after the seizure is called the post-ictal phase. Some types of seizures leave the individual fatigued or confused and unable to follow directions. It is important to focus on findings that may indicate a brain lesion. Tests: The approach to testing depends on whether or not it was the individual's first seizure. If it was the first episode, extensive testing is necessary. Comprehensive blood tests look for a metabolic or chemical cause for the seizures. Routine tests include MRI, EEG, CT, and possibly a cerebral angiogram. The EEG is the most useful test in classifying seizures and can direct the best approach to therapy. Positron emission tomography (PET) imaging can be used to identify areas of the brain that are producing seizures. Occasionally a 24- to 72-hour sleep study or epilepsy lab observation may be necessary to help classify the type of seizure, or to rule out pseudo-seizures (the manifestation of malingering, factitious disorder, or hysteria).
If the individual was previously seen for seizures and the diagnosis of a recurrent seizure disorder or epilepsy was established, then the testing is more limited. If the individual is on medication for seizures, measurement of blood drug levels can determine whether the individual has been taking the medications or if the dosage should be changed. |
Source: Medical Disability Advisor
| Treatment of the underlying cause, if identified, may stop the occurrence of seizures. Such treatments may include medication, surgery, a special diet, or implanted device, depending on the underlying cause.
Oral anticonvulsant medications help prevent or minimize the number and severity of future seizures. Response to treatment with oral anticonvulsants varies with different individuals. The medication or combination of medications and their dosages may be changed frequently until the optimal treatment regimen is found. These medications may have unpleasant side effects, including drowsiness and impaired concentration that may lead to noncompliance. Follow-up visits should be scheduled anytime from monthly to annually, depending on response to treatment. Monitoring of plasma drug levels is important for seizure control.
In approximately 15% to 25% of individuals with epilepsy, seizures cannot be controlled with medication, and individuals may be evaluated for epilepsy surgery. The most common form of surgery involves the removal of the area of the temporal lobe where the seizures originate (temporal lobectomy). Resections of the frontal lobes can also be performed (extra-temporal resections).
Another treatment used when medications fail is vagus nerve stimulation (VNS). In this procedure, a generator is surgically implanted in the left chest wall. An electrode lead that is attached to the left vagus nerve is tunneled under the skin and connected to the generator. After implantation, the generator is programmed to deliver intermittent bursts of electricity to the vagus nerve. |
Source: Medical Disability Advisor
| Epilepsy (idiopathic seizure disorder) is a chronic, usually lifelong condition. Anticonvulsant therapies prevent or minimize the number of seizures. Surgical removal of brain lesions may stop or lessen seizure activity. For some individuals, the need for medication may be reduced or eliminated over time (the milestone for this change in treatment is a seizure-free period of 2 years).
Death or permanent brain damage from epilepsy is rare but can occur with prolonged seizures or status epilepticus. |
Source: Medical Disability Advisor
| Complications of epilepsy include prolonged seizures (status epilepticus), injury from falls, injuries from self-biting (during a seizure), injuries sustained while driving or operating machinery during a seizure, pneumonia secondary to foreign matter such as food particles in the lungs (aspiration pneumonia), stroke, brain damage, and learning disabilities.
Age-related physiologic changes may affect the pharmacokinetics of anticonvulsant therapies; therefore, careful, routine monitoring of anticonvulsant levels in older individuals is imperative. |
Source: Medical Disability Advisor
| An individual with epilepsy may be unable to perform jobs that require operating machinery, driving motor vehicles, or working from heights. Special precautions should be taken for those individuals at risk of recurrent seizures. These rules may be gradually relaxed if an individual remains seizure-free for a period of 1 year.
Individuals with epilepsy should wear a medical identification bracelet or carry an informational card to aid in obtaining proper medical treatment if a seizure occurs. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- What type of seizure does individual have—generalized motor seizure (grand mal), partial seizure, cognitive or absence seizure (petit mal), or sensory seizure?
-
Does individual have idiopathic seizures?
-
Does individual have an aura?
-
Has individual had birth trauma, head injury, central nervous system infections, brain tumor, stroke, ingestion of toxic substances, or metabolic imbalance?
-
Does individual have a family history of seizures?
-
Has individual had a witnessed seizure?
-
Are individual's documented seizures recurrent and chronic?
-
Has individual had a single seizure or repeated seizures in a short period of time?
-
Is it a sign of a serious underlying condition?
-
Has individual had comprehensive blood tests, skull x-rays, MRI, EEG, CT, and possibly a cerebral angiogram?
-
Has individual had sleep study or epilepsy lab observation?
-
If individual has a diagnosis of epilepsy, were drug levels done?
-
Have conditions with similar symptoms been ruled out?
Regarding treatment:
- Has an underlying cause been identified?
-
Is individual on oral anticonvulsant drugs?
-
Does individual see physician regularly for monitoring plasma drug levels?
-
Is individual a candidate for surgery?
-
Has vagus nerve stimulation been considered?
Regarding prognosis:
- Is individual's employer able to accommodate any necessary restrictions?
-
Does individual have any conditions that may affect the ability to recover?
-
Does individual have any complications, such as status epilepticus, injury from falls, injuries from self-biting (during a seizure), injuries sustained while driving or operating machinery during a seizure, aspiration pneumonia, stroke, brain damage, and learning disabilities?
|
Source: Medical Disability Advisor
| Schachter, Steven. "What Causes Epilepsy?" Epilepsy.com. 14 Sep. 2004 <http://www.epilepsy.com/101/ep101_who.html>. |
Source: Medical Disability Advisor
| Feedback |
| Send us comments, suggestions, corrections, or anything you would like us to hear. If you are not logged in, you must
include your email address, in order for us to respond. We cannot, unfortunately, respond to every comment.
If you are seeking medical advice, please contact your physician. Thank you! |
Send this comment to:
Sales
Customer Support
Content Development
|
|
| |
|
|
|
|
|
This publication is designed to provide accurate and authoritative information in
regard to the subject matter covered. It is published with the understanding that
the author, editors, and publisher are not engaged in rendering medical, legal,
accounting or other professional service. If medical, legal, or other expert assistance
is required, the service of a competent professional should be sought. We are unable to respond to requests for advice.
Any Sales inquiries should include an email address or other means of
communication.
|