Epilepsy
Other articles:
Multiple Sclerosis
Epilepsy in the Workplace
The word “epilepsy” derives from the Greek word “to be
seized”. It is a generic term that refers to a wide variety of
seizure conditions. There are very well known individuals in
history such as Julius Caesar, Socrates, Vincent van Gogh,
Dostoyevsky, and others who had active seizure conditions, as do
a number of present day celebrities, sports figures, and
political figures (e.g., Margaux Hemingway, Buddy Bell, Tony
Coelho). These individuals were or are quite obviously very
productive persons contributing significantly to society.
A seizure involves a disruption of the normal activity of the
brain through neuronal instability. Neurons become unstable and
fire in an abnormally rapid manner, similar to a misfiring
engine, with the excess electric discharges resulting in a
seizure. The seizure may be confined to one area of the brain
(partial seizure) or take place throughout the entire brain
(generalized seizure). It is of interest that the most common
generalized seizure, formerly known as a “grand mal” seizure
(now known as a tonic‑clonic seizure), is often easier to
control than a partial seizure. A majority of the individuals
coming to specialized epilepsy centers for treatment have
partial seizures which can be more difficult to control --
although usually functionally safer. The causes of epilepsy are
wide ranging and include infectious diseases in a pregnant
mother, parasitic infections, vascular diseases, birth trauma,
etc. The genetic causality for epilepsy is only within a range
of 1-2%. It must be remembered that epilepsy involves recurring
or more than one seizure -- for various medical reasons any
number of individuals may experience a singular seizure.
Establishing a seizure diagnosis involves medical history taking
and evaluation by a neurologist, but generally awake and/or
sleep electroencephalograph (EEG) assessment. It is important to
note that precise seizure diagnosis can involve not only both
types of EEGs, but may involve magnetic resonance imaging (MRI),
computerized tomography (CT) scanning, or even 24 hour EEG video
monitoring. The MRI can now be the first step in diagnostic
sequence, preceding EEG. Many individuals with the correct
diagnostics and medication can have their epilepsy easily
managed. The vast majority of individuals with epilepsy can have
complete seizure freedom or good seizure control. Individuals
with recurring seizures should always be referred to a
neurologist. If a neurologist cannot achieve seizure control
with an individual over a nine month period, referral to a
specialized epilepsy center should be made. During the 1990s, a
number of new medications including Gabepentin, Lamotrogine, and
Topiramate have been developed‑‑a third generation of
medications. Some of the newer medications can be used
individually or as “add on” drugs usually without negative side
effects. A number of individuals in our society with continuing
seizures are often not adequately medically treated. In addition
to anticonvulsant medications, some individuals can benefit
dramatically from use of a vagal nerve stimulator (VNS) or
epilepsy surgery relative to seizure freedom or improved
control.
First Aid for Seizures
Since the majority of individuals with epilepsy have partial
seizures which typically involve a short period of
disorientation (e.g., 30 seconds) or brief cessation of
activity; first aid concerns are minimal. These individuals
simply need to be watched during the period of seizure, or
gently guided (not restrained) to a chair with reassuring
statements. For individuals who have a generalized tonic‑clonic
or grand mal seizure involving loss of consciousness, a period
of rigidity, and convulsions, the most important first aid
concern is that the seizure be timed. Emergency medical aid is
not required unless the seizure length approaches five minutes.
Most of these seizures last slightly over a minute. Most persons
will require some time in order to orient and compose themselves
post‑seizure. When possible they should be turned on their sides
for comfort and any harmful items moved out to the way. It is
often dangerous to individuals with seizures to try to place
something in their mouths during a seizure (e.g., to prevent
biting their mouths) and simply not necessary.
