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May 16, 2001

Like many neurological conditions, epilepsy is a disease about which there are many misconceptions. People with epilepsy are basically no different to the rest of society - except they are prone to recurrent seizures. Jennifer Paterson reports.

What is Epilepsy?

The seizures epileptics experience are caused by a temporary change in the way their brain cells work. The brain functions something like a computer, with a vast network of nerve cells called neurons. Electrical signals fired between these cells control everything we think, feel or do.

Inbuilt 'balancing' systems ensure that the messages that travel between these nerve cells do so in an orderly way. However an upset in brain chemistry can sometimes cause messages to become scrambled, and neurons to fire faster than usual.

It's this unpredicted activity that triggers a seizure.

During a seizure an individual may experience a number of unusual sensations or movements. The seizure usually only last for a matter of seconds or minutes, after which brain cells will return to normal.

Who develops epilepsy?

The disease affects people of all ages, and from all walks of life, however boys and men tend to be slightly more likely to develop it. No definitive evidence has been established as to why this is this case.

Many who develop epilepsy do so in childhood, but it can affect individuals of any age. Sometimes the reason it develops is quite obvious -brain damage at birth; a blow to the head; an infection such as meningitis; a stroke where part of the brain dies; or cerebral hypoxia where the brain is starved of oxygen (breath holding, carbon monoxide poisoning, anaesthesia). Other causes include brain tumours, heat stroke, toxic agents (lead, alcohol, strychnine) and occasionally external stimulation from sound and light.

The tendency to have seizures may also run in some families. It is not the epilepsy itself that is inherited, rather a low 'trigger point' or 'seizure threshold'. Basically what this means is that this type of individual is more likely to be affected by a change in circumstance, which would not cause other people to have a seizure.

For most epileptics, around six in every ten, the exact cause of their illness is still a mystery.

Types of seizure

Epilepsy is referred to as a single condition when there are in fact over 40 types of seizures. They affect sufferers differently, and each individual will experience epilepsy in a unique way.

Most seizures are of two types: generalised or partial. The symptoms individual experiences will depend on where the change in brain activity begins and how widely and rapidly it spreads out.

Generalised seizures affect the whole brain and are bilaterally symmetrical, while partial seizures, as the name suggests, start in just one part of the brain and can occur with or without loss of consciousness.

What causes a seizure?

Most seizures will strike suffers unexpectedly, however it is possible to pinpoint certain factors which spark them off.

These can include:

Alcohol - excess alcohol consumption has been known to trigger seizures, even in those without epilepsy.

Stress - many epileptics experience more seizures during periods of anxiety or stress. This may be due to sleep patterns being disrupted.

Light patterns - a commonly held belief is that watching TV, playing video games, or certain patterns of light (such as strobe lights) can trigger seizures. This is true for a minority of individuals who are photosensitive, but only about five percent of epileptics are affected in this way.

Late nights or lack of sleep - a series of late nights, or complete sleep deprivation, can trigger seizures.

Illness - high temperature (fever) can bring on a seizure, probably because it lowers seizure threshold.

Hormones - many women report that seizures are often linked to their menstrual cycle.

Natalie, 29, was first diagnosed with epilepsy at the age of 15: "The first time I was aware that I had Epilepsy was just after I had turned 15. I was diagnosed with Tonic Clonic Type.

"I'm told (as I don't remember anyhing 10 minutes prior to my jerking fits) that I would go into a daze, be confused, start mumbling things, and then I would lose consciousness. My body would get rigid and I would start to jerk and twitch and shake.

"While I was in this state I would lose control of my bladder and then when I came out of it (this I always remember - wishing I didn't though) I would vomit to the point where I was bringing up the acid in my stomach, would have a shocking migraine and feel as if I was floating in between two worlds. Which then I would have to sleep off. On a two occasions I'm told when had a fit I also frothed at the mouth.

"It didn't really start to have a huge impact until I was at the age where you start to go out, and suddenly had all these rules that I had to follow. I wasn't allowed to drink alcohol, and any other substances would have been a big risk. Mixing my medication with the other things could have left me in a coma or even dead. I wasn't allowed to drive unless I had a record of seizure free for five years and then only if my specialist approved it and thought it safe enough.

"When I was going for job interviews I had to state that I had epilepsy and some cases some certain individuals wouldn't take me on once they learnt I had it. The medication made me put on weight, had an effect on my kidneys and liver. I had to be careful in sexual activities as I couldn't go on the pill and it would have been stupid of me to fall pregnant, as there would be a lot of complications - like spending the majority of the nine months in bed. I would have to discontinue my medication.

"I was treated by my family and friends with kid gloves (which I hated) my parents got to a point where they were too scared to let me out of their site.

"When reached the age where I was allowed to legally go out to clubs and bars I was always on guard in case lights, strobes and the heat of the place would make me have one of my fits. Which basically took all the fun out of going out.

"It seems that my menstrual cycle had a lot to do with what was causing my fits. I was getting the fits around the same time in the month and always about one week prior to getting my periods.

"Once I was put on my medication I didn't have any more seizures. I was taking one tablet in the morning, and two tablets at night.

"There have been many people who, as soon as they learnt that I had epilepsy, would immediately move a few feet away from me and ask "Is it 'catchable', can I get it being in the same room as you?" or "Wow - you can't even tell that you have epilepsy!"

"I found that as soon as they learnt that I was an epileptic they would start to treat me differently, sometimes as if I were a cripple. I know they all meant well but it's hard being treated as if you are weird."

Diagnosis and Treatment

Epilepsy can be difficult to diagnose, as there can be many other reasons for loss of consciousness. No one test is available to diagnose the condition. About one in 20 people have an epileptic seizure at some time in their lives but not all develop epilepsy. For this reason some doctors prefer to 'wait and see' after a single attack.

A brain specialist (neurologist) may use a combination of electroencephalograms (EEG), CT or brain scans, blood tests and patient reports to make a diagnosis.

There is a wide choice of effective anti-epilepsy drugs available Australia today. They act in several ways and usually come in tablet or capsule form, or as syrup for children. For four out of five sufferers, taking the right drug can control seizures. All medicines have potential side effects as well as benefits.

For sufferers whose seizures are confined to a particular part of the brain, surgery may help control seizures by removing a small amount of tissue in the area involved. However, only this type of procedure can help a small percentage of sufferers who usually can not be controlled on medication.

Learning to live with epilepsy

It's a sad fact that epilepsy is still treated by many as a mental illness or handicap. Faced with these kinds of misconceptions, it's not surprising that many sufferers choose to keep their illness a secret. However, like many other illnesses, epilepsy can be managed to the degree that sufferers are able to lead relatively normal lives, without too many problems.

May 13th -19th is Epilepsy Awareness Week

By Jennifer Paterson

Reprinted with permission from Editforce

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