A Brief Overview of Epilepsy: The Oldest Known Neurological Disorder

Epilepsy may be the oldest known neurological disorder. Many say Hippocrates identified Epilepsy as a disease of the brain in his work, On The Sacred Disease, in 400 B.C. A few even say that the Code of Hammurabi may have mentioned the phenomenon of seizures. (Wells-Duncan, 1980, p. 116) For some time, the general populace attributed supernatural reasons for seizure disorders and epilepsy. For instance, when Jesus cast the demon out of that man who kept falling down, it is now thought that the man may have been an epileptic. To take it another step, what better way to show a god's displeasure than by striking you down with ��"šï¿½ï¿½"fits��"šï¿½ï¿½?

Today, we of course have a much better understanding of seizure disorders, and in specific, epilepsy. However, to understand epilepsy, it is necessary to have a basic idea of how the brain actually works. The brain is a wonderfully complex system of millions of cells called neurons, and their supporting glial cells. (Carlson, 2005, chap. 2) Each neuron rests itself in an electrically charged state. It receives signals from other neurons, and transmits them onward to other neurons. What happens inside is that a special chemical is released from the terminals of one neuron, only to elicit an electrical response in the next neuron in the sequence, and so the signal moves onward.

All functions of the body, from feeling, seeing, thinking, and even muscular activity depend on these electrochemical reactions moving from one neuron to the next, the message being interpreted as required. The normal brain is constantly generating these electrical signals in a fairly orderly way.

However, in approximately 2.5 million Americans, this signal does not always remain so orderly (My Web MD, 2005). This makes epilepsy a relatively common disorder, with about 1% of the U.S. population affected. In these people, ��"šï¿½ï¿½Å"normal' electrical functioning is scrambled by neurons discharging signals inappropriately. This may cause a type of electrical ��"šï¿½ï¿½"storm��"šï¿½ï¿½ that produces seizures, stemming from inherently unstable neurons from, for example, trauma, infections, tumors, or genetically predisposed factors (Aird, Masland & Woodbury, 1984, p. 1).

It is known that just about anybody can develop epilepsy under the right circumstances. Each person has an individual brain seizure threshold which makes us more or less resistant to seizures (National Society for Epilepsy [NSE], 2005). Someone who has a low threshold is apt to develop epileptic tendencies suddenly for no obvious reason. However, it may take a severe trauma of some sort to cause a seizure in someone with a high seizure threshold. The seizure threshold is part of our genetic makeup, and epilepsy does not limit itself to any age, sex, race, or lifestyle. However, it is known that roughly half of all epileptics have their first seizures before the age of ten.

There are several known forms of epilepsy. Most people will recognize the symptoms of a major epileptic seizure, the sudden loss of consciousness, convulsions, etc. But there are other types of epilepsy ��"šï¿½" for example, one form of epilepsy consists of staring blankly and losing awareness of the surroundings for a few seconds (Epilepsy.com, 2005)

The best way to begin classification is to divide them into partial and generalized seizures. The partial seizure is an abnormal electrical discharge that originates from one specific area of the brain. The generalized seizure is more encompassing, normally involving the whole of the brain. What can make it complicated is that a partial seizure may go on to become generalized, if the partial epileptic discharge is strong enough to spread to the whole brain. However, even if a partial seizure does progress, the initial symptoms will be enough to distinguish it from the other forms of generalized epilepsy, where the whole brain is involved from the start.

The partial seizure can then be categorized into two main types, simple partial, and complex partial (Epilepsy.com, 2005). The simple partial seizure is one in which the epileptic activity in one area of the brain doesn't impede consciousness. It may simply involve the involuntary jerking motion of a body part as the only symptom.

The complex partial seizure does involve the impairment of consciousness. For instance, the involuntary motion of a body part may be accompanied by an intense feeling of confusion or disembodiment.

Generalized seizures have a few more subcategory types than the partial seizures. Generalized seizures are separated into: tonic-clonic, absence, myoclonic, clonic, tonic, and atonic types of seizures (My Web MD, 2005).

The tonic-clonic seizures, or the ��"šï¿½ï¿½"grand mal��"šï¿½ï¿½, are fairly, well, grand. The attacks usually consist of a sudden stiffening of the body with loss of consciousness. This is usually followed by an intense period of violent convulsions, in which the victim may actually severely bite the tongue or lips, and maybe even lose urinary control. This is followed by deep sleep.

The absence seizures are just the opposite. The victim may not even know they are having these. Typically, the person stares vacantly for several seconds and seem to be unaware of their surroundings. These begin and end abruptly, and the person may only be aware that they are ��"šï¿½ï¿½"losing time��"šï¿½ï¿½.

Myoclonic seizures are characterized by sudden shock-like convulsions on both sides of the body. This occasionally occurs with loss of consciousness, and often leads to dropping of objects, or throwing things.

Clonic seizures are symptomized with sudden, repetitive jerking motions.

Tonic seizures mainly consist of total rigidity. Stiffness and arching of the back is a very common sign of a tonic seizure. This type of seizure may also be followed by a loss of consciousness.

And atonic seizures are the reverse of tonic. Muscle tone is lost during this seizure, resulting in a sudden fall to the ground or dropping of the head. Atonic seizures are also called the drop attack.

Epilepsy appearing for the first time in anyone should be investigated thoroughly. There are many different ways to make a study of epilepsy (Adams, Victor, & Ropper, 1997, Chap. 16). The first and most utilized method would be the EEG, or electroencephalograph, in which the brain's electrical rythms are monitored by electrodes placed on the scalp, and recorded on videotape or on a paper chart. However, since a proportion of patients will have no abnormality in their EEG patterns between attacks, additional tests may be needed.

Other investigational procedures may include blood tests, diagnostic imaging tests, such as the CT scan, or the MRI (Magnetic Resonance Imaging). Sometimes, in order to test whether or not there is a single epileptic focus which could be removed surgically, the radioisotope scan by SPECT (single photon emission tomography) or the PET (positron emission tomography) might be used.

Once effectively diagnosed, treatment of Epilepsy may begin. The most common method of treatment is through drugs. Many types of these drugs exist, so it is vital to know the type of epilepsy to choose the best drug for treatment.

And, since the reaction of a patient to any drug is as individual as the patient, many drugs may be tried before finding the most satisfactory match. Some very common drugs are Tegretol, Zarontin, or Felbatol. All drugs have different, possibly severe side effects, so newer, safer drugs are always being created. Some drugs work by increasing inhibition in the brain. Some work by preventing excitation in the brain. However, medication is often only effective for 70% of patients (My WebMD.com, 2005).

There are alternative methods in the event that drugs fail. Some epileptics require surgery to combat seizures. Such methods are the Corpus Callosectomy, in which the corpus callosum is cut, separating the two hemispheres of the brain, and preventing an epileptic attack from spreading to the entire brain. One method used when a specific area of the brain is determined to be the focus of the epileptic seizure, is to remove that portion of the brain, assuming it is in an area where removal does not significantly impair any major brain function.

It is important to understand, as well, that epilepsy does not just affect the brain (Adams et al., 1997, pg 341). It can have serious psychosocial effects also. Epileptics often have a feeling of inferiority, and are self conscious about their illness. Epileptics also evidence a marked increase in depression and social disorders. Patients and their families may benefit from extensive counseling, and a semblance of a normal life is crucial. Medical science has just begun to unravel the inner workings of the brain and those of neurological disorders. As we begin to understand the causes of such illnesses and disorders, perhaps a cure may be found for them, including epilepsy. Until that time, a little patience, kindness, and human understanding may be just what the epileptic, and indeed everyone, needs.

REFERENCES

Adams, R. D., Victor, M., & Ropper, A. (1997) Principles Of Neurology (6^th ed.) McGraw-Hill Companies Inc.

Carlson, Neil R., (2005) Foundations of Physiological Psychology (6^th ed.) Pearson Education Inc.

Haines, C., (2004) Epilepsy: Medications to Treat Seizures [www.MyWebMD.com]. http://my.webmd.com/content/Article/87/99652.htm

Holmes, G., (2005) Classifying Seizures ��"šï¿½" How Are Seizures Classified? [www.epilepsy.com] http://professionals.epilepsy.com/page/seizures_classified/

Wells, C. & Duncan G. (1980) Neurology for Psychiatrists (1^st ed.) Philadelphia: F.A. Davis Company

Epilepsy: Understanding Seizures and Epilepsy (2005) [www.MyWebMD.com] http://my.webmd.com/content/Article/87/99658.htm

Epilepsy: Type of Seizures and Their Symptoms (2005) [www.MyWebMD.com] http://my.webmd.com/content/Article/87/99668.htm

Information on Epilepsy: What is Epilepsy (2004) NSE The National Society for Epilepsy [www.epilepsynse.org] http://www.epilepsynse.org.uk/pages/info/leaflets/