Epilepsy has been around forever. Traces and mentions of it can be found in documents dating as far back as 4,500 B.C. From ancient Greece to the Middle Ages, seizures were attributed to demonic manifestations and belonged in the realm of the supernatural. The ostracism shown towards epileptics is therefore nothing new…
Even today, epilepsy is misunderstood and there are many misconceptions about it. Those with the condition are still all too often subject to prejudice and discrimination. And while we hear very little about epilepsy, it isn’t because the disorder is rare – it is estimated that one percent of the Canadian population has one form or another of epilepsy and that nearly 80 percent of cases are diagnosed during childhood or adolescence. Other than migraine, epilepsy is the most common neurological disease. It’s worth talking about!
In Canada, March is Epilepsy Awareness Month. Whether it pertains to clinical or fundamental research, or to the prejudices and taboos that surround the disorder, there is still much work to be done in this area.
It is therefore through a great many education and awareness programs, as well as through support to those affected and their families, that Epilepsy Canada pursues its efforts to bring the condition out of the shadows. The best way to demystify the disorder and to help people who are affected is therefore to disseminate more information about epilepsy.
What is epilepsy?
The brain is an extremely complex organ. It is the powerhouse that governs our movements, actions, thoughts, perceptions, vital functions, etc. All of these functions are carried out by a network of infinite brain cells that communicate together through small, synchronized energy discharges. An epileptic seizure occurs when communication within a group of brain cells occurs in an abnormal manner. The electrical discharges are then sudden and disorganized, which alters the person’s movements, actions or state of consciousness for a short period of time.
What causes epilepsy?
Epilepsy can strike anyone at any age, without regard for nationality or social environment. Research has made it possible to identify certain factors responsible for the brain lesions that can induce epilepsy, such as tumours, head trauma, infection or intoxication. However, the cause remains unknown in nearly 75 percent of cases, which is why fundamental research remains crucial in this field.
Are there different forms of epilepsy?
The manifestations of epilepsy can be quite varied, the most commonly known being convulsive seizures. Some seizures, however, can manifest very differently, for example through a fixed gaze, muscle spasms, strange sensations or an altered state of consciousness. The manifestations and frequency of the seizures varies greatly from one person to another, depending on the area of the brain where the abnormal electrical discharges occur.
Seizures are classified into several medical categories. One basic distinction relies on the extent of the seizure. An electrical discharge that is limited to a specific area of the brain will result in what is called a focal or partial seizure. When the whole brain is affected, the seizure is termed generalized.
Complex partial seizures are the most common clinical presentation, affecting nearly two-thirds of epileptic individuals. In this presentation, affected individuals appear stunned and confused, walk around blindly, roll their head constantly or pull on their clothes while muttering. They generally have no residual memory of the event. The treatment and management of epilepsy varies according to the type and frequency of the seizures.
How is epilepsy treated?
Epileptic patient management is no banal matter. It must be taken into account that seizures can brand epileptic individuals and impede their everyday activities. Their care therefore entails not only medically treating their seizures, but also supporting them and their loved ones in order to reduce collateral damage. To that end, there are many organizations – local epilepsy associations or support groups – that can offer invaluable outside help.
Addressing the medical problem remains essential, however. Clinicians can treat epilepsy in two ways. The first involves controlling the seizures through anticonvulsant medication. When this treatment is undertaken, the goal is not to cure the individual but rather to reduce the frequency of the seizures in order to make the disease more socially acceptable.
For a long time, the arsenal for treating epilepsy was quite meager and doctors could only count on a few traditional drugs. Scientific breakthroughs in the past few years have led to the launch of several new medications that are effective in treating refractory seizures. It is estimated that adding a new agent to a traditional treatment can potentially cut seizures by 50 percent in 20 to 50 percent of patients.
When initiating a pharmacological treatment, the latter must be tailored to the individual by finding the dose that best controls symptoms while producing the least adverse effects possible. When it is properly adapted, the treatment can allow for complete seizure control in nearly 70 percent of cases. This type of treatment can therefore be very effective, but it requires that patients get actively involved, as it is very important to take the medication exactly as prescribed by the physician and according to the most regular schedule possible. The efficacy of the product depends partly on the stability of the concentration achieved in the blood. If patients do not tolerate the treatment well or frequently forget doses, it is important that they speak to their physician and pharmacist in order to find a solution to the problem.
Likewise, patients must not stop taking their anticonvulsant medication suddenly. They must discuss any break in treatment with their physician, gradually decrease the dose and closely monitor any effect on the control of their epileptic seizures. Stopping this treatment suddenly can lead to repeated seizures within a short span of time, which could have potentially serious consequences.
For reasons still unknown, some individual have seizures that are more difficult to control; in such cases, it may prove necessary to combine several drugs. A small proportion of patients with chronic epilepsy do not respond to the medications currently on the market.
The other alternative involves surgery. More and more doctors turn to this option for patients who do not respond (or respond very little) to anticonvulsant medication. Technological advances now make it possible to better identify the source of the seizures in the brain. In some cases, physicians may contemplate a surgical procedure that involves removing the exact area in the brain where the seizures occur. This is a delicate procedure, however, and not all epileptic patients are good candidates for it.
Proper epilepsy management should not only allow those affected to obtain relief from debilitating seizures, but also to avoid long-term psychosocial consequences stemming from having to live with poorly controlled epilepsy.
Living with epilepsy
Having epilepsy does not necessarily mean that we can no longer drive a car or do sports! The various treatments available on the market increasingly allow for good symptom control, which lets epileptic individuals enjoy a normal, active life. However, it is important for them to take into account the type of activity they want to practice and the level of control they have over their seizures. No general advice or rule applies to all cases. Epileptic individuals must first and foremost use their judgment and practice activities accompanied by persons who are aware of the situation and know what to do in case of a seizure.