Seizure Disorder (Epilepsy), Part 1 — Description and Diagnosis

What is epilepsy?

Epilepsy is a disorder of the central nervous system (brain) characterized by recurrent (repeated) seizures. A person with epilepsy is prone to seizures due to a presumed or identified problem in the brain. Previously, most authorities had required at least two seizures before labeling the disorder as "epilepsy". However, with the development of newer and more sensitive diagnostic technologies, plus a wider selection of medications, the diagnosis may now be established more rapidly. Prompt diagnosis allows the doctor to begin appropriate treatment much earlier.

Neurologists currently refer to this disorder as a "seizure disorder", rather than "epilepsy". The term seizure disorder is actually more descriptive and more accurate. In addition, the older term still carries a social stigma.

What is a seizure?

CT of the head. A seizure is a sudden, time-limited event that results from abnormal activity in the brain. It appears as an involuntary alteration in perception, behavior or movements. Perception may include what the person sees, hears, smells, tastes or feels. Seizures are believed to be due to abnormal rapid and synchronized electrical discharge of cortical neurons (nerve cells near the surface of the brain). The physical behaviors or actions are usually stereotyped (characteristic) and repetitive.

Neurologists also identify "non-epileptic seizures", which are events that resemble seizures physically, but are not caused by abnormal brain activity. These are also referred to as "pseudoseizures" or "paroxysmal non-epileptic seizures".

What does a seizure look like, and are there different types of seizures?

There are many different types of seizures. Seizures can look very different from person to person and even from event to event for the same person. Seizures are categorized by how they start in the brain and how they affect consciousness.

Partial seizures start in a specific area of the brain, rather than in the entire brain at once. They may cause the individual to feel or see something that is not there (hallucinations), or to move a specific part of the body. If the patient remains fully conscious, it is called a simple partial seizure. If consciousness is impaired, it is then called a complex partial seizure. In this type of seizure, the patient might appear dazed, have a dim memory of what happened, or be only partly responsive. The most notable observation is the fact that the patient will usually remember the beginning of a partial seizure, and will often recall some warning symptom, or "aura", before the seizure started. This aura can be extremely helpful. It can allow the patient to seek help and get to a safe location before the seizure begins.

If the seizure includes the entire brain at the same time, it is called a generalized seizure. Historically, generalized seizures were broken into several categories:  sudden staring spells, formerly called absence (ab-SAWNS') seizures; loss of consciousness without movement, formerly called petit mal (PE'-tee-mawl) seizures; and the typical seizures, formerly called grand mal (GRAHN'-mawl) seizures, also called generalized tonic-clonic seizures. These are now referred to as primary generalized seizures. Sometimes, a seizure may start out as partial or focal, and then spread to involve the entire brain. These are referred to as secondarily generalized seizures. In general, partial or secondarily generalized seizures require more attention and testing to determine the specific cause for the seizures.

The brain controls muscle movements. Because the patient's brain causes or "has" the seizure, it is possible for the patient to do almost anything during the seizure. However, the patient cannot control these actions, and will not respond to another person during the seizure.

Electroencephalogram (EEG)

An electroencephalogram (EEG) is a recording of the child's brain wave activity using a special apparatus. This is similar to using an electrocardiogram (ECG or EKG) to obtain a recording of the electrical activity of the heart. During the procedure, electrodes (wires) are attached to the child's scalp with a special glue that will conduct the brain's electrical activity. Typically, the brain activity is recorded for 30 to 45 minutes, including samples during both sleep and wakefulness. Sometimes, the doctor will need a longer recording, lasting two of more hours. In certain circumstances, such as when the doctor needs to better determine the exact origin of a partial seizure, a special recording that combines the EEG with a video record of the child's activities may be needed. This type of recording can run for several days and requires admission to the hospital.


For more information:

Part 2 — Treatment, Side Effects, Restrictions, and Implications for School

Pediatric Epilepsy Update Workshop
March 12, 2010, KU Medical Center

View three separate presentations from experts in the field.
<View the presentations>

Epilepsy Foundation

8301 Professional Place
Landover, MD 20785-7223
(800) 332-1000

Living with Epilepsy (great videos for kids, teens, adults and those who care about them)

From the Epilepsy Foundation: "Entitled to Respect ... Get the Word Out", a brochure for teens and "tweens" with seizures as well as their family and friends.

Epilepsy.com

http://www.epilepsy.com/
Information for families, caregivers, children, teens, women and seniors.

Contributed by:

Enrique Chaves, MD
Clinical Professor
Pediatric Neurology
Department of Pediatrics
University of Kansas Medical Center

Kathy Davis, MSEd, PhD
Associate Professor
Project Director, Connected Kansas Kids
Director, KU Kids Healing Place
University of Kansas Medical Center