Epilepsy – An Overview

Posted on August 01, 2018

Epilepsy is not one single condition. Epilepsy is defined as a spectrum of disorders that involve the central nervous system (brain and spine). In epilepsy, abnormal brainwaves disturb brain activity, leading to seizures. Seizures may cause people to have unusual sensations or emotions, behave in unusual ways, or experience convulsions or loss of consciousness. Brain damage, illness, and irregular brain development can all cause abnormal brainwaves that lead to seizures.

Approximately half of all people who have had one seizure will have more. However, in order to be diagnosed with epilepsy, a person must have had more than one seizure, and doctors must consider it likely that they will continue to have seizures.

Some forms of epilepsy only last for a limited time, while others are lifelong. There are many treatments available for epilepsy; about 70 percent of people with seizures can control them effectively with medication.

There are many different types of seizures, and some people with epilepsy will experience more than one type. Learn more about epilepsy symptoms and seizure types.

The history of epilepsy

People have been aware of epilepsy and seizures for millennia. A Babylonian medical textbook made up of 40 tablets and dating to 2000 BCE contains a chapter that accurately describes many of the different types of seizures known today. However, seizures were thought to be supernatural in cause – each seizure type was associated with a different evil spirit or angry god – so the treatments prescribed were spiritual.

By the 5th century BCE, the Greeks still considered epilepsy a "sacred" disease. Yet, in the writing of Hippocrates, the ancient physician described epilepsy as a brain disorder – a radical idea for the time. He recommended physical treatments while also recognizing that if the seizures became chronic, the disorder was incurable. The word "epilepsy" comes from the Greek word epilepsia, meaning "to seize" or "to take hold of."

Despite Hippocrates’ writings, epilepsy continued to be considered a supernatural condition for the next two millennia. People with epilepsy were subjects of immense social stigma, treated as outcasts and even punished as witches. In many places, people who suffered seizures were prevented from going to school, working, marrying, and having children. There were a few men with epilepsy who occupied prominent positions – including Julius Caesar, Tsar Peter the Great of Russia, Pope Pius IX, and Fyodor Dostoevsky – but most people with epilepsy were prevented from living as full members of society.

During the Renaissance, some scientists tried to prove epilepsy was a physical, not spiritual, illness. It wasn’t until the 19th century when neurology became a recognized medical discipline (separate from psychiatry), and the idea of epilepsy as a brain disorder took hold in North America and Europe. In 1857, Sir Charles Lacock introduced bromide as the first anti-epileptic drug (AED). In the mid-to-late 1800s, a variety of epilepsy colonies and treatment facilities opened.

In 1873, a British neurologist named John Hughlings Jackson first described epilepsy as we understand it today. Jackson proved that seizures are caused by sudden, brief electrochemical discharges of energy in the brain. In 1909, the International League Against Epilepsy was founded as a global professional organization of epileptologists. By the 1920s, Hans Berger, a German psychiatrist, had developed the electroencephalograph (EEG) to measure brainwaves. It showed that each type of seizure is associated with a different brainwave pattern. The EEG also aided in the discovery that specific sites in the brain were responsible for seizures and expanded the potential for surgical treatments. Surgery became a more widely available option by the 1950s.

Phenobarbital was identified as an AED in 1912, and Phenytoin (sold under the brand names Dilantin and Phenytek) was developed in 1938. Both drugs continue to be used today. Carbamazepine (sold under the brand names Tegretol and Carbatrol) was identified in 1953. An accelerated drug discovery process began in the 1960s as scientists gained a better understanding of the brain. Keppra (Levetiracetam) was approved by the U.S. Food and Drug Administration (FDA) in 1999. Several newer drugs, including Vimpat (Lacosamide), Briviact (Brivaracetam), and Aptiom (Eslicarbazepine acetate) have been introduced in past 10 years. Other promising medications are in the pipeline.

Neuroimaging capabilities have also improved over the past few decades. Magnetic resonance imaging (MRI), computer tomography (CT) scans, and other techniques are able to detect more and more subtle brain lesions responsible for epilepsy.

The stigma around epilepsy has lessened as more people are able to effectively treat their seizures; however, epilepsy largely remains an "invisible" illness. Millions of people in developing countries do not have access to AEDs, and stigma and discrimination are still widespread, especially in places where people still believe that seizures have a supernatural cause.

How common is epilepsy?

Males and females of all backgrounds, races, ethnicities, and ages are equally affected by epilepsy. It is estimated that epilepsy affects 1 percent of the population of the United States and over 65 million people worldwide, making it one of the most common neurological disorders. Approximately 45,000 children under the age of 18 are diagnosed with epilepsy every year in the U.S., and roughly 10.5 million children worldwide live with epilepsy.

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FAQ

Can you die from epilepsy?

The majority of people with epilepsy live a normal lifespan. However, people with epilepsy do have a higher overall risk of dying than the general population. How epilepsy affects mortality depends on the frequency and severity of seizures. For people whose epilepsy has an unknown cause, life expectancy is two years shorter on average. People whose seizures have a known cause die, on average, as many as 10 years before the average life expectancy. Some early deaths may be a consequence of falls or accidents – people with epilepsy and no other health conditions are 30 percent more likely to be injured in accidents than members of the general population.

However, the most common cause of death among people whose seizures are uncontrolled is sudden unexpected death in epilepsy (SUDEP). In people with epilepsy, approximately one in 1,000 adults and one in 4,500 children will die from SUDEP. Because it is so rare, SUDEP is poorly studied. Researchers do not yet know what causes SUDEP, but one theory is that a seizure triggers a fatal change in heart rhythm.

Studies have found that people with epilepsy have a risk 3.5 and 5.8 times higher for death by suicide than the rest of the population. Depression is common in epilepsy, as in all chronic illnesses, and many anti-epileptic drugs (AEDs) are known to worsen depression and suicidal thoughts and behavior. Report any feelings of depression and thoughts of suicide to your doctor. A change in medication can make a big difference.

Can you drive if you have epilepsy?

It can be complicated for people with epilepsy to obtain driver’s licenses in the United States. Different states have different rules about issuing driver’s licenses to people with a history of epilepsy. In some states, doctors are bound to report diagnoses of epilepsy to the government. In order to qualify for a driver’s license, people with epilepsy generally need to provide medical proof that they have been seizure-free for a certain period of time, usually three months or six months. They may also be required to provide periodic medical updates proving their seizure-free status.

Can you qualify for U.S. government disability benefits if you have epilepsy?

Under certain conditions, people with mental or physical impairments caused by epilepsy or epilepsy medication that make it impossible for them to work may qualify for social security benefits. Whether you qualify for disability benefits depends on several factors, including the type of seizure(s) you have, the type of work you do, your age, and your work history. Other factors may include whether you are eligible for a driver’s license and whether side effects from anti-epileptic drugs make it difficult for you to drive or work.

Can you live alone if you have epilepsy?

Most people with epilepsy can safely live alone. Some people install monitors and alarm systems that can detect seizures and call for help if one occurs.

How is epilepsy diagnosed?

To diagnose epilepsy, a doctor will take a detailed history of the symptoms, behavior, and seizure duration provided by their patient or their caregiver. The diagnosis process may involve brainwave monitoring with EEG, imaging scans, and blood tests. Learn more about how epilepsy is diagnosed.

How is epilepsy treated?

There are a wide range of epilepsy treatments, with most falling into one of three categories: medication, diet, or surgery. Before prescribing a course of treatment, a physician will take into account your age, overall health, medical history, severity of condition, and type(s) of seizure. Read more about epilepsy treatments.

A MyEpilepsyTeam Member said:

Agreed, it’s frustrating with no being able to remember silly things like reading a text message. I think it’s hard for family to understand and my… read more

posted 8 days ago

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