Epilepsy 101

1 in 26 people live with epilepsy. There is no cure.

WHAT IS EPILEPSY?

Epilepsy is a chronic neurological disease characterized by recurrent, unprovoked seizures. A person is considered to have epilepsy if any of the following conditions are met: 1) a person has at least two unprovoked (or reflex) seizures that occur more than 24 hours apart; 2) a person has one unprovoked seizure and it is suspected that there is a minimum of a 60% likelihood of recurrence within the next ten years; and 3) a person is diagnosed as having an epilepsy syndrome. Seizures and epilepsy are not the same entity, although a seizure is the principal clinical manifestation of epilepsy, the incidence of a single seizure does not necessitate an epilepsy diagnosis. A seizure is an event in the brain that causes abnormal changes in movement, behavior, perception or consciousness. Epilepsy is the disease which involves recurrent, unprovoked seizures.

WHAT CAUSES EPILEPSY?

Epilepsy has many causes. In some people the cause is evident, in others unclear, and in others the cause remains unknown. The most common causes of epilepsy vary at different stages of the life span. 1) In childhood: issues that may occur during birth such as lack of oxygen and an intracranial bleed, inborn errors such as brain malformations and genetic mutations, and infections of the central nervous system. 2) In adulthood: head trauma commonly associated with an accident while in a motor vehicle, cycling, or performing some other outdoor activity and progressive brain diseases. 3) In the elderly: stroke, brain tumor, and Alzheimer’s disease. Although this list includes a large variety of conditions which may lead to epilepsy, in approximately half of the individuals with epilepsy, the cause is unknown.

IS EPILEPSY AN INHERITED DISEASE?

Only some types of epilepsy are genetically determined, such as juvenile myoclonic epilepsy, most epilepsies are idiopathic, secondary to an unknown cause, or are secondary to one of the causes mentioned in the previous question. However, according to the Epilepsy Foundation, children of parents with epilepsy are at higher risk than the general population for developing seizures. Children whose father has epilepsy have a 2.4 percent incidence versus the 1-1.5 percent incidence of the general population. Children of mothers with epilepsy have a 4 percent incidence; the incidence is 6 to 12 percent in children who have both parents diagnosed with epilepsy

WHAT AGE GROUPS ARE MOST AT RISK FOR EPILEPSY?

Epilepsy is the fourth most common chronic neurological disease and affects people of all ages, gender, and races. However, the elderly population is at the highest risk followed by the early childhood population. Middle age people are the least affected group by this disease. About 1 in 10 people will have a single unprovoked seizure in their lifetime and 1 in 26 people will develop epilepsy at some point in their lifetime but people with certain conditions will be at higher risk. The majority of these cases occur in the very young and in the older population. Currently, more than 3 million people are diagnosed with epilepsy in the USA. Epilepsy affects more than 65 million people worldwide.

WHAT CAUSES EPILEPTIC SEIZURES?

Epileptic seizures occur when bursts of abnormal electrical activity are generated in the brain. Normally, electrical energy is a function regulated by complex chemical changes carried out by brain cells called neurons. Neuronal misfiring results from an imbalance between excitatory and inhibitory neurons in response to abnormal chemical changes. This misfiring causes the robust electrical activity to generate the seizure. The severity of the seizure is in direct proportion to the number of neurons affected; so that, the convulsion can be a focal event affecting only some parts of the body or a generalized convulsion affecting the whole brain and body.

WHAT FACTORS TRIGGER EPILEPTIC SEIZURES?

Knowing what triggers your seizures can help you recognize and avoid them; thus, you may lessen the chance of having seizures. Some commonly recognized triggering factors are: missing doses of the medicine or not taking the medicine as prescribed, fever, sleep deprivation, stress, over-exertion, consumption of excessive alcohol, and taking recreational drugs (for example cocaine). Hormonal changes, such as during the menstrual cycle, changes in sugar (glucose) level, dehydration, environmental factors such as high heat and humidity, flickering and strobe lights, some noises and colors, as well as specific time of day or night, among others, may also trigger seizures in people with epilepsy.

CAN PEOPLE OUTGROW EPILEPSY?

Yes. In many cases, especially the genetic types of epilepsy, children may simply outgrow the seizures as they go through adolescence and puberty. Seizures are unpredictable; they may continue to occur or decrease with time. Epilepsy is considered to be resolved for individuals who have remained seizure-free for the last 10 years with no seizure medicines for the last 5 years.

CAN SOMEONE WITH EPILEPSY OBTAIN AND MAINTAIN A DRIVER’S LICENSE?

In many cases, yes, the critical issue is seizure control. Florida, like the rest of the states in the U.S., has specific guidelines concerning driver’s licensure for individuals with epilepsy. In Florida, applicants should be seizure free for at least 6 months and under medical supervision to be able to apply for a driver’s license. However, if the individual has been seizure free for a period of two years, he or she can apply for a license even if not under medical supervision. For more information contact your local office of Driver Licenses or Florida Department of Highway Safety and Motor Vehicles in Tallahassee at www.hsmv.state.fl.us/html/dlnew.html.

CAN SOMEONE WITH EPILEPSY PARTICIPATE IN SPORTS AND OTHER ACTIVITIES?

Most people with epilepsy want to participate in a wide variety of life’s activities, including sports, exercise, and fitness programs. In most cases they can participate in such programs depending on the degree of seizure control. High risk activities (mountain climbing, skiing, sky diving, swimming alone, scuba diving) and contact sports (boxing, martial arts, football) and other hazardous high risk activities are not GENERAL ISSUES 221893 EPI Q&A BroE.indd 4 2/28/20 2:42 PM 5 GENERAL ISSUES recommended for individuals with epilepsy. Always contact your doctor prior to beginning any physical sport or activity in which a brief lapse of consciousness would significantly increase the chance of injury. Keeping an active life and exercising is good therapy and fun for everyone but for people with epilepsy the following safety tips could be helpful when exercising: take frequent breaks, stay cool, and save your greatest exertion for the coolest part of the day. Exercise on soft surfaces if you can. Avoid swimming alone. Wear head protection when playing contact sports.

DOES EPILEPSY AFFECT MENTAL ABILITY?

For most people with epilepsy, particularly those whose seizures are not very frequent or severe, epilepsy does not cause any serious compromise of memory, thinking, or cognitive functions. However, lapses of memory and cognitive impairments are two of the most common complaints of persons with epilepsy. They are usually most likely related to the seizure activity itself over a specific area of the brain regulating mental ability and/or side effects of the anticonvulsant drugs and not to a progressive decline of intellectual function. Individuals with uncontrolled, severe, prolonged, and very frequent seizure activity as well as frequent episodes of status epilepticus might have intellectual decline, memory problems, and cognitive and learning difficulties.

CAN PEOPLE DIE FROM EPILEPSY?

Most people with epilepsy live a full life span. However, there are potential factors associated with living with epilepsy and seizures that may increase the risk of early death. Prolonged seizure activity or seizures that happen quickly, one after another, must be considered life-threatening and 911 must be called. When the uninterrupted seizure activity lasts more than 5-10 minutes, this is called status epilepticus, it is a medical emergency and needs immediate medical attention. Some people with epilepsy may die suddenly and without explanation.  This is called SUDEP which stands for Sudden Unexplained Death in Epilepsy. The risk of sudden death occurs more often among people with convulsive seizures, especially with uncontrolled generalized tonic-clonic epilepsy and complex partial seizures with secondary generalization.

ARE THERE ANY SAFETY PRECAUTIONS I SHOULD TAKE AT HOME IF MY SPOUSE OR CHILD HAS EPILEPSY?

Most people do not get hurt when they have a seizure but it can happen. There are many practical steps you can take to minimize your risk for injury in case of seizure, for example:

1) set the thermostat of the water heater low enough to prevent scalding or purchase a scald protection product; 2) pad sharp corners; 3) try a microwave oven for cooking; 4) select chairs with arms to prevent falling; 5) hang bathroom doors so they open outwards instead of inwards (so that if someone falls against the door, it can still be opened); 6) remove burner controls from gas or electric stoves when not in use; 7) consider Embrace or other sensor movement monitor device to be worn by the person or installed at home; 8) consider installing a closed circuit video monitoring system; and 9) do not allow the affected person to wander around alone over unprotected or elevated places where a brief lapse of consciousness may increase the risk of injury or death.

WHAT FAMOUS PEOPLE HAVE OR HAVE HAD EPILEPSY?

Many famous people throughout the ages have had epilepsy, including: Alexander the Great, Julius Caesar, Socrates, Napoleon Bonaparte, Leonardo da Vinci, Vincent Van Gogh, Charles Dickens, Agatha Christie, Thomas Edison, Harriet Tubman, Alfred Nobel, Peter Tchaikovsky, Richard Burton, Margaux Hemingway, Danny Glover and many others.

 

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