TOPIC: GENERAL INFORMATION ABOUT EPILEPSY
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The word "epilepsy" is derived from a Greek word meaning “a condition of being
overcome, seized, or attacked." People used to believe that the seizure was caused
by a demon, and Epilepsy became known as a sacred disease. This is the background
to the myths and fears that surround Epilepsy; myths that colour people's attitudes
and make the goal of a normal life more difficult than it needs to be for people who
have Epilepsy. The word "Epilepsy" means nothing more than the tendency to have seizures.
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Epilepsy is not a disease. It is a sign or symptom of an underlying neurological disorder.
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The brain is a highly complex and sensitive organ. It controls and regulates all
our actions. It controls motor movements, sensations, thoughts, and emotions. It is
the seat of memory, and it regulates the involuntary inner workings of the body such
as the function of the heart and the lungs.
The brain cells work together, communicating by means of electric signals. Occasionally
there is an abnormal electrical discharge from a group of cells, and the result is a
seizure. The type of seizure will depend upon the part of the brain where the abnormal
electrical discharge arises.
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Before the onset of a seizure some people experience a sensation or warning called
an "aura". The aura may occur far enough in advance to give the person time to avoid
possible injury. The type of aura experienced varies from person to person. Some
people feel a change in body temperature; others experience a feeling of tension or
anxiety. In some cases, the epileptic aura will be apparent to the person as a musical
sound, a strange taste, or even a particular curious odour. If the person is able to
give the physician a good description of this aura, it may provide a clue to the part
of the brain where the initial discharges originate. An aura could occur without being
followed by a seizure and in some cases can by itself be called a type of simple
partial seizure.
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Epilepsy is the oldest known brain disorder. It was mentioned more than 2,000 years
before Christ. References can be found in ancient Greek texts and in The Bible. It
wasn't until the mid 1800's, however, that Epilepsy was given serious study. Sir
Charles Locock was the first to introduce a sedative that aided in controlling
seizures in 1857. In 1870, John Hughlings Jackson identified the brain's outer layer,
the cerebral cortex, as the part involved in Epilepsy. Hans Berger demonstrated that
the electrical impulses of the human brain could be recorded in 1929.
TOPIC: PEOPLE WITH EPILEPSY
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Virtually everyone can have a seizure under the right circumstances. Each of us has
a brain seizure threshold which makes us more or less resistant to seizures. Seizures
can have many causes, including brain injury, poisoning, head trauma, or stroke; and
these factors are not restricted to any age group, sex, or race and neither is
Epilepsy. 1 in 28 people will develop epilepsy some time in their life.
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Epilepsy is far more common than most of us realize. 50 million people worldwide
have epilepsy; 300,000 in Canada, 12,000 in Durham Region. Current estimates indicate
that more than one per cent of the population have had, or will have, some form of
Epilepsy in their lifetime.
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Epilepsy can strike anyone at any age. However, most persons who develop seizures
during their formative years tend to experience a reduction in the intensity and
frequency of their seizures as they grow older. In many cases the Epilepsy will
disappear completely. 50% of all cases develop before 10 years of age.
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Epilepsy occurs more frequently in some cultures. In Tanzania, 4% of the population
experiences severe seizure disorders. In this case, genetic predisposition to lower
seizure thresholds is known to exist. In Canada, 1-2% of the population has epilepsy.
TOPIC: TYPES OF SEIZURES
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Many varieties of epileptic seizures occur, and frequency and form of attacks vary
greatly from person to person. With modern methods of treatment, however, most cases
can be fully controlled. Because there are so many nuances in epilepsy and so many
different kinds of seizures, a specific classification system is being promoted by
the International League Against Epilepsy. The International Classification of
Epilepsy Seizures has been adopted by the medical community and is gradually replacing
outdated seizure terminology including "grand mal” and "petit mal".
The new classification scheme describes two major types of seizures: "partial" and
"generalized". It also divides each of these categories into subcategories including
simple partial, complex-partial, absence, tonic-clonic, and other types.
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The distinction between "partial" and "generalized" seizures is the most important
feature of the new classification system. If the excessive electrical discharge in
the brain is limited to one area, the seizure is partial. If the whole brain is
involved, it is generalized.
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Partial seizures (formerly known as focal seizures) with elementary symptomology
are often referred to a simple partial. During this type of seizure the patient can
experience a range of strange or unusual sensations including sudden, jerky movements
of one body part, distortions in hearing or seeing, stomach discomfort, or a sudden
sense of fear. Consciousness is not impaired. If another seizure type follows, these
sensations may be referred to as an "aura".
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Complex-partial seizures (formerly psychomotor or temporal lobe epilepsy) are
characterized by a complicated motor act involving impaired consciousness. During
the seizure the patient appears dazed and confused. Purposeless behaviours such as
random walking, mumbling, head turning, or pulling at clothing may be observed.
Usually, these so-called "automatisms" cannot be recalled by the patient. In children
this seizure may consist of staring or lip-smacking, and therefore may be confused
with the absence seizure described below.
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Generalized absence seizures (formerly petit mal) are characterized by 5 to 15 second
lapses in consciousness. During this time the patient appears to be staring into
space and the eyes may roll upwards.
Absences are not preceded by an aura and activity can be resumed immediately afterwards.
Typically, they occur in children and disappear by adolescence. They may, however,
evolve into other seizure types, such as complex-partial or tonic-clonic. The occurrence
of absence seizures in adulthood is rare.
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The tonic-clonic (formerly grand mal) seizure is a generalized convulsion involving
two phases. In the tonic phase, the individual loses consciousness and falls, and
the body becomes rigid. In the clonic period the body extremities jerk and twitch.
After the seizure, consciousness is regained slowly. If the tonic-clonic seizure begins
locally (with a partial seizure) it may be preceded by an "aura". These seizures are
said to be secondarily generalized.
While the tonic-clonic seizure is the most visible, obvious type of Epilepsy, it is
not the most common. Partial seizures are more frequently encountered and occur in
62% of all epilepsy patients. Complex-partial seizures account for approximately 30%
all cases.
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Benign Rolandic Epilepsy is an epileptic syndrome occurring in young children that
is age limited (you stop having seizures in the teen years). Salivation and twitching
of the mouth or upper extremity on one side are typical manifestations. Seizures
occur almost exclusively nocturnally.
Juvenile Myoclonic Epilepsy is characterized by onset in childhood or adolescence
and is associated with extremity jerking or generalized tonic clonic seizures
('grand mal') within an hour or two of wakening from sleep. Seizures which may be
due to sleep deprivation, alcohol intake or coffee tend to occur in the morning.
Pleases contact your local epilepsy association or clinic for additional information.
Other seizure terms include: Atonic (Drop Attacks), Myclonic, Infantile Spasms,
Nocturnal, Photosensitive, Visual, Musicogenic, Jacksonian, Sensory, Bilateral
Myclonus, Atkinetic, Autonomic, Prolonged seizures, and Ictal State.
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Status Epilepticus is the term used to describe recurrent seizures without recovery
of consciousness between attacks. This is a medical emergency and can be life
threatening, or cause brain damage. Immediate action to get the necessary medical
care should be taken.
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Pseudo-seizures (or psychogenic seizures) are quite common and can occur in people
who have, or do not have, epilepsy. The attacks are triggered by a conscious or
unconscious desire for more care and attention. The seizures start with rapid breathing,
triggered by mental stress, anxiety, or pain. As the person breaths rapidly, they
build up carbon dioxide in their body and change their chemistry. This can cause
symptoms very much like a seizure: prickling in the face, hands, and feet, stiffening,
trembling, etc. The appropriate treatment for pseudo-seizures is to calm the person
and start them breathing at a normal rate. Treatment should also involve investigating
the mental and emotional factors that led to the pseudo-seizure.
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Epileptic seizures and pseudo-seizures are distinguishable both by their nature and
symptoms, but the diagnosis can be difficult. Epileptic seizures are caused by a
change in how the brain cells send electrical signals to each other, while pseudo-seizures
are triggered by a conscious or unconscious desire for more care and attention. Thus,
measuring brain activity with an EEG and video telemetry is important for distinguishing
epileptic and pseudo-seizures. Also, pseudo-seizures often lack the exhaustion,
confusion, and nausea that is associated with epileptic seizures. Psychogenic seizures
can occur in people who also experience epileptic seizures.
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Epilepsy is a chronic condition of recurrent unprovoked seizures. Isolated seizures
and provoked seizures (e.g., drug or alcohol induced) are not epilepsy even though
the events are real seizures. There are many types of non-epileptic seizures. Non-epileptic
seizures differ from epileptic seizures in that there is usually no evidence of abnormal
electrical activity in the brain after the seizure, and they do not occur repeatedly.
Some of the more common causes of non-epileptic seizures are: low blood sugar, fainting,
heart disease, stroke, migraine headaches, kinked blood vessels, narcolepsy, withdrawal,
and extreme stress or anxiety.
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The nature of the seizures varies depending upon the type of epilepsy the individual
has. Some seizures may be very noticeable while some may go completely unrecognized.
With the most common types of seizures there is some loss of consciousness, but some
seizures may only involve small movements of the body or strange feelings. The
different seizures types have certain characteristics that accompany them.
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Epilepsy is a broad classification for a wide variety of seizures, so different
people's seizures can be very different. Common feelings associated with seizures
include uncertainty, fear, physical and mental exhaustion, confusion, and memory
loss. Some types of seizures can produce visual and auditory phenomena, while others
can involve a "blank" feeling. If a person is unconscious during a seizure there may
be no feeling at all. Many people also experience an "aura" before the seizure itself.
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Depending on the type of seizure, they can last anywhere from a few seconds to
several minutes. In rare cases, seizures can last many hours. For example, a
tonic-clonic seizure typically lasts 1-7 minutes. Absence seizures may only last a
few seconds, while complex partial seizures range from 30 seconds to 2-3 minutes.
"Status Epilepticus" refers to prolonged seizures that can last for many hours, and
this can be a serious medical condition. In most cases, however, seizures are fairly
short and little first aid is required.
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There are over 2000 types of seizures, and some types are more severe than others.
Long tonic-clonic convulsions, for example, can produce more physical and mental
effects than shorter partial seizures. Some people may experience very frequent
seizures (every few hours), while others can go for months or years without a seizure.
Also, some seizures are easily controlled by drug therapies, while others may
continue regardless of the medication that is tried.
TOPIC: CAUSES AND TRIGGERS
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There is no single cause of epilepsy. Many factors can injure the nerve cells in the
brain or the way the nerve cells communicate with each other. In approximately 65%
of all cases there is NO known cause. The following are some of the most frequently
identified causes:
- Head injury that causes scaring of the brain tissue.
- Trauma at birth, or high fever.
- Excessively rough handling or shaking of infants.
- Certain drugs or toxic substances when administered in large doses.
- Interruption of blood flow to the brain caused by stroke, tumour, or certain
cardiovascular problems.
- Diseases which alter the balance of blood or its chemical structure, or diseases
that damage the nerve cells in the brain.
When physicians can identify the underlying disorder, such as those mentioned above,
the condition is referred to as "symptomatic" epilepsy. In some cases, however,
the underlying disorder can't be identified and this is called "Idiopathic" epilepsy.
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In most cases epilepsy is not inherited. In a few cases the tendency towards epilepsy
might be inherited, but even with this tendency certain conditions must exist in the
brain before a person will experience seizures. It is most unlikely that children
will inherit the disorder.
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Epilepsy is in no way contagious. No one can get the disorder by talking to, kissing,
or touching somebody with epilepsy. Epilepsy can only be transmitted through hereditary
transfer. Epilepsy that runs in families suggests an underlying metabolic or genetic
etiology, and this is the least common of all epilepsy causes.
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Epilepsy can be the result of an infection or disease. Some conditions known to have
a risk of resulting in epilepsy are meningitis, viral encephalitis, and less frequently
mumps, measles, diphtheria, and abscesses.
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In some cases, epileptic seizures can be triggered by things that happen in the
environment. Seizures can be triggered by flashing lights or sudden changes from dark
to light (or vice versa). Other people can react to loud noises or monotonous sounds,
or even certain musical notes. It is important for people with epilepsy to learn what
kinds of events can trigger seizures for them.
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"Photosensitive Epilepsy" is the name given to a form of the disorder where seizures
are triggered by flickering or flashing lights. Though it occurs more frequently in
girls aged 6-12, it can occur at any age and regardless of gender.
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People with epilepsy should have regular meals at regular intervals and pay attention
to what they eat and drink. Prescription and non-prescription drugs, as well as food
additives, may interact with anti-epileptic drugs (AED). Alcohol can lower seizure thresholds.
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Excessive sleep deprivation can lower seizure thresholds and possibly result in a
seizure. Lack of sleep is known to be an important precipitating factor in causing
seizures. Other factors that can lower seizure thresholds are high fever, increased
excitement, and changes in body chemistry. It is important for people with epilepsy
to learn what kinds of events can trigger seizures for them.
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Hypoglycemia (low blood sugar) can induce epileptic-type seizures. This condition
can be caused by diet or by drugs such as insulin. This is not really Epilepsy since
it is not recurrent seizures that are due to abnormal brain activity. Here the seizures
are directly caused by the blood sugar levels.
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In 1984, there were 3 reports about large amounts of Aspartame causing a lowering of
the seizure threshold and therefore increasing seizure activity. The Centre for Disease
Control in Atlanta did a review of this and was unable to find any cause or effect
relationship at normal doses. More recently, Aspartame has been found to be unsuitable
for some children with generalized absence epilepsy. A Queen's University study looked
at the brain-wave patterns in 10 children and the effects of the artificial sweetener
"Nutrasweet". A 40% increase in abnormal brain-wave activity associated with absence
seizures was found in this study. However, there was no effect on the actual number
of seizures. Research on this topic is continuing.
Aspartame can “block” or reduce the effectiveness of AEDs
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Alcohol can raise and then lower the seizure threshold, and thus increases the
tendency to have a seizure. More important are interactions between alcohol and
seizure medicines. Also, some drugs of abuse, especially cocaine and amphetamines,
can cause seizures. Some prescription medications when taken in large doses can also
bring on seizures.
TOPIC: FIRST AID FOR SEIZURES
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The appropriate behaviour for helping someone who has a seizure depends on the type
of seizure it is. While a person experiencing a tonic-clonic seizure may require some
first aid, in most cases there is little that can be done.
Tonic-Clonic (Grand Mal)
This type of seizure is often the most dramatic and frightening, but it is important
to realize that a person experiencing a seizure is usually unconscious and feels no
pain. The seizure usually lasts only a few minutes, and the person does not need medical
care. These simple procedures should be followed:
- Stay calm. Never attempt to restrain someone having a seizure. Simply let the seizure
take its course. Remember a person having a seizure is not always aware of their
actions and may not be able to hear you.
- Time the seizure. If it repeats or lasts longer than 5 minutes, call for medical
attention.
- Consider safety hazards. Move any sharp objects or obstacles out of the way. If the
person is wandering about, stay by their side and gently steer them away from danger.
If you perceive the person to be unconscious loosen tight clothing such as a necktie
or scarf.
- If the person has fallen to the ground, roll them on to their left side and place
something soft under their head.
- NEVER INSERT ANYTHING INTO THEIR MOUTH.
- After the seizure has subsided, speak to the person in a gentle, quiet and friendly
manner. Be comforting and reassuring as they may be confused and disoriented. Stay
with them until full consciousness returns, and offer assistance.
- Help maintain the individual’s dignity by moving away from onlookers.
Absence (Petit Mal)
No first aid is required.
Complex-Partial (Psychomotor or Temporal Lobe)
- Do NOT restrain the person. Protect him or her by moving sharp or hot objects away.
- If wandering occurs, stay with the person and talk quietly.
Simple-Partial (Focal)
No first aid is required.
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Children are usually awakened by seizures that occur while they sleep. Thus, a parent
of a child with a known seizure disorder is usually aware when their child has
seizures during the night. Only in those rare cases where a child vomits or experiences
other problems during a seizure is there a need to worry.
TOPIC: DIAGNOSIS
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The diagnosis and evaluation of epilepsy requires the physician to know all about
the seizures - when they started, the patient's appearance before, during, and after
a seizure, and any unusual behavioural occurrences. A background of the family's
health history is also useful. In addition, an electroencephalogram (EEG) may help
detect areas of increased nerve cell activity.
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Any licensed physician is qualified to treat epilepsy. There are doctors who
specialize in neurological disorders, and these neurologists can be found practicing
in many hospitals and private practices. Epileptologists may work in an epilepsy
clinic, as well as in private practices. Usually a referral is required from another
physician in order to see a Neurologists and Epileptologists. Some people also
consult alternative health practitioners who specialize in holistic healing, acupuncture,
or chiropractic treatments.
Often, the first doctor to diagnose epilepsy is the family doctor. Most of them have
had some experience with it, and will be the one to refer a person with epilepsy to a
specialist initially. Paediatricians are also well aware of epilepsy, since about
two-thirds of all epilepsy occurs before the age of 14. A neurologist has specialized
training in the disorders of the brain and nervous system. A neurosurgeon, psychiatrist,
or psychologist may also get involved if the circumstances require them.
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An EEG measures the electrical activity on the surface of the brain. An EEG may
appear to be normal if the abnormal electrical activity is occurring deeper in the
brain than the EEG is able to monitor.
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Many people who do not have epilepsy may have some "epileptiform" activity on an EEG.
However, this does not prove that they have a seizure disorder. Reading EEG's is a
highly skilled activity, and a diagnosis of epilepsy is based on the clinical picture
as well as the EEG. Other tests, such as CT scans and MRI scans, may be performed to
confirm any findings.
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A child having an absence seizure may appear to the onlooker as if they are day
dreaming or just staring into space. What may be happening is a sudden period of
altered consciousness. To be able to tell the difference, close observations might
have to be done. Usual behavioural characteristics of an absence seizure may include:
eye blinking, chewing of the mouth, and perhaps a slight rhythmic movement of the
facial muscles, head, or arms. During the seizure the child may not respond to verbal
or physical stimulation. Immediately after the seizure, the child is able to resume
normal activity. If you observe unusual behaviour in your child, a visit to a
neurologist should be arranged through your family doctor.
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Seizures occurring as a result of alcohol withdrawal, fever, or hypoglycemia can be
mistaken for epilepsy. Other causes of seizures that do not indicate epilepsy are
strokes, migraine headaches, calcified blood vessels, narcolepsy, and psychogenic
or pseudo-seizures.
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The symptoms of seizures are not always noticeable for on-lookers or for the person
who is experiencing the seizure. Seizure may result in rigidity in the body,
convulsions, chewing of the mouth, unusual behaviours, or loss of consciousness.
Some symptoms may be less apparent, such as disorientation or unusual sensations.
Milder symptoms do not mean that the seizure is of less importance.
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TOPIC: TREATMENTS
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There is no known "cure" for epilepsy. Medications can often control seizures, but they are not a cure. Some forms of epilepsy occur only in childhood, and the person is said to have outgrown the seizures. In some cases there is a spontaneous remission of the seizure disorder. Sometimes, surgery to remove the part of the brain in which the seizures originate can produce a complete and permanent stop to seizures.
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Epilepsy itself can cause death if prolonged repeated seizures ("status Epilepticus") are not treated properly or SUDEP, Sudden Unexpected Death in Epilepsy. http://www.sudep.org/sudep.asp such deaths are rare, however. More common is death due to hazards or accidents that occur when someone has a seizure unexpectedly in a potentially dangerous situation.
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When a physician diagnoses epilepsy, a specific treatment can be recommended. The treatment prescribed by the physician is designed to control the seizures and help the patient to carry on a healthy life, participating in all normal activities, including most sports. The two major kinds of treatments are drug therapy and surgery.
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Treatment of epilepsy is primarily through the use of special anti-convulsive drugs (AEDs). There are many different types of these drugs, and the type prescribed will depend upon the particular needs of the individual. The drugs are prescribed either alone or in a combination. The various drugs or combination of drugs control different types of seizures.
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The drugs used to control seizures are called anticonvulsants. How they stop the seizures, change the seizure threshold, or prevent electrical discharges from occurring is not fully known. The neuro-chemical basis for their action is also unknown. Research has shown that some of the drugs can block the spread of abnormally fast nerve impulses in the brain, while others can increase the flow of chloride ions, which stabilize the nerve cells. Research is still being done in this area.
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There are many different drugs used to treat Epilepsy. Some of the more common ones are: Tegretol (carbamazepine), Dilantin (phenytoin), Mysoline (primidone), Epival (valproate), Frisium (clobazam), Rivotril (clonazepam), Mogadon (nitrazepam), Phenobarbitol, Depakene (valproic acid), Zarontin (ethosuximide), Neurontin (gabapentin), Lamictal (lamotrigine), Sabril (vigabatrin). There are also many new drugs under development.
The choice of drug is determined by the type of seizure, the side effects of the drugs, and the age and health of the person. Often a number of drugs, and combinations of drugs, have to be tried until the seizures are brought under control.
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Most seizures are controlled by anti-convulsive drugs (AED) prescribed by a physician. About 50 per cent of those who take this medication will have their seizures controlled; 30 per cent will have their seizures reduced in intensity and frequency to the point where they can live and work normally. The remaining 20 per cent are either resistant to the medication, or else they require such large dosages of the drug to control the seizures that it is preferable to accept partial control.
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Many medications for epilepsy have side effects. These can range from mild to severe, and will differ depending on the drug and dosage. Some of the more common side effects of anti-epileptic drugs (AED) are: drowsiness, dizziness, nausea, irritability, hyperactivity and depression.
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"Blood level" refers to the amount of anticonvulsant in the blood. It is measured with a simple blood test and is used to help determine if a patient's symptoms may be due to toxicity or to side effects of medication. It is also used to determine if the patient is taking enough medication to prevent seizures. The therapeutic range for different AEDs has been determined by testing blood levels in thousands of patients whose seizures are controlled and who are not experiencing toxic effects.
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Too high of a drug level may cause a person to experience side effects such as drowsiness, confusion, breakthrough seizures, unsteadiness, and nausea. This may require a reduction in dosage or a change to a different medication.
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The cost of the AEDs will depend on the dosage levels needed, the drug being used, and the amount in each prescription. There is usually a difference in price between a drug's brand name and its generic equivalent. Ask your doctor or pharmacist if a generic one is available for you to use, and if it is appropriate.
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Treatment of epilepsy is primarily through the use of AEDs. There are many different types of drugs and the type prescribed will depend upon the particular seizure pattern of the individual. If someone has been seizure free for several years, the doctor may decide to slowly withdraw the medication.
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Surgery is used only when medication fails and only in a small percentage of cases where the injured brain tissue causing the seizures is confined to one area of the brain and can be safely removed without damaging personality or functions.
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The likelihood of a child outgrowing a seizure disorder is difficult to answer. Sometimes children do outgrow epilepsy, while for others the seizures may stay the same or intensify with age. Some people experience the same type of seizures throughout their lifetime. Some epilepsies are known to almost always remit (for example, Benign Rolandic Epilepsy or epilepsy with centrotemporal spikes and rolandic seizures), some are known to usually remit (e.g., childhood absence) and some are known to almost never remit (e.g., Juvenile Myoclonic Epilepsy). The medical community cannot predict who will continue to have seizures and who will not, but they feel that the sooner epilepsy is diagnosed, the better it can be controlled.
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Some people with epilepsy have tried many different approaches to improve their seizure control. In some cases, the person feels that they have experienced improvement. However, scientific studies have not been conducted into most non-traditional approaches. Techniques known to reduce stress or improve overall health may be helpful to some people. Other techniques that have been tried are biofeedback, diets, acupuncture, and meditation.
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The medical community has not determined if things such as transcendental meditation have any real effect on epilepsy. It has been shown that when people know what is happening at a given moment, some can influence the automatic processes of the body. With biofeedback, some people can moderate and possibly change certain functions thought to be involuntary, such as the rhythm of their brain waves, blood pressure, heart rate, etc. The significance of this for epilepsy is not known.
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Biofeedback is the process of moderating, limiting or changing certain physiological functions previously thought to be involuntary, such as heart rate, blood pressure, brain waves, etc. For epilepsy, a person could be given extensive biofeedback training and taught behavioural modification techniques through which he/she control certain physiological functions related to seizures. Biofeedback training can also be taught as a method of stress reduction. This in itself can reduce the frequency of seizures in some persons with stress related seizures. Further study is needed to ascertain the value of biofeedback in the treatment of epilepsy. Non-medical approaches may improve seizure control in some persons, but should not be undertaken without the knowledge of the physician prescribing the AED. Under no circumstances should AED be stopped suddenly as this may precipitate prolonged and life-threatening seizures.
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Good nutritional habits and a healthy life style may assist in the maintenance of optimum seizure control. Experiencing a drastic weight change may mean that either a chemical or metabolic imbalance is occurring and you should consult your physician. Though some AED may cause nutrient deficiencies in some people, a well balanced diet will usually prevent this. Also see KETOGENIC DIET.
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A Ketogenic diet is very rich in lipids (fats) and oils, but low in proteins and carbohydrates. This unusually high intake of lipids and oils creates a condition in the body know as "ketosis". The metabolic shift that is created increases the seizure threshold for some. This diet is also calorie and liquid restricted. The Ketogenic diet is mainly effective in children. It requires careful preparation and strict adherence. Although it takes a significant commitment to be successful, many children have greater seizure control with this diet than with conventional (drug) therapies. Some are able to reduce or eliminate anti-seizure medications. Careful medical supervision is essential when using this as a therapy.
TOPIC: LIVING WITH EPILEPSY
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Experience has shown that people with epilepsy have fewer seizures if they lead normal active lives. This means they should be encouraged to find jobs, either full or part-time. People with any disabilities are now protected under amendments to the Human Rights Code (Canada). However, some jobs, because of the nature of technical equipment or machinery, may not be recommended for a person with epilepsy. It is therefore most important for a young adult to work with the school guidance department to establish appropriate career goals.
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Like any medical condition, epilepsy is affected by the general health and well-being of the person affected. So, anything that can be done to improve the state of the person can have a positive effect on epilepsy. This includes diet, exercise, rest, reducing stress, avoiding depression, and staying away from alcohol and illegal drugs.
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Openness and honesty about epilepsy is important. A child's teacher should be informed about the type of seizure, what they look like, their frequency, and any first aid requirements. There are advantages and disadvantages to telling an employer. What you tell them may depend upon how comfortable you are discussing your epilepsy, the kinds of seizures involved, and the type of job. An employer may ask if you have a medical problem that would make you unable to do your job, but they may not ask generally about your medication condition.
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While much progress has been made in reducing societal prejudice against epilepsy, discrimination or rejection may also be a problem for the person with the seizures. In addition, family and friends may be overprotective or impose unnecessary restrictions. In the end, the person with seizures may lose confidence or feel "like a second class citizen".
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Women who use seizure-controlling drugs must be careful when it comes to having children. There have been reported cases of birth defects for these women. While the "normal" rate of birth defects is 2-3%, women with epilepsy who are not taking medication have a slightly higher (1/2%) risk of malformations. Women on a single medication have a risk of about 6-7%, with some differences due to the particular medication involved. Multiple drug combinations drastically increase the risk.
This creates a problem because the drugs may create risks for the baby, but the need for anti-seizure drugs remains during pregnancy. Seizures may even be more frequent during pregnancy, and harm both the baby and the mother.
A doctor may decide to change or reduce a woman's medication if she plans to become pregnant. In some cases, however, the doctor may recommend that the risks of pregnancy are too great for the mother and child. Any changes in medication must be considered carefully, and a woman should never adjust her own medication.
There are some special issues relating to maternal health during pregnancy for women with epilepsy, and this may require special attention.
Finally, some seizure medications can lead to failures of oral birth control pills.
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Always check with your physician if you are on AEDs and planning to breast feed. Although anticonvulsant medication has been measured in the breast milk of mothers with Epilepsy, the amount is usually too low to harm the child.
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In Ontario, the situation is that anyone with a history of epilepsy may drive a motor vehicle, provided the person's physician certifies that he or she has been free from seizures for a minimum period of a year. Each case is reviewed by a medical advisory committee.
The situation may be different in your location. Ask your physician about it, or contact a driver examination centre. http://www.drivetest.ca/
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It is advised that before a person with epilepsy goes swimming, they should consult their doctor. When a person with epilepsy does go swimming, they should not do it alone (common water-safety advice for everyone). It is also recommended that swimming be done in a supervised pool rather than beaches, lakes, or rivers.
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Longstanding seizure disorders may be associated with seizure-induced brain damage and memory problems. Also, children with Epilepsy may experience learning or concentration problems because of the neurological disorder or the medications.
If a child who has epilepsy is having problems at school, either academically or socially, the teacher and the principal should be asked to help. If you would like your child to be tested by the school psychologist, arrange it through the principal. If your child is having academic problems, ask to see the Special Education Consultant for the area. In consultation with the child's teacher, a modified program can be arranged if necessary. Children with epilepsy should be allowed to take part in all regular school activities, including sports. Contact your local epilepsy agency to seek assistant in your child’s school.
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People with epilepsy may develop depression for both biological and social reasons. Some longstanding poorly controlled seizure disorders may be associated with chronic personality changes. Also, short durations following temporal lobe seizures some patients may have emotional "swings" or other thinking difficulties.
While epilepsy is a medical problem, the person with the seizures must also make a number of emotional adjustments. The first challenge is acceptance of the diagnosis. Initially people with epilepsy and their families may experience shock or denial. Anger, fear, and depression are also common. However, with information and support, people with epilepsy can understand the condition and develop positive coping strategies.
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It is important to remember that people with epilepsy can, and do, live full, productive lives. If self-esteem becomes a problem, open discussion with supportive friends, family, or a professional counsellor can help you develop new ways of coping and a new sense of hope.
Topic: Working With Epilepsy
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Given that they are trained with appropriate sets of skills and/or education, the vast majority of people with epilepsy are capable of performing any job. Some exceptions to the rule are: occupations in the military, commercial airlines and fire brigade as the lives of others may be endangered should a seizure occur. Consideration should be give to the type of seizures and how well they are controlled by medication.
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Persons with epilepsy may not be able to fly a plane. There are strict standards that must be met by anyone wanting to get their pilot's license. Each person is individually assessed and must meet a regime of standards set up by the Civil Aviation Medical Centre.
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Employers hiring someone with epilepsy are often concerned that job safety will be compromised in the event of an injury caused by a seizure in the workplace. One study revealed that the accident rate of workers with epilepsy was lower than those employees without disabilities. Liability is not a factor as long as the employee has been placed in an appropriate job and reasonable accommodation is provided as necessary.
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Under the Ontario Human Rights Code (Chapter 53, Section 22(2)), it is illegal for an employer to ask about medical problems on the application form. A person with Epilepsy (or any other health problem) is not required to respond to any medical related question. A copy of the Ontario Human Rights Code and A Guild to the Ontario Human Rights Code is available by calling Access Ontario at (613) 238-3630.
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In the Ontario Human Rights Codes (Chapter 53, Section 22(3)), nothing precludes the interviewer from asking questions about your health status, however it MUST relate to your ability to perform the essential duties of the job. They may ask "Do you have any medical problems that would make you unable to do the job?", but they MAY NOT ask "Do you have any medical problems?" A copy of the Ontario Human Rights Code and A Guild to the Ontario Human Rights Code is available by calling Access Ontario at (613) 238-3630.
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The Ontario Human Rights Code does not permit employers to fire an employee because they had a seizure at work, or have Epilepsy. Before a person is dismissed, the employer must show that "reasonable accommodation" (Chapter 53, Section 23(2)) has been made to help the person keep their job. Accommodations are determined by doing a physical demands analysis, which is a breakdown of the exact physical requirements necessary to perform the job. Access Ontario, at (613) 232-0489, will be able to provide you with more Ontario Human Rights Information.
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A person who has epilepsy may qualify for assistance to prepare for and to obtain employment under the Ontario Ministry of Community and Social Services' Vocational Rehabilitation Services Program. Assistance may take the form of vocational assessment, counselling, academic, or technical training or job placement. Application should be made to the nearest office of the Ontario Ministry of Community and Social Services. Durham Region is covered by the Central East Region Office, Tel.: (905) 868-8900 or Toll Free: 1-877-669-6658.
A person who is severely disabled by seizures and unable to compete in the work force, may apply for assistance under Ontario's Benefits Program, often called GAINS-D. Application should be made to the nearest office of the Ontario Ministry of Community and Social Services, listed in the Government of Ontario section of the blue pages on the telephone directory.
Two other kinds of financial assistance are available in Ontario, depending on a person's income: General Assistance, usually referred to as welfare, is available for anyone in urgent need of financial aid. Special Assistance is for a person who is employed, but has extraordinary needs such as a high prescription drug costs. Application for each of these assistance programs should be made through the Municipal Social Service Department.
Topic: Epilepsy and Other Disorders
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Epilepsy is not necessarily associated with other neurological problems or learning disabilities. Occasionally, the source of the seizures may be reflected in other neurological deficits. Also, medication for seizures may cause sedations and thus decrease the rate of learning. People with epilepsy have the same range of intelligence as the general population.
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Epilepsy is not related to mental illness. Because of the involvement of the brain, Epilepsy has been mistakenly associated with psychiatric disorders. Epilepsy differs from psychiatric disorders in that seizures last for very brief periods and begin and end abruptly. Further, when not having seizures, people with Epilepsy need not have any changes in their mood or behaviour.
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Seizures can affect intelligence, so prompt diagnosis and rapid control of seizures is important. There is also a risk if seizures are prolonged and there is a significant reduction in oxygen in the brain during seizures. However, these are extremely rare occurrences. In the case of developmentally delayed persons with epilepsy, it is most likely that the cause of the developmental delay is also the cause of the seizures. In most cases, people with epilepsy have normal intelligence.
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Some people with epilepsy do experience a difficulty in recalling distant and recent events. Often, this is caused by the medications used to treat epilepsy, or by regular seizure activity. People affected in this way can learn to compensate by using lists and reminders, and by creating an organized environment.
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Asthma occurs in children with epilepsy at about the same frequency as it occurs in the general population. Likewise, the reverse is also true. The drug theophylline can trigger seizures.
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People with epilepsy who are on medications may experience side effects that make them more susceptible to other diseases and disorders. One common condition is Hyperplaxia, an over-growth of the gums caused by the drug Dilantin. Other common problems are liver dysfunction and depression.
TOPIC: MISCELLANEOUS
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Epilepsy can occur in animals. Like humans, epilepsy in animals is really just abnormal electrical activity in the brain.
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It is possible that some dogs are able to detect pre-seizure changes in the physiology of some people with epilepsy before the person becomes aware themselves. In many cases, the person with epilepsy is aware of an aura before the onset of the main part of the seizure.
Not enough is known about how dogs can detect seizures before their onset to know exactly what sense(s) are involved in this detection. However, one might hypothesize that since dogs can detect chemical changes due to fear, seizures that are preceded by a sense of fear might also produce detectable changes.
Lions Foundation of Canada – Special Skills Dogs of Canada – Dog Guide Program 1-800-768-3030
TOPIC: MORE INFORMATION
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There are a number of information sources about epilepsy. Here is a partial list: External resources
Epilepsy Durham Region
850 King Street West, Unit 20
Oshawa, ON L1J 8N5
905-571-2099
Canadian Epilepsy Alliance
http://www.epilepsymatters.com/
Canadian League Against Epilespy
http://www.clae.org/
Internatoinal Bureau for Epilepsy
http://www.ibe-epilepsy.org/
Epilepsy Ontario
1 Promenade Circle, Suite 308
Thornhill, ON
M4J 4P8
Telephone: (416) 229-2291 or (905) 764-5099 or (800) 463-1119
E-Mail: epilepsy@epilepsy.org
http://www.epilepsy.org
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Check your local library for books on Epilepsy.
FAQ’s Adapted from Andrew Patrick, Ph.D. andrew@calvin.dgbt.doc.ca
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