UCLA Pediatric Neuropsychiatry

Epilepsy

Overview | Treatment

 
   

Definition

  

A brain disorder involving recurrent  seizures.
 

Alternative names

seizure disorder
 

Causes, incidence, and risk factors

A seizure disorder includes any condition in which there are repeated episodes of seizures of any type. Epilepsy (idiopathic seizure disorder) is a term used when the seizure disorder has no identifiable cause such as brain disease. A seizure disorder affects about 0.5% of the population. It can affect people of any age.

Transmission of information from nerve cell to nerve cell occurs by an electrochemical process. This process can be detected as electrical activity by an electroencephalograph (EEG). Abnormal patterns of electrical activity are associated with seizures.

The cause of the seizure correlates to some extent with the age of onset. In some people, seizures may be triggered by hormone changes such as pregnancy or menstruation. They may also be triggered by illness or by sensory stimuli such as lights, sounds, and touch. In many cases, no trigger is found for the seizures. Given sufficient circumstances, any person will have a seizure. The amount of stimulation required to cause a seizure is called the seizure threshold. Many people with epilepsy are considered to have a low seizure threshold.

Some of the more common causes of seizures include:

  • Idiopathic (no identifiable cause)
    • usually begin between ages 5 to 20
    • can occur at any age
    • no other neurologic abnormalities present
    • often a family history of epilepsy or seizures
  • Congenital defects and perinatal (near the time of birth) injuries--seizures usually begin in infancy or early childhood
  • Metabolic abnormalities
  • Brain injury
    • may affect any age, highest incidence in young adults
    • most likely if the brain membranes are damaged
    • seizures usually begin within 2 years after the injury
    • early seizures (within 2 weeks of injury)--do not necessarily indicate that chronic seizures (epilepsy) will develop
  • Tumors and brain lesions that occupy space (such as hematomas)
    • may affect any age, more common after age 30
    • partial (focal) seizures most common initially
    • may progress to generalized tonic-clonic seizures
  • Disorders affecting the blood vessels (stroke , TIA, and so on)
    • most common cause of seizures after age 60
  • Degenerative disorders (senile dementia Alzheimer type, or similar organic brain syndromes)
    • mostly affect older people
  • Infections

There may be changes in mental status (such as alertness and awareness) and/or focal neurologic symptoms (localized symptoms of changes in brain function) associated with the seizures. The type of seizure that occurs varies depending on the location and type of the problem causing the seizure and with individual response to the problem.

Seizures may occur in a generalized form (affecting all or most of the brain) or in a partial form (affecting only a portion of the brain). Epilepsy is typically generalized (except in some cases that develop in childhood and have a specific focus). Generalized seizures include variations of generalized tonic-clonic seizures and petit mal seizures. Partial seizures include focal seizures (during which the person remains alert but there are abnormal movements or sensations) and partial complex seizures (during which the abnormal movement or sensation is accompanied by changes in consciousness).
 

Prevention

Generally, there is no known prevention for seizure disorders.
 

Symptoms

Epilepsy is characterized by seizures of any type that occur on a chronic, recurrent basis and have no known cause. Nonspecific symptoms and/or signs may occur along with the seizures; including a headache, changes in mood or energy level, dizziness, fainting, confusion, and memory loss . An aura, sensations indicating a seizure is imminent, occur in some persons just prior to a generalized seizure.

Types of seizures and their symptoms:
PETIT MAL SEIZURES

  • minimal or no movements (usually, except for "eye blinking")
  • brief sudden loss of awareness or conscious activity
  • recurs many times
  • occurs most often during childhood
  • decreased learning

GRAND MAL SEIZURES (GENERALIZED TONIC-CLONIC SEIZURES)

SINGLE FOCAL SEIZURES

PARTIAL COMPLEX SEIZURES

  • automatism (automatic performance of complex behaviors)
  • abnormal sensations
  • may have nausea, sweating, skin flushing, and dilated pupils
  • may have other focal (localized) symptoms
  • recalled or inappropriate emotions
  • changes in personality or alertness
  • may or may not lose consciousness
  • olfactory (smell) or gustatory (taste) hallucinations or impairments -- if temporal focus
 

Signs and tests

The diagnosis of epilepsy and/or seizure disorders involves a history of recurrent seizures of any type. A physical examination , including a detailed neuromuscular examination, may be normal or may show focal neurologic deficits (localized abnormalities of brain functions).

  • An electroencephalograph (EEG), a reading of the electrical activity in the brain, usually confirms the presence of various types of seizures. It may, in some cases, indicate the location of the lesion causing the seizure.

Tests for the cause may include various blood tests (as appropriate depending on the suspected cause), including:

Tests for the cause may include procedures such as:

A physical examination and testing may be used to rule out other temporary and reversible causes of seizures such as a fever , various temporary chemical imbalances, toxemia of pregnancy, withdrawal from alcohol or drugs (especially benzodiazepines and barbiturates), use of drugs (especially street drugs), or other causes.

Disorders that may cause symptoms resembling seizures include transient ischemic attacks, rage or panic attacks, and any disorder that causes loss of consciousness or that causes tremors or tics as symptoms (abnormal muscle movements that are not caused by abnormal brain electrical activity).
 

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