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What is it about ?
Epilepsy is a condition of the brain accompanied by seizures. Epilepsy is when a person has two or more seizures in a year. The first attacks often begin during childhood and early adulthood (around 20 years). An epileptic fit is also known as a seizure or convulsive fit. It is the result of a sudden and temporary disturbance of the electrical balance in the brain. It is as if there is a ‘short circuit’ in the brain.
Some seizures start in a specific region of the brain (focal or partial seizures), while others start more diffuse in both hemispheres of the brain (generalized seizures). Because of this, seizures vary from person to person. Some lose consciousness, others make jerky movements with their arms and legs. Still others seem absent, stare into space or drop whatever they are holding in their hands.
A person who has had a seizure does not necessarily have epilepsy. Indeed, certain situations can trigger an epileptic seizure without there being any question of epilepsy. We think eg. high fever, cerebral hemorrhage and / or brain damage, whatever the cause (infection, accident, etc.). It also often happens that no cause can be determined.
What is its frequency?
In Belgium, around 60,000 people suffer from epilepsy. It is estimated that 150,000 will experience an episode of epilepsy at some point in their life, but not all of these people develop the disease.
How to recognize it?
Most of the time, seizures are reported by passers-by or family members. The first time you witness a seizure it can be very scary. Some forms of seizure are very spectacular, others are rather subtle and hardly noticeable.
A seizure can manifest itself in several ways:
- complete or partial disturbance of consciousness. The person may appear to be ‘cut off from the world around them’. Absence is a characteristic form, in which the person stares into space for a few moments (a few seconds). Due to the brevity of this type of seizure, the diagnosis can take a long time to be made;
- involuntary movements (jerky, stiff, rhythmic) that the person cannot control;
- automatic gestures (the person may swallow, chew, pull at a garment or at an object without realizing it);
- sudden loss of strength, eg. suddenly falling to the ground or dropping an object suddenly and involuntarily;
- sensory experiences: the person feels, hears or sees things that are not there;
- spasmodic movements: the person bends and straightens the arms and legs quickly and repeatedly;
- a ‘tonic-clonic crisis’ or what most people think of as an ‘epileptic fit’: first the muscles stiffen (tonic phase). The vocal cords (which are also muscles) contract, causing the person to cry out. Then she loses consciousness. Then begins the clonic phase: the arms and legs then contract rhythmically. The crisis stops after a few minutes. Uncontrolled loss of urine and stool is possible. The person gradually regains consciousness. After a seizure, the person feels tired, confused, and somewhat dizzy.
How is the diagnosis made?
The doctor does not usually attend the crisis personally. He therefore only has second-hand information to make the diagnosis. If he suspects epilepsy, he will always refer you to the hospital for a full neurological exam and possibly to start treatment.
What can you do ?
Respect a regular rhythm of life (regular meal and sleep pattern), avoiding pressure and stress as much as possible. Factors such as lack of sleep, alcohol, stress, and flashes of light can trigger a seizure without actually being the cause.
If you witness a seizure, make sure that all dangerous objects are out of reach and that the person’s airways are clear. Put the person on their side and undo tight clothing. Do not slide anything into their mouth or between their teeth. Also, don’t try to contain jerky movements.
If this is a first seizure or a generalized seizure lasting more than 5 minutes, it is best to contact the emergency room immediately (112).
Always try to remember the precise course of the crisis. This information is crucial for a first diagnosis.
What can your doctor do?
It is extremely important to make the correct diagnosis. Indeed, the management is very different depending on whether the cause that triggered the crisis is known or not. If the cause is known, the doctor will start by treating it.
The basic treatment is started by the specialist (neurologist). This treatment aims to limit the number of seizures and, if possible, to suppress them. The doctor will try to set the lowest dose capable of controlling the seizures. The treatment can then be monitored by the general practitioner. Not only will he prescribe your medicines, but he will also determine the concentration in your blood and, if necessary, adjust the dose.
Modern drugs can eliminate seizures, or at least control the disease, in 70% of people with epilepsy. The remaining 30% need other drugs.
In severe cases, epilepsy surgery may be considered. This is a procedure in which the surgeon removes the area of the brain that is responsible for epilepsy.
It is the neurologist who decides whether you are fit to drive a vehicle. He is also responsible for the follow-up in the event of pregnancy.
Sources
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