Epilepsy is any condition that predisposes someone to have recurrent seizures. I would point out there are hundreds of different conditions that can predispose to someone having unprovoked recurrent seizures. Epilepsy can manifest as a variety of different types of seizures, sometimes as subtlest staring, but can be as obvious as a generalized convulsion. The age groups that we see epilepsy in aren't just kids, but actually even more common in adults over the age of 65. the treatments that are available are many and that we point out that most people actually respond well to treatments and become seizure free. In those that don't, there are a variety of other options including surgery and dietary changes. With respect to overall prognosis, over 60% of patients become seizure free, and then the ones that don't, there are a multitude of options to consider.
So the definition of epilepsy is any condition which causes or predisposes somebody to recurrent seizures. And so a little bit of a background and you know, anybody can have a seizure. A seizure is an electrical storm in the brain. The brain is misfiring in a way that causes the brain not to function right. And anybody can have one. I mean, if your electrolytes are out of whack, if you've had too much alcohol, you can have a provoked seizure. But the difference between someone with epilepsy and a provoked seizure is that people with epilepsy, it's not provoked. It comes out of the blue. And about 10% of the population will have a seizure at some point in their life, but about 1% of the population has epilepsy.
With respect to who gets epilepsy, It's interesting because there's a bit of a, a misconception and that is that everybody with epilepsy has it from childhood. I think there are a lot of people have this vision of a child with cerebral palsy in a wheelchair and that's what epilepsy is. And in the 1990s through some epidemiologic studies we realized that actually isn't exactly true. Yes, there's a spike in the occurrence of epilepsy in childhood and in young age, maybe around 10 it does start to peter off and through your 20s and 30s and 40s it's relatively infrequent and stays relatively stable. And then you hit about age 55 and we realized there was an increase in the incidence of epilepsy. And after about age 65, the incidence of epilepsy appears to be higher than in any other age group. So as people get older, new cases of epilepsy are much more common than we thought. Now the question is, well why, where are these coming from? It's probably mostly related to post-stroke, epilepsy, but in general thing, people are living longer, living through things that in the past they didn't, they didn't live through, whether that's brain trauma, cancer, or strokes, and that's where they're coming from.
So there are some major triggers for seizures that everybody should be aware of. There are specifically, three big ones, actually. One: stress. Stress is the universal trigger for actually everything neurological frankly, but especially epilepsy. And it's tough because stress is such an individual sort of problem, you know, what's stressful to you might not be what's exactly stressful to me. But stress as a general rule is an absolute trigger for seizures. So I recommend my patients find ways to sort of manage their stress, find techniques that work well for them. If it's seeing a counselor to help work on relaxation techniques, do it, it's important. Sleep deprivation, a big one. You know, my recommendation is that people try to get what is whatever is regular for them. If they don't know, then shoot for about eight hours a night. Now, you know, I've got some lucky folks who, you know, lived on six hours of sleep a night and that's what they need. Fine. Whatever works well for you, just get it on a regular basis and you want to have a relatively regular sleep cycle. You know, what is really hard on my epilepsy patients on someone who switches, you know, from night shifts, two days of the week, and then daytime, you know, the other days those switches for epilepsy patients is a really hard, and it can be a big trigger for seizures. And then last is alcohol use alcohol itself is it lowers your seizure threshold and then can provoke seizures. And so I recommend my epilepsy patients abstain from alcohol as much as possible.
So with respect to anatomic or specific types of epilepsy and seizures, there's actually several different types of, which is one of the ways, one of the reasons it's so interesting for me and I think difficult for patients to understand. I would back up and say that in general, seizures come in two different types. One type is from a very specific area of the brain. We call those focal or partial seizures. And then there are seizures that come from everywhere in the brain at once we call those generalized seizures. And then that also then applies to the epilepsy. And that there are generalized epilepsies and focal epilepsies or localization-related epilepsies. And those, those differences actually have a huge impact on what the symptoms are and what the patient feels. And the big difference is in the generalized seizures, they start everywhere in the brain at once. And the way that I tend to think about them is that often these are genetic epilepsies. So the gene is in every cell of the brain. So when someone has a seizure, everything goes off at once. There's no warning, they can't tell it's happened and just boom, it happens. And they can have several different types of seizures.
Commonly they'll have absence seizures or what we used to call petit mal seizures and with those is people just sort of stare off. No warning. That my flutter their eyes and my last for 10, 15 seconds, no aura or warning and no after effects. They're just not there. These are hard to detect for patients. They don't always notice and, you know, these is are the types of seizures that astute parents or teachers will recognize in kids, but in adults there are really difficult to nail down. People can have generalized tonic-clonic seizures where they stiffen up and shake all over. Those are very scary for families. Appears as patient stops breathing, often people can bite their tongue, have urinary incontinence. But there are other types as well, something called a myoclonic seizure where people just have a jerk and that's it. A jerk is, they're seizure. Often happens after a poor night's sleep. People can have also atonic seizures where they lose all tone and fall. Those often happen in people who often have cognitive impairment, developmental delay, and had these seizures since childhood, often very difficult to control.
As opposed to the generalized seizures, the focal seizures or partial onset seizures are much more common in adults. This is what most of what I see. With partial onset seizures again the symptoms are interesting and difficult too, because it completely depends where they're coming from in the brain. And so in adults, the seizures have three main types. They're called simple-partial, complex-partial, and then secondarily generalized. And it all has to do with how much of the brain is involved. And so you can imagine there's a scar in the brain, the size of your pinky tip and that scar can be anywhere, let's say it's in the temporal lobe where the majority of seizures originate. In that area, that part of the brain is firing off in a disorganized way. It's a tiny area and because it's so small, there's no alteration of consciousness, there's no confusion, but the area right around it gets activated. That electrical activity sort of is conducted to the brain cells right around there. And so you get a feeling for whatever that is. And I point out if that was in your vision area, you could have a visual hallucination. If it was in a motor area, you might get jerking on the opposite side in the temporal lobe. There are some very consistent symptoms people get. Often either butterflies in the stomach or this rising feeling in the stomach, like you're on a roller coaster. But people can get Deja Vu. A funny taste. Almost always unpleasant, a funny smell. A panic feeling, unprovoked anxiety. And again, there's no alteration of consciousness. So people will often say, that's not a seizure. That was an aura. Well, that is, that's a small seizure. That's a simple partial seizure. Then as a seizure, gets a little bit bigger, a little bit more of the brain is involved. Then you start to have some alteration of consciousness. And I would point out that this is often very gray, right? There's the there, you know, there is the black and the white. No the totally aware of what's going on in the, totally not aware of what's going on. But there's all of these shades of gray in between and we call these sort of dyscognitive symptoms where you're just not quite right. You're not functioning at full capacity. And again, it has to do with just how much of the brain is involved with the seizure activity.
Send this to a friend