1. What is epilepsy?
Ans. Epilepsy may be defined as a continuing tendency to epileptic seizures. A seizure is a paroxysmal discharge of cerebral nerve cells apparent to the person and/or an observer.
2. What causes epilepsy?
Ans. The cause of most kinds of epilepsy is unknown (cryptogenic). There are some kinds of epilepsy for which we do know the cause. These include types of epilepsy with specific clinical features and EEG findings such as petit mal which have a strong inherited component. This group is known as idiopathic epilepsy.
The cryptogenic group is likely to grow smaller as sophisticated neuroimaging studies, particularly MRI is able to pick up small abnormalities in the brain. In a much smaller group we are able to identify a specific cause.
These include congenital abnormalities, anoxia, head injury, infection, tumors, cerebrovascular disease, degenerative disease and metabolic problems e.g. alcohol.
Congenital abnormalities may or may not be obvious at the time of birth. Some of these may be inherited. The commonest type of congenital abnormality is a disorder of neuronal migration during development. Nerve cells end up in the wrong place or with the wrong connections. It seems likely that this group may turn out to be the target.
3. I don't have convulsions but I do have other attacks? Could it be epilepsy?
Ans. Yes. Seizures may be of different types. Some patients could experience symptoms that may be related e.g. blank spells, or difficulty in concentrating. Some patients may have sub-clinical seizure activity that interferes with their activity.
4. Why does epilepsy sometimes develop so late in life?
Ans. The commonest causes of epilepsy in older people are intracranial space-occupying lesions (ICSOLs) and cerebrovascular disease.
5. Is epilepsy infectious?
Ans. No.
6. Can epilepsy affect memory?
Ans. Yes, poor memory can be the result of epilepsy or its treatment. The epilepsy may take the form of recurrent absence seizures in children or uncontrolled tonic/clonic seizures. There may also be significant brain damage in addition to the epilepsy.
7. My seizures only occur during sleep. Why?
Ans. During sleep, there are various stages of electrical activity in the brain. Seizure discharges might occur due to changes from one stage to another.
In some people, seizures occur only during sleep, but if such people are followed up over a period of 5 years, one in three will have had a seizure when awake. This knowledge, and the fact that lack of sleep precipitates seizures, are used by the electroencephalographer to get a recording of seizure electrical discharge. The patient is deprived of sleep on the night before the recording, which is taken while the person is asleep on the following day. The chance that he will have seizure discharges is then much greater.
8. Can epilepsy affect the physical and emotional development of a patient?
Ans. Drugs may cause side effects which are cosmetic. There may be gum hypertrophy or weight gain. Psychological and emotional factors are a consequence of epilepsy, not a component.
9. Are seizures life threatening? Can someone choke during a seizure?
Ans. Yes, but very rarely. The standardized mortality ratio (SMR) for epilepsy is 2-4. This means that the chance of a person with epilepsy dying is 3 (between 2 and 4) times as great as the chance of dying of a person of the same age and sex without epilepsy. Most such deaths occur because of the underlying cause of the epilepsy e.g. stroke or tumour or severe head injury. These deaths usually happen in the first two years after the onset of epilepsy. People with idiopathic epilepsy also have a raised SMR of - 1.6. Causes of death in this group include other diseases such as cancer (not necessarily brain tumours or cerebral metastases) strokes, pneumonia, suicide and death immediately related to a seizure. Death immediately related to a seizure may be of unknown cause (sudden unexpected death or SUD). SUD is thought to be due to a cardiac arrhythmia or cerebral hypoxia resulting from a seizure. It usually occurs in young, previously healthy people at the rate of between 1 in 370 and 1 in 1100 epilepsy patients per year. Other than SUD, death may follow a seizure due to status epilepticus or due to an accident such as drowning.
10. Can vaccinations cause seizures?
Ans. No. Triple vaccine (DPT) and MMR (Measles, Mumps and Rubella) may produce a febrile seizure. To prevent this, paracetamol should be given for both vaccines before the vaccination and for 2 days afterwards. MMR may also cause a febrile illness a week to 10 days later, during which paracetamol should again be used.
11. Could forceps delivery have been responsible for my daughter's seizures?
Ans. No. Studies have shown that the frequency of epilepsy is no different among those born unassisted and those born with the help of forceps.
12. Can seizures lead to brain damage?
Ans. No, unless there is status epilepticus or severe head trauma during a seizure.
