If you “Google” the definition of “epilepsy,” the result is more confusing than it need be. The basic definition of epilepsy is a condition in which a person suffers recurrent seizures. The reason the search result is so confusing is that instead of just saying “epilepsy is recurrent seizures,” the writers are trying to include all of the many potential manifestations of a seizure. Seizures come in many forms and entail a variety of symptoms, a meaningful discussion of which is far beyond the scope of this discussion.
Seizures can include a loss of consciousness, no alteration of consciousness or simply altered consciousness. Shaking, called “tonic-clonic” movement of one arm and leg on one side or all 4 limbs may occur. Loss of bowel and bladder control may occur. Often the afflicted person experiences phenomena of one or more of the senses (sight, smell, taste, hearing, touch). Vocal output may occur, anything from an incomprehensible sounds to words or phrases; even singing. Sometimes a person with seizures can tell when they are about to have a seizure. This is called an “aura” and is most commonly an unusual odor, but can be a sound, taste, or other sensation, even something seen.
The manifestations of a seizure are “all over the map” because on a physiologic level they are a condition of “out of control” activity of a group of neurons (brain cells). While this most frequently occurs in the temporal lobes of the brain, it can occur in any part of the brain, “controlling” any number of brain functions. Often the abnormal activity spreads throughout one side or even the entire brain, thus the possibility of any number of manifestations. Sometimes diagnostic tests of the brain, for example, imaging techniques like MRI or electrodiagnostic techniques (EEG or electroencephalography) can localize, quantify, and qualify seizure activity.
The actual causes of seizures are varied and often poorly understood. Babies will often have a seizure when their fever is high. Young people will sometimes have a seizure after a hard blow to the head. Alcoholics sometimes have seizures when particularly intoxicated or more commonly when withdrawing. Remember, the occasional seizure is not epilepsy.
Seizures are generally not dangerous unless one’s consciousness or motor/sensory function are impaired while driving a car or climbing a ladder, for example. In most states, persons who have had seizures must be seizure-free (with or without treatment) for one year to maintain their driver’s license. On the other hand, the condition of intractable seizures, repeated seizure activity that will not stop, often despite emergency treatment, called status epilepticus, can cause permanent brain damage.
To the unfamiliar, observing a seizure in a friend or loved one can be particularly frightening, but seizures are mostly harmless. If one observes a person having a major seizure, simply remain calm, help the person avoid a major fall or accident, lie them down and wait. Nearly always, and typically after a period of drowsiness and confusion (called the postictal period), they will come around as say, “I had a seizure, didn’t I?” Do not stick your fingers or anything else their mouth to “pull their tongue out of their throat.” This is an “old wive’s tale.” You could lose a finger and it will not help the victim.
The diagnosis and treatment of seizures has progressed by leaps and bounds over recent decades. Most can be controlled with the regular use of medications with few risks or side-effects. Epilepsy that cannot be controlled with medication can sometimes be reduced with brain surgery. This requires a highly sophisticated team of experts, including a specially trained neurosurgeon and advanced technology.
Thomas Chappell, MD