KNOWING ABOUT EPILEPSY AND SEIZURES (PART 2)
Is Epilepsy Inherited?
Heredity (genetics or the physical traits we get from our parents) plays an important role in many cases of epilepsy.
For instance, not everyone who has a serious head injury (a clear cause of seizures) will get epilepsy. Those who do develop epilepsy may be more likely to have a history of seizures in their family. This family history suggests that it is easier for them to develop epilepsy than for people with no genetic tendency.
When seizures begin from both sides of the brain at the same time it's called generalized epilepsy. Generalized epilepsy is more likely to involve genetic factors than partial or focal epilepsy.
In recent years, genetic links to some forms of partial epilepsy have been found.
If I Have Epilepsy, Will My Children Also Have It?
Most children of people with epilepsy do not develop seizures or epilepsy. However, since genes are passed down through families, it is possible. Here are a few general points to remember.
Less than 2 people out of every 100 develop epilepsy at some point during their lifetime.
The risk for children whose father has epilepsy is only slightly higher.
If the mother has epilepsy and the father does not, the risk is still less than 5 in 100.
If both parents have epilepsy, the risk is a bit higher. Most children will not inherit epilepsy from a parent, but the chance of inheriting some types of epilepsy is higher.
Learning The Facts And Understanding The Risks Of Passing It Along To Your Children Can Help.
If you have epilepsy, you may be afraid that your children will have epilepsy, too. However, it’s important to know the facts. The risk of passing epilepsy on to your children is usually low. Epilepsy shouldn’t be a reason not to have children. Medical testing may help people who have a known genetic form of epilepsy understand their risks.
If a child does develop epilepsy, remember that many children can get complete control of seizures. For some, the epilepsy may go away.
Most importantly, having seizures and epilepsy doesn’t mean you or your child are any different or less important than anyone else!
Will I Have To Stay On Seizure Medicine All My Life?
If seizures go away, you may be able to come off seizure medicine (with your doctor’s advice) if you have been seizure free for 2 to 5 years. There are a number of issues to think about before slowly stopping your seizure medications. For example, do you drive a car and what is the risk of driving if you have another seizure? What type of work do you do? Would you be at risk of injury coming off medicine? Are you ready and willing to make changes in your medicines?
The length of time a person is seizure free before stopping his medicine depends on many issues.
The longer the time a person is seizure free on medications, the better chance she has of coming off medicines.
More than 50 out of 100 children outgrow their epilepsy. Twenty years after the diagnosis, 75 out of 100 people will have been seizure free for at least 5 years, although some may still need to take daily medication.
People who have surgery and become seizure free may be able to come off seizure medicine. However, some people may need to stay on their medication to prevent seizures from coming back, even after surgery.
What If I Am Still Having Seizures While Taking Seizure Medications?
If you continue to have seizures while taking seizure medications, ask the following questions.
Is your diagnosis correct? Sometimes people are diagnosed with seizures but they may not be caused by electrical discharges or storms in the brain. If your diagnosis isn’t clear, it’s time to find out what is going on.
Do you know what type of seizures you have? Some medicines work best for specific types of seizures. If you and your doctor don’t know what type of seizures you have, testing -- called Video EEG Telemetry -- can record you having a seizure and determine its type. This information will help the doctor choose the best medicine to use.
Can you tolerate the medicine’s side effects? Sometimes a medicine’s side effects make it hard to take a drug at the right dose. People may feel too sleepy, confused, have memory problems, or feel uncoordinated or unsteady walking when the dose is raised. Other side effects may occur that don’t agree with a person but are not related to the dose of the medicine. Finding the right medicine to control seizures means finding one that also doesn’t cause bothersome side effects.
Can you afford the medicine? Is it available? Many practical issues, such as the cost of medicine and if it‘s available are the first things to consider before deciding if a drug works. A drug can’t work if you can’t take it regularly.
Do you know how to take the medicine and can you take it on the schedule your doctor sets up? Medicines work only when they can be taken on a regular basis. Knowing if a person has had a good trial with a medicine depends on whether or not the person understood how to take it and was able to do it.
You should see an epilepsy specialist to evaluate your seizures and treatment if
You have tried at least 2 seizure medications that are the right kind for your seizure type.
If the seizure medications were tried for a long enough time at the right doses.
If you were able to take the medicines regularly.
If bothersome side effects limit your ability to stay on the medicines.
Commonly Used Names For Seizure Types
Seizures are generally described in two major groups of seizures, primary generalized seizures and partial seizures. The difference between these types is in how and where they begin. A new way of naming seizures has been developed by epilepsy specialists, but most often these common names are still used.
Primary generalised seizures
Primary generalized seizures begin with a widespread electrical discharge that involves both sides of the brain at once. Hereditary factors are important in many of these seizures.
Partial seizures begin with an electrical discharge in one limited area of the brain. Many different things can cause partial seizures. These include head injury, brain infection, stroke, tumour, or changes in the way an area of the brain was formed before birth (called cortical dysplasia). Many times, no known cause is found, but genetic factors may be important in some partial seizures.
Partial seizures can be broken down further, depending on whether a person's awareness or consciousness (the ability to respond and remember) is affected.
The diagnosis of epilepsy is typically made based on observation of the seizure onset and the underlying cause. An electroencephalogram (EEG) to look for abnormal patterns of brain waves and neuro-imaging (CT scan or MRI) to look at the structure of the brain are also usually part of the workup. While figuring out a specific epileptic syndrome is often attempted, it is not always possible. Video and EEG monitoring may be useful in difficult cases.
While many cases are not preventable, efforts to reduce head injuries, provide good care around the time of birth, and reduce environmental parasites such as the pork tapeworm may be effective. Efforts in one part of Central America to decrease rates of pork tapeworm resulted in a 50% decrease in new cases of epilepsy.
Rolling a person with an active tonic-clonic seizure onto their side and into the recovery position helps prevent fluids from getting into the lungs. Putting fingers, a bite block or tongue depressor in the mouth is not recommended as it might make the person vomit or result in the rescuer being bitten. Efforts should be taken to prevent further self-injury. Spinal precautions are generally not needed.
If a seizure lasts longer than 5 minutes or if there are more than two seizures in an hour without a return to a normal level of consciousness between them, it is considered a medical emergency known as status epilepticus. This may require medical help to keep the airway open and protected; a nasopharyngeal airway may be useful for this. At home the recommended initial medication for seizure of a long duration is midazolam placed in the mouth. Diazepam may also be used rectally. In hospital, intravenous lorazepam is preferred. If two doses of benzodiazepines are not effective, other medications such as phenytoin are recommended. Convulsive status epilepticus that does not respond to initial treatment typically requires admission to the intensive care unit and treatment with stronger agents such as thiopentone or propofol.
Is There Any Treatment?
Epilepsy is usually treated with daily medication once a second seizure has occurred, but for those at high risk, medication may be started after the first seizure. Once epilepsy is diagnosed, it is important to begin treatment as soon as possible. For about 70 percent of those diagnosed with epilepsy, seizures can be controlled with modern medicines and surgical techniques. Some drugs are more effective for specific types of seizures. An individual with seizures, particularly those that are not easily controlled, may want to see a neurologist specifically trained to treat epilepsy. In some children, special diets may help to control seizures when medications are either not effective or cause serious side effects.
A ketogenic diet (high-fat, low-carbohydrate, adequate-protein) appears to decrease the number of seizures and eliminate seizures in some. It is a reasonable option in those who have epilepsy that is not improved with medications and for whom surgery is not an option. About 10% stay on the diet for a few years due to issues of effectiveness and tolerability. Side effects include stomach and intestinal problems in 30%, and there are long term concerns of heart disease. Less radical diets are easier to tolerate and may be effective. It is unclear why this diet works. Exercise has been proposed as possibly useful for preventing seizures with some data to support this claim.
In people with coeliac disease or non-celiac gluten sensitivity and occipital calcifications, a gluten-free diet may decrease the frequency of seizures.
What Is The Prognosis?
While epilepsy cannot be cured, for some people the seizures can be controlled with medication, diet, devices, and/or surgery. Most seizures do not cause brain damage, but ongoing uncontrolled seizures may cause brain damage. It is not uncommon for people with epilepsy, especially children, to develop behavioural and emotional problems in conjunction with seizures. Issues may also arise as a result of the stigma attached to having epilepsy, which can lead to embarrassment and frustration, or bullying, teasing, or avoidance in school and other social settings. For many people with epilepsy, the risk of seizures restricts their independence (some states refuse drivers licenses to people with epilepsy) and recreational activities.
Epilepsy can be a life-threatening condition. Some people with epilepsy are at special risk for abnormally prolonged seizures or sudden unexplained death in epilepsy.
People with epilepsy are at an increased risk of death. This increase is between 1.6 and 4.1 fold greater than that of the general population and is often related to: the underlying cause of the seizures, status epilepticus, suicide, trauma, and sudden unexpected death in epilepsy (SUDEP). Death from status epilepticus is primarily due to an underlying problem rather than missing doses of medications. The risk of suicide is increased between two and six times in those with epilepsy. The cause of this is unclear. SUDEP appears to be partly related to the frequency of generalized tonic-clonic seizures and accounts for about 15% of epilepsy related deaths. It is unclear how to decrease its risk. The greatest increase in mortality from epilepsy is among the elderly. Those with epilepsy due to an unknown cause have little increased risk. In the United Kingdom, it is estimated that 40–60% of deaths are possibly preventable. In the developing world, many deaths are due to untreated epilepsy leading to falls or status epilepticus.
What Research Is Being Done?
Scientists are studying the underlying causes of the epilepsies in children, adults, and the elderly, as well as seizures that occur following brain trauma, stroke, and brain tumours.
Ongoing research is focused on developing new model systems that can be used to more quickly screen potential new treatments for the epilepsies. The identification of genes or other genetic information that may influence or cause the epilepsies may allow doctors to prevent the disorders or to predict which treatments will be most beneficial to individuals with specific types of epilepsy.
Scientists also continue to study how neurotransmitters interact with brain cells to control nerve firing and how non-neuronal cells in the brain contribute to seizures. Some researchers have developed a flexible brain implant that could one day be used to treat seizures.
Scientists are continually improving MRI and other brain scans that may assist in diagnosing the epilepsies and identify the source, or focus, of the seizures in the brain. Other areas of study include prevention of seizures and the role of inflammation in epilepsy. Patients may enter trials of experimental drugs and surgical interventions.
Living With Epilepsy
While epilepsy is different for everyone, there are some general rules that can make living with the condition easier.
It's important to stay healthy through regular exercise, getting enough sleep, eating a balanced diet and avoiding excessive drinking.
You may have to think about your epilepsy before you undertake things such as driving, using contraception and planning a pregnancy.
....making effort to "STAYWELL"