Epilepsy: More than twitching and screaming

animation of nerv cells. (picture: Gerd Altmann/pixelio.de)
In an epileptic seizure, many nerve cells discharged simultaneously. (picture: Gerd Altmann/pixelio.de)

Epilepsy is the most common chronic disease of the central nervous system. But wild twitching, screaming and foaming at the mouth are rare.

During a seizure, the brain gets "out of step". For a healthy person, the activity of the billions of nerve cells in the brain by electrical and chemical signals is well accorded. In an epileptic seizure or epilepsy, this balance is temporarily disrupted. Many nerve cells suddenly simultaneously unload. These abnormal discharges may spread in the brain and irritate individual brain regions or the whole brain.

The important distinction

There is a distinction between partial seizures in which the attack happens in a circumscribed region of the cortex, and generalised seizures which are recorded from the beginning in the whole brain.

The generalised seizures are further divided into different forms. Among the most common forms are:

  • Absence seizures (petit mal epilepsy)

Here it comes to second-long absences and loss of consciousness. Affected people are "absent", have a rigid, blank stare, possibly weak muscle twitches, are unresponsive and then have a memory gap.

  • Grand mal epilepsy

The best known, though not the most common form, is the generalised tonic-clonic seizure. Here, the person is in a tonic phase of deep unconsciousness. After a brief period of consciousness, the patient falls into a deep sleep. After waking, the patient cannot remember the attack and complains about sore muscles and headaches.

  • Status Epilepticus

Status epilepticus seizures last longer than half an hour or seizures repeat so quickly that those affected cannot recover in between. A status epilepticus seizure is a life-threatening emergency and must be treated immediately.

CT recording of the brain. (picture: Dieter Schütz/pixelio.de)
EEG and imaging techniques like MRI are used for diagnosis. (picture: Dieter Schütz/pixelio.de)

Cause of epilepsy often unclear

The cause of epilepsy and epileptic seizures is still often unclear, despite steadily improving research. On one hand, there is a inherited cause (idiopathic epilepsy), on the other are congenital or suffered brain damages (symptomatic epilepsy).

Whether someone is suffering from epilepsy, specialists can find out by a series of investigations. For the diagnosis, it is very important to receive a very accurate description of the medical history and seizures. Because of impaired consciousness in epilepsy or epileptic seizures, the doctor usually depends on the observation of third persons who have witnessed the attack.

To understand the attack, it is important to know as many details of the attack as possible. In addition, electroencephalography (EEG) and imaging techniques like magnetic resonance imaging MRI or computed tomography CT should be consulted.

Drugs or surgery?

The focus of the treatment of the patients lies on the normalisation of everyday life, the prevention of long-term damage, preserving the ability to work and on the avoidance of accidents or injuries. The treatment is normally with anti-epileptic drugs.

If the seizure control is not sufficient with medication, a surgical procedure may be considered. The decisive factors are the nature of attacks, which brain region is affected and how important this region is for everyday life.

Still today, a full control of epilepsy is not always possible. However, about two thirds of the sufferers lead a normal life with medication support. Researches into the causes of epilepsy always bring new insights, so that in the future, more effective ways to treat or prevent epilepsy could be developed.

Text: Patrick Gunti – 08/2011

Translation: MPL

Picture: pixelio.de