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1 EPILEPSY - Introduction Epilepsy is one of the most common serious disorders of the brain, affecting about 50 million people worldwide. The term "epilepsy" encompasses a group of syndromes that vary in its associated pathology and seizure types. The diagnosis of the epileptic syndrome is one of the primary objectives undertaken when managing a patient with seizures. Epilepsy was one of the first brain disorders to be described. It was mentioned in ancient Babylon more than 3,000 years ago. The strange behaviour caused by some seizures has contributed through the ages to many superstitions and prejudices. People once thought that those with epilepsy were being visited by demons or gods. However, in 400 B.C., the early physician Hippocrates suggested that epilepsy was a disorder of the brain and we now know that he was right. The term "epilepsy" is derived from the Greek word "epilambanein”, which means "to seize upon", "to attack". Thus epilepsy is a seizure or rather a disease which causes seizures to occur. As, however, there are many very different types of seizure, it is better to speak of epilepsies. Epilepsy is a common neurological disorder marked by involuntary, recurrent seizures that arise from excessive discharges of neurons in the brain. Seizures vary in type, severity and intensity, and can be manifested by changes in consciousness, movement, sensation, or behaviour. Epilepsy — that is, the occurrence of more than one unprovoked seizure — affects both men and women, yet gender-specific patterns have been noted. Females develop seizures at greater rates in the first five years of life, but males predominate after this age, with the greatest differences noted in the older age groups. Epilepsy can present itself at any age; however, the incidence and prevalence is highest in the very young and the elderly. Depending on age of manifestation, the causes for epilepsy can differ widely. Epilepsy is not a mental illness, and it is not a sign of low intelligence. It is also not contagious. Between seizures, a person with epilepsy is no different from anyone else. How can epilepsy be defined? When someone repeatedly has epileptic seizures then we say that that person is suffering from epilepsy. An epileptic seizure itself is one of the many pathological forms of reaction which can take place in the brain; it is the brain’s "response" or reaction to a disturbing, irritating or damaging stimulus. This reaction to the stimulus is accompanied by abnormal HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 2 electro-chemical excitatory processes in the cerebral nerve cells. This pathological process takes place when suddenly an unnaturally large number of nerve cells are stimulated simultaneously, causing a difference in voltage between the outer side of the cell wall and the inside of the cell (membrane potential). This voltage difference is then suddenly discharged, creating a kind of "storm in the brain", or, to put it another way, "making a fuse blow". - What is epilepsy? Epilepsy is a disorder of the brain. In people with epilepsy, brain cells create abnormal electricity that causes seizures. The term "seizure" is widely used to describe an abnormal spasm or convulsion, generated by excessive electrical activity in the brain. Seizures vary from a momentary disruption of the senses, to short periods of unconsciousness or staring spells, to convulsions. Some people have just one type of seizure; others have more than one type. A seizure may cause "jerking" movements. In some cases, seizures cause: only a loss of consciousness, a period of confusion, a staring spell or muscle spasms. A single seizure is not considered epilepsy. People with epilepsy have repeated episodes of seizures. HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 3 Absence epilepsy People with absence epilepsy have repeated absence seizures that cause momentary lapses of consciousness. These seizures almost always begin in childhood or adolescence, and they tend to run in families, suggesting that they may be at least partially due to a defective gene or genes. Some people with absence seizures have purposeless movements during their seizures, such as a jerking arm or rapidly blinking eyes. Others have no noticeable symptoms except for brief times when they are "out of it." Immediately after a seizure, the person can resume whatever he or she was doing. However, these seizures may occur so frequently that the person cannot concentrate in school or other situations. Childhood absence epilepsy usually stops when the child reaches puberty. Absence seizures usually have no lasting effect on intelligence or other brain functions. Temporal lobe epilepsy Temporal lobe epilepsy, or TLE, is the most common epilepsy syndrome with focal seizures. These seizures are often associated with auras. TLE often begins in childhood. Research has shown that repeated temporal lobe seizures can cause a brain structure called the hippocampus to shrink over time. The hippocampus is important for memory and learning. While it may take years of temporal lobe seizures for measurable hippocampal damage to occur, this finding underlines the need to treat TLE early and as effectively as possible. HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 4 Neocortical epilepsy Neocortical epilepsy is characterized by seizures that originate from the brain's cortex, or outer layer and maybe caused by a lesion, such as a tumour or vascular malformation; an injury to the brain, such as a traumatic injury or an infection; or abnormal brain development before birth. In this condition, the morphology, or structure, of the neurons changes so that the region is more easily excitable and more prone to seizures. Neocortical epilepsy involves both ictal (during seizure) and interictal (between seizures) neuronal activity. The seizures can be either focal or generalized. They may include strange sensations, visual hallucinations, emotional changes, muscle spasms, convulsions, and a variety of other symptoms, depending on where in the brain the seizures originate. - Seizures Today specialists speak of "grand mal" and "petit mal" seizures, or "generalised" and "focal" seizures. These manifestations often occur in combination, for instance stiffening, jerking; salivation, wetting oneself and loss of consciousness are symptoms of a "major seizure", a "grand mal" ("great evil"). In the past, people differentiated between such "major" seizures and "lesser", "petit mal" attacks, which manifest themselves in a short clouding of the consciousness or absence) which only lasts for a few seconds, in a single jerk (myoclonia) or in a so-called twilight state. HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 5 These seizures, which are also termed psycho-motor or partial complex seizures, are characterised by a twilight state lasting between 30 seconds and 3 minutes, during which the patient is confused, displays inappropriate behaviour (e.g. chewing movements, fiddling with the hands, running away) and sometimes utters intelligible but meaningless words, or incomprehensible sounds. The salaam spasm is a special form of petit mal seizure which occurs almost exclusively in infants and which is generally a pointer for a severe type of epilepsy. (The "salaam seizure" is so called because of the nature of the seizure, during which the patient suddenly jerks nods or slowly bends forward, as if to make an oriental greeting.) During a generalised seizure, both halves of the brain are affected simultaneously and thus the attack influences both sides of the body from the onset. This does not necessarily mean that the whole body is affected by the seizure; what is primarily important is the simultaneous nature of the attack from the onset. The above-mentioned grand mal seizures, absences and salaam seizures are all generalised seizures. Focal seizures are in contrast attacks which at the onset only affect one side of the body or a certain part of the body. (This in its turn means that in the brain only a certain part of one hemisphere is affected by the seizure.) Examples of focal seizures are one sided grand-mal seizures, one-sided jerking, stiffening or dysaesthesia, and psychomotor (partial complex) seizures. A grand mal seizure — also known as a tonic-clonic seizure — is a type of seizure characterized by loss of consciousness, falling down, loss of bowel or bladder control, and rhythmic convulsions. Seizures result from an abnormal electrical discharge in the brain. When a person is having this type seizure, you may see the following: - Sudden crying, falling or slumping, loss of consciousness; - The body may become stiff, then start to jerk and relax involuntarily; - Breathing becomes shallow, or temporarily suspended. The skin takes on a bluish tone; - Possible loss of bladder or bowel control because of the involuntary muscle spasms; - The seizure may last two minutes or longer; - The spasms will slowly subside; - When breathing resumes, it may be noisy; - There will be a slow return to full consciousness. HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 6 A generalized tonic clonic seizure Here the whole brain is affecting from the beginning. In (a) there is a cry and loss of consciousness, arms flex up then extend in (b) and remain rigid (the tonic phase) for a few seconds. A series of jerking movements take place (the clonic phase) as muscles contract and relax together. In (c) the jerking is slowing down and will eventually stop. In (d) the man has been placed on his side to aid breathing and to keep the airway clear HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 7 Generalized Seizures Seizures may affect an isolated part of the brain or may involve abnormal activity in the whole brain (called generalized seizures). They affect the entire brain and often cause a person to lose consciousness or awareness of their surroundings. The following are different types of generalized seizures: Absence seizure: sometimes called "petit mal" seizure most common in childhood may last from a few seconds to a minute may cause clouding of consciousness, staring, minor facial movements and eye movement Scientists are unsure of the underlying reasons for absence seizures in most cases. Some research suggests that genetics may play a role. Affecting two of every 1,000 people, absence (formerly called petit mal) seizures are caused by abnormal and intense electrical activity in the brain. Normally, the brain's nerve cells (neurons) communicate with one another by firing tiny electric signals. But with a seizure, these signals become abnormal. HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 8 Absence seizures are one form of generalized seizure. Typically, this type of seizure lasts between 10 and 30 seconds. The person, most often a child aged 5 to 15, abruptly stops whatever he's doing (talking, walking) and appears to "stare into space." Absence seizures rarely cause a true convulsion in which the person falls down or collapses, and despite briefly losing consciousness, the person recovers fully with no lingering confusion or other ill effects. These "spells" may occur infrequently or several times per hour. In children, absence seizures may interfere with learning and are often misinterpreted as impertinence or inattention. About a quarter of people who have absence seizures will develop another type of generalized seizure called tonic-clonic (formerly called grand mal) seizures. The vast majority of children, however, will outgrow them. Ictal EEG of typical absence seizure of childhood absence epilepsy : Note the regular rhythm of the discharge, the constant spike and slow wave relation, and the abrupt onset. The opening phase is often variable and unreliable. The child remains unresponsive from the onset of the initial phase to the onset of the terminal phase of the discharge. However, she is able to understand the technologist during the terminal phase, when the ictal discharge is waning. HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 9 Tonic-clonic seizure: sometimes called "grand mal" seizure begins suddenly and without warning may cause loss of consciousness, stiffening of the body, jerking of the arms and legs may cause loss of bladder control may last one to two minutes full consciousness may not return for 10 to 15 minutes may cause lingering confusion or fatigue, which could last for hours or days Atonic seizure: a sudden loss of muscle tone that makes a person drop to the floor may last a few seconds can occur without loss of consciousness Myoclonic seizure: quick muscle jerk often occurs early in the morning usually does not cause loss of consciousness may be triggered by lack of sleep or too much alcohol HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 10 Tonic seizure: a sudden increase in muscle tone, with stiffening of the arms and legs may cause a person to fall most common in childhood Clonic seizure: jerking of the muscles causes loss of consciousness common in children Partial Seizures Partial seizures occur when an abnormal electrical discharge takes place only in one part of the brain. The following are different types of partial seizures: Simple partial seizure: consciousness is not altered may cause brief changes in how things look, taste, feel or sound may last a few seconds may involve body movement may progress to a complex partial seizure or to a generalized tonicclonic seizure Complex partial seizure: person will appear to be conscious, but will lose contact with the world around him/her may vary in length from seconds to minutes person may exhibit "automatisms," or non-purposeful movements, such as rubbing hands, smacking lips, fidgeting with objects or grinding teeth may cause a period of confusion after the seizure is over person may not be able to recall any of the events that happened during the seizure may progress to a generalized tonic-clonic seizure HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 11 Secondarily generalized seizure: any partial seizure may progress to a generalized tonic-clonic seizure Repeated brain seizures characterize a seizure disorder known as epilepsy. Only a small percentage of people who experience at least a single seizure episode go on to develop epilepsy. HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 12 - Causes The brain consists of more than 100 billion nerve cells. These all communicate with one another; some provoke others into sending further messages (excitation), while others tend to block them (inhibition). The proper working of the brain depends on a balance between these: too many nerve cells sending messages at once without enough being blocked can produce a sort of electrical storm - or a seizure. Common causes include brain damage from birth injuries, head injuries, stroke, brain tumours and alcoholism. Some seizures probably have a genetic basis, although it's rare for epilepsy to run in families. However, no one apparent cause has been found. How can epilepsy be defined? When someone repeatedly has epileptic seizures then we say that that person is suffering from epilepsy. An epileptic seizure itself is one of the many pathological forms of reaction which can take place in the brain; it is the brain’s "response" or reaction to a disturbing, irritating or damaging stimulus. This reaction to the stimulus is accompanied by abnormal electro-chemical excitatory processes in the cerebral nerve cells. This pathological process takes place when suddenly an unnaturally large number of nerve cells are stimulated simultaneously, causing a difference in voltage between the outer side of the cell wall and the inside of the cell (membrane potential). This voltage difference is then suddenly discharged, creating a kind of "storm in the brain", or, to put it another way, "making a fuse blow". If a person has one epileptic fit, it does not mean that he or she has epilepsy. Only when that person suffers repeated spontaneous epileptic seizures (i.e. without any direct trigger), should they be diagnosed as having epilepsy. Epilepsy is therefore always a chronic illness which can go on for many years (but which does not necessarily last a lifetime!). Seizures result from paroxysmal and excessive electrical neuronal discharges in the brain that cause a variety of clinical manifestations. The term "epilepsy" is usually restricted to those cases with a tendency for recurrent seizures. The identification of a seizure as a symptom and not a disease diagnosis is important. Seizures are the clinical manifestation of epilepsy; the challenge is to identify the disease that explains the symptom. Often the underlying disease is epilepsy, but at other times it may be a non-epileptic disorder that causes a symptom resembling an epileptic seizure. HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 13 During normal waking and sleeping, your brain cells produce various electrical discharge patterns. If the electrical discharges by your brain cells become abnormally synchronized, a convulsion or seizure occurs. The abnormal firing of your brain cells can remain localized to a small area or can spread rapidly to involve your entire brain. Many factors may contribute to the onset of epilepsy. The cause of an individual's epilepsy can be divided into two categories: symptomatic and idiopathic. The term cryptogenic is used to describe epilepsy where the cause is suspected to be symptomatic but the underlying illness or damage has not been identified.The term idiopathic means "a disorder unto itself", and not "cause unknown". No other condition has been implicated as the cause of the epilepsy. Idiopathic epilepsies are often but not exclusively genetic and generalised - for example Juvenile Absence Epilepsy. Symptomatic epilepsies originate due to some structural or metabolic abnormality in the brain. Often, the cause of a seizure is unknown. Generally, some of the known causes of seizures include: Metabolic disturbances: diseases of the kidney or liver can cause chemical disturbances in the body, as can very low levels of sodium, calcium or magnesium. Previous brain trauma: traumatic head injuries, such as those sustained in automobile accidents or serious sports injuries can cause seizures. HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 14 Vascular system problems: blood vessel disorders, such as arteriovenous malformation of the brain — in which an abnormal connection exists between arteries and veins, and strokes are common causes of seizures in older adults. Toxic substances: using drugs or other chemicals or withdrawing from addicting substances, especially alcohol, can affect the brain's electrical activity and the nervous system. Infection: an inflammation of the brain, such as that caused by meningitis or encephalitis (bacterial or viral), may trigger a seizure. Birth defects: congenital malformations in the brain can be responsible for seizures in infants and young children. Brain tumour: although a brain tumour is an uncommon cause, a seizure may be an indication of a brain tumour genetic conditions such as tuberous sclerosis complications during pregnancy or birth stroke neurosurgical operations parasitical infection Drug or alcohol abuse Brain abnormalities present before birth or brain damage related to birth Lead poisoning Family history of seizure disorders Low blood sugar Exposure to toxic fumes Genetic predisposition … HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 15 - How is Epilepsy Diagnosed? It's not uncommon for a person to experience a single seizure during his or her lifetime. Isolated seizures may occur during early childhood, or they may be brought on by certain circumstances, such as a high fever or prolonged sleep deprivation. However, if a person has more than one seizure, a diagnosis of epilepsy should be considered. When a seizure occurs, the person affected usually won't be able to recall it. If a spouse, family member or friend witnessed the episode, he or she will be able to provide important information to help a doctor determine what happened. If the patient loses consciousness or experience unusual body movements, the doctor will need to determine whether the patient had an actual seizure. If it was a seizure, the doctor will try to determine whether it was caused by a short-term problem, such as an infection or fever. In these cases, the problem can be treated easily. In other cases, there may be a structural problem in the brain that's causing to have seizures, or may have problems with the way brain's electrical system works. The doctor will order tests to confirm the diagnosis and to see whether there is any identifiable cause for the epilepsy. Tests may include: HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 16 Blood test This will help to give a picture of the general health; a blood test also may show any metabolic reason for the seizures. Electroencephalogram (EEG) An EEG measures electrical activity of the brain. The procedure is painless and lasts about 35 to 45 minutes. Small electrodes are placed on several areas of the scalp. The electrodes transmit information about brain waves. This information is then recorded on to paper for analysis. An EEG is most valuable if patterns of epilepsy or hyper-excitability occur during the procedure. A negative EEG does not rule out a diagnosis of epilepsy. Computed tomography (CT) A CT-scan is a computerized X-ray that provides a three-dimensional view of body structures. Prior to the test, a technician may inject dye into one of the veins to make the scan easier to read. The dye may make feel hot and flushed, it may leave a metallic taste in the mouth, or it may make feel nauseated for a moment. Magnetic resonance imaging (MRI) Similar to a CT scan, an MRI provides a three-dimensional view of body structures. However, an MRI uses magnetic fields – not radiation – for imaging. MRI may provide better definition of brain structures than a CT scan. Symptoms caused by a seizure may vary depending on where the seizure starts. (if a seizure begins in the "sight" area, a person may see flashing lights at the onset of the seizure, etc…) HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 17 - Treatment Treatment for seizures is normally anti-epileptic medication, which does not cure epilepsy or the tendency to have seizures but usually does help control the seizure activity. For the people on these drugs, seizures are eliminated in about 50% of cases. Drugs reduce the frequency and/or intensity of seizures in another 30%. The remaining 20% of people have seizures that can not be brought under control by conventional drug therapy. They may require large doses or more than one drug, or they may be drug-resistant. The "traditional" anti-epileptic drugs are: phenobarbital, primidone (Mysoline), phenytoin (Dilantin), carbamazepine (Tegretol), valproic acid (Depakene), divalproex sodium (Epival), clonazepam (Rivotril), and ethosuximide (Zarontin). There is an increasing awareness of the benefits of surgery in the treatment of certain patients who continue to have seizures despite of the best treatment with anticonvulsants. The last decade has seen significant advances in the surgical treatment of epilepsy. This has come about with the development of better imaging techniques such as magnetic resonance imaging (MRI) and - better seizure localization with increasing sophistication of electroencephalographic (EEG) technology, single photon emission computed tomography (SPECT) and positron emission tomography (PET). HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 18 These advances together with improvements in surgical techniques have increased the safety and efficacy of operations for the treatment of epilepsy. Recent data suggest that Gamma Knife Radiosurgery can be used with acceptable safety and efficacy in patients with medial temporal lobe epilepsy and offers a potentially valuable modality to provide long-term seizure control in patients with a single temporal lobe seizure focus. This procedure may offer a way to treat patients effectively that have a single, well-defined seizure focus and avoid the risks associated with a craniotomy (following standard temporal lobectomy). Gamma Knife® radiosurgery is a sophisticated radiation therapy technique that precisely delivers a single, finely focused, high dose of radiation to well-defined, small intracranial targets. It is especially effective for treating tumors, epilepsy, trigeminal neuralgia, and arteriovenous malformations. Only patients whose seizures are not well controlled on medical treatment are considered for surgery. Before seizures are considered medically intractable, the physicians must ensure that the correct seizure diagnosis has been made and that the correct drugs have been used in the appropriate amounts. Even then, however, there is no clear definition of when to move to surgery. Among the factors to consider are seizure type, frequency and severity, the length of time since the diagnosis and the impact of the epilepsy on the patient's quality of life. There are also other reasons to consider surgical therapy. HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 19 For instance, repeated seizures may lead to neurological deterioration and certain patients may have intolerable side effects to anticonvulsant medications. It is important to stress that not all patients with medically refractory epilepsy can be helped with surgery. The best surgical candidates have seizures arising from a single location and from an area of the brain that is relatively silent meaning that the seizure focus can be safely and completely removed. Vagus Nerve Stimulation is a mild electrical stimulation of a nerve called the vagus nerve that runs through the neck and carries information to the brain. A pacemaker-like generator implanted in the patient's chest delivers electrical impulses to this nerve at regular intervals around the clock. Vagus nerve stimulation therapy is another form of treatment that may be tried when medications fail to stop seizures. It is currently approved for use in adults and children over the age of 12 who have partial seizures that resist control by other methods. The therapy is designed to prevent seizures by sending regular small pulses of electrical energy to the brain via the vagus nerve, a large nerve in the neck. It is thought that nerve fibers from the vagus nerve carry information to the brainstem and thence to areas of the brain known to be involved in seizures. Epileptic seizures are caused by normally well-organized brain waves becoming completely disorganized. It has been suggested that stimulation of the vagus nerve may be able to intercept this abnormal brain activity, preventing seizures. Patients must undergo a 1-2 hour operation performed under general (or local and regional) anaesthesia. Two incisions are made – each about 5-6 cm.long – one on the left chest wall, and the other on the neck. A small pulse generator, about the size of a stopwatch, is surgically implanted in the patient's upper left chest. Wires are tunnelled under the skin and attached to the vagus nerve in the neck. The electrical connection between the vagus nerve and the pulse generator is checked before the incision is closed. HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 20 After a short healing period, the battery-powered pulse generator is programmed by the doctor to begin sending a particular "dosage" of stimulation to the vagus nerve, say 30 seconds of stimulation, at five minute intervals, with a strength of 0.25 milleamperes of electrical current. During follow-up visits the generator can be "ramped up" to higher levels of stimulation to achieve better seizure control. The vagus nerves branch off the brain on either side of the head and travel down the neck, along the oesophagus to the intestinal tract. They are the longest nerves in the body, and affect swallowing and speech. The vagus nerves also connect to parts of the brain involved in seizures. In many seizures disorders, electrical stimulation of the vagus nerves may afford relief of symptoms. There has not been much research done into alternative therapies for epilepsy, and, as yet, there is little scientific evidence of their effectiveness. On the other hand, some people who have tried complementary treatments have felt that these have helped their epilepsy and improved their quality of life. Certainly, reducing stress can reduce seizures in some people, and alternative therapies that include stress-reduction techniques can help some people better control their seizures. Furthermore, the greater involvement of the person with epilepsy in his or her own seizure management through these therapies can be positive in itself. HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 21 Alternative therapies include such techniques as acupuncture, chiropractic, massage therapy, relaxation, guided imagery, biofeedback, aromatherapy, yoga, therapeutic touch, homeopathy, diet, etc. These are unconventional or non-medical therapies that tend to focus on the integration of the body, mind and spirit, sometimes referred to as the holistic model.Most people with epilepsy need to take anti-epileptic medication to control their seizures, so the nonmedical therapies are more often "complementary" to their conventional medical treatment, and not truly "alternative". HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 22 Conclusion The adult human brain weighs 1.4 kilograms and contains approximately one hundred billion nerve cells or neurons. The abnormal excessive and synchronous discharge of a group of neurons is the basis for epilepsy. In this respect, epilepsy is very much like a thunderstorm inside the brain. The location of this disturbance, its duration and spread to neighbouring areas determine the clinical features of seizures. 1% of the population has a tendency for recurrent seizures, making epilepsy a common disorder. Anticonvulsant drugs suppress abnormal neuronal discharges and limit the spread of seizure activity in the brain. 60% of patients are well controlled with these medications. This leaves 40% of patients who are not adequately controlled for whom alternate strategies need to be considered. If a person has one epileptic fit, it does not mean that he or she has epilepsy. Only when that person suffers repeated spontaneous epileptic seizures (i.e. without any direct trigger), should they be diagnosed as having epilepsy. Epilepsy is therefore always a chronic illness which can go on for many years (but which does not necessarily last a lifetime!). Hardly any other illness can be traced back in medical history as far as epilepsy can. Many pointers from early history indicate that this condition has been part of the human lot from the very beginning. Then as now, it is one of the most common chronic diseases that there are: 0.5% of all human beings suffer from epilepsy. Just as there are many different kinds of seizures, there are many different kinds of epilepsy. Science has identified hundreds of different epilepsy syndromes -disorders characterized by a specific set of symptoms that include epilepsy. Some of these syndromes appear to be hereditary. For other syndromes, the cause is unknown. Epilepsy syndromes are frequently described by their symptoms or by where in the brain they originate. People should discuss the implications of their type of epilepsy with their doctors to understand the full range of symptoms, the possible treatments, and the prognosis. The causes of seizures can vary. Often, the cause is unknown. Sometimes seizures run in families. Finding the underlying cause can help stop seizures. A seizure is a sudden burst of electricity in the brain, very much like a tiny bolt of lightning. This electricity is a signal that causes the body to feel different, or makes the body do things that the patient can't control. Sometimes the electrical signal only reaches part of the brain. HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1 23 Then a part of the body, like an arm or a leg, may move on its own. If the signal goes all through the brain, the patient may shake all over or may fall asleep for a short time. The whole seizure is usually rather short (usually 10 – 60 seconds). Epileptic seizures can look very different. There is hardly any function of the brain which cannot also be part of an epileptic seizure. As a result, seizures can manifest themselves in many different ways: in movements (e.g. jerking, trembling, stiffening of the muscles), in paralgiae/ sensory disturbances (e.g. tingling, numbness, hearing or seeing something), in so-called vegetative signs (e.g. flushing, lips turning blue, salivation, bowel sounds, wetting oneself), or in psychological changes (e.g. fear, sudden memory impairment, loss of consciousness). In the United States e.g., there are approximately 1.6 million people who have epilepsy (roughly 0.6% of the population). Epilepsy has a lifetime prevalence of 3% - that is, 7.2 million persons (U.S) will become affected by this disorder. Almost 10% of the population will experience at least one epileptic seizure in 80 years of life. For many years, epilepsy, though clearly a chronic disease with both medical and social components was not a public health priority. This was partly because public health has traditionally focused on tracking sources of infectious disease and related health hazards with a view to controlling and preventing their effects and promoting a more healthy society. However, as medical care extends the lives of the chronically ill, their issues are increasingly affecting the social fabric and the character of public health. The need to track the incidence, prevalence, health status, quality of life, and social outcomes of chronic disease is now more pressing, requiring the public health community to pay ever greater attention to these issues, using many of the same strategies with which they formerly tracked infection and its management… HHROESELARE – AHOUTMAN BELGIUM 3/05/2017 VERSION 1