Epilepsy is not a disease in and of itself, it is a symptom of disease. Epilepsy, or seizure disorder, is a condition in which a person has recurrent seizures under normal environmental conditions. Seizures and changes in behavior or activity are brought about by an abnormal electrical discharge of brain cells. With such a complicated and dynamic brain which we humans have, capable of thought, music, art and science, it is remarkable that the circuits do not misfire more frequently.

The complex inhibition in the brain prevents most people from having seizures while allowing normal function. Any disease that affects the central nervous system circuits including brain damage before or at birth, brain trauma, tumors, strokes, infections, metabolic disorders, or genetic defects can cause a seizure.

The list of famous intelligent people who have had this disorder is almost endless; Julius Caesar, Alexander the Great, Buddha, Napoleon, Handel, Van Gogh, Dante, Tchaikovsky, Alfred Nobel, Socrates, Isaac Newton, Alfred Tennyson, Charles Dickens and Dostoyevsky. One percent or 1 out of 100 people in the

United States have an ongoing seizure disorder. It affects driving, employment, psychosocial adjustment and every other aspect of life for the patients with a seizure disorder as well as their families.There are many different types of seizures.

The two main categories are:

  1. Generalized Onset in which the seizure discharge starts on both sides of the brain at once and
  2. Partial or Focal Onset in which the discharge starts in one area of the brain and then spreads over other areas. The generalized onset seizures are more likely to be of genetic origin and include generalized tonic-clonic or Grand mal seizures, Absence or Petit ma seizures and Myoclonic seizures. Tonic means stiffening. Clonic means jerking, Myoclonic means single or repetitive jerks. Partial onset seizures are usually caused by focal brain damage from any cause. They are further divided into simple partial seizures in which there is no loss of consciousness and complex partial seizures in which there is a loss of consciousness. Loss of consciousness implies an interference with the person interacting with his or her environment.

Epilepsy is further categorized into epilepsy syndromes. The epilepsy syndromes have characteristic ages of onset, specific causes (trauma, tumor, infection, stroke, genetics, etc.) and often specific localizations of the seizure discharge within the brain.

The type of seizure and epilepsy syndrome are very important in treating patients because they determine the evaluation, the anti-epileptic medications that are more likely to be effective, and the prognosis of that patient.

The aim in treating patients is to have no seizures and no side effects from the treatment.

Importance of Proper Diagnosis:

It is essential to make an accurate diagnosis of the epileptic seizure and epilepsy syndrome to determine the treatment and prognosis.

Diagnosis of seizure and syndrome rely on a detailed history and physical examination and the routine EEG.

Most patients with epilepsy are controlled by medication. There are over 13 different types of medications, each with a specific type of action.

The type of medication to use depends on accurate diagnosis of the seizure type and of the epilepsy syndrome. Medications have been designed to be more specific with fewer side effects and longer duration of action, making it easier to take the medication routinely without missing a dose. If the patients seizures are not controlled easily by the medications, then referral to a neurologist is customary. The goal is always: seizure free with no side effects of medication.

Unfortunately, up to 30% of patients continue to have seizures despite medication or have unacceptable side effects of the doses of medications required to control their seizures. Specific epilepsy syndromes such as complex partial seizures, usually temporal lobe epilepsy and Lennox-Gastaut Syndrome tend to be medically intractable.

Before determining the best treatment option for a patient, a detailed description of the seizure, a history highlighting etiological factors, a neurological exam and diagnostic tests of the cerebral function must be conducted by an epilepsy specialist.

These tests include Video-EEG done in the hospital, MRI, Neuropsychometric testing and WADA test. In some patients, PET, SPECT, MRS , or MEG can add useful information.

Video-EEG actually records the behavior of the seizure at the same time as the brain's electrical activity.

Video-EEG is a diagnostic test to make an accurate diagnosis and localization of the part of the brain giving rise to the seizures.

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