Epilepsy: Causes, Symptoms, Diagnosis, and Treatment

Introduction

Seizure disorders, collectively referred to as epilepsy, have been troubling mankind since its beginnings. According to Friendlander (2001), "The term epilepsy is from the Greek meaning to take hold on, to seize upon; in other words, it was an illness in which the sufferer was attacked or seized upon, presumably by a supernatural force. The clinical picture of an otherwise well individual suddenly being forcibly thrown to the ground and violently shaken would suggest that he or she had been attacked" (p. 1). Science has, of course, evolved quite a bit over the centuries, and seizures are no longer associated with supernatural or demonic attacks, but are understood to be neurological disorders. While there is still a great deal that remains to be understood about seizure disorders, the medical profession has developed generally acceptable etiologies, diagnosis techniques, and treatments.

Epilepsy is caused by periodic disruptions of the normal electro-chemical activity in the brain. These neurological disruptions can be caused by a multitude of factors, from heredity to brain trauma to infectious diseases. In terms of heredity, according to Cull and Goldstein (1997), "Porencephaly, microgyria (and other abnormalities of the cortex), tuberous sclerosis, and arteriovenous malformations are other congenital malformations that may be associated with the development of epilepsy. In addition, the person may have acquired structural brain abnormalities that then predispose to epilepsy" (p. 6).

The Neurological Basis of Seizure Disorders

Another common cause of seizure disorders is an injury that occurs during pregnancy or during delivery. As Cull and Goldstein (1997) explain, "Particularly relevant here is damage that produces anoxia or cerebral haemorrhage. Illnesses early in infancy (e.g., cardiorespiratory disorders, infections, or metabolic disorders) may also produce seizures. The occurrence of febrile convulsions, possibly with status epilepticus, may give rise to anoxic damage and the formation of scar tissue. This so-called 'mesial temporal sclerosis', which consists of gliosis of mesial temporal lobe structures, is commonly found in patients with temporal lobe epilepsy" (p. 6). While originally this was considered to be a unilateral cause, more modern data has revealed a more frequent bilateral incidence of abnormality.

In regard to post-traumatic epilepsy caused by a head injury, there is a serious risk of seizures following such an incident. In the case of a closed head injury, the fundamental neurological symptoms often consist of the development of scar tissue (known as gliosis) along with focal cerebral atrophy. Seizures associated with head injuries do not always occur immediately; in fact, they have been known to take years before surfacing. Although this is unusual — most often the symptoms will appear within the first year — it is certainly a conceivable occurrence. When the skull has actually been fractured, post-traumatic epilepsy is even more likely to occur (Cull & Goldstein, 1997).

Seizure disorders may also be caused by infections that have affected the central nervous system. According to Cull and Goldstein, "Certain infections of the central nervous system are likely to be associated with the development of epilepsy. Thus encephalitis or cerebral abscesses are more likely to lead to the development of epilepsy than is meningitis. In certain parts of the world, parasitic cysts play an important role. Epilepsy may also develop as a consequence of subtle brain involvement during childhood mumps or whooping cough, although this may be hard to determine in individual cases. In older patients, neurosyphilis should be ruled out as a cause of seizures" (p. 6).

Seizure disorders often vary from one another in terms of the nature of the impairment. While some seizure disorders are connected with problems related to consciousness, other types are more often associated with sensory- or motor-related symptoms. The most common sensory-related symptoms are connected with vision — for example, an individual might see objects as bigger, smaller, or a different shape than they actually are. Auditory symptoms are also common, as some people report hearing voices or music during a seizure. These are not the same type of auditory hallucinations that individuals with schizophrenia experience, in that they tend to be short and repetitive and, most importantly, the individual understands that they are not real (Schein et al., 2003).

Seizure disorders can also affect the brain in terms of cognitive thinking and memory. According to Schein et al. (2003), "If a person is conscious during a seizure, he or she may seem inattentive or apathetic and will perform poorly on tests of intellectual function, especially memory" (p. 248). In addition, the individual may exhibit "automatisms," which are simple, repetitive movements such as repeated swallowing or rubbing a certain part of the body (Schein et al., 2003).

Behavioral Symptoms and Functional Deficits

Another common symptom of seizure disorders is the appearance of auras either before, during, or after the seizure. According to Schein et al. (2003), "Some patients may have 'auras' that precede the seizure or continue during the seizure. These are cognitive, affective, perceptual, or sensory experiences. Some may have cognitive auras, like depersonalization or déjà vu experiences. Some may have affective auras, like fear or pleasure. Some may have perceptual changes (illusions, hallucinations). Some may have sensory changes (strange smells, like 'burning rubber')" (p. 248).

The effects of seizure disorders on an individual's ability to live a normal and fulfilling life vary according to the person. While there are definite limitations placed on individuals who suffer from seizure disorders — such as driving restrictions or limits on personal independence — this does not mean that they cannot live a productive life.

One of the greatest challenges to normality for a seizure disorder sufferer is the episodic, unpredictable nature of the seizures. The fact that they may occur at any time and in any place can be a cause of extreme social anxiety, which can in turn lead to depression, social isolation, low self-esteem, and anxiety disorders. All of this can negatively affect the individual's personal and professional life if not properly identified and addressed through psychotherapy and/or pharmacological treatment. Most critically, according to Schein et al. (2003), "Mood disorders in epilepsy can cause substantial morbidity and contribute to a higher risk of mortality" (p. 249). Similarly, Patja et al. (2000) report that seizure disorders and hearing loss augmented the relative risk of death for all levels and types of intellectual disability.

Intellectual disability, in fact, is frequently associated with seizure disorders. As Harris (2006) reports, "Seizure disorders are common in intellectually disabled persons. In institutional settings, approximately one-third (most often, severely intellectually disabled individuals) have seizure disorders. In noninstitutionalized groups, the rate of seizures is approximately 15% vs. 1.5% for a control group. Rates in the mild-to-moderately intellectually disabled group range from 3%–6% to 12%–18%, depending on the population studied. For more severely intellectually disabled individuals, approximately 33% have seizures" (p. 89). Considering the prevalence and severity of seizure disorders, treatment protocols are continually being examined and re-examined in the hopes of finding new and better ways to reduce the symptoms of these disorders.

In order to treat seizure disorders, they must first be properly diagnosed. An electroencephalogram (EEG), which is a diagnostic test that measures the electrical activity of the brain, is one method of diagnosing a seizure disorder. The difficulty is that when the individual is not experiencing a seizure, brain activity can appear normal, making it hard to confirm a diagnosis unless the EEG is conducted during an actual seizure — something that is difficult, if not impossible, to arrange. Therefore, the majority of seizure disorders are diagnosed based on the clinical symptoms associated with them.

Conclusion

The search for new and better drug treatments is, however, just one aspect of the therapeutic strategies available to help people with epilepsy. Cognitive therapies that focus on the physical and social limitations that seizure disorders can cause are also essential. As discussed previously, seizure disorders can lead to a number of psychological conditions including depression, anxiety, and social inhibition. The limits these conditions place on normal social and professional functioning can be a significant source of stress for sufferers and can often require intensive psychotherapeutic treatment in conjunction with pharmacological interventions.

Seizure disorders are difficult to live with in terms of both their physical symptoms and their psychological and behavioral consequences. These disorders not only affect the individuals who suffer from them, but can deeply affect their families and loved ones as well. Because there are so many psychological and emotional symptoms associated with epilepsy — and with its pharmacological treatments — it has come to be viewed as an all-encompassing disorder that affects the mind, body, and spirit. While scientists and therapists continue to work toward new and better treatment methods, there is still a great deal of work to be done before the sufferers of these disorders can find any true sense of relief.