March is National Epilepsy Awareness Month. It is a global initiative to raise awareness of epilepsy culminating on March 26 which has been named Purple Day. Purple Day was actually started by a 9-year-old girl in Nova Scotia Canada to let others diagnosed with epilepsy that they are not alone.
So what is epilepsy?
Epilepsy is the fourth most common neurological disorder and affects people of all ages. Epilepsy means “seizure disorders” and is characterized by unpredictable seizures along with other potential health problems. Epilepsy is a spectrum condition with a wide range of seizure types and control varying from person-to-person. Public misunderstandings of epilepsy cause challenges that are often worse than the seizures itself. The seizures in epilepsy may be related to a brain injury or a family tendency, but often the cause is completely unknown. The word “epilepsy” does not indicate anything about the cause of the person’s seizures or their severity.
Types of epilepsy
It is quite a common misconception that epilepsy looks only one way with the episodic and sporadic body movements. However many people with epilepsy have more than one type of seizure and may have other symptoms of neurological problems as well. Sometimes EEG (electroencephalogram) testing, clinical history, family history, and outlook are similar among a group of people with epilepsy. In these situations, their condition can be defined as a specific epilepsy syndrome.
So what are the different types?
Generalised epilepsy classifications
- Generalised tonic-clonic (Grand Mal). Symptoms: The patient loses consciousness and usually collapses. The loss of consciousness is followed by generalized body stiffening (called the “tonic” phase of the seizure), then by violent jerking (called the “clonic” phase of the seizure), after which the patient goes into a deep sleep (called the “postictal” or “after-seizure” phase). During grand-mal seizures, injuries and accidents may occur, such as tongue biting and urinary incontinence.
- Absence. Symptoms: Brief loss of consciousness (just a few seconds) with few or no symptoms. The patient typically interrupts an activity and stares blankly. These seizures begin and end abruptly and might occur several times a day. Patients are usually not aware that they are having a seizure, but may have a feeling of “losing time.”
- Myoclonic. Symptoms: Sporadic and brief jerking movements, usually on both sides of the body. Patients sometimes describe the jerks as brief electrical shocks. When violent, these seizures might result in dropping or involuntarily throwing objects.
- Clonic. Symptoms: Repetitive, rhythmic jerking movements that involve both sides of the body at the same time.
- Tonic. Symptoms: Muscle stiffness and rigidity.
- Atonic. Symptoms: Consist of a sudden and general loss of muscle tone, particularly in the arms and legs, which often results in a fall.
Partial epilepsy classifications
Simple partial (awareness maintained). Symptoms: Simple partial seizures are further divided into four groups according to the nature of their symptoms:
- Motor. Motor symptoms include movements such as jerking, stiffening, muscle rigidity, spasms, and head-turning.
- Sensory. Sensory symptoms involve unusual sensations affecting any of the five senses (vision, hearing, smell, taste, or touch). The term “aura” is used to describe sensory symptoms that are present only (and not motor symptoms).
- Autonomic. Autonomic symptoms most often involve an unusual sensation in the stomach termed “gastric uprising”.
- Psychological. Psychological symptoms are characterised by various experiences involving memory (the sensation of déjà vu), emotions (such as fear or pleasure), or other complex psychological phenomena.
- Complex partial (awareness impaired). Symptoms: Includes impairment of awareness. Patients seem to be “out of touch,” “out of it,” or “staring into space” during these seizures. Symptoms may also involve some complex symptoms called automatisms. Automatisms consist of involuntary but coordinated movements that tend to be purposeless and repetitive. Common automatisms include lip-smacking, chewing, fidgeting, and walking around.
- Partial seizure with secondary generalisation. Symptoms: A partial seizure that evolves into a generalised seizure (typically a generalised tonic-clonic seizure).
Approximately 70% of patients with partial seizures can be controlled with medication. Partial seizures that cannot be controlled with medication can often be treated surgically.