Epilepsy Health Dictionary

An epileptic fit is a temporary spasmodic disturbance in the brain of sudden onset caused by a spurious discharge of electrical energy by brain cells. Can be sparked off by an excess of zinc. Loss of consciousness signalled by an aura and a fall to the ground with a cry. Breathing is noisy, eyes upturned. General causes: hereditary, severe head injury (even before birth), chronic disease, stroke, tumour, hardening of the arteries, drugs, lack of oxygen. An attack may be triggered by the flickering of a television or computer screen. Screen-addicted children may develop photosensitive epilepsy, suffering fits while using electronic games.

Three forms: major (grand mal); temporal lobe; and minor (petit mal). In petit mal the period of unconsciousness consists of brief absences lasting less than 15 seconds.

Treatment. Orthodox medical: Carbamazepine, phenytoin and many other drugs.

Alternatives. BHP (1983) recommends: Grand mal: Passion flower, Skullcap, Verbena. Petit mal: Hyssop. Standard central nervous system relaxants are Hops, Lobelia, Passion flower, Vervain, Valerian, Skullcap. Wm Boericke used Mugwort. Peony leaf tea had a long traditional use. In nearly all epileptics there is functional heart disturbance (Hawthorn, Lily of the Valley, Motherwort). Mistletoe can help in the struggle to control seizures and improve the quality of life.

Two important remedies are Skullcap and Passion flower. Both work quickly without risk of respiratory arrest. If dose by mouth is not possible insert gelatin capsules containing powders, per rectum, child or adult lying prone. This method is particularly suitable for feverish convulsions or Grand mal.

Repeat after 5 minutes if patient continues in convulsion. Where neither of these powders are available, Chamomile, Valerian or Mistletoe may be used.

“The remedy I have relied on most,” writes C.I. Reid, MD (Ellingwood’s Journal) “is Passion flower. Use this alone or in combination with Gelsemium – more often alone. I cannot say I obtain an absolutely curative effect, but the spasms disappear and do not return while the remedy is continued. It has none of the unpleasant effects of other medicines. I give the liquid extract in doses from 25-30 drops, 3-4 times daily, for continued use. It may be given more frequently for convulsions.”

Alfred Dawes, MNIMH. Green tincture of Mistletoe, 3-5 drops. Or, combine equal parts: Liquid Extract Skullcap, Valerian and Black Horehound.

Finlay Ellingwood MD combines White Bryony, Prickly Ash, Skullcap and St John’s Wort.

Samuel Thomson MD. Lobelia 2; Cayenne 1; (antispasmodic drops) given at the premonitary stage. 1-2 teaspoons.

Edgar Cayce. Passion flower tea. Hot Castor oil packs.

Excess acidity and intestinal toxaemia. There is considerable opinion that these trigger an attack. Combination: Liquid Extracts – Skullcap 15ml; Mistletoe 10ml; Meadowsweet 10ml; Elderflowers 10ml. Two 5ml teaspoons in water thrice daily.

West African Black Pepper. (Piper guineense) is used by traditional Nigerian healers to good effect. Associated with imperfect menstruation. Liquid Extracts, single or in combination: Black Cohosh, Life root, Lobelia. Dose: 5-15 drops thrice daily.

Associated with mental weakness. Liquid Extract Oats (avena sativa). 2-3 teaspoons in water thrice daily.

Aromatherapy. (Complex partial seizures) Massage with essential oils found to be beneficial. (The Lancet, 1990, 336 (8723) 1120)

Diet. Salt-free lacto-vegetarian. Oatmeal porridge. A cleansing 8-day grape juice fast has its advocates. Vitamin E. In 24 epileptic children refractory to anti-epileptic drugs (AEDs) with generalised tonic- clonic and other types of seizures, addition of Vitamin E 400iu daily to existing AEDs was accompanied by a significant reduction in 10 of 12 cases. (Epilepsy 1989; 30(1): 84-89)

Supportives: osteopathic or chiropractic adjustments.

Note: A number of Italian physicians linked a salt-rich diet with epileptic fits. Number and violence diminished when discontinued and did not recur for weeks. Dr W.P. Best found that, in children, circumcism made a valuable contribution.

Drug-dependency. Herbal medication may offer a supportive role to primary medical treatment. Under no circumstances should sufferers discontinue basic orthodox treatments except upon the advice of a physician.

Information. British Epilepsy Association, 40 Hanover Square, Leeds LS3 1BE, UK. Send SAE.

To be treated by or in liaison with a qualified medical practitioner. 

A tendency to have recurrent seizures. In many people with epilepsy, the cause is unclear, although a genetic factor may be involved. In other cases, seizures may be the result of brain damage from head injury, birth trauma, brain infection (such as meningitis or encephalitis), brain tumour, stroke, drug intoxication, or a metabolic disorder.

Many people with epilepsy do not have any symptoms between seizures. Some people experience an aura shortly before. In some cases, a stimulus such as a flashing light triggers a seizure. Epileptic seizures may occur more frequently in times of illness or stress.

Epileptic seizures can be classified into two groups: generalized and partial. Generalized seizures cause loss of consciousness and may affect all areas of the brain. There are two types: grand mal and absence (petit mal) seizures. During a grand mal seizure, there may be an aura initially, then the bodybecomes stiff and consciousness is lost; breathing may be irregular or may stop briefly, then the body jerks uncontrollably. The person may be disorientated for hours afterwards and have no memory of the event. Prolonged grand mal seizures are potentially life-threatening. Absence seizures occur mainly in children. Periods of altered consciousness last for only a few seconds and there are no abnormal movements of the body. This type of seizure may occur hundreds of times daily.

Partial seizures are caused by abnormal electrical activity in a more limited area of the brain. They may be simple or complex. In simple partial seizures, consciousness is not lost and an abnormal twitching movement, tingling sensation, or hallucination of smell, vision, or taste occurs, lasting several minutes. In complex partial seizures, also known as temporal lobe epilepsy, conscious contact with the surroundings is lost. The sufferer becomes dazed and may behave oddly. Typically, the person remembers little, if any, of the event.

Diagnosis is made from examination of the nervous system and an EEG.

CT scanning or MRI of the brain and blood tests may also be carried out.

Anticonvulsant drugs usually stop or reduce the frequency of seizures.

Surgery may be considered if a single area of brain damage is causing the seizures.

Epilepsy that develops during childhood may disappear following adolescence.

(See also FIT; SEIZURE.) Epilepsy is the name given to any condition in which a person suffers repeated ?ts or seizures. It is present in one in 200 (0·5 per cent) of the population and up to 5 per cent of all children will have had a ?t by the age of 12, although most of these are harmless accompaniments of an acute feverish illness.

It is a recurrent and paroxysmal disorder starting suddenly and ceasing spontaneously due to occasional sudden excessive rapid and local discharge of the nerve cells in the grey matter (cortex) of the BRAIN. Epilepsy always arises in this way from the brain, but its origin is often of microscopic size. It is diagnosed by the clinical symptoms based on the observations of witnesses. Its cause can sometimes be established by laboratory tests, and brain scanning. Fits can be the ?rst sign of a tumour, or follow a stroke, brain injury or infection, but in the large majority no underlying cause is found – so-called idiopathic epilepsy.

A single epileptic ?t is not epilepsy. Of those people who have a single seizure, a signi?cant minority (20 per cent) have no further attacks.

Major (generalised) seizures have a sudden, often unprovoked onset; the patient emits a cry, then falls to the ground, rigid, blue, and then twitching or jerking both sides of the body: the tonic-clonic convulsion. Drowsiness and confusion may last for some hours after recovering consciousness. Some experience a momentary warning (AURA): a smell, or sensation in the head or abdomen, vision, or déjà vu.

Partial seizures: focal motor (Jacksonian) begin with twitching of the angle of the mouth, the thumb, or the big toe. If the seizure discharge then spreads, the twitching or jerking spreads gradually through the limbs. Consciousness is preserved unless the seizure spreads to produce a secondary generalised ?t. In some attacks the eyes and head may turn, the arm may rise, and the body may turn, while some patients feel tingling in the limbs.

Complex partial seizures (temporal lobe epilepsy) The patient usually appears blank, vacant and may be unable to talk, or may mumble or chatter – though later they often have no memory of this period. They may be able to carry out complex tasks, taking o? gloves or clothes, and may smack their lips or rub repeatedly on one limb (automatisms). A sense of strangeness supervenes: unreality, or a feeling of having experienced it all before (déja vu). There may be a sense of panic. Strange unpleasant smells and tastes are olfactory and gustatory hallucinations. The visual hallucinations evoke complex scenes. An initial rising sense of warmth or discomfort in the stomach, or ‘speeding-up’ of thoughts are common psychomotor symptoms. All these strange symptoms are brief, disappearing within a few seconds or up to 3–4 minutes.

Minor seizures (petit mal) Attacks start in childhood. They last a few seconds. The child ceases what he or she is doing, stares, looks a little pale, and may ?utter the eyelids. The head may drop forwards. Attacks are commonly provoked by overbreathing. The child and parents may be unaware of the attacks

– ‘just daydreaming’. Major ?ts develop in one-third of subjects. By contrast with other types of epilepsy, the ELECTROENCEPHALOGRAM (EEG) is diagnostic.

Precautions Children with epilepsy should take normal school exercises and games, and can swim under supervision. Adults must avoid working at heights, with exposed dangerous machinery, and driving vehicles on public roads. Current legislation allows driving after two years of complete freedom from attacks during waking hours; those who for more than three years have had a history of attacks only while asleep may also drive.

Treatment identi?es, and avoids where possible, any factors (such as shortage of sleep or excessive ?uids) which aggravate or trigger attacks. If ?ts are very infrequent, treatment may not be recommended. However, frequent ?ts may be embarassing, may cause injury or may cause long-term brain damage so treatment is advisable. Anti-epileptic drugs are usually necessary for several years under medical supervision. Carbamazepine and sodium valproate are the most frequently prescribed. The dose is governed by the degree of control of ?ts and sometimes drug levels can be monitored by blood tests to check on dosage. Strict adherence to the drug schedule gives a reasonable chance of total suppression of ?ts, especially in younger patients whose ?ts have started recently. The table summarises anticonvulsant drugs in use. Interactions can occur between anti-epileptics and, if drug treatment is changed, the patient needs careful monitoring. In particular, abrupt withdrawal of a drug should be avoided as this may precipitate severe rebound seizures.

Indications First-choice drugs: Ethosuximide PM, JME Phenobarbitone M, P Phenytoin M, P, CP Carbamazepine M, P, CP Valproate M, PM, JME Second-line drugs: Primidone M, P, CP Clobazam M, CP Vigabatrin M, P, CP Lamotrigine M, P, CP Gabapentin M, P, CP Topirimate P

M = major generalised tonic-clonic; P = partial or focal; CP = complex partial (temporal lobe); PM = petit mal; JME = juvenile myoclonic epilepsy.

Anticonvulsant drugs

As all anticonvulsant drugs have an e?ect on the brain, it is not surprising that there may be side-effects, especially inolving alertness or behaviour. In each case careful assessment is necessary for doctor and patient to agree on the best compromise between stopping ?ts and avoiding ill-effects of medication.

Patients who have an epileptic seizure should not be restrained or have a gag or anything else placed in their mouths; nor should they be moved unless in danger of further injury. Any tight clothing around the neck should be loosened and, when the seizure has passed, the person should be placed in the recovery position to facilitate a return to consciousness (see APPENDIX 1: BASIC FIRST AID).

Patients with epilepsy and their relatives can obtain further advice and information from the British Epilepsy Association or Epilepsy Action Scotland.

An affection of the nervous system resulting from excessive or disordered discharge of cerebral neurons

n. a disorder of brain function characterized by recurrent seizures that have a sudden onset. The term idiopathic is used to describe epilepsy that is not associated with structural damage to the brain. Seizures may be generalized or partial. Generalized epilepsy may take the form of tonic-clonic or absence seizures. In tonic-clonic (or major) seizures (formerly called grand mal), the patient falls to the ground unconscious with the muscles in a state of spasm. The lack of any respiratory movement may result in a bluish discoloration of the skin and lips (cyanosis). This – the tonic phase – is replaced by convulsive movements (the clonic phase) when the tongue may be bitten and urinary incontinence may occur. Movements gradually cease and the patient may rouse in a state of confusion, complaining of headache, or may fall asleep. Absence seizures (formerly called petit mal in children) consist of brief spells of unconsciousness lasting for a few seconds, during which posture and balance are maintained. The eyes stare blankly and there may be fluttering movements of the lids and momentary twitching of the fingers and mouth. The electroencephalogram characteristically shows bisynchronous spike and wave discharges (3 per second) during the seizures and at other times. Attacks are sometimes provoked by overbreathing or intermittent photic stimulation. As the stream of thought is completely interrupted, children with frequent seizures may have learning difficulties. This form of epilepsy seldom appears before the age of three or after adolescence. It often subsides spontaneously in adult life, but it may be followed by the onset of major or partial epilepsy.

In partial (or focal) seizures, the nature of the seizure depends upon the location of the damage in the brain. For example, a simple partial motor seizure consists of convulsive movements that might spread from the thumb to the hand, arm, and face (this spread of symptoms is called the Jacksonian march); there is no loss of awareness. Complex partial seizures are commonly caused by damage to the cortex of the temporal lobe or the adjacent parietal lobe of the brain: this form of epilepsy is often called temporal lobe (or psychomotor) epilepsy. Symptoms may include *hallucinations of smell, taste, sight, and hearing, paroxysmal disorders of memory, and *automatism. Throughout an attack the patient is in a state of clouded awareness and afterwards may have no recollection of the event (see also déjà vu; jamais vu). A number of these symptoms are due to scarring and atrophy (mesial temporal sclerosis) affecting the temporal lobe.

The different forms of epilepsy can be controlled by the use of antiepileptic drugs (see anticonvulsant). Surgical resection of focal epileptogenic lesions in the brain is appropriate in a strictly limited number of cases. See also aura; postictal phase. —epileptic adj., n.