Kraemer Epilepsy from A to Z

A Dictionary of Medical Terms
1. Auflage 2004
ISBN: 978-3-13-258066-4
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 439 Seiten, ePub

Reihe: Thieme

For all questions about epilepsy: Look here first, and inform yourself quickly!

Whether you are preparing for a visit to the doctor, or are attempting to understand the information provided with medications, this unique reference is a quick guide to the entire spectrum of the problems associated with epilepsy, and the available treatments.

Use this practical patient helper wherever you need it. Approximately 1,000 terms are defined and described in a brief and easy-to-understand way. Additional terms from general medicine that you may encounter, are provided as well. For patients of epilepsy and their relatives, this is a treasure chest of easy-to-access information. Physicians who treat patients with epilepsy will welcome this book as a giveaway to help their patients understand the condition better.

Kraemer

Zielgruppe

Ärzte

Autoren/Hrsg.

Kraemer, Guenter

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Neurologie, Klinische Neurowissenschaft

Inhaltsverzeichnis

About this book
What are epileptic seizures, and what is epilepsy?
Medications used to treat epilepsy
Abbreviations
Dictionary
Books and other useful sources of information about epilepsy
International League Against Epilepsy (ILAE) – Global Chapters

Leseproben

What are epileptic seizures, and what is epilepsy?

Epileptic seizures, often called “seizures” for short, are the visible or otherwise apparent manifestations that are produced when the brain briefly becomes dysfunctional because of an abnormal, excessive electrical discharge in its nerve cells (neurons). There are more than ten different types of seizure (? Tab. 2 and 3, pp. 12–15) and more than 30 different forms of epilepsy (? Tab. 4, 5 and 6, pp. 15–20). Individual forms of epilepsy are sometimes associated with more than one type of seizure. Each affected person, as a rule, has only one form of epilepsy, and suffers from seizures of the type, or types, that are associated with it. The interval of time separating one seizure from the next may be as little as a few seconds, or as great as several years or even decades.

The word “epilepsy” comes from a Greek word meaning “to be taken hold of” or “to be seized or gripped,” and thus, metaphorically, “to be affected by something beyond one's control” (note the similar origin of the English word “seizure”). In ancient times, epilepsy was called “morbus sacer,” Latin for “the holy disease”–-reflecting a feeling, which partly survives to this day, that this disease, among all others, belongs in a special category.

Many people think epileptic seizures are easy to describe. Out of a clear, blue sky, a person suddenly lets out a shout, losesconsciousness, becomes stiff, perhaps bites his or her tongue, and then drops to the ground. The sufferer stops breathing, turns blue, and then twitches in the arms and legs for a certain period of time, before falling, exhausted, into a kind of deep sleep. Afterward, the person may complain of exhaustion, headache, dizziness, or muscle pains, or may note that he or she has involuntarily passed urine during the seizure. While it is true that this is an accurate description of one common type of epileptic seizure (the socalled grand mal seizure or generalized tonic-clonic seizure), this type is only one of many.

In fact, epileptic seizures come in many different types. Not every seizure begins with a shout followed by loss of consciousness; not every seizure includes stiffness, tongue-biting, or falling; not every seizure causes the sufferer to turn blue or twitch. Some seizures are so inconspicuous that the sufferer never notices anything out of the ordinary and no one but an expert observer would even realize that a seizure had occurred. Some seizures consist of no more than a fleeting “funny feeling,” a loss of attentiveness lasting only a few seconds, or brief twitching of a single arm.

If we wish to define epileptic seizures in a general way that applies to all types of seizure, we can say the following: epileptic seizures are suddenly appearing, relatively brief alterations of consciousness, thinking, behavior, memory, sensation, emotion, or muscle tension that are caused by a transient functional disturbance of neurons in the brain consisting of excessive electrical discharges. Though this definition is correct, it is much too long to remember and put to use in everyday life. We can thus simplify the matter and say that epileptic seizures are an expression of a temporary dysfunction of neurons, whose particular effects depend on the function or functions that these neurons normally have.

Every neuron and every group of neurons in the brain has the potential to become “epileptic,” and thereby have its normal activity disturbed or interrupted. If the affected cells are normally responsible for the sense of smell, for example, then this sense may be disturbed; if they are responsible for vision, the result may be a perception of lightning-like or other visual phenomena. If the affected cells take part in the complicated processes underlying memory and behavior, the result may be an impairment of learning, and perhaps also a temporary loss of consciousness, leaving behind a permanent gap in the individual's recollection of events.

As we have seen, the expression “epileptic seizure” is a collective term that covers a wide variety of different diseases and functional disturbances. For many affected individuals, though, even the sophisticated diagnostic methods available today will fail to reveal the cause of their seizures. And it should be remembered that the mere occurrence of an epileptic seizure does not necessarily imply that the affected individual suffers from epilepsy. Epileptic seizures occur, for example, in almost all persons suffering from a local bacterial infection of the brain (a so-called brain abscess), a major traumatic brain injury, an insufficient supply of oxygen to the brain, or an overdose of certain medications. Such persons might continue to have seizures for as long as the responsible condition lasts, but they still cannot be said to have epilepsy. Epilepsy is said to be present only when an individual sustains at least two epileptic seizures, spaced at least 24 hours apart, for which no immediate cause or precipitating factor can be determined (so-called “spontaneous” seizures). This definition does not, however, exclude seizures due to permanent changes in the brain, such as birth injuries or other types of longstanding brain damage.

Thus, to repeat the usual definition, epilepsy is said to be present when an individual sustains at least two spontaneous epileptic seizures spaced at least 24 hours apart. Another important component of the definition is the requirement that the underlying cause of seizures in the brain is continually present in unaltered form, not just during the seizures, but between them as well. In some cases, the seizures occur very rarely and at very long intervals. Patients affected in this way were previously said to suffer from “oligoepilepsy” (from a Greek word meaning “rare”), though in recent years there has been a change in usage, so that they are simply said to have rare seizures, rather than epilepsy.

Even today, misapprehensions and prejudices about epilepsy and persons suffering from it abound among the general public, which is surprising in view of the major advances in medical knowledge in this area that just the last few decades have brought. Hippocrates, the famous physician of ancient Greece (460-375 BC), already realized that epilepsy was due to a disturbance of the brain, but it was not until the nineteenth century that this basic concept began to be reflected in medical practice and–very slowly at first–in the understanding of the public at large. Some correct and incorrect statements about epilepsy are presented in Table 1.

Table 1: Correct and incorrect statements about epileptic seizures and epilepsy

INCORRECT

CORRECT

Any person who has had an epileptic seizure has epilepsy.

The definition of epilepsy requires at least two seizures, spaced at least 24 hours apart, without any identifiable cause or precipitating factor.

Epileptic seizures are always obvious and dramatic.

Some types of epileptic seizure, such as absence seizures and certain focal seizures, are only mild or barely noticeable, and even experts may have difficulty detecting them.

Epilepsy is a disease.

Strictly speaking, epilepsy is not a disease, but rather a disturbance of the brain. A disease, in medical terminology, is a typical combination of symptoms and signs that have a single underlying cause. There are, however, many different types of epilepsy, each with its own symptoms and signs, and the causes of epilepsy are manifold. (Note: This explanation is provided for those who want to use terms very precisely. In the end, how ever, it only involves matters of definition and will not be very helpful to persons suffering from epilepsy.)

The manifestations of epilepsy are always the same.

There are many different types of epilepsy; in fact, there are more than 20 types, ranging from very mild to very severe.

Epilepsy is hard to treat.

60 to 70 percent of persons with epilepsy are well treated with medication, i.e., they have very few or no seizures and suffer from no major side effects of medication. There are also cases of epilepsy that require no treatment at all and resolve by themselves over time.

All “epileptics” are just about the same.

There is no such thing as a typical “epileptic.” Persons with epilepsy differ from each other as much as persons with diabetes or high blood pressure.

Epilepsy is a mental illness.

Epilepsy is a neurological illness, not a mental illness.

Persons with epilepsy are mentally impaired (“retarded”).

The vast majority of persons with epilepsy (more than 90 %) are not mentally impaired.

Epilepsy is hereditary.

It is true that the hereditary transmission of a “seizure tendency” plays a role in many types of epilepsy, but parents with epilepsy still have children without epilepsy in more than 90 % of...

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Kraemer