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Epilepsy

Epilepsy is a disorder of the brain in which there is a tendency to suffer from fits (seizures or convulsions). It has been estimated that one in every two hundred people may be affected. Epilepsy may begin at any age, and seizures may occur with a frequency varying from once in a lifetime to many times a day. The general health of the individual may be perfect, both mentally and physically, or there may be severe mental and physical retardation. With treatment many epileptics are capable of leading a completely normal, productive life, while others are so severely affected that constant care is necessary. Mental defect, though often a feature of the disorder, is in many cases a result of the condition interfering with education rather than inherent mental inadequacy. There is a slight tendency for epilepsy to run in families.

Symptoms

Epilepsy can be divided into two basic varieties, described by the French words petit mal and grand mal. Both these forms of epilepsy are characterized by loss of consciousness, but they differ enormously. Petit mal consists of a brief break in consciousness without a convulsive seizure and lasts for seconds only. It may not even be apparent to the casual observer, since the subject does nol usually fall to the ground and simply appears to be daydreaming. If this type of seizure occurs frequently however - and it may happen in serious cases up to hundreds of times a day - the implications are obvious. This type of epilepsy has been termed 'absences'.

Attacks come without warning; the patient is motionless, and either a failure to respond to commands or a staring expression is the only sign of abnormality. In its more severe forms, petit mal may cause more prolonged periods of unconsciousness and there may be involuntary urination. Convulsion, in the sense of a fit, however, does not happen. This form of epilepsy is more common in childhood and adolescence and often disappears at puberty.

Grand mal, the commonest form of epilepsy, can occur at any age. It is a loss of consciousness with a convulsion (also called a fit or seizure) which may affect only one side of the body. Typically there is an aura, a warning signal which may be a feeling or a physical movement in the form of twitching muscles or limbs. It may precede the actual fit by a matter of hours or seconds. When the fit starts the patient falls to the ground completely unconscious, and the body first stiffens and then jerks. At the beginning of the attack, because of the muscle stiffness, breathing may stop and the face become blue. There is often incontinence of both urine and faeces. As the muscles relax, the breathing is resumed, often noisily, and froth may appear at the mouth, frequently mixed with blood if the tongue or lips have been bitten. Gradually the whole body relaxes as the convulsion dies away.

After regaining consciousness, the individual usually has a headache and an overwhelming desire to sleep. There may be mental confusion for some hours, with an incoherence of speech similar to drunkenness, but this post fit period varies considerably from person to person. In this state, known as post-epileptic automatism, or the epileptic fugue, the affected person is apparently fully conscious, but behaves in an odd manner, sometimes violently or abusively or otherwise anti-socially and at variance with his or her normal behaviour. Paralysis of one or more limbs (Todd's paralysis) may last for a few hours. A severely epileptic person may have several fits without regaining consciousness between each one. This condition, called status epilepticus, requires urgent treatment.

Sometimes a fit can be triggered by external factors such as watching a flickering television screen, or hearing church bells or a particular piece of music. It is not clear why the brain of an epileptic reacts to external stimuli in this way.

Diagnosis and treatment

The most important aspect of diagnosing epilepsy is to determine whether the cause of the condition is unknown (which is the case in about two-thirds of sufferers) or the result of organic disease of the brain, such as a tumour. The history of the case, type of fit, past medical history and family medical history all contribute to a diagnosis, but much depends on the result of electroencephalography (EEG), to record the electrical impulses from the brain. The normal brain has a characteristic pattern of impulses and an expert can interpret abnormal changes. The EEG can be almost normal in epileptics and abnormal in people who have never had fits, but absence of certain nervous-system signs combined with abnormalities in the EEG tend to confirm a diagnosis of epilepsy.

Although epilepsy is a handicap, epileptics must he encouraged to maintain their general health by means of social activities, sport and exercise of all kinds. In other words, epileptics must try to lead as normal a life as possible. Moderation, however, should always be exercised, particularly if the sufferer is having some form of drug treatment. About seventy-five per cent of cases can he controlled by anti-convulsant drugs.

Finding work can be a problem, depending on the frequency of fits and general mental capacity. Fits occur less often when the attention of an epileptic is fully occupied and is not unduly tired, but working with unproreaed machinery, at heights, and driving vehicles must be avoided in most cases. There are laws governing the issue of driving licences and car insurance to diagnosed epileptics. Happill, there are sympathetic and understanding employers and well-controlled epileptics of normal intelligence seldom have difficulty in obtaining suitable work.

An epileptic fit is almost always self-limiting, and if the epileptic is fortunate enough to experience warning signs of an attack, it is usually possible to arrange to be in the leasil harmful situation.

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