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Epilepsy

When the Brain Misfires: Understanding Epilepsy


Author:

Carl Bazil, MD, PhD

New York Presbyterian Hospital Columbia College of Physicians and Surgeons

Susan Herman, MD

University Hospital of Brooklyn Epilepsy Center

Medically Reviewed On: November 17, 2013

More than 2.5 million Americans, and nearly 50 million people worldwide, have epilepsy, and despite the numbers of those affected, epilepsy remains a poorly understood disease. In this featured article, two neurologists discuss what is known about epilepsy, and its causes.

What is the definition of epilepsy?
CARL W. BAZIL, MD, PhD: The definition of epilepsy is very simple. A person who has two or more unprovoked seizures has epilepsy. By "unprovoked" I mean the seizure was not caused by a brain infection or a controlled substance, but came out of nowhere.

Why does it have to be two? Can you have one unprovoked, and that's not enough to be declared epilepsy?
CARL W. BAZIL, MD, PhD: The reason we define it as two is, if you have one, the chances of having another one are relatively small. If you have two, the chances of going on to have recurrent seizures are a lot greater, and that's when it's considered epilepsy.

What is a seizure?
SUSAN T. HERMAN, MD: A seizure is an abnormal discharge in the brain. Usually neurons in the brain, the cells of the brain, talk to each other, to do the things we do everyday: to talk, to move, to laugh. But when you have a seizure, the cells work together in a more exuberant fashion. They actually fire all at the same time. And that abnormal firing is what causes the symptoms of a seizure.

What is the most common type of epileptic seizure, and how does it manifest itself?
CARL W. BAZIL, MD, PhD: The most common type is a focal seizure. It starts in one area of the brain and can remain very small, or can get bigger. For instance, if you had a seizure that started in the area of the frontal lobe, which controls the movement of your arm, you might have uncontrolled shaking of your arm at the beginning of that seizure. And it might be nothing else at the beginning.

If that were to then spread to cover more and more of the brain, that can evolve into shaking of that entire half of your body and, ultimately, to unconsciousness and falling to the ground in a dramatic grand mal seizure, which is what most people are used to seeing on television or dramatized in other ways.

SUSAN T. HERMAN, MD: The most common place for seizures to begin is in the temporal lobe. And the temporal lobe is involved in emotion and in memory, so people may describe feelings of anxiety or fear or specific memories, or sensations of déja vu, when they have a seizure beginning from that area. Those are probably one of the most common beginnings of a seizure that you'll hear from patients.

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