MEDICAL SURFARI: MANY LIVING IN THE SHADOW OF EPILIPSY

What disorder affects nearly 50 million people worldwide, yet nearly three-fourths are untreated? Epilepsy -- the same disorder, with early diagnosis and treatment, which often can be controlled in 75 percent of those affected.

Epilepsy is characterized by recurrent brief disturbances in the normal electrical functions of the brain, known as seizures. Seizures may cause an interruption of movement, generalized contraction of the body, decreased responsiveness, loss of awareness of surroundings and complete loss of consciousness. Some seizures can be linked to identifiable conditions or injuries to the brain; however, the cause of nearly 70 percent of seizures remains unknown

Approximately 2.5 million Americans, slightly less than one percent of the population, suffer from some form of epilepsy and thirty percent of all epilepsy patients are under the age of eighteen. In older patients, epilepsy is the third leading neurological disorder.

Convulsions, seizures, shaking fits, falling sickness, twitching fits, staring spells -- The English language is replete with words to describe the symptoms and signs of epilepsy. Despite what many people think, people with epilepsy do not always fall to the floor unconscious with limbs twitching and saliva bubbling from the mouth. This is a grand-mal (big and bad) seizure and it occurs in some forms of epilepsy but there are many other forms less dramatic.

Some patients experience a distinctive warning sign, an aura, before a seizure. The aura itself is a form of seizure, but one in which the patient retains awareness. Some forms of epilepsy cause uncontrollable laughing, strange talking, walking in circles, or automatic movements like lip-smacking or chewing.

Do "spells" mean epilepsy? No, not all brief events causing loss of consciousness, altered mental function or automatic movement are epileptic. Other causes may be due to abnormal heart rhythm, very low blood pressure, blood sugar or oxygen level. This must be sorted out by a careful and thoughtful evaluation by your physician.

In people with epilepsy, seizures may be brought on by flashing lights, fatigue from lack of sleep or low seizure medication levels. In a few very rare cases, reading or certain types of music has caused seizures. Every epileptic patient is unique in the symptoms, frequency, duration, and type (or types) of seizures he or she experiences. Although most seizures can be well-controlled with medication(s), this is not a cure for this disorder. Surgery can be quite effective for seizures that cannot be controlled with medication.

New medical and surgical treatments are currently being researched and developed. A novel "pacemaker for the brain" has been developed and surgically implanted in nearly 1000 patients that has effectively reduced the frequency of seizures in some patients.

Can epilepsy be prevented? Yes. While the search goes on for better treatments, many cases of epilepsy need never develop. Prevention of epilepsy applies to pregnant women as the developing nervous system is sensitive and especially vulnerable to injury. Prenatal care, a good diet rich in vitamins, avoidance of cigarettes, alcohol and other drugs improve the chances that a baby will be healthy and full-term. Some specialists believe that some cases of epilepsy may be due to oxygen deficiencies in the brain at critical times in early development.

Prevention also means pressing the fight against organisms that infect the nervous system. Infections and parasites are a major problem in many parts of the world where medical treatment is scanty and immunization programs are rare. These infections often leave a lifelong complication of epilepsy in their wake. Western nations, less prone to infectious causes of epilepsy, must work to reduce the 8000 new cases that occur each year from head trauma.

World Wide Web Information Resources: To learn more about the signs and symptoms of various forms of epilepsy, new medication trials, epilepsy surgery, diets and support groups, consult these reliable sources:

Epilepsy: Overview and Treatments of Grand Mal

http://genbiol.cbs.umn.edu/1009/1009h/epilipsy.html

This is a succinct site for patients or family members. A good starting point for someone newly diagnosed with epilepsy or someone who just wants solidly good update on the topic.

Robert's Neurology Listings on the Web

http://mediswww.meds.cwru.edu/dept/neurology/robslist.html

This is a well-organized site for laypersons and professionals. Go to Albert Einstein's Comprehensive Epilepsy Center to learn about epileptic syndromes and how to get into new medication trials.

The EpiCentre

http://137.172.248.46/treatmen.htm

This one is comprehensive! Excellent information on anti-seizure medications, their effects during pregnancy, monitoring blood levels, first-aid for seizures, the characteristic of various types of seizures and much much more.

Dr. Scott Gibbs is a neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63701