Epilepsy is one of the most common chronic diseases of the central nervous system. Permanently affected by epilepsy, i.e. repeatedly occurring epileptic seizures, are 500,000 people in Germany. The term comes from the Greek and means “to be seized violently by something”. The disorder, which was already known in antiquity, was considered mysterious even back then: those affected fall to the ground – often screaming – lose consciousness and move their entire body uncontrollably. In some cases, foam may also form in front of the mouth.
Definition: epilepsy or epileptic seizure?
Even today, the condition is fraught with many preconceptions. Contrary to common belief, epilepsy is not hereditary; at most, the tendency to epilepsy can be inherited. Furthermore, a distinction must be made between individual “epileptic seizures” and the disease “epilepsy”. The latter is diagnosed only when the patient has suffered more than two seizures for no apparent reason. People who have epilepsy are severely restricted in many areas of life, depending on the severity of their condition. To shed light on the seizure disorder and reduce prejudice against people with epilepsy, Epilepsy Day is celebrated every October.
Epilepsy: seizure as a thunderstorm in the head
To explain what epilepsy actually is, medical professionals and sufferers like to use the image of a “thunderstorm in the head.” However, they are not thinking of headaches. Rather, the uncontrolled impulse discharges of the nerve cells are in the foreground, which make the normal, orderly functioning of the brain impossible. In an epileptic, the signals sent by the nerve cells are either too long or too short: the result of the “false signals” is then uncontrolled muscle movements that are experienced as convulsions. But nerve cells responsible for thinking and consciousness can also be affected. An epileptic then loses consciousness during a seizure. Epileptic seizures can look very different. Some patients convulse very violently; in others, the symptoms of epilepsy are so minimal that they are barely noticed.
Caution, risk of confusion
However, not all seizures are the same as epileptic seizures. Many infants and young children suffer so-called “febrile convulsions” during febrile illnesses, which also disappear after the underlying illness has subsided. Nevertheless, after a febrile convulsion, an epileptic illness must always be ruled out by measuring the brain waves.
Forms of epilepsy
The International League Against Epilepsy has described a total of ten different forms of seizures and even more forms of epilepsy. One form of epilepsy can have different types of seizures. An epileptic usually suffers from only one form of epilepsy, but he or she may experience several different forms of seizures. As different as the individual forms of epilepsy and seizure types are, so are the intervals between seizures. In some patients, years or decades pass between seizures. In others, only seconds pass before the next seizure. The main distinction is between “focal” and “generalized” seizures. In a focal seizure, only a demarcated area in the brain is affected, whereas in a generalized seizure, both hemispheres of the brain or the entire brain is affected from the beginning.
Causes and diagnosis of epilepsy
About 50 percent of disorders occur in childhood, with the possibility of “spontaneous” recovery. Epilepsy can also develop as a result of brain injury, for example, after an accident, when the cells of individual brain regions can no longer work in a coordinated manner. Other causes of epilepsy include:
- Brain inflammation
- Brain hemorrhage
- Oxygen deficiency during birth
- Stroke
- Metabolic disorder of the brain
- Tumors
- Malformation in brain development
If a patient has suffered a first seizure without an apparent cause, the diagnosis is confirmed with an electroencephalogram (EEG).
Therapy of epilepsy
Several options are available for the treatment of epilepsy:
- Medication
- Operational
- Line interruption
- Detection and prevention of seizure triggers.
- Vagus Nerve Stimulation
1. treatment with drugs
Drug treatment of epilepsy involves decreasing the hyperexcitability of nerve cells or increasing inhibitory mechanisms. This requires regular use of the medication, such as gabapentin, and medical supervision. Even though many drugs for epilepsy are easy to take, the side effects are massive in many cases. These include allergic skin reactions, nausea and vomiting, as well as dizziness, fatigue and visual disturbances. The liver, lymph glands and bones can also suffer from the drug administration. Usually, one drug is given, which is monitored with the help of EEG and drug levels. Only when all possible single drugs have been unsuccessful are combination treatments with two or more drugs used. If patients are seizure-free for a period of three years, attempts are often made to gradually discontinue the medication.
2.Surgical therapy for epilepsy.
The seizure focus in the brain is removed surgically. However, this is only possible if the seizures always originate in the same place and this area can be safely removed from the brain without other unacceptable disadvantages for the patient.
3. conduction interruption
In conduction interruption, those nerve pathways over which a seizure is propagating are disconnected. Impulse transmission is then no longer possible.
4.Detection and prevention of seizure triggers.
This form of treatment requires a great deal of self-discipline on the part of the affected person. However, as a concomitant treatment to the other forms of treatment, self-control has an importance in epilepsy treatment that should not be underestimated.
5. vagus nerve stimulation.
This treatment involves the use of a pacemaker that affects the vagus nerve, making the discharges of nerve cells controllable.
Living with epilepsy
Epileptics today have good options for controlling their disease. However, they are at particular risk for accidents due to falls during seizures. One of the ways they are restricted at work and in their leisure time is that they are not allowed to operate machinery, for example: Driving a car or even a job as a pilot are out of the question, and handling sensitive or hazardous substances is also not possible. Many young people with epilepsy therefore have considerable difficulty finding an apprenticeship at all. While families with epileptics can adjust to the disease over the years, employers and colleagues are often overwhelmed by the condition. It must also be possible to act immediately in the event of a seizure: Even if patients carry an emergency ID card and appropriate medication, the environment must be able to handle the patient. People with epilepsy therefore need understanding and support – but not pity.
Adolescent epileptics
The Bethel Vocational Training Center has been particularly concerned with training young people with epilepsy. In its own hotel “Lindenhof”, young people with epilepsy are trained in all areas of the hotel and catering industry. The training model is unique in Germany.
