It is a major chronic medical condition, similar to arthritis, heart disease, diabetes or cancer. It can limit activity, and cause pain, anxiety or depression. But its impact can extend beyond its medical consequences, to social stigma, emotional stress, and even discrimination.
“Epilepsy is a condition denoted by a
tendency to have spontaneous, recurrent seizures under conditions that
would not normally cause seizures,” said Andrew Blum, M.D., Ph.D., director
of the Comprehensive Epilepsy Program at Rhode Island Hospital in
The cause of the seizures, says Dr. Catherine Phillips Co-Director
of the Comprehensive Epilepsy Program at UMass Memorial Health Center
in Worcester, is “excessive excitability of nerve cells in the
person’s brain, with neurons firing in an abnormal way. That affects
the behavior of the individual.”
Dr. Blum and Dr. Phillips, board certified neurologists with a
subspecialty in clinical neurophysiology and epilepsy, discussed the
many aspects of this disorder as guests on the March edition of the
Massachusetts Medical Society’s Physician Focus program. Among the
topics discussed with host Dr. Bruce Karlin are the
causes of this condition, how it’s diagnosed, how it affects
patients and those around them, and what treatments are available for
patients with this disorder.
“A person may fall to the ground and shake all over,” says Dr.
Phillips in describing the outward appearance of the condition, “or
there may be an alteration in awareness, where a person may just stop
and stare or have some other behavior. Or there may be some reaction
in between.” The seizure may last from a few seconds to a few
minutes with confusion afterwards, and the patient many times will not
even know they’ve had a seizure.
Different types of seizures may occur, depending on which part of
the brain and how much of it is affected by the abnormal activity. The
origin of the activity may be due to any one of a number of factors,
including head trauma, infections, sleep deprivation, or genetics.
Dr. Blum emphasizes that it’s important to recognize epilepsy is
characterized by spontaneous, recurrent seizures. Up to 10 percent of
the population may experience a seizure sometime in their life, he says,
but that doesn’t mean they have epilepsy.
The condition can be difficult to diagnose, as distinctions must be made
from such conditions as migraine headaches, fainting spells, or
transient ischemic attack (TIA), the last of which produces
stroke-like symptoms. The first step, and perhaps most crucial says
Dr. Blum, in diagnosing the condition is compiling an accurate medical
history of the patient. That often means getting information from
family members or witnesses who can describe the seizures and what the
patient actually experienced.
The history is then followed by medical tests, which include an
electroencephalogram (EEG, a test to detect problems in the electrical
activity of the brain), or imaging tests such as Magnetic Resonance
Imaging (MRI), or Computed Tomography (CT, or Cat-Scan) to see what is
happening inside the brain and body. Treatment may include using any
one of a wide array of anti-convulsive medications (with a careful eye
to any side effects the patient may experience), implantable
electrodes, nerve stimulation, or in some cases, surgery.
The impact of epilepsy on the patient, however, goes far beyond the
physical. “The emotional impact is not to be underestimated,” says
Dr. Blum, as the disorder can mean problems with memory and learning,
stress, depression, and anxiety. Epileptic
patients are also prohibited from driving a motor vehicle, and can
only do so after a period of six months without seizures.
Social stigma and discrimination may occur as well, but the doctors
see progress in these areas. Dr. Blum says “Our culture is much more
attuned to epilepsy and seizures representing a disorder of the brain,
much as diabetes is seen to the body.” And Dr. Phillips adds that
“even though some social stigma still exists, it’s much better
Dr. Blum and Dr. Phillips carry their work for patients with epilepsy
beyond their medical practices. Both are active with the Epilepsy
Foundation of Massachusetts, Rhode Island, New Hampshire, and Maine
– Dr. Blum as chairman of its board of directors and Dr. Phillips as
a member of the board of directors. Their work with the Foundation includes enhancing employment
opportunities for those with the disorder, advocating for patients as
they encounter discrimination in the workplace, and educating the
public and first responders to be more sensitive to the nuances of
epilepsy – work that bodes well for their patients and all those who
have this disorder. Visit epilepsyfoundation.org/local/massri to
learn about the Foundation's regional activities.
Watch the accompanying video for the full discussion.