Rebecca Case - A Practical Guide to Supporting People with Epilepsy

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Historically, epilepsy has been thought about in many different ways. The term epilepsy comes from the ancient Greek language meaning to possess. It was felt the Ancient Greek Gods or supernatural forces were responsible for causing seizures (Smithson and Walker ). Later, Hippocrates described epilepsy as an organic disease of the brain, being hereditary as with other diseases. Nowadays most cultures understand it as a neurological disorder of the brain, however some places in the world still view it differently, and may still see it as a mental health condition or even witch craft.

Epilepsy is a neurological condition, which results in someone having recurrent (more than 1), unprovoked epileptic seizures. During a seizure there will be an abnormal increase in electrical activity in the brain. It can happen in one small area (focal) or across the whole brain (generalised) and so can be divided into two main types of epilepsy (focal or generalised epilepsy). The symptoms can present very differently depending on what part of the brain is affected, the cause and the age of the person.

Epilepsy is considered to be resolved if a person has an age dependent syndrome and they are past the relevant age. Or if the person has been seizure free for 10 years and off antiseizure medications for 5 years (Fisher et al. ).

An Epilepsy Syndrome is when a group of clinical characteristics occur for a person, such as seizure types, age it started, EEG results, genetic factors, prognosis and response to medication.

Many people can have a single, unprovoked seizure and never go on to have a further seizure. This is why epilepsy is diagnosed after more than one unprovoked seizure. Treatment is not usually started until a person has had more than oneunprovokedseizure.

People can have seizures which are provoked, often referred to as acute provoked seizures. This can occur due to a number of different acute clinical situations. It can be due to metabolic changes, for example low sodium levels can cause seizures. They may occur after an anaesthetic. Provoked seizures can be due to acute drug or alcohol abuse, or drug or alcohol withdrawal or immediately or in the few hours following a head injury. A febrile convulsion in children is considered an acute seizure. This is not considered to be epilepsy as the seizures are directly related to the provoking factor and would not have occurred without it.

Some conditions can look like seizures but they are actually caused by something else. For example some cardiac problems can look like a seizure, including fainting (Syncope). Sometimes, psychological conditions, such as panic attacks or symptoms such as hallucinations can be misinterpreted as a type of seizure. Migraine symptoms, such as visual disturbances may also appear as a seizure. The most common conditions which are misdiagnosed as epilepsy are syncope and dissociative seizures.

Although many terms may be used for this condition, terms such as psychogenic, functional or pseudo-seizures can be unhelpful as they can make it sound as though the individual has control over the attacks.

This is a condition that involves the person experiencing an event similar to an epileptic seizure. However, it is not associated with electrical disturbances in the brain. It is thought that the attacks or seizures are caused by emotional processing difficulties, often due to a stressful or traumatic event, which can be at the time and/or in the past. It is not unusual for people to not be aware of what has caused the dissociative seizures and to find it difficult to accept the diagnosis.