Tonight I will be presenting Epilepsy. The topics will include a history of E.

, the
electroencephalogram, the classification of seizures, then causes and treatments.
The word epilepsy is derived from Epilepsia, Greek, which means seizure. Seizure is
derived from the Latin word, Sacire, which means: To take possession of.
One of the earliest descriptions of epilepsy or seizure was recorded in On the Sacred
Disease, a work of the Hippocratic Corpus, dating back to 400 BC. This work
attributed the cause of the disease to the body, as opposed to the divine, stating
the source as the flux of the phlegm flowing from the brain into the veins. I will
discuss further the modern interpretation of the disease.
The statistic is that about 18000 new cases of epilepsy are reported each year and
they are most prevalent in childhood and elderly adults.
So what is epilepsy? Epilepsy is a central nervous system disorder (neurological
disorder) in which nerve cell activity in the brain becomes disrupted, causing
seizures or periods of unusual behavior, sensations and sometimes loss of
consciousness. We will get into the types of seizures and its classifications later on.
However, before I go into that, I would like to discuss a little bit about the EEG.
So the Electroencephalogram, or EEG, made it possible for the first time to study
the human brain in vivo. The technology was developed by Hans Berger, Austria, in
the 1920s. It is used to measure electrical activities of the cerebral cortex. This is
done by placing electrodes along the scalp, which then, when hooked onto
something like an oscilloscope, will read the voltage difference between two
electrodes. This gives the chaotic reading as you see here on the right.
Note that the EEG only shows activities of groups of neurons. This is also only
possible because of the types of neurons in the cortex of the brain, which are made
of pyramidal neurons. These neurons run parallel to one another and perpendicular
to the cortical surface. Neurons deeper in the tissue are orientated more randomly
and a proper reading cannot be performed.
Now, how is a seizure characterized? A seizure is characterized by groups of
neurons that, during a sudden onset, display hyperexacitability and
hypersynchronization. If you compare the EEG of a normal brain to one during a
seizure, you can see the obvious difference in the amplitude and frequency of these
spikes that indicate frequent, synchronized firing of groups of neurons. Chemically
speaking, during a seizure, there is a high release of excitatory neurotransmitters
like glutamate and aspartate and/or low release of inhibitory neurotransmitters like
GABA.
Onto the classification of seizures: A seizure is partial or focal if it affects only one
area of the brain, like the frontal, parietal, or temporal. A seizure that does not
affect consciousness is called Simple. In these cases, the patient remains alert and

experience symptoms like jerking of a limb, dj vu, nausea, strange taste or smell.
However, if the seizure does affect consciousness, then it is classified as complex.
Patients experiencing partial complex seizures have altered awareness and
behavior.
A generalized seizure affects the entire brain and a patient will lose consciousness
at the onset. Note that a partial seizure may lead to a generalized seizure. This
clarification is important in treating such patient. Therefore noting the onset
symptoms during the partial seizure event is important for accurate diagnosis.
Generalized seizure can lead to the following symptoms:
1)
2)
3)
4)

Tonic Clonic or Grand-mal

Absence or Petit-mal
Tonic or Atonic
And Myoclonic

Here is an example of Absence Epilepsy, otherwise known as Petit-mal or

childhood absence epilepsy due to its high prevalence in childhood. Kids with
Absence epilepsy will experience attacks of impaired consciousness, almost trancelike, that last less than 2 seconds at a time. While it seems harmless, kids with
absence can have great learning impairment as they try to remember what was said
to them during those attacks.
Note the EEG where it shows the onset of such attack.
Next, you see a patient suffering from tonic clonic seizure. This is a generalized
seizure characterized by sudden onset of rigid muscle tone, the tonic phase. This
tonic phase often affects the diaphragm, causing the patient to let out a moan or
cry. Many times, when the patient is not lying down, the sudden onset of muscle
rigidity also causes him/her to fall. Next, the patient experience the clonic phase,
characterized by convulsive movements occurring bilaterally and synchronously
before slowing and eventually stopping. This is followed by a variable period of
unconsciousness and gradual recovery.
Often times, seizures can happen rarely and doctors cannot conveniently perform
an EEG during such times. Therefore, an Interictal EEG reading can help support the
diagnosis of seizure or epilepsy.
So causes for epilepsy or recurring seizures are not very well known, but you can
imagine any condition that disrupts the balance between excitatory and inhibitory
activities in the brain such that it causes Hyperexcitability in the neurons can cause
a seizure. Some of the potential causes are listed here.
It has long been recognized that seizures often lessen or disappear during periods of
fasting in some individuals with epilepsy. Used to treat generalized e. in kids with
syndromes such as Lennox-Gastaut