American Sleep and Epilepsy Centers
Epilepsy
What is Epilepsy?

Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally.
In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions,
and behavior or sometimes convulsions, muscle spasms, and loss of consciousness. Epilepsy is a disorder with
many possible causes. Anything that disturbs the normal pattern of neuron activity - from illness to brain damage
to abnormal brain development - can lead to seizures. Epilepsy may develop because of an abnormality in brain
wiring, an imbalance of nerve signaling chemicals called neurotransmitters, or some combination of these
factors. Having a seizure does not necessarily mean that a person has epilepsy. Only when a person has had
two or more seizures is he or she considered to have epilepsy. EEGs and brain scans are common diagnostic
test for epilepsy.


Is there any treatment?

Once epilepsy is diagnosed, it is important to begin treatment as soon as possible. For about 80 percent of
those diagnosed with epilepsy, seizures can be controlled with modern medicines and surgical techniques. Some
antiepiletic drugs can interfere with the effectiveness of oral contraceptives. In 1997, the FDA approved the
vagus nerve stimulator for use in people with seizures that are not well-controlled by medication.


What is the prognosis?

Most people with epilepsy lead outwardly normal lives. While epilepsy cannot currently be cured, for some
people it does eventually go away. Most seizures do not cause brain damage. It is not uncommon for people
with epilepsy, especially children, to develop behavioral and emotional problems, sometimes the consequence of
embarrassment and frustration or bullying, teasing, or avoidance in school and other social setting. For many
people with epilepsy, the risk of seizures restricts their independence (some states refuse drivers licenses to
people with epilepsy) and recreational activities. People with epilepsy are at special risk for two life-threatening
conditions: status epilepticus and sudden unexplained death. Most women with epilepsy can become pregnant,
but they should discuss their epilepsy and the medications they are taking with their doctors. Women with
epilepsy have a 90 percent or better chance of having a normal, healthy baby.


What research is being done?

Scientists are studying potential antiepileptic drugs with goal of enhancing treatment for epilepsy. Scientists
continue to study how neurotransmitters interact with brain cells to control nerve firing and how non-neuronal cells
in the brain contribute to seizures. One of the most-studied neurotransmitters is GABA, or gamma-aminobutryic
acid. Researchers are working to identify genes that may influence epilepsy. This information may allow doctors
to prevent epilepsy or to predict which treatments will be most beneficial. Doctors are now experimenting with
several new types of therapies for epilepsy, including transplanting fetal pig neurons into the brains of patients to
learn whether cell transplants can help control seizures, transplanting stem cells, and using a device that could
predict seizures up to 3 minutes before they begin. Researchers are continually improving MRI and other brain
scans. Studies have show that in some case, children may experience fewer seizures if they maintain a strict diet
- called the ketogenic diet - rich in fats and low in carbohydrates.


One of the Nation's Most Common Disabling Neurological Conditions

Epilepsy is a general term that includes various types of seizures. People with diagnosed epilepsy have had
more than one seizure, and they may have had more than one kind of seizure. A seizure happens when abnormal
electrical activity in the brain causes an involuntary change in body movement or function, sensation, awareness,
or behavior.

Epilepsy affects about 2.7 million Americans, and results in an estimated annual cost of $15.5 billion in medical
costs and lost or reduced earnings and production. People of all ages are affected, but particularly the very
young and the elderly. About 10% of Americans will experience a seizure sometime during their lifetime, and
about 3% will have had a diagnosis of epilepsy by age 80.
The first national conference on public health and epilepsy, Living Well with Epilepsy I, convened in 1997. The
conference was co-sponsored by CDC, the American Epilepsy Society (AES), the National Association of
Epilepsy Centers (NAEC), and the Epilepsy Foundation (EF). This conference defined the aim of epilepsy
treatment as "no seizures, no side effects." Its key messages can be summarized as: "take seizures seriously,
do it early, do it right the first time, be systematic, efficient and effective, and empower the patient."
Participants collaborated on developing a list of priority epilepsy concerns ranging from researching the
evaluation and care of patients having a first seizure to combating stigmatization and reducing disabilities
associated with epilepsy. This list of priority concerns was the impetus for developing CDC epilepsy programs
directed at improving care; improving communication and combating stigma; self-management; surveillance and
prevention research; increasing public awareness and knowledge about epilepsy; and strengthening partnerships.

Living Well with Epilepsy II, held on July 30-31, 2003, was co-sponsored by CDC, AES, NAEC, EF, and the
Chronic Disease Directors. The aim of this conference was to review progress since Living Well with Epilepsy I,
and to recommend priorities for a public health agenda on epilepsy for the next 5 years, focusing on early
recognition, diagnosis, and treatment; epidemiology and surveillance; self-management; and quality of life. An
additional aim was to identify other needs and challenges that might be addressed by the epilepsy community
and those who support it. Examples of CDC activities include those listed under Program Activities.


Key Public Health Issues

•        The goal of eliminating seizures, while at the same time preventing side effects from treatment, is
achievable for most people with epilepsy. However, most areas of the country do not have the organized
systems of care necessary to provide needed service, and support for all people with epilepsy.
•        Epidemiological and surveillance data on epilepsy are limited. More research is needed on epilepsy, in
particular on how the causes, frequency, and severity of the condition differ among age groups, races, and
communities.
•        People with epilepsy often struggle to overcome low self-esteem and the stigma that is attached to having
epilepsy. The stigma is due in part to a lack of understanding by people they see every day — family members,
schoolmates, colleagues. Some people mistakenly believe that epilepsy is a form of mental illness or mental
retardation, that seizures are something to fear, that drastic first aid measures must be taken to help someone
having a seizure, or that people with epilepsy cannot be valuable and productive employees. Public education is
needed to eliminate these misconceptions.