What is “Epilepsy”?

How do doctors define “Epilepsy”?

Let us simplify the definition of Epilepsy:

Epilepsy is an Increased tendency of the brain to have Unprovoked or minimally provoked seizures.

Many other definitions of Epilepsy exist. The other definitions have subtle differences. For example, a new definition (ILAE 2014) attempts to make it more practical, helping us to identify which people are more likely to have seizures. Other definitions focus on the social and emotional aspect of Epilepsy. But, for our purposes here, the above definition is perfect.

There are two parts (highlighted) which we need to understand:

  • Tendency = Epilepsy is not an event. It is a tendency of the brain. The word Epilepsy denotes that there is a higher tendency of the brain to have seizures.
    Seizures are the Event, the tendency is Epilepsy
  • Unprovoked or minimally provoked = A potent provoking agent should be absent, e.g. Even if I had multiple seizures due to severe Alcohol withdrawal, I would still not be diagnosed with Epilepsy.
    But what if the triggering event is minor, e.g. Mild sleep deprivation? Actually, I can still be diagnosed with Epilepsy in that scenario: This is described more in detail in the Seizures section:
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Could you provide some examples?

Sure!

John & Max:

Let’s consider two people:

  • John had a seizure after he received an Antibiotic called Imipenem – which is known to cause seizures in some people.
  • Max, a 12-pack a day alcoholic, had a seizure after he suddenly stopped drinking alcohol.
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Does John or Max have Epilepsy?
No! Because both of them had seizures that happened after strong provocation.

Sid:

Let’s consider another person:

  • Sid sleeps only for 6 hours on consecutive nights trying to get something done. On the third morning, he has multiple jerks of his upper body, followed by a generalized seizure.
  • He neglects this, and the next week, the same thing happens again.

Was there a strong provocation?
No, the sleep deprivation was mild.

Does Sid’s brain have a tendency to have recurrent seizures?
Yes, based on the fact that he had seizures on two successive weeks.

Sanjay:

  • Sanjay had one unprovoked seizure when he was 3 years old.
  • He has had no seizures since then, and is now 55 years old.

Does Sanjay’s brain ever have an increased tendency to have seizures?
Probably not, considering that he had only one seizure and then none in the last 52 years.

Pooja:

  • Pooja had 15 seizures between 5 and 10 years of age.
  • Since that time she never had a seizure, and is now 60 years old.

Did Pooja’s brain ever have an increased tendency to have unprovoked seizures?
Yes, between 5-10 years of age, she certainly had many seizures. So she had Epilepsy.

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Does Pooja’s brain still have an increased tendency to have unprovoked seizures?
Probably not, considering she has had no seizures for the past 50 years!

Therefore, it is certainly possible to outgrow your Epilepsy.

Your brain can heal itself, and make itself less susceptible for seizures through ways that we don’t completely understand. The chances that you will outgrow your Epilepsy can be predicted based on the “Epilepsy syndrome” that you have (see Question 4).

Is the history of a person always sufficient for making a diagnosis of “Epilepsy”?

If we have a long enough history, probably yes.

But – and this is a very common occurrence – let’s say a 5th person: Prasad – has a single seizure and rushes to your clinic. How can you predict whether he will have more seizures?

In addition to the history, two tests help in estimating the chance that a person will have recurrent seizures: An MRI and an EEG. An abnormal result in any of these tests indicates a higher tendency to have seizures. These tests are described in more detail here:

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Is Epilepsy Common?

Yes!

About 1% of the general population has Epilepsy.

An easier way to think of it is: If there are 200 people in any sort of group, e.g. a social gathering, then 1-2 people there will have Epilepsy.

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If I am diagnosed with Epilepsy, what is the next step before treatment is started?

Many doctors get both an EEG and an MRI before starting treatment.

If possible, once this is done, your doctor will try to determine whether your characteristics fit into a known “Epilepsy Syndrome”. Once you understand this article completely, I strongly suggest you read the next article also:

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Caution:
This information is for educational purposes. It is not a substitute for professional medical diagnosis & treatment. Do not change your medications, supplements or other treatments without your doctor's permission.

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Dr. Siddharth Kharkar

Dr. Siddharth Kharkar is a board certified (American Board of Psychiatry & Neurology certified) Neurologist. He is a Epilepsy specialist & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

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