Biology 202
2002 Third Paper
On Serendip

Epilepsy: Any of various neurological disorders characterized by sudden recurring attacks of motor, sensory, or psychic malfunction with or without loss of consciousness or convulsive seizures (1).

Is epilepsy a purely physical phenomenon? The question is a complicated one. Put simply, the answer should be yes. The psychological trauma sometimes caused by the seizures, however, makes the answer more complex, along with a more troubling trend. In years past epileptics were classed among the mentally ill, and received the same maltreatment as did that unfortunate group of people. Before that they were perceived as having been possessed by evil spirits. But now, in the modern world, we are free of those ignorant superstitions. Aren't we?

Scientifically, epilepsy is the term under which many seizure disorders are grouped. There are four basic types of seizures: petit mal, tonic-clonic (grand mal), simple partial, and complex partial (2). While petit mal seizures consist merely of a short period of immobility and blank staring, occasionally accompanied by brief loss of awareness, tonic-clonic seizures are much more dramatic (2). Also called grand mal seizures, they involve whole-body muscle contractions, loss of consciousness, temporary cessation of breathing, and involuntary biting of the tongue or cheek (2). The simple and complex partial seizures are calmer; the simple includes muscle contractions of a specific part, abnormal sensations, nausea, sweating, flushed skin, and dilated pupils. The complex partial seizure consists of all these symptoms as well as automatism (repeated motions), inappropriate emotions, changes in personality, altered consciousness, and hallucinations of taste or smell (2).

The causes of epilepsy are varied, and one seizure alone doth not an epileptic make. It is only after a repeated pattern of seizures that epilepsy is diagnosed (3). Epilepsy has multiple possible causes (2). Infections such as encephalitis or meningitis, or even complications from AIDS, may trigger seizures, although these are generally more easily treated (2). Developmental problems or genetic defects present at birth trigger seizures as early on in life as infancy (2). Some problems are inherent to the brain, such as degenerative diseases like Alzheimer's, brain injuries, tumors, or brain lesions disrupting normal activity of neurons (2). Others, such as stroke or metabolic problems such as diabetes, have a more indirect effect on the brain's functions (2). Still other epileptics are diagnosed with the mysterious "idiopathic;" causes unknown (2).

Modern medications are quite effective in controlling seizures, and most patients can gain reasonable control over their seizures, or even become seizure-free. Old standbys such as Carbatrol and Phenobarbital are being bolstered by new drugs: Lamictal, Neurontin, Zonegran (4). There are side effects such as drowsiness, dizziness, et cetera, as there are with many medications. (2). The most daunting side effect is perhaps that the doubled risk of neural tube defects in children whose mothers were taking Carbatrol or Depakote during pregnancy (5). However, the incidence of this occurring is only 6-8%, and with careful management a healthy child can easily be born to an epileptic mother. On the whole, then, the phenomenon is scientifically understood and scientifically managed. The situation seems to be under control: diagnose with epilepsy, treat with medications, and that's it. It's a physical solution for a purely physical problem.

Unfortunately, the reality is far different. Many of the old superstitions still stand against those with epilepsy, especially in developing nations, making it impossible for them to live normal lives. In Cameroon, Nepal, and some parts of rural India, those suffering from epilepsy are thought to be possessed by evil spirits and are treated accordingly (6). While some of their "treatments" are merely humiliating, others include beating or starving (6). In some parts of Central America and India during the last five years, of the many suffering patients in psychiatric hospitals – some tied to beds, some without any psychological treatment whatsoever – one-third were committed solely because they had epilepsy (7). With proper medication, many would have been able to live normal lives, according to the medical workers who examined them (7). The United States has not been blameless either, although certainly it has behaved less violently. Until the 1970s, it was perfectly legal to deny epileptics access to public buildings (6). In the UK at that time, a law forbidding those with epilepsy to marry was finally repealed (6). Up until 1980, various states in America also forbade epileptics to marry (6).

When it comes to employment, those whose seizures are controlled by medication are not considered disabled under the Americans with Disabilities Act (8). However, this isn't always completely accurate. Depending on the severity of the seizures, the medication taken can have debilitating effects upon the patient, such as concentration or memory problems, while for some increased need for sleep decreases their productivity (9). Another problem that presents itself is that of transportation: depending on the laws of the state in which the person lives, there may be laws preventing them from obtaining a driver's license due to their epilepsy (9). It is unknown whether it is due to these factors or to actual job discrimination – or a combination of the two – that has such a drastic effect on the employment rate of epileptics. Exact data differs; one study claims that in Germany, Italy, and the United States, 15-20% of people with epilepsy are unemployed and 20% will retire early, while another declares that the unemployment rate for American epileptics is 25% (8). Economic conditions for epileptics in developing countries are so bad that obtaining medication is difficult and can lead to further health problems (10).

This problem, therefore, is not so simply cured. In some contexts, those who cannot control their seizures suffer from more than just the medical consequences. This phenomenon is similar to those who have contracted the AIDS virus: the reaction of their community may be as devastating, or even more so, than the realization of the disease itself. This effect, combined with occasional unexpected effects of medication, lead to a depressive state in many people (9). This problem is magnified by the emotional havoc that epilepsy can wreak upon the brain. Besides the usual turmoil caused by any chronic illness, the "random electricity" of wayward neurons can trigger unexpected and inappropriate emotions before and during some types of seizures (9). Another symptom, sometimes manifesting in simple partial seizures, is that of hallucinations, which if unexpected can lead the patient to worry about their mental health (11). These stresses, combined with anxiety about when the next seizure will occur, can lead to severe depression. The suicide rate for those with epilepsy is much higher than that of the general population, accounting for 7% of deaths, five times the national rate for those who do not have epilepsy (12).

Another problem that presents itself is the phenomenon known as SUDEP: Sudden Unexplained Death in Epilepsy (12). Most patients had a history of grand mal seizures and were found prone in bed, but the cause of death is still mysterious (12). Epilepsy, however, has an unnerving link to death: 42% of deaths in epileptics have been because of their epilepsy (12). Accidents – caused when a seizure occurred while a person was doing something dangerous – made up 8% of deaths for people with epilepsy (12). This phenomenon only serves to add to the stress put on a person diagnosed with epilepsy.

So is epilepsy a fairly simple problem, restricted to the physical? Like many chronic illnesses, the answer proves to be no. A diagnosis of epilepsy, just like a diagnosis of AIDS or cancer, brings along with it a parade of side effects, social problems, and mysteries that are impossible to ignore. The brain is still largely unknown to us, and thus treatments for epilepsy are still imprecise, although they are improving rapidly. More worrying is the fact that, for many, epilepsy is still a mysterious ailment, to be treated by starvation or beatings, or, slightly more moderately, by job discrimination and ostracization. While these are social problems rather than neurological ones, the fact remains that it will be impossible to truly find a solution to epilepsy without both educating of the ignorant and further investigating the mysteries of the brain.

References

1)Dictionary.com, the entry for epilepsy in a dictionary website

Medline, an entry in a medical encyclopedia regarding epilepsy

3)Medline, an entry in a medical encyclopedia regarding seizures

4)The Epilepsy Foundation, a page charting different epilepsy medications

5)The Epilepsy Foundation, a page answering questions about pregnancy as related to epilepsy

6)The World Health Organization, an information page of the World Health Organization website

7) Solving Mental Health Problems Cpt. 3. World Health Organization 2001.

8)The Epilepsy Foundation, a page discussing the civil rights arguments put forth by various groups of people with epilepsy

9)The Epilepsy Foundation, a page dealing with the secondary problems caused by epilepsy

10)The World Health Organization, a webpage detailing the struggles of people with epilepsy in developing countries

11)The Epilepsy Foundation, a page discussing the impact of epilepsy on the mental health of the patient in both a short-term and long-term context

12)The Epilepsy Foundation, an article discussing epilepsy as a cause of death


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