What Is Epilepsy?

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Epilepsy is a brain disorder that causes seizures, and it is sometimes referred to as a seizure disorder. The word “epilepsy” comes from a Greek word meaning “to seize” or “to attack.” Anyone, regardless of age, background, gender, race, or economic position can develop epilepsy. According to the Epilepsy Foundation of America, epilepsy is the fourth most common neurological disorder, and in 2022, the World Health Organization estimated that 50 million people worldwide suffer from epilepsy. Often, epilepsy can be controlled with medications, dietary treatments, and surgery, but in 30 to 40 percent of people, their seizures are not completely controlled with the available treatments.

During normal brain activity, cells called neurons constantly send electrical messages through the body in an orderly fashion. In the brain of a person who has epilepsy, however, normal brain functioning is sometimes disrupted when small groups of neurons start to fire rhythmically together, and this abnormal activity spreads to other parts of the brain. Simply put, a seizure is the symptom produced by the temporary disruption in the electrical activity of the brain, just as a sore throat may be considered a symptom of a cold. Seizures may cause changes in a person’s movement or behavior. They can produce major convulsions—uncontrollable muscle movements—or minor twitches, blank staring spells, or strange sensations. Seizures can affect how you feel, think, or act. Epileptic seizures can vary in how long they last, usually from a few seconds to a few minutes, and how frequently they occur. For most kinds of epilepsy, it is impossible to predict when a seizure will occur. Seizures are sometimes called fits, spells, convulsions, and attacks, but seizure is the most correct term for these events when they result from abnormal brain activity.

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If a person has seizures, they do not necessarily have epilepsy. Seizures can occur because of fever, drug or alcohol withdrawal, low blood sugar, changes in blood chemistry due to illness, or lack of oxygen to the brain, for example. These seizures are not considered epilepsy. Having a single seizure does not necessarily mean a person has epilepsy. A person is considered to have epilepsy after having two or more seizures not caused by fever, illness, or any other medical reason. Over 450,000 children and adolescents have epilepsy.

Causes of Epilepsy

In most cases, the cause of seizures is unknown, and the condition referred to as idiopathic epilepsy. When the cause of epilepsy is known, such as after a head injury, it is referred to as symptomatic epilepsy. A third category, cryptogenic epilepsy, refers to conditions in which a symptomatic cause is suspected but not found.

Severe head injuries are a common way to develop symptomatic epilepsy. A serious blow to the head can injure brain cells or cause neurons to temporarily shut down and stop passing electrical signals between them, resulting in a concussion. A concussion is a serious brain injury that can cause memory loss, dizziness, numbness, headache, disorientation, slurred speech, or unusual behavior. A concussion does not necessarily involve loss of consciousness. Rarely, concussions can cause seizures. More commonly, seizures may develop months or years after the head injury.

In some cases, if a newborn does not get enough oxygen during birth, the delicate electrical system in their brain may be damaged, leading to seizures. Other causes of seizures include brain tumors, genetic conditions, lead poisoning, problems in embryonic brain development, and infections that affect the brain, such as meningitis and encephalitis. Epilepsy may also be brought on by strokes, drug abuse, and even degenerative disorders that affect the brain such as Alzheimer’s disease.

A Historical Perspective

There are many misconceptions about epilepsy. Some people believe myths about the condition or believe that having epilepsy is a sign of mental illness or intellectual disability. Thanks to an increasing awareness, misconceptions such as these are on the wane.

Epilepsy has been around for centuries. However, there are still many myths, stigmas (shameful associations), and misunderstandings about what epilepsy is and what causes it. Long ago, people with epilepsy were labeled as being possessed by demons and were often burned at the stake. Other societies thought that people with epilepsy had inferior or weak minds. People with epilepsy were discriminated against, abused, and even punished for having seizures. Fear and lack of understanding help maintain old, incorrect attitudes. Over the years we have learned much about the brain and why some seizures occur, and we have made progress in the diagnosis and treatment of epilepsy.

Myths and Misconceptions

In the seventeenth century, people believed that epilepsy was caused by demons and that it might be contagious. As late as the nineteenth century in England, men were castrated because it was believed that masturbation led to seizures.

In the past, public attitudes, and even laws, were cruel to those who had epilepsy. At one time, people with epilepsy were locked up in asylums and were considered harmful. Some people with epilepsy were discouraged from attending school, getting married, or having children.

Medical discoveries have helped our understanding of epilepsy. In England in the late 1800s, Dr. John Hughlings Jackson discovered that specific regions of the brain control specific parts of the body. Tests that help us understand the brain have evolved over time. The discovery of X-rays in 1895 helped to show a picture of the brain. In the 1930s, the electroencephalogram, or EEG, was introduced. This test measures the electrical activity in the brain. Computed tomography (CT) was first used in 1972. This form of testing, sometimes called a CAT scan, provides a three-dimensional image of the brain. Magnetic resonance imaging (MRI) uses magnetic signals to show an even more detailed picture of the brain. Other advanced technologies for examining the brain include positron emission tomography, or PET scans, which show the activity of different parts of the brain.

Treatments for seizures have also changed over time. At one time, doctors drilled holes into the skulls of people who had epilepsy in the hope that this would cure them. Other age-old treatments for seizures included herbs, fasting, and prayer. As of 2022, there are over twenty different medications available to control most types of seizures.

Measuring and testing the brain’s functions help medical professionals understand the effects of epilepsy, but do not always reveal the cause. Medical professionals place the causes of epilepsy into five main groups: genetic, structural, metabolic, immune-related, or infection. Roughly half of people with epilepsy will be able to know its cause as determined by doctors.

At one time, people with epilepsy were thought to have low intelligence or to have a cognitive or intellectual disability. We now know that the two conditions are separate and unrelated. Although some people with cognitive or intellectual disabilities also have epilepsy, many do not. In most cases, there is no relationship between epilepsy and intellectual or cognitive abilities.

Epilepsy can affect people's school performance, however. Having seizures can interrupt a person’s attention span or affect their memory. Some of the medications prescribed to treat epilepsy can cause drowsiness, memory loss, and mood or behavior problems, which can sometimes interfere with learning. For this reason, some people do not like taking medication. In many cases, a different medication can reduce the problems while still controlling seizures.