Disorder in which abnormal electrical activity in the brain cells causes convulsions. Epilepsy can be congenital and have no recognizable cause. Acquired epilepsy can occur after brain damage, for example after a birth injury, serious concussion or as a result of circulatory disorders (stroke). Other causes are stimulus from a brain tumour or encephalitis. Epilepsy manifests itself in various ways; sometimes the patient and those around him notice little; in other cases the attacks are so severe that they could cause serious brain damage, but fortunately such attacks can often be controlled or prevented by medication. The best-known and most dramatic type of epileptic seizure is the grand mal, in which all the brain cells are stimulated by the abnormal electrical discharge. The attack is often preceded by a strange premonitory feeling (aura). The patient loses consciousness in the course of the attack, and suffers general convulsions, which may cause biting of the tongue. After a few seconds more violent muscular convulsions occur, the eyes are often open and turned away, and there may be urinary incontinence. Because breathing is affected by the attack, the patient becomes red, and then blue; the breath then becomes whistling, and he foams at the mouth. The convulsions are followed by a coma lasting up to 15 minutes, from which the patient often wakes in a confused state. Such attacks can often follow close on each other, so that consciousness is never completely restored (status epilepticus). This is a dangerous condition, because oxygen shortage can cause brain damage. Less common are atacks caused by localized electrical discharge, so-called focal epilepsy. These often begin with a strange sensation in the abdomen. Another kind of local attack involves tingling in, for example, the hand, spreading throughout that side of the body, and possibly followed by loss of consciousness. Local muscular convulsions may also occur. Focal attacks may finally become general. Epilepsy manifests itself differently in children because the brain is immature. The most important feature are so-called absences, generalized attacks that occur between the ages of 4 and 12 and consist of short periods of lowered consciousness during which the child’s expression is vague and there are muscular convulsions around the mouth and eyelids. After this the child continues with what he was doing. The attacks can occur several times a day. The child appears to be daydreaming. Such attacks may cease spontaneously after puberty, without any residual symptoms. A more serious form of epilepsy occurs between birth and the age of 1 or 2, often caused by brain damage at birth. The attacks consist of sudden twitching of the head and trunk, combined with stretching of the limbs, after which the whole body becomes limp. Such children can become severely handicapped mentally, and spasticity41 often develops, despite good medical treatment. This also applies to the so-called Lennox syndrome, a form of epilepsy affecting 2 to 5 year olds, and involving brain damage. Attacks of muscular convulsions in the head, shoulders and arms alternate with sudden limpness, in which the child may fall. Generalized attacks often occur later. Fever fits are epileptic attacks that occur in children between the ages of 6 months and 4 years, and occur during periods of high fever; they may be repeated during a subsequent period of fever. The chance of epilepsy developing later in such children is not high. Epilepsy is diagnosed by the symptoms and an EEG, which shows the disturbances characteristic of particular kinds of attack. An underlying condition is looked for if suspected, and can sometimes be treated. During an attack the patient must be protected from injury as much as possible. Try to ensure that he is lying away from furniture on which he could injure himself. It is often suggested that something should be put between the patient’s teeth to stop him biting his tongue, but the inexperienced should not attempt this because they may be bitten.

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