Aging Begins at 30

When the Brain Overfires Electrically

In sixth grade one of my classmates had an epileptic fit in the playground. I still remember it clearly after more than 60 years.

Epilepsy is called grand mal (major illness) or (little) petit mal also called absence attacks. The latter is uncommon in the elderly. Epilepsy is Greek for seizures and is a family name for 20 types of seizure disorders. Ictus is a blow in Latin, so events in the seizure are ictal and at other times interictal. About 3% of the population have a seizure at some time in their life. The cause is paroxysmal electrical discharges from the brain of unknown cause. The brain gets stuck in the "on" position electrically. Life as an epileptic has some element of risk that must be faced at all ages.

When I graduated in medicine we could use phenobarbitol (introduced in 1912) or the new dilantin (1938) also called phenytoin. Bromide (1857) had fallen out of use. In the 1970s carbamezepine (tegretol) and valproic acid were added. Now there are more medicines to choose from, which has improved treatment dramatically.

You can faint and twitch a little. In contrast, an epileptic attack has a tonic phase with generalized muscle stiffening. It may be preceded by a hoarse cry of air forced out of the chest. This is followed by alternating periods of muscle spasm and relaxation (the clonic phase) which usually lasts 1 to 3 minutes. Sometimes there is a warning of the attack called an aura perhaps an unpleasant odor or spots before the eyes. There may be impairment or loss of consciousness. There is no way to stop a seizure once it has started. One should cushion the fall, cradle, the head, remove glasses, and loosen tight clothes. Some bite their tongue. Some are nocturnal only. Bladder and bowel control is sometimes lost. After a seizure the patient is confused (in 12%), may have a headache, be weak, and may have slow speech. Some have localized attacks perhaps in the right arm. These are called focal attacks. An absence attack is a blank state that lasts a few seconds.

Epilepsy can be diagnosed best by an eyewitness report. The electroencephalogram (EEG) is abnormal in the interictal period in only 50% and sporadically in another 35%. It's never positive in 15%. A CT scan may pinpoint the precipitating cause in over 80% such as a scar in the brain.

About 1/3 will have less than 1 attack a year; another 1/3 will have 1-12 attacks yearly and a third will have more than 12 attacks yearly. Alcohol may make attacks worse or more frequent.

A differentiation has to be made from fainting spells, TIA's (little strokes), various encephalopathies (brain degenerations), diabetic low sugar attacks, brain infections, alcoholic withdrawal fits (DT's or rum fits) and a subdural hematoma (a space-occupying bruise beneath the skull pressing on the brain.)

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