Epilepsy and Brain

Epilepsy is a disorder of the central nervous system, specifically the brain. In simple terms, our nervous system is a communications network that controls every thought, emotion, impression, memory, and movement, essentially defining who we are. Nerves throughout the body function like telephone lines, enabling the brain to communicate with every part of the body via electrical signals. In epilepsy, the brain's electrical rhythms have a tendency to become imbalanced, resulting in recurrent seizures.

If you have seen a picture of the brain before, it probably looked like this one, which illustrates the outer surface of the upper brain. This outer surface contains numerous folds that increase the surface area and allow more cerebral cortex to be packed into the skull, giving us more "brain power."

The brain is an extraordinarily complex organ. When it comes to understanding epilepsy, there are several concepts about the brain you'll need to learn.

The first is that the brain works on electricity. Normally, the brain continuously generates tiny electrical impulses in an orderly pattern. These impulses travel along the network of nerve cells, called neurons, in the brain and throughout the whole body via chemical messengers called neurotransmitters. A seizure occurs when the brain's nerve cells misfire and generate a sudden, uncontrolled surge of electrical activity in the brain.

Another concept important to epilepsy is that different areas of the brain control different functions.

If seizures arise from a specific area of the brain, then the initial symptoms of the seizure often reflect the functions of that area. The right half of the brain controls the left side of the body, and the left half of the brain controls the right side of the body. So if a seizure starts from the right side of the brain, in the area that controls movement in the thumb, then the seizure may begin with jerking of the left thumb or hand.

What is Epilepsy?

Epilepsy is a disorder that disrupts the transmission of electrical signals inside the brain. Although you may assume that epilepsy always causes episodes of uncontrolled movements and loss of consciousness, the condition is actually quite variable. Symptom episodes — known as seizures — are often subtle, causing strange sensations, emotions and behavior. Some people with epilepsy simply stare blankly for a few seconds when having a seizure, while others have full-fledged convulsions.

About one in 100 people in the United States has experienced an unprovoked seizure at some point in life. However, a solitary seizure doesn't mean you have epilepsy. Many people — for example, children with high fevers — experience one seizure and then never have another one. But after you've had two seizures, the chance that you'll have additional seizures increases dramatically. At least two unprovoked seizures are required for a diagnosis of epilepsy.

The onset of epilepsy is most common during childhood and after age 65, but the condition can occur at any age. Treatments may leave you free of seizures, or at least reduce their frequency and intensity. Many children with epilepsy even outgrow the condition with age.

What Causes Epilepsy?

To understand how epilepsy arises, we must briefly outline how the brain functions normally.

The brain consists of millions of nerve cells, or neurones, and their supporting structure. Each neurone maintains itself in an electrically charged state. It receives electrical signals from other neurones, and passes them on to others. What actually happens is that a tiny quantity of a special neurotransmitter substance is released from the terminals of one neurone. This chemical excites an electrical response in the nuerone next in the chain, and so the signal moves onward.

All the functions of the brain, including feeling, seeing, thinking and moving muscles depend on electrical signals being passed from one neurone to the next, the message being modified as required. The normal brain is constantly generating electrical rhythms in an orderly way.

In epilepsy this order is disrupted by some neurone discharging signals inappropriately. There may be a kind of brief electrical "storm" arising from nuerones that are inherently unstable because of a genetic defect (as in the various types of inherited epilepsy), or from neurones made unstable by metabolic abnormalities such as low blood glucose, or alcohol. Alternatively, the abnormal discharge may come from a localised area of the brain (this is the situation in patients with epilepsy caused by head injury, or brain tumour).

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