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Background: Seizures are rarely witnessed by physicians, and the diagnosis is usually made on the basis of the history. Tongue biting is classically considered to favor a diagnosis of epileptic seizure. The usefulness of tongue biting in the differential diagnosis of seizures was evaluated. Methods: A prospective study of the presence of oral lacerations in 106 consecutive patients admitted to our Epilepsy Monitoring Unit and a retrospective study of a population of 45 patients with syncope were performed. The relationship between tongue biting and diagnosis (epileptic vs nonepileptic events) was analyzed. Results: Of the 106 monitored patients, 63 had episodes characterized by bilateral motor activity, complete loss of consciousness, or both; 34 patients had epileptic seizures, while 29 patients had exclusively nonepileptic episodes. Eight patients suffered an oral laceration; all involved the side of the tongue, and all had documented epileptic seizures. Of the 45 patients with syncope, in only one was the tongue lacerated, and this was at the tip. Tongue biting had a sensitivity of 24% and a specificity of 99% for the diagnosis of generalized tonic-clonic seizures. Lateral tongue biting was 100% specific to grand mal seizures. Conclusion: Tongue biting, particularly if it is lateral, is highly specific to generalized tonic-clonic seizures.

In the UK, an annual 30,000 people are diagnosed as having a first epilespy seizure, of which most are under 20 years of age. A total of 150-350,000 people suffer from chronic epilespy. The seizure is a symptom of abnormal electircal activity in the brain, which results in automatic, motor or sensory dysfunction. Details of the condition, diagnosis, and treatment are included.

Syncope is a transient loss of consciousness which results from a momentary deficiency in the blood flow to the brain. One of the many ways in which the blood flow to the brain may become temporarily inadequate is an abnormal physiological response to changes in posture. Syncope resulting from abnormal postural responses is sometimes called vasovagal syncope, because it is mediated by the vascular system and the tenth cranial nerve, the vagus. In some cases, the low blood pressure and slow heart beat resulting from a postural change may result in convulsive seizures. Convulsive seizures are common, and it is estimated that 3 percent of the US population has recurrent unprovoked seizures. It is clearly important to distinguish between seizures which result from epilepsy or other causes and those resulting from syncope. A study was done to determine if tilt table testing might prove useful in identifying convulsive syncope and distinguishing it from epilepsy. In this test, the patient is monitored for physiological responses while on a table which may be tilted to varying angles. This permits the patient's balance system and blood pressure demands to be altered without the patient himself moving. This method was used in the evaluation of eight men and seven women with a history of recurrent seizures which have proved unresponsive to antiepileptic medication. None of the patients had abnormal electroencephalogram (EEG) recordings. A total of 16 episodes of convulsions were elicited from 10 patient on the tilt table. In four patients, the convulsions were elicited by tilting only after administration of the heart drug isoproterenol. In two patients, momentary cessation of the heartbeat was observed. A significant observation in the present study was that the convulsions occurred almost simultaneously with the syncope, in contrast with the belief of some that convulsions would begin later, only as the brain used up its oxygen. The patients whose seizures appeared to be due to vasovagal syncope, based on this test, were placed on beta blocker drugs (two eventually received pacemakers); after an average of 21 months of follow-up, these patients have remained free of seizures. (Consumer Summary produced by Reliance Medical Information, Inc.)

People with epilepsy can lead full and active lives, and can also participate in regular exercise programs and sports. Many people with epilepsy have reported that they feel better and can control their seizures better when they are following a regular exercise program. Physicians and parents should be careful not to be overly restrictive in recommending exercises or sporting activities, and should let the individual decide which sports and activities that he wants to perform. In choosing a sport or activity, it is important to consider the associated risks, the frequency and duration of the seizures, and the type of medication the patient is taking. People who have frequent seizures and tend to fall down should avoid activities such as rope and rock climbing, horseback riding, cycling, gymnastics, and skydiving. In most cases of epilepsy, the illness is diagnosed before the age of 20. Diagnosis involves a complete neurologic examination and blood tests. Before a person can be diagnosed with epilepsy, the patient must have had at least two seizures. There are three basic types of seizures, grand mal, petit mal, and partial seizures, which vary in severity and duration. The primary treatment involves antiepileptic drugs such as Dilantin (phenytoin), Luminal (phenobarbital), Zarontin (ethosuximide), Tegretol (carbamazepine), and Klonopin (clonazepam). Surgery is performed only in rare cases. If you are with someone who has a seizure you should help the person lie down, remove glasses or tight clothing, and do not try to restrain the person. (Consumer Summary produced by Reliance Medical Information, Inc.)

Misdiagnosis of the sleep disorders and epilepsy is common. This is due, in part, to the relatively little attention given these topics in medical schools. There are several manifestations of misdiagnosis: sleep disorders are sometimes not differentiated from each other; sleep disorders may be incorrectly diagnosed as epilepsy; or epilepsy may be treated as a sleep disorder. Better professional education regarding the clinical symptoms of sleep disorders and epilepsy, and more accurate reporting of the episodes by affected individuals and their families, will make recognition easier and more accurate. It is also possible, given that epilepsy affects at least one percent of children and sleep disorders affect more, that children exhibit behavior suggesting that both epilepsy and some sleep disorder are present. Emotional problems, characteristic of children with epilepsy, may themselves cause sleep disturbance. Parents are encouraged to observe their children's behavior as accurately as possible in order to aid in proper diagnosis of disturbed behavior, with the help, if necessary, of equipment such as overnight video recordings and sleep recordings. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical technology in the areas of anatomical and morphological imaging, and biochemical and bioelectrical functioning has become quite sophisticated. While noninvasive techniques are available for obtaining information from some organs and systems, localizing sources of bioelectric current in the heart and brain still requires invasive techniques, and the data that can be obtained are limited. Increasing knowledge in this area would be important in diagnosing and treating epilepsy, conductivity problems of cardiac tissue, and other abnormalities of the heart and the brain. This study looked at a newly developed method for measuring the magnetic fields that are generated by bioelectric currents. Magnetic fields are easier to localize with noninvasive methods. The device is run in a shielded room to prevent outside interference of electromagnetic fields. The sensor that scans the patient consists of 37 superconducting pickup coils and counterwound compensating coils. It is connected to a superconducting quantum interference device system. Information is processed by a computer. The technique was tested on 13 patients with a form of epilepsy and on 10 patients suffering from Wolff-Parkinson-White (WPW) syndrome, a problem of heart conductivity. Results of magnetoencephalography (MEG; record of the magnetic fields in the brain) using the technique showed positive results in 11 of 13 epilepsy patients that were consistent with data obtained from other diagnostic methods. In three of the five WPW patients, results of magnetic measurement showed abnormalities consistent with the disease and with measurements taken by invasive methods. These early results indicate that measuring magnetic activity with this noninvasive method should become an important tool in clinical diagnosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Since seizures are can be epileptic or nonepileptic in nature, the risks are also ambiguous. Nonspecific causes of nonepileptic seizures include syncope (a sudden loss of consciousness) and cardiac causes, which are precipitated by emotional or physical stress. Among children, breath-holding, which may be precipitated by anger, frustration and pain, and pallid infantile syncope (reflex anoxia seizures, caused by the temporary lack of oxygen) can occur with or without crying. This type of non-epileptic seizure is more common in children than those from cardiac causes. Rapid loss of consciousness results, sometimes followed by jerking movements. Benign paroxysmal vertigo is a form of seizure that occurs suddenly without the loss of consciousness. Narcolepsy is another type of nonepileptic seizure, which rarely appears before the age of 15 years. Epileptic seizures can occur when temperatures increase rapidly (febrile seizures). Febrile seizures occur in three percent of the childhood population. Since unprovoked nonfebrile seizures are not likely to occur after these febrile seizures, they are not epileptic in origin. Epileptic seizures are more common among males. Children with abnormal results of electroencephalography (EEG; a record of the electrical activity of the brain), abnormal findings from neurological examination and histories of a partial seizure are at risk for epileptic seizures. Most seizures experienced during the immediately newborn period are due to metabolic disorders and are not neurologically based. Children with identifiable brain lesions and a family history of epilepsy are at risk for epileptic seizures. Children are 7.7 percent times more likely to have a fever-associated seizure and a 2.9 percent chance of a unprovoked seizure if a sibling has had similar episodes. The risk increases to 11.4 percent if the sibling has had both provoked and nonprovoked seizures. Children with brain abnormalities caused by cerebral palsy have a 25 percent chance of having epilepsy as well. Children with neurofibromatosis, an inherited disordered marked by nerve tissue growths, are 10 times more likely to experience seizures. When assessing the individual risks for seizures, the patient's neurological status, family history and age must be carefully considered. (Consumer Summary produced by Reliance Medical Information, Inc.)

Severe brain injury in children is often followed by the development of epilepsy, and a review is provided of the diagnosis, treatment, and prognosis of this disorder in injured children. Epilepsy is usually defined as the separate occurrence of at least two seizures in the absence of any apparent cause. Probably between one third and one half of childhood epilepsy is associated with brain pathology, and prenatal factors are more significant in this regard than influences after birth. Specific causes are discussed. Forms of epilepsy not usually associated with brain damage include primary generalized epilepsy; patients who receive such a diagnosis do not need extensive X-ray documentation. Forms that almost always are associated with lesions include startle seizures in children with congenital paralysis, focal myoclonus, and partial seizures. When diagnosed, the occurrence of seizures in children with brain damage requires consideration of several factors. Seizure control and the impact of the seizures on daily life, the relationship between the seizures and the brain damage, and possible effects of seizures on the brain, must all be evaluated. Approximately half the epilepsies associated with brain injury can be controlled with anticonvulsant medication, with some types being easier to control than others. These are reviewed. The underlying brain damage when seizures are present is usually more severe than when they are absent. Lasting, deleterious effects on the brain can be produced by prolonged seizures as well as by nonconvulsive partial seizures. Treatment of epilepsy associated with brain pathology follows the general guidelines for seizure control. These include consideration of whether the damage will influence the treatment approach or outcome; whether treatment will influence any already-present brain dysfunction; and whether treatment will prevent subsequent damage. Children who have both brain damage and epilepsy need correct diagnosis and management, and hope should be retained, since many will be helped by appropriate treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Upsher-Smith Laboratories announced the addition of the topic Sleep Disorders and Epilepsy to its epilepsy-focused educational website, Epilog.us. The site now features a review of the relationship between epilepsy and [...]