With numerous types of epilepsy and a variety of different kinds of epileptic seizure, underwriting for customers living with the condition can be troublesome. Vanessa Leyland fills in the gaps.
Epilepsy is caused by a misfire of electrical currents in the brain. The word originates from the Greek 'epilepsia' meaning taking hold or seizing.
The cause is unclear, and almost all epilepsy is known to be non-hereditary. However, it was once thought to be passed down through generations and a law passed in 1734 constituted epilepsy to be a legal impediment to marriage. The law was absolved in 1969.
Epilepsy can be due to brain damage from head injury, trauma during birth, drug intoxication, disease such as meningitis (inflammation of the membranes of the brain) or encephalitis (infection in the brain tissue). Rarely is it caused by a brain tumour. When the cause is known, it is referred to as 'symptomatic' epilepsy, but for 60% of sufferers there is no known cause and it is termed as 'idiopathic epilepsy'.
Cryptogenic seizures have no known cause but the most common link is heart disease, cerebrovascular disease in older people, infection or chronic alcohol abuse.
Everyone has a seizure threshold and, depending on how high this is, affects someone's resistance to seizures. However, while epilepsy is mainly non-hereditary, the seizure threshold is dependent on the threshold of both parents. Those with a low threshold are more likely to have fits, whereas those with a high seizure threshold are more likely to have fits due to conditions such as a severe head injury.
Symptoms of an epileptic fit may consist of violent shaking movements, staring spells, unusual repetitive behaviour, numbness or loss of consciousness.
Types
There are two main types of seizures: generalised and focal. These types then break down into further classification, whereby generalised seizures are quite varied and can be described using the following terms.
n Grand mal: Before the attack there may be a feeling of dread, often in the stomach area, the person then becomes unconscious and there are tonic-clonic (jerky) movements of the limbs, they may cry out, bite their tongue or have bowel/bladder incontinence. Following the attack they will feel drowsy, possibly confused and may have a headache. To help someone who is having a grand mal seizure, it is important to stay calm and note how long the attack lasts, move any objects away so they do not hurt themselves, cushion their head but do not try to restrain them or put anything in their mouth. Afterwards, put them in the recovery position and check there is nothing blocking their airway. Usually they will make a full recovery but if they have any trouble breathing, or if the seizure lasts longer than five minutes an ambulance should be called. Grand mal epilepsy can occur at any age but it usually begins in childhood or early adulthood.
n Status epilepticus: This describes seizures that happen back to back without return of consciousness. Most epileptic seizures last the same amount of time and stop by themselves, but when it is continuous it is a medical emergency as there is an increased risk of brain damage, kidney failure and heart failure. There is a 10% to 15% risk of death.
n Petit mal: Also known as absence seizures, these seizures present themselves in childhood. The person may become unconscious for a short period of time, may look blank and stare, their eyelids may flutter and they will not be aware of anything around them. These can occur up to 100 times a day and many go unnoticed.
Focal, or partial, seizures are confined to a localised area of the brain. When it occurs in children the cause is unknown, but in adulthood they are usually caused by a brain tumour. Symptoms are dependent on which area of the brain if affected. The brain is separated into four lobes.
n The temporal lobe: The area around the ear. Symptoms may include butterflies in the stomach, a feeling of déjà vu, a strange smell or taste or sudden happiness or fear.
n The frontal lobe: The area around the forehead. Symptoms may include a wave-like feeling in the head or a changed sensation in part of the body, such spasms in the hand or arm.
n The parietal lobe: The top of the head. Symptoms include pins and needles or a feeling that a part of the body feels bigger or smaller than it actually is.
n The occipital lobe: The back of the head, symptoms include flashing lights or seeing things that are not actually there.
There are two types of focal seizures. When there is no loss of consciousness it is referred to as simple partial. When there is a change or loss in consciousness or paralysis it is referred to as complex partial.
Other types of seizures include:
n Febrile: These occur only in children aged between one and six years and occur during illness associated with fever. The majority of children do not later develop epilepsy although, while in childhood these seizures can be recurrent, the major risk factor here is when the seizure lasts longer than 20 minutes.
n Nocturnal: Sleep-related seizures, this term can be related to any type of seizure, it simply means that the seizure happens while asleep.
n Reflex: These can be caused by a flickering light, such as strobe lights - being in this situation must be avoided in order to control the condition.
Diagnosis
If an individual believes they have experienced an epileptic seizure, they must contact their GP, usually a diagnosis is made when a person has experienced more than one seizure. The doctor will refer the person to a neurologist but, although tests will help to confirm the diagnosis, there is not a single test that can confirm this. Tests include an EEG, where electrodes are placed on the head and connected to a machine that records electrical activity in the brain. Patients will be given tasks to do, such as looking at flashing lights. An EEG only records brain activity at that time, it cannot provide historic information. Another test is a CT scan. This does not diagnose epilepsy, it looks for a cause of the epilepsy. An MRI scan studies the brain structure by using radio waves in a magnetic field. The neurologist will also ask questions such as how the patient felt before the seizure, was there any dizziness or chest pain and whether any drugs and alcohol had been taken.
Treatment
There are many types of medication on the market used to treat epilepsy, although in 30% of cases it is not possible to retain control. The first was called phenobarbitone and was introduced in 1912 - there are now 19 types of medication. Occasionally the seizures cease following treatment and some people are able to stop medication, others may need medication long term, even though the condition appears to be well controlled. Some may never regain control even though they are taking the correct medication. Side effects are minimal, although concentration and alertness may be affected, which is why people cannot drive until they have been seizure-free for 12 months and the DVLA is satisfied that they are of no risk. n
Vanessa Leyland is life and disability underwriter at Aegon Scottish Equitable
Sources:
n Swiss Re
n www. epilepsy.org.uk
n www.epilepsynse.org.uk
