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WHAT ARE THE CAUSES OF SECONDARY EPILEPSY
Secondary epilepsy is an easier concept to grasp. It means that the symptoms, namely the fits, are secondary, or subsequent to, some obvious abnormality of the brain. In other words, if you could look at the brain itself and examine it, either during life using X-ray techniques like CT or PET scanning, or at autopsy, it would be possible to find an actual abnormality in the brain. The person may have been born with this abnormality of the brain or it may be a scar related to brain damage at birth, a head injury and so on.
It can be fairly easily understood that if there is a structural abnormality of brain tissue, then the brain cells surrounding that abnormality will be somewhat misshapen and possibly functioning abnormally as a result. If you have a scar somewhere on your body, glance at it and notice how it pulls the surrounding skin and tissues in various directions.
It is now appropriate to discuss, if only briefly, some of the particular causes of epilepsy. These include:
Inheritance
Parents often ask if epilepsy is inherited, as this is commonly believed to be the case. It depends on the type of epilepsy. In most types of epilepsy, inheritance is uncommon. If one parent has epilepsy, the chances of the children developing it are about one per cent. This is the same as the occurrence in the general population. On the other hand, if both parents have epilepsy, the chances increase to about 10 per cent. This is clearly greater than the incidence in the general population and represents a significant risk. It is important to understand that it is not the epilepsy itself that is inherited, but the underlying cause of the epilepsy. In other words, if a person’s epilepsy is due to a condition such as tuberose sclerosis, it may well be handed on to their children. On the other hand, if epilepsy developed as the result of a head injury during a car accident, it will not be handed on.
Anoxia (hypoxia)
This means a lack of oxygen, which is essential to the normal working of all body cells, especially the brain. If the oxygen supply to the brain is cut off, damage to the brain cells occurs after some minutes. Some cells will die, but others may be damaged in such a way that they function abnormally and may produce abnormal electrical discharges.
Brain anoxia may occur to the foetus during labour, at birth, in any other situation when breathing is interrupted for some time, or after a stroke where the blood supply to an area of brain is cut off.
Brain damage
This may occur during birth or from any other cause of trauma to the head such as motor vehicle or industrial accidents. The fits may not occur for years after the injury.
Tumours
Many people who have had a fit are scared that they may have an underlying brain tumour. This is a very uncommon cause of epilepsy, especially in children. It is important, however, for reasons of reassurance, to dispel this fear by clinical examination and reasonable tests.
Infections
Epilepsy may result from meningitis, encephalitis (a viral infection of the brain), infections transmitted from mother to baby during pregnancy (toxoplasmosis), and parasites such as the sheep tapeworm (Echinococcus) or dog tapeworm (Toxacara).
As previously mentioned, there are a number of provoking factors which may bring out fits in people with epilepsy. These are important as they should obviously be avoided if at all possible. They include:
Lack of sleep
Sleep deprivation is known to alter the electrical activity of the brain and thus may provoke fits. This is particularly the case in young adults who like to stay up late at night, but is important for epileptics of all ages. A good night’s sleep is strongly recommended.
Menstruation
It has long been recognised that women may have a deterioration in seizure control either just before, or in association with, their periods. The cause of this phenomenon, which is called catamenial epilepsy, is not understood although it may relate to the retention of fluid, possible alterations in hormonal balance, or changes in the blood levels of anticonvulsants which sometimes occur in association with menstruation. Treatment is difficult, although there have been recent reports that the use of clobazam for several days before the start of menstruation and during the period itself may be helpful. There is a need for more research in this area, which is a fairly small one but quite troublesome for those affected.
Stress
This is a very difficult area, as what is stressful for one person may not be for someone else. However, stress, in some people, can make seizures worse. It is important for people whose seizures are made worse by stress to appreciate this, as no amount of anticonvulsant medication will solve the problem. Often more and more medication is given, leading to quite severe side effects such as drowsiness, unsteadiness and some degree of confusion.
Alcohol
This is often combined with a lack of sleep. Alcohol acts by removing inhibiting factors, as you can observe by watching anyone who has had too much to drink. It is this lack of inhibition of brain cells which probably accounts for the fits which may occur with alcohol. The seizures usually occur in the hangover (morning after) period. People with epilepsy should drink very modestly indeed, both for this reason and also because it may interfere with some anticonvulsant medications. Alcoholics who suddenly stop drinking may have withdrawal fits; these seizures do not represent epilepsy.
Infections
This applies especially in childhood. It is common to observe that, when a child whose fits are normally well-controlled develops an infection such as tonsillitis, the fits go out of control. This is probably related to the fever that is associated with the infection and the deterioration usually lasts two to four days. It is particularly important for parents to be aware of this association as it makes coping with the situation much easier.
Drugs
Some drugs may precipitate fits. These include the tricyclic antidepressants, phenothiazines and very high doses of penicillin. The withdrawal of drugs, such as barbiturates and Valium, may also cause fits.
Last, but not least, there is the important subject of non-epilepsy. These are conditions which may mimic a fit, but are not epilepsy. It is very important that these are recognised. Because of the social stigma of epilepsy, it is vital that the diagnosis be correct and that people are not labelled epileptic unless this is in fact the case. The diagnosis of epilepsy has social implications which may be very difficult to correct. Non-epilepsy includes:
fainting episodes;
breath-holding attacks in young children;
abnormalities of the heart beat (cardiac dysrhythmia);
vertigo;
narcolepsy;
myoclonic jerks (jumping legs). This usually occurs when just drifting off to sleep and affects the majority of us from time to time. This is a very minor form of an epileptiform phenomenon which occurs so commonly that it really does not represent epilepsy as such in any one individual.
tics and ritual habits such as facial twitching, blinking, brushing hair away from the face and so on;
night terrors in young children;
overbreathing. This is often associated with acute anxiety and occurs mostly in adolescent girls. The overbreathing alters the chemical balance of the blood and can produce some muscular twitching;
pseudoseizures (false fits). Some people, often someone with epilepsy, may exaggerate their fits to manipulate particular situations. This is not common, but needs to be borne in mind. True hysterical fits may also occur.
The causes of seizures not related to epilepsy have not been discussed in great detail, but are mentioned to stress the fact that not everything which appears to be epilepsy is in fact so. This emphasises the importance of correct diagnosis.
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