In contemporary society, the frequency and importance of epilepsy,
i.e., chronically recurrent cerebral cortical seizures, can hardly
be overstated. From the epidemiologic studies of Hauser and colleagues,
one may extrapolate an incidence of approximately 2 million individuals
in the United States who are subject to epilepsy and predict about
44 new cases per 100,000 persons each year. These figures are exclusive
of patients in whom convulsions transiently complicate febrile and other
intercurrent illnesses or injuries. It has also been estimated that
slightly less than 1 percent of persons in the United States will
have epilepsy by the age of 20 years (Hauser and Annegers). Over
two-thirds of all epileptic seizures begin in childhood (most in
the first year of life), and this is the period when seizures assume
the widest array of forms. In the practice of pediatric neurology,
epilepsy is one of the most common disorders and the chronicity
of childhood forms adds to their importance. The incidence increases
again after age 60 years. For all these reasons, physicians should
know something of the nature of seizure disorders and their treatment.
It is notable that, in striking contrast to the many treatments
available for epilepsy, as pointed out by J. Engel, 80 to 90 percent
of epileptics in the developing world never receive attention.
Epilepsy is defined as a condition of recurrent unprovoked seizures.
In 1870, Hughlings Jackson, the eminent British neurologist, postulated
that seizures were due to “an excessive and disorderly discharge
of cerebral nervous tissue on muscles,” and modern electrophysiology
offers no evidence to the contrary. The discharge may result in
an almost instantaneous loss of consciousness, alteration of perception
or impairment of psychic function, convulsive movements, disturbance
of sensation, or some combination thereof.
Terminologic difficulty arises from the diversity of the clinical
manifestations of seizures. The term convulsion,
referring as it does to an intense paroxysm of involuntary repetitive
muscular contractions, is inappropriate for a disorder that may
consist only of an alteration of sensation or consciousness. Seizure is
preferable as a generic term because it embraces all paroxysmal
electrical discharges of the brain and also because it lends itself
to qualification. The term motor or convulsive
seizure, therefore, is not tautologic, and one may likewise
speak of a sensory seizure or psychic seizure.
The word epilepsy is derived from Greek words meaning “to
seize upon” or a “taking hold of.” Our
predecessors referred to it as the “falling sickness” or
the “falling evil.” Although a useful medical
term to denote recurrent seizures, the words epilepsy and epileptic still
have unpleasant connotations and should be used advisedly in dealing
A first solitary seizure or brief outburst of seizures may occur
during the course of many medical illnesses. It indicates that the
cerebral cortex has been affected by disease, either primarily or
secondarily. Convulsive seizures by their nature, if prolonged or
repeated every few minutes, a condition termed ...