Simone Lawson
Epilepsy is a seizure disorder that constitutes a wide variety of conditions. It is one of the most common neurological disorders, characterised by spontaneous bursts of neuronal overactivity, known as seizures. Seizures can manifest in different ways, from convulsions and loss of consciousness to tonic seizures, where the body, arms, or legs make sudden stiffening movements. Epilepsy is considered a developmental disorder when it interferes with normal growth or functioning, and it must originate before the age of 18. The onset of epilepsy can be sudden, with individuals engaging in normal activities one minute and becoming totally nonfunctional the next. Epilepsy is often associated with other developmental disabilities, such as intellectual disability, autism, cerebral palsy, or other physical limitations. The treatment for epilepsy may include medication, psychotherapy, vagal nerve stimulation, or a ketogenic diet.
| Characteristics | Values |
|---|---|
| Definition | Developmental disability is defined in state and federal law as intellectual disability, cerebral palsy, epilepsy, and autism. |
| Onset | The onset of these conditions must be before the age of 18. |
| Duration | Likely to continue indefinitely. |
| Disability | Constitutes a substantial disability for the individual. |
| Seizure control | Complete seizure control is a reasonable therapeutic goal. |
| Treatment | Treatment options include medication, psychotherapy, vagal nerve stimulation, and the ketogenic diet. |
| Social stigma | Epilepsy has a social stigma attached to the disorder due to its sudden onset. |
| Concurrent conditions | Individuals with epilepsy may or may not have concurrent conditions such as intellectual disability or other physical limitations. |
| Brain disorder or injury | In 60% of infants with epilepsy, a brain disorder or injury, such as birth trauma with oxygen deprivation, precedes seizures. |
| Genetic conditions | Dravet syndrome is a severe type of epilepsy syndrome resulting from a gene mutation. Tuberous sclerosis complex is a neurocutaneous syndrome characterized by benign tumors, early-onset epilepsy, intellectual disability, and autism. |
| EEG | Electroencephalographs (EEGs) in children with epilepsy are typically abnormal, showing diffuse slowing of the background and frequent seizure discharges. |
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What You'll Learn
Epilepsy is a neurodevelopmental disorder
Epilepsy is often associated with other neurodevelopmental disorders, including intellectual disability, autism, cerebral palsy, and learning disabilities. In children, epilepsy is frequently accompanied by developmental delays and can interfere with language development and cognitive functioning. The onset of epilepsy typically occurs before the age of 18 and is likely to continue indefinitely, constituting a substantial disability.
The causes of epilepsy are varied and can include congenital brain malformations, genetic mutations, brain injuries, infections, developmental malformations, or chromosomal abnormalities. In some cases, the cause of epilepsy is unknown. Recent studies have also indicated that defects in synapse elimination and remodeling during early "critical periods" can trigger hyperexcitability later in life, leading to the concept of epilepsy as a neurodevelopmental disorder.
The treatment for epilepsy often involves medication, psychotherapy, or other treatments such as the vagal nerve stimulator or the ketogenic diet. The goals of treatment are typically complete seizure control and the optimal quality of life for the individual. It is important to note that the social stigma attached to epilepsy can be a primary concern, as the disorder can cause sudden changes in functionality.
In summary, epilepsy is considered a neurodevelopmental disorder due to its impact on normal growth and functioning, its association with other neurodevelopmental disorders, and the role of developmental factors in its onset. Understanding epilepsy as a neurodevelopmental disorder has important implications for disease prevention and therapy.
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Developmental and epileptic encephalopathies
DEEs are often genetic conditions, with changes in the genetic code (DNA) disrupting normal brain function and development. These gene changes can be new in the affected individual (de novo) or inherited from healthy parents (recessive). In some cases, DEEs may also be caused by non-genetic factors such as cerebral palsy, head trauma, infection, developmental malformations, or chromosomal abnormalities.
The electroencephalographs (EEGs) of children with DEEs typically show abnormal results, with diffuse slowing of the background and frequent seizure discharges. The seizures themselves can vary widely, but the patterns tend to be consistent within individuals. Some common types of seizures experienced by people with DEEs include epileptic spasms, tonic or atonic seizures, and myoclonic seizures.
DEEs are characterised by two types of encephalopathy: developmental encephalopathy and epileptic encephalopathy. Developmental encephalopathy refers to the direct impact of the underlying cause of epilepsy on developmental delays. Epileptic encephalopathy, on the other hand, is caused by very frequent seizures and markedly abnormal EEGs, which further worsen developmental problems. While improving seizure control can help reduce the impact of epileptic encephalopathy, the developmental delays associated with developmental encephalopathy are unlikely to change.
The complexity of DEEs, with their combination of seizures and developmental issues, makes diagnosis and management challenging. Early diagnosis and treatment are crucial for improving long-term developmental outcomes. Holistic management approaches, including antiseizure therapies and care for multimorbidities, are tailored to each individual's unique condition and epilepsy syndrome.
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Epilepsy and developmental disabilities
Epilepsy is a neurological disorder characterised by the repeated occurrence of spontaneous bursts of neuronal overactivity, known as seizures. Seizures typically arise in restricted regions of the brain and may remain confined to these areas or spread to the whole cerebral hemisphere. The hippocampal formation and cerebral cortex are considered the most epileptogenic regions of the brain.
Epilepsy is considered a developmental disorder as several developmental factors contribute to epileptogenesis, leading to epilepsy. These factors include congenital brain malformations, altered neuronal signalling during embryonic life, and defects in postnatal maturation of neuronal networks. For instance, mutations in the RELN gene, which codes for the extracellular glycoprotein Reelin, cause a neuronal migration disorder called lissencephaly with cerebellar hypoplasia. This results in epilepsy in postnatal life.
Additionally, epilepsy is often associated with other developmental disabilities. For example, tuberous sclerosis complex is a neurocutaneous syndrome characterised by benign tumours, early-onset epilepsy, intellectual disability, and autism. Children with epilepsy may also have an underlying brain disorder or injury, cerebral palsy, head trauma, infection, developmental malformations, or chromosomal abnormalities. These underlying conditions can result in developmental delays in addition to the seizures.
The social stigma attached to epilepsy is a primary concern, as it can cause individuals to suddenly become totally nonfunctional while engaging in normal activities. Furthermore, children with epilepsy and developmental disabilities are at risk for prolonged seizures, which can be life-threatening. Treatment options for these children include medication, psychotherapy, vagal nerve stimulation, and the ketogenic diet.
In summary, epilepsy is considered a developmental disorder due to its association with various developmental factors and its overlap with other developmental disabilities. The social implications and health risks associated with epilepsy highlight the importance of effective treatment options, such as those mentioned above.
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![Cognitive and Behavioural Disorders of Epileptic Origin in Children [Clinics in Developmental Medicine No. 168]](https://m.media-amazon.com/images/I/61of0ry3qVL._AC_UY218_.jpg)
Epilepsy and social stigma
Epilepsy is a chronic brain disorder characterised by recurring seizures, which are brief episodes of involuntary movement of the body sometimes accompanied by loss of consciousness. The seizures are caused by spontaneous episodes of uncontrolled and excessive electrical activity in the brain. This neurological condition spans all age groups, but it is often a developmental disability that starts in infancy or early childhood.
Developmental disabilities are those that interfere with normal developmental functioning or growth. To be considered a developmental disability, the condition must originate before the person is 18 years old, be likely to continue indefinitely, and constitute a substantial disability for the individual. Epilepsy is often a developmental disability because it can cause developmental delays and cognitive impairment in children.
People with epilepsy face a significant amount of social stigma. Stigma arises from the transformation of the body, blemish of individual character, or membership in a despised group. In the context of epilepsy, stigma arises from the sudden onset of the disorder, which can make individuals feel fearful and different from their peers. The social stigma surrounding epilepsy can lead to shame, fear, and rejection, causing individuals to hide their condition and not seek treatment. People with epilepsy may lose friends, face discrimination at work, and be bullied at school. The stigma is perpetuated by myths and misconceptions, such as the belief that epilepsy is contagious or a form of mental illness.
However, there are efforts to address the stigma surrounding epilepsy. The Epilepsy Foundation, in collaboration with the Centers for Disease Control & Prevention, launched the "Change Our Epilepsy Story" campaign to reduce the stigma associated with the condition. The campaign aims to shift the conversation from silence to one of education, safety, and the pursuit of new treatments. Individuals with epilepsy can also share their stories to empower others and build a broader understanding of the condition. Additionally, educating the public about epilepsy and humanising the condition can help to combat stigma and improve understanding and acceptance.
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Epilepsy and depression
Epilepsy refers to a wide variety of seizure conditions that often result in physical convulsions of the body. The onset of epilepsy can be sudden, with individuals engaging in normal activities one minute and becoming totally nonfunctional the minute after. This unpredictability of seizures, along with the social stigma attached to epilepsy, can lead to depressive thoughts and feelings.
Depressive disorders (DDs) are the most common type of psychiatric comorbidity in patients with epilepsy. In a study of adults aged 18 years and older, researchers found that adults with epilepsy were twice as likely to report feelings of depression in the previous year compared to adults without epilepsy. The more severe the epilepsy, the more severe the depression. The brain areas responsible for certain types of seizures also affect mood and can lead to depression.
The close association between DDs and epilepsy has been observed in animal models of epilepsy, which show decreased activity of serotonin and norepinephrine. Additionally, neuroimaging and neuropsychological data support the presence of frontal lobe dysfunction in DDs, with concomitant dysfunction of mesial temporal structures.
Depressive disorders in epilepsy patients can be classified into four types: major depressive disorder (MDD), dysthymic disorder, minor depression, and depressive disorder not otherwise specified. Diagnosing depression can be complicated, and a full assessment with a mental health professional is necessary to identify the causes. Treatment for depression is very effective, even in serious cases.
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Frequently asked questions
Epilepsy refers to a wide variety of seizure conditions which oftentimes, depending on the type of seizure, result in physical convulsions of the body. It is one of the most common neurological disorders, characterised by the repeated occurrence of spontaneous bursts of neuronal overactivity, known as seizures.
Developmental disabilities are attributable to intellectual disability, autism, cerebral palsy, epilepsy, or disabling conditions found to be closely related to intellectual disability. Epilepsy is considered a developmental disorder due to the frequent seizures and markedly abnormal EEGs that substantially worsen developmental problems.
Treatment options for epilepsy as a developmental disorder include medications, psychotherapy, and other treatments. The vagal nerve stimulator and the ketogenic diet have also been used with some success in children with epilepsy and developmental disabilities.
