What exactly is different in the brain of an epileptic person versus the brain of a non-epileptic person?
In: 51
Fo simplify, a cluster of brain cells in the epileptic person start firing randomly and the “storm” takes over briefly.
Seizure = part of the brain decides it’s party time and goes mental by firing off neurones quickly and inappropriately 🪩 if it is the typical seizure people think of (unconscious and flipping about on the floor, a tonic-clinic generalised seizure) it means that the areas next to party central (the part of the brain where the abnormal triggering is happening) has joined in and it starts doing the same, then it spreads throughout the brain.
Epilepsy is a tendency towards having seizures for various reasons (many don’t have an identifiable reason). Everyone has the potential to have a seizure in the right (or probably better to say the wrong) conditions. But some people, that threshold is lower, and they can develop seizures from identifiable triggers (stress, sleep deprivation, flickering lights).
Putting it as what is the difference in an epileptic brain vs a non-epileptic brain is probably a bit too simple, as there will be lots of different variations in the brain that cause one person to have epilepsy compared to another, and another.
Some people are born with little areas that don’t form properly (dysplasia). These areas are prone to miss firing and starting a seizure. Likewise if there is an injury (head trauma) or illness to the brain (meningitis, tumour) those areas are the source of the start of the seizure. Also if the salts in your blood like sodium are too far out of the normal range, that can cause a seizure too. There is growing knowledge of genetic reasons for someone to be prone to seizures (problems with ion channels in cell membranes, protein problems, it goes on and on but very very not ELI5 territory).
But it all boils down to an area getting too excited and synapse firing in a purposeless way causing a seizure in anyone. But people with epilepsy are those who are more likely to have a seizure without their body being under severe illness/stress.
It varies not all seizures are the same and not all epilepsy is cause by the same thing. I have seizures and my doctor can’t figure out why all my scans have come up normal. My seizures aren’t caused by any outside stimuli that we can determine so there’s no way to pin down what is causing them.
Fun fact not all seizures are epileptic. I experianced a Traumatic Brain Injury (TBI) and am now susceptible to seizures. After a multitude of tests and scans they were able to determine an area of my brain that the neurons are always firing my neurologist calls it a “focus.” I’m not quite sure what happens in my brain when the seizures begin and are happening, I didn’t think to ask.
Have fun with that knowledge.
There is also something called PNES, psychogenic non epileptic seizures. This is commonly seen in younger women with significant history of trauma such has sexual abuse, physical abuse, molestation but can also be seen in men or anyone of any age but less commonly.
Patients who suffer from this condition have what we call “spells” which look very much like seizures, but when hooked up to a continuous brain wave monitor (continuous EEG) which is the gold standard for diagnosing seizure and record a spell, there is no electro graphic correlate to suggest it is a true epileptogenic seizure that is due to electrical misfiring. Seizure medications (anti epileptic medications) do absolutely nothing for these types of seizures. And NO, these patients are NOT faking it. It is a stress response…
For example, say you hate public speaking. Before you go up to speak, you stomach my gets sharp achy pains in it, your palms might sweat, you might stutter more. These are things that your body is doing in response to a stressor that you really don’t have much control over…when someone with PNES feels stressed, their brain will respond in very bizarre ways. Sometimes these people look like their having full blown tonic clonic seizures, sometimes they flail their extremities around, sometimes they stare off among many other presentations. If you didn’t know any better, these spells look very convincing for a true seizure.
The treatment is acceptance of the diagnosis and cognitive behavior therapy and if the patient adheres to that they generally do very well and can become spell free. You can imagine how debilitating it must be for someone. It’s not often I get to tell people what they have is treatable in the neurology world.
However, what can be dangerous about these spells is when patients present to an emergency room or whatever it may be, sometimes if the care provider doesn’t know the patient’s history, they will end up placing these patients of ventilators and blasting them with multiple seizures medications because they look so convincing for something called status epilepticus which is essentially just prolonged seizures back to back (which can be deadly because just like all your other muscles tensing up, so does you diaphragm which can lead to respiratory failure) So it’s really important to us when we diagnose someone with PNES we make it VERY clear in their chart and do a lot of patient education so they can hopefully avoid those very invasive procedures down there road.
Latest Answers