Epilepsy: sorting the myths from the facts of a common disorder

One of AFL’s biggest stars, Lance Franklin, was briefly hospitalised for a mild epileptic seizure last week. He was also ruled out of Saturday’s qualifying final, as he is reportedly suffering from an “ongoing mental health condition”.

Although they may coexist, epilepsy is a neurological disorder that doesn’t fall under the umbrella of mental or mood disorders. But the likelihood of mood disorders, such as depression and anxiety, increases with chronic brain illnesses. And there may be a slight further increase if you have epilepsy.

People with epilepsy need treatment, but also understanding they are normal, capable people. Unless someone has a noticeable seizure in a public place, you won’t know they have epilepsy. There’s no abnormality, as such, springing from the illness. Nor is there a limit to what someone with the condition can accomplish.

Understanding epilepsy

Globally, epilepsy is one of the most common neurological diseases, particularly among children. Epilepsy is not a single disorder; it has many causes that share the hallmark of a seizure, when brain function is disrupted, often dramatically. When seizures remain isolated in just one part of the brain, they can be very small and can even pass by unnoticed.

But when seizures involve large parts of the brain, the consequent event is what people typically associate with an “epileptic fit”. The person’s muscles stiffen, they lose consciousness and fall to the floor, and their body starts jerking rhythmically. These types of seizures are called “tonic-clonic” seizures - because the body is first stiff all over (tonic) and then has rhythmic jerking (clonic).

Seizures can be frightening for those who have never witnessed one before. Historically, the loss of control of the body and brain that came with having an epileptic seizure was often misunderstood. The biblical story of Jesus performing an exorcism on a young boy having a seizure, for instance, led some to believe they were a result of demonic possession. Only in modern times has epilepsy been truly recognised as a disease of the brain.

There are still misunderstandings, though. It’s wrong to think, for instance, something should be put into the mouth when someone is in the middle of a seizure; it’s not true that the tongue can be “swallowed”. First aid is applied to prevent injury while the person is stiff and jerking, but when they go limp at the end of the seizure, they should be put on their side to prevent the floppy tongue obstructing breathing. After a seizure, it may take some time for behaviour to return to normal and sleepiness is common.

Epilepsy is a diverse condition that can have many, different causesfrom shutterstock.com

Treatment options

Saying someone has epilepsy is a little like saying that they’re ill. Its cause is diverse and can be anything from a brain tumour to an inherited genetic condition, the consequence of injury, or any other disorder that affects the brain. In some cases, epilepsy is associated with other brain problems and intellectual disability. But mostly, people with epilepsy are normal between seizures and can participate in normal activities. If seizures are not controlled, then operating dangerous machines, like cars, or swimming unsupervised must be avoided.

Most epilepsy is well controlled with medications. Options for treatment have expanded with new drugs available, more precise diagnosis based on sophisticated imaging, and better understanding of the mechanism of epilepsy in each individual patient. In some cases, very precise detection of brain lesions can allow for a surgical cure of epilepsy. Even devices used as brain implants have been developed that can control severe epilepsy.

It’s common for some mood disorders also to be present in people with epilepsy. Naturally, the fear of having an unexpected seizure can directly lead to an anxiety disorder, while the stress of coping with chronic illness can contribute to depression. In some types of epilepsy, the brain networks that give rise to the illness may also make people more vulnerable to these co-morbidities. It is important that both problems are properly assessed and diagnosed.

For someone like Lance Franklin, simply “carrying on” if there is a mental or neurological problem would be as bad as “playing on” with a muscle problem that was not recognised and treated. Like the physical side of sport, where an optimised musculoskeletal system is important, so it’s important to recognise that the brain needs just as much care, effort and medical attention.

Graeme Jackson receives funding from the National Health and Medical Council Australia