"It's the gorilla in the living room that nobody wants to talk about."

Data on Epilepsy Point to Dangers of Repeated Seizures
For years, doctors have reassured epilepsy patients that seizures are relatively benign. While a fall during a seizure may cause injury, the surge of electricity in the brain does no actual damage, patients were told.

…mounting evidence now suggests that repeated seizures can indeed harm the brain — or, in rare cases, even lead to death.

In the past decade, research in epilepsy has exploded. In part, the boom has been driven by advances in biology and technology, like the mapping of the genome and the continuing miniaturization of electronics.

But largely, it has been driven by a new recognition that seizures themselves are harmful. Mounting data point to damage to the hippocampus, the part of the brain responsible for laying down new memories, as the cumulative effect of a lifetime of uncontrolled seizures.

Furthermore, recent studies suggest that seizures beget seizures: each electrical surge in the brain causes changes that make future seizures more likely.

Doctors are also realizing that patients with seizures that are not suppressed by drugs or surgery are at higher risk of dying prematurely. A syndrome called sudden unexpected death in epilepsy patients, or Sudep, appears to be much more common than previously thought. No one is sure exactly what happens in the syndrome, but the suspicion is that an electrical short circuit either turns off respiration or the heart.

Among patients with severe epilepsy, about 10 to 15 of 10,000 die unexpectedly each year, according to Dr. Robert S. Fisher, a professor of neurology at Stanford. Often patients and their families know nothing about the syndrome, until there is a death.

In a commentary published last spring in The Lancet, the London-based medical journal, epilepsy experts pointed to new information on the prevalence of the sudden death syndrome among patients with poorly controlled seizures and said the information should serve as a "wake-up call" to the doctors who treat them.

About 1 percent of Americans have epilepsy, a condition characterized by periodic seizures that originate in the brain. Basically, experts say, normal brain activity is fairly chaotic, with neurons sparking as needed. But in people with epilepsy, neurons occasionally begin to fire in sync. There is a power surge and the finer circuits of the brain are overwhelmed as the seizure progresses.

The seizures themselves can range from a brief loss of consciousness lasting one to 10 seconds to a complete loss of consciousness. It is the seizures that provoke a loss of consciousness that most worry researchers because these seizures appear to be most linked to sudden death and damage to the hippocampus.

Although there were hints in the past that uncontrolled seizures led to hippocampal damage, only in the last few years has strong evidence been accumulated.
Data on Epilepsy Point to Dangers of Repeated Seizures