Vitality's John Downes explores epilepsy. Its history, symptoms and underwriting considerations
Epilepsy is a chronic disease of the brain, characterised by recurrent seizures or fits which are usually brief episodes of involuntary movement affecting either part of the body, known as partial seizures, or the whole body, known as generalised seizures. When experiencing these seizures, there is sometimes a loss of consciousness and there may also be loss of bowel and bladder function.
Epilepsy has a rich history, with records of its existence dating back as far as 2000BC. The name of this disease, as we know it today, is derived from the Greek epilepsia, meaning to take hold of or to seize. The Babylonians called epilepsy the Sacred Disease, attributing it to supernatural origins, which were usually evil in character. The Romans also shared this view and believed it to be contagious - which it isn't - forcing sufferers to live apart. While, in the Middle Ages, the disease came to be known, for obvious reasons, as the Falling Sickness. It was Hippocrates (c.460 - 375 BC) who first suggested that the condition had a neurological origin, but it wasn't until the 18th century onwards that this view gained widespread credence. Notable sufferers from epilepsy are said to have included Julius Caesar and the poet, Lord Byron.
What causes it?
The cause of seizures is not always clear. There may be some inherited factors, but seizures can also occur without these and traumatic brain injury can also be a factor.
The brain, which has millions of nerve cells that control everything that we do, uses electrical signals to send messages between these nerve cells. Seizures can occur when bursts of this electrical activity temporarily affect how the brain functions. These seizures can originate in different parts of the brain and can vary in severity. The frequency of seizures can also vary, with people experiencing as few as a couple of seizures a year to several in one day, making diagnosis and treatment more difficult.
Seizures can affect different parts of the brain and therefore have different symptoms. These include losing awareness of what's around you and staring fixedly into space, unusual tastes and smells, jerking and shaking symptoms, as well as collapsing with or without loss of consciousness. On recovering from a seizure, an individual may have no memory of what has happened. They can also occur while a person is asleep. There are many different types of seizures including:
Simple Partial Seizure
Sometimes described as an aura, this can be a feeling of apprehension, a sense that the same event has happened before (déjà vu), tingling sensations in the arms and legs or a stiffness or twitching of an arm or a hand. The person will normally remain awake and aware, but this type of seizure may be a precursor to another type of seizure and they are sometimes known as warnings or auras because they are often a sign that another type of seizure is about to happen.
Complex partial (focal) seizures
In this type of seizure, the person may lose their sense of awareness and start to make random body movements, such as rubbing hands or fiddling with clothes or other objects. During such a seizure, they will not be able to respond to another person and will not remember the episode.
This is the type of seizure that many people associate with epilepsy and is sometimes also known as a grand mal fit. As the name suggests, tonic-clonic, has two stages. In the tonic stage the person will lose consciousness and the body will go stiff and collapse. This is followed by the clonic stage where there will be jerking of the limbs, biting of the tongue and possible loss of bowel/bladder control. It usually lasts a few minutes and is followed by a headache and feelings of confusion. You can also have separate tonic or clonic seizures.
This type of seizure is sometimes known as a petit mal fit. As the name suggests, the person becomes absent and loses awareness of their surroundings for a short amount of time, as if they were daydreaming. These seizures are generally very short in duration but may occur several times a day. They mainly affect children, although can occur at any age.
In a myoclonic seizure, the body twitches or jerks as though having had a sudden electric shock. They last a second or so and often occur on waking up.
This type of seizure is quite different, and instead of the jerky, random movements seen in other types, atonic seizures cause all the muscles to relax, leading a person to collapse. Normally they are very short in duration with a quick recovery.
This is the most serious type of seizure. It can theoretically occur in any type of seizure but its defining characteristic is that it lasts a long time or takes the form of a number of seizures without regaining consciousness in between. These seizures are a medical emergency requiring urgent treatment.
Diagnosis and treatment
An epileptic seizure can mimic the appearance of other conditions such as a migraine or fainting. More than one seizure is required to make a diagnosis and the doctor will need to know when a seizure happened, what they were doing at the time and how they felt before, during and after the seizure. If there were any witnesses, their recollection would also be important. If further investigation is required, this may take the form of an electroencephalogram (EEG) which looks for unusual electrical activity in the brain. An MRI scan of the brain might also be used to look for any other causes, such as a brain tumour.
Treatment will take the form of anti-epileptic drugs (AEDs), such as lamotrigine or sodium valproate. In some cases surgery (drug resistant epilepsy requiring surgery is a covered condition in the more comprehensive serious illness policies) may be an option, as well as a special diet and lifestyle advice to avoid certain triggers such as stress, alcohol and drug interactions. The elimination of triggers may help to reduce the chances of further symptoms, but any treatment is likely to be lifelong.
In assessing the risk, the underwriter will look to determine what impact epilepsy is having on the applicant's life. The types of seizure, frequency and duration will be the most important factors along with any underlying cause. Income protection and disability benefits will be the biggest challenge owing to the ability of the individual to continue working. Uninvestigated seizures are likely to result in a postponement of cover, particularly if they are fairly recent. Infrequent, absence type seizures may be accepted at standard rates for life cover with ratings increasing with frequency. Other types of seizure may be accepted at mild to moderate ratings. An applicant with frequent status epilepticus seizures however, is likely to be declined.
John Downes is underwriting & claims director for VitalityLife
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