How Epilepsy Works

his mouth helps for sure. So Chuck, today we were talking about epilepsy and this has been a long time request. We've gotten requests for this one over the years. Yeah, plenty of times. And uh, I don't know why it took us so long to do it, but I'm glad we finally did because it's something I didn't know about. I think it's one of those things like you're aware of epilepsy and seizures and seizure disorders, but there's almost like this um cartoonishly narrow version of like what epilepsy is.

It's just a movie version, yes, exactly, um, which actually is kind of accurate. Depending on the type of epilepsy or the type of seizure you're having. But um, there's it's such a broad spectrum of really just kind of as a physiological brain disorder that can happen in so many different ways that I had no idea. Yeah, the the movie while it's sort of like, uh, the every square is a rectangle type of thing. Like, movies only

display seizures in one way, the Natalie Portman way. Yeah, the kind where you're like, you're on your back, convulsive, wildly frothing at the mouth. There's some jerk nearby with a wooden spoon. That's you don't want to do that. We should go ahead and say that, maybe more than once. Do not stick a spoon or your wallet, or a credit card anything else in somebody's mouth. He keeps them from swallowing their tongue. Now, you can't swallow your tongue, no,

because it's attached. I tried, Look, yeah, you all right, stop it's not working. I was just grabbing a wooden spoon. You do that, keep that thing away from me. Yeah, but movies display them as one kind, and that those definitely exist. But it's far more nuanced than that. Leave it to movies to get rid of nuance, you know. But really isn't that the audience is fault. Isn't it up to the audience whether there's nuance or not. Well, what like during a seizure scene, next time, we should

all just stand up and shout this isn't real. I think they would get the picture. All filmmakers would get the picture. How about some nuance? Well, and also, movies are all about drama, and a lot of seizures are not very dramatic. No, it's almost like in certain types of seizures, somebody like it just kind of zones out for a second and then comes back back and says, so what were we just started saying that that constitutes

the seizure? Ak chuck, on any given evening. Sure, there's probably a big difference of what's going on in the brain of somebody who's actually enduring a seizure. Right then then you're zoning out, But to the observer it would look very similar. All right, that's a nice intro. Let's

talk a little history first, can't we? Yeah, okay, well I will say this, um, ancient medicine has always been nutty as a fruitcake, but especially when it comes to seizures, from how they're diagnosed and what people think is going on to the various treatments. It is wacky. Yeah, people

with epilepsy have been stigmatized for ever since there was civilization. Basically, the Code of Hammurabi, the first set of laws from Mesopotamia four thousand years ago, contains a law that says, if you have epilepsy, they didn't call it that, but they were talking about people with epilepsy, you can't get married. Yeah, they called it like the devil shakes or something basically, and the idea was that there were that you were infected with some sort of demon or the devil or

something like that. And what's interesting is that by the time Hippocrates came around, he was like, no, no, no no, you guys have it all wrong. This is just some sort of disorder in the brain. You can probably treat with diet and exercise and that kind of stuff, which is actually pretty good advice for somebody who was driving this years ago. And then somehow they got lost and there everybody was like, no, no, it's demons, unclean spirits all that, and it went back to being a very

stigmatized disease. Yeah, it was. It was an unexplainable thing, and I think back then. Um, now we try to poke around and learn like the real reasons behind something, even if it still remains unexplainable at the end. But back then they would just say they're possessed or they're

a witch, right that which thing? It was in the Maletheus Maleficarum, the witch the witch Finder's handbook, it was basically in there, and either if you had epilepsy, you were a witch or you were possessed by a demon or in some cases you could be possessed by like an angel or something like that. Um, but more often than not, it was like a negative thing, like a negative spirit had possessed you, or you were under the

influence of a witch. So somebody in your village could be accused of witchcraft if you had epilepsy because they were like this, which over here is giving this guy epilepsy. Berner, that was a thing. So epilepsy has always been tied to that and that law about people with epilepsy not being able to marry. There were laws on the books in the United States up until nine that said people

with epilepsy can't get married, can't get married. Yeah, but I'm sure those were those like laws that aren't enforced, right, or were they literally enforcing those laws? I don't know that part. I'm sure they were back in like the twenties and thirties during the eugenics movement, right, I don't know that they were up until that sounds like one of those laws where like you can't spit on the street after sundown, you can't put lipstick on a horse. Oh,

you can can't spit on the um. And then you know, ancient treatments are exactly what you would think, like everything from drinking blood to killing a dog and drinking it's bile. Uh, if someone's having a seizure near you p in your shoe and give it to them to drink, like it's a jellyfish sting. Yeah, but in the shoe. I I don't know, Like what is that just because they know that that you have something that holds urine? That would

be my guess. Okay, I didn't know if that was like, oh, no, a p into like cupped hands, you're cupped hands and then just kind of like just drop it onto their mouth. God regardless. That's another thing. Don't put a wallet or a spoon or a credit card in somebody's mouth. Don't put your urine in somebody who's having a seizure's mouth. Doesn't help. Um. I also saw that it wasn't until the eighteenth century that people finally were like, I don't

think this is actually infectious. One of the reasons why people with epilepsy were so shunned, just shunned and stigmatized and just kept on the outskirts or the yeah, the outskirts of society because people thought epilepsy was contagious and you can catch it from the breath of someone with epilepsy. So like people with epilepsy have been treated horribly for all the time basically, so hopefully we can kind of

dispel any of the last myths around it. That's my hope with this episode, Chuck, Let's see if we can do it. Okay, Well, we like to start off every episode by stating our hopes and dreams. You know. Uh so,

what's going on in the brain. We'll get to that a little bit more in detail, but kind of the way this article in our on our own website puts it, which this was so like ten years ago writing wise, but they basically talk about a kind of traffic jam in your brain when there's confusion when there's too much, too many neurons firing at once, and uh, it can cause an overwhelming sensation that can eventually cause a seizure. Yeah.

It's like, um, I've seen it compared to like electrical storms. Yeah, where basically it's a a sudden overload, an electrical overload in your brain and your brains just like I'm just shutting down here for a second and then it resets itself. Your brain sounds like pop Newark? Yeah, mind does mine? Uh?

Mind us? Um? And you said from from a bunch of neurons firing at once, Yeah, not just a bunch of neurons, but those neurons that are firing fire a lot more than usual too, something like so they fire eighty times a second normally, where during a seizure they're going to fire like five times a second. Yeah. And you know, we'll talk about the brain machines later. But one thing that's characteristic of UH seizures is when they look at your brain scan, they're big peaks and valleys.

It's not a steady stream of do do do do? Just make that noise? Who knew he was going to show up? That's great uh, but let's talk about some of the types of seizures. UM. There are a couple of broader categories, focal seizures or generalized seizures. Focal seizures are just in one part of the brain, were generalized and I think about six people with epilepsy have the focal kind and generalized are on both sides of the brain. Yeah,

like your whole brain is under attack. Whereas yeah, the focal seizures, it could just be from like a lesion in its specific part, or there's something that's hypersensitive that's just just one tiny region of your brain, but it's enough to do some wacky stuff to you. And within those groups, there are further subgroups, for instance, a simple focal seizure or a complex focal seizure, or the two

types of focal seizures. So as simple focal seizure is UM, you're you just kind of have like a weird feeling like you're conscious the whole time, yes, yeh. And it's also sometimes called an aura and an aura itself. It can just be a stand alone seizure, but it's kind of like seizure light L I T E. Right. Um. But that same simple focal seizure can also be the beginning of a larger complex focal seizure larger seizure of either type, where um, it's just the ora, it's just

the beginning symptoms of it. So it can be stand alone or it can lead to a larger um seizure. Yeah, and we'll we'll get in you send a really cool thing. We'll get into in a second about like exactly what a seizure is like. But quickly a complex vocal seizure the other type of focal seizure, UM, you do lose consciousness. Um. And if you are around someone that has one of these, uh, you might see it's a little bit more like what you would think of as a movie seizure. Yeah, life

of a better term. It can be like twitching, blinking, Maybe someone's just sort of, um, seems dazed and sort of walking around. Well that's the thing that got me, Like when I think of, well they lost consciousness, it means they fainted or whatever. That's not necessarily what that means when you're having a seizure, Like, lose consciousness means like you you're not there, you blacked out, you're gone, You're not you're not your awareness is no longer functioning

in the here and now. But people standing around you, they might see you just kind of walking slowly around in a circle or something like that, or sitting upright and just kind of with a blank look on your face or something like. It's not the traditional just falling over, fainting away loss of consciousness. That was that was new info to me. Yeah, and this aora you were talking about,

it's really interesting that UM. Other document you sent was, I had no idea that you if you're a person with epilepsy, you can sometimes and it's it's different for everyone, but sometimes you can sense these seizures coming on days ahead of time. Yeah, that's I've never heard of that. Yeah. I think when you when you get when you start having seizures, if you UM are an actual like if you actually have epilepsy UM, you will start to notice

patterns stereotypic. It means like it's typically follows the same patterns, the same sensations, and an aura can be anything from seeing blinking lights to hearing a humming sound to suddenly inexplicably experiencing panic or joy, or all number of things. But basically, your brain is suddenly doing something. It's suddenly getting a jolt of electricity that's actually not being stimulated

from anything outside. You're not actually seeing bright lights, but your brain is showing you bright lights because that impulse is actually starting from the inside rather than coming from the outside in. That could be an oora. It could also be a weird taste. Yeah. I think a lot of times too, it's um People that experience the aura have a hard time describing it in a way that

people that have never experienced the aura can understand. That's sort of one of the hallmarks of it is, you know, people like us end up stammering out you know, a bunch of things that we can relate to. But I think if you have had this sensation, it's sort of one of those things like you've got to kind of

have it to really understand what it feels like. And and the reason why is because you're probably different parts of your brain that don't normally co function are functioning together, and the information you're getting is being merged together into it just a totally novel experience that no human has ever had before. Yeah, which is pretty awesome if you think about it in that way. Yeah, so pre seizure, um,

a lot of different things can be happening. You can smell things, you can hear things, you could taste things. You might get blurry vision or like you might have a visual loss briefly or momentarily. Um, like you said, it might be a very pleasant feeling. It can be. I hope. I just wish it was like that for everybody. Sure, I wish everybody who had epilepsy just had nothing but

pleasant brain attacks. Yeah, I totally agree. Uh So that's at the onset um sort of pre seizure activity, when you start to recognize these symptoms, and that's when you might tell, you know, your friend or loved one or whoever you're with, like, hey, I may have a seizure here soon or maybe hours from now. Yeah. Um. And I think this is from the Epilepsy Foundation, is called what happens during a seizure Really interesting. Yeah, But they

say like every seizure has three stages to it. It's just some are really hard to discern, Some appear to just be the first, some have like clearly all three. Um. But that beginning thing can technically stand alone, and aura can be its own, like seizure light like I was saying, but more often than not, it will lead into the middle part of the um the seizure, which is called the ictic stage of the seizure. Yes, and that's from the first time symptoms and the aura accounts as a

symptom like, that's officially part of the seizure. Uh, to the to the end of seizure activity activities at middle section. Yeah, and the middle section is what you usually think of as a seizure like that. It can be the classic movie seizure where you can be um, you can convulse, you can um your your your muscles might tighten suddenly um, and you might go rigid. You might actually lose muscle uma.

And either way what those will result in it is called a drop attack where you are standing up and all of a sudden you tense up and fall over like remember the fainting goats. Yeah, my clients, I knew I knew that word from something my clonic goats and then um or you can just lose muscle tone and fall over. But either way it can be really bad news for you because you can hit your head and um, you can cut yourself. It's it's not good to fall

over with zero control over your body. No. And then um, the final phase is post seizure, and that is that can be really rough. Um, and it can take hours or days to kind of fully feel like yourself again. Um. And if someone and we'll talk about what to do during a seizure, of course, Um, if you are around someone that's having one, don't put your wallet in their mouth. But post seizure is very important too, because you need to be there and be very comforting and um, just

sort of take things slow in general. So um, that's called the post ictic phase. And that can actually last a lot longer than either of the other two phases of a seizure. It can last twenty minutes, thirty minutes, an hour, who knows. Yeah, you could be sleepy or scared or anxious, have memory loss, uh, difficulty talking. It's basically what it sounds like is is your brain and your body has just undergone a traumatic experience and it's

just rough. Yeah, and it had to reset itself and it was a hard reset and now you're paying the prices price of it. Yeah. And that's not to even mention um, some of the physical things. That is one of the real dangers of having a seizure as if you know, you fall on a glass coffee table or you know, all the supplementary physical uh injuries that can occur.

One of the things that stuck out to me from this UM Epilepsy Foundation article was that one of the signs and symptoms of the posteictic phase is um that the person may be frustrated, embarrassed, or ashamed. Man, that is so sad. Um, that's just so sad, you know, And I think it comes up later on too. And this article from how Stuff Works about like the challenges of living with epileps and you know, one of them, I'm sure is just feeling stigmatized. Sure, people, Yeah, you

want to take a break. Yeah, we'll take a break and we'll pick up with the different types of generalized seizures right after this. If you want to know, then you're in luck. Just listen to Chuck self fusire. Alright, So generalized seizures. Remember we broke it down into the two broad category raised focal generalized. There are many kinds of generalized seizures. UM. The words you won't hear anymore from a doctor are petite mall and grand mall. Seizures.

Those are outdated terms, but um, what they are now referred to as is formally petite mall seizures are now known as absence seizures uh and grand Mall are now known as tonic clonic seizures. And and yes they are outdated, but they still kind of highlight the early contributions of some of the first French neurologists in the late eighteenth century Dr Grandmall, who Stanley grand Mall. French neurologists. Um, they helped pull this out of the realm of superstition.

And you know you can catch it from like someone with epilepsy breathing on you. So hats off to the early French neurologists for at least studying and identifying it. But that's why, that's why there are French terms that were applied to it previously. Just stuff to your work, pie hat I did actually a little chorus line thing like you can't see un at the table of my foot's kicking too. Uh So one of the uh like I like I said, the absent seizure formally petite mas seizure.

This is usually in children, and I think overall, I don't know if you mentioned that children and people over seventy five are most likely to have epilepsy, which is interesting, and you can grow out of it depending on the type of epilepsy, and I think you can even grow back into it in your older age. Yeah, if you're seventy five or older, you're at high you're at the highest risk developing epilepsy. So the absent seizures um, like I said, are mostly in children. Um, that's just like

where they zoned out, all yeah, exactly. You might see some eyelid fluttering or something like that, or a twitch or two, and it might just be a few seconds long and then it's over. Very hard to spot what was just going on. Were you thinking about Barney or were you having You're just tired like it, it's tough to spot. I think clonic seizures you will have convulsions and jerking movements on both sides of your body. Myoclonic like we talked about with the Goats, and it's funny.

I just was going through the archive today and I saw her that was one of the best titles we've ever had, that dangle Goat fell Over on a Fainting Goat. I think that was one of yours. Maybe, I'm pretty sure. But myoclonic seizures, uh, the upper body is mainly involved, and it might look like someone has been shocked, like a jerking of the upper body. The tonic seizures is when you stiffen up, like you were talking about. Yeah, we just suddenly your muscles go fully tense and you

just can't control them anymore. A tonic is the other one that you were talking about, when you lose muscle control. Yeah. And then there's the big daddy. This is the movie seizure, the tonic clonic seizure. Yes, just the name of it sounds menacing, you know, the tonic clonic. It sounds like, uh, Star Wars character from the dark Side or something chronic. The Fallen. Yeah, Grandmaal does too well. I think because of the dark Mall thing and grand mof Darken. It's

a combination. Okay. I don't know who that last guy is grand mof Darken. Yeah, which one is that? All right? We should just move past this. No, No, I need to know, especially if it's somebody from like the original three. I think grand mof Tarkin was the guy. Wasn't that Peter Cushing? Yeah? Okay, the digitally Peter Cushing instead of

fran Tarkington. What are you talking about? So the tonic chronic movie style seizure is that that's the one that you've probably seen on TV and films and after school specialist. Is when the body stiffens, you sort of pass out on the floor and your body is convulsive and jerking on the ground. You're like eyes roll back in your head. Yeah,

that kind of thing. I couldn't tell if it kind of alternates back between the two, or if it follows that discernible pattern where it goes tonic like your muscles tents you fall over, followed by chronic so you're convulsive after that, or if you kind of bounce back and forth, which would be pretty awful too. Yeah. Um, but that's yeah, that's the like you said, the movie, that's the movie seizure that use. I've never it just occurred to me. I've never seen someone have a seizure that that I

could recognize. I'm not either, Yeah you just knocked would I did? Is that someone trying to come into this is like particle board? But I think it's still that counts um seizure is generally are pretty brief a few seconds, maybe a few minutes at the most, uh in most cases. But they, like we said, they take a lot out of your brain and body. Yeah, it's rough stuff. Here's the thing. It's like, so tens your tents all, like

all the muscles in your body for a second. I don't even know how to do that, So it's it's like just doing it for a second. Sure, I'm like, oh man, I'm sure already I'm tired. Imagine doing that for like three minutes and like really like every muscle in your body's tense, or imagine like convulsive for a couple of minutes. Like heck, yeah, you're going to be

physically tired. It's a violent reaction, it is. But also the normal processes of your body have just been totally thrown out of whack and now they have to get back into whack. And one of your body's like main things for telling you something's wrong is to feel nauseated. So you're going to probably feel nauseated. You're going to feel um, maybe perturbed. You're not gonna feel very good,

and it's going to last a while. Sometimes people will sleep and maybe they'll sleep for a minute, maybe they'll sleep for an hour. There's a lot of different things that can happen in that post actal state. Um, but the the thing you want to look out for. So we've never seen anybody have a seizure before, but there if you do see someone who is having a seizure, there are some very specific things that you should do

and not to. One of the things you should not do take your dirty wallet in their mouth, card or a spoon. What are you carrying a spoon around with you for anyway, If it's to save somebody from swallowing their tongue, leave it at home because you don't need it anymore. Yeah. The main thing you want to do is make sure that they will not further injure themselves. Like if you're in an apartment and they're on the couch, you may want to like move the coffee table out

away from the couch or something like that. Um, turn them on their side if they have gone to the ground, so they won't choke. That is a real thing, But the tongue has nothing to do with it. It's I think something like that. Yeah, sure, uh, and just sort of try and ensure their safety, like don't try and hold them down. Don't try and get them to stop what they're doing, Like you can't. I'm gonna lay on until the demons get out. Yeah, it's not a good idea.

So basically, just try and make things as safe as possible, Like if they're around them, if their clothing is right, yeah, keep sharp stuff away from uh. And yeah, if they're sitting up or standing up or whatever, yet try to get them on to the lowest point as comfortably. Um, if their clothes are like bunching up around their neck, like, try to loosen the clothing. Uh. Yeah, make it safe and comfortable for them. Yeah, don't don't be like all right, well I'm gonna go get my eyes checked or go

or go call the police or not the police. But on one right, that was a really surprising thing that that um, this article said was don't leave, just hang out with them. That is more important than calling nine one one. There is a point where you should call nine on one though. There's a type of seizure or there's a mode that seizures can go into called um status epilectus, which is like a really bad situation. That's

when it continues debated keep minutes. It used to be I think twenty or thirty minutes, and then they said that's way too long. If someone has is having a seizure of any type UM for five minutes or longer, you want to call nine on one because what you're seeing is a medical emergency on Under almost every single case of a seizure, the brain can kind of reset itself um and come out of the seizure within a

five minute period. If it doesn't, it strongly suggests that it's not going to happen, and they may actually have to medically induce a coma to just stop the electrical activity in the brain and let it reset itself. So you've got a bona fide medical emergency on your hands. Or the other way it can happen is they can be having a seizure and then have another seizure and

not regain consciousness in between. That actually qualifies as a status epilectus seizure as well, and you want to call nine and one for those, or if uh, if it's a pregnant woman, then you want to call nine one one because there can you know, be further complications there, Yeah, for sure. Alright, So it looks like there's six different types of epilepsy. If I'm reading this right, we'll say

at least six, starting with benign rolandic epilepsy. This is the one that you would have in childhood and that you would probably outgrow, Hence the benign thing. Yeah, it's just kind of like, yeah, I don't any more about it. It's just a phase the kids going through, you know. Uh. Juvenile myoclonic epilepsy is actually one you wouldn't have it in early childhood, but it actually would come on around the same time as puberty. As if puberty is not

tough enough now with caesures. Yeah, I mean I feel so bad for for for anyone that has this condition, but especially like if it comes on at puberty, you don't know what's going on. Well. Plus also it's like the severe type of siege. There's tonic clonic seizures usually characterize it or myoclonic, and you don't you don't outgrow it. He comes on in childhood, but yet you got you have it for life. Lenox guest syndrome. I feel like

I've heard of this one before. I had not. This one's very severe and there are many kinds of caesars that you can have and uh I believe this one sticks around for life too. It doesn't. It's uh usually it comes after it's become a parent. That they're cognitive impairments. Um. It can there can be delayed motor skill development. Um. It's it's kind of like co morbid with um like

a type of cognitive impairment as well. But it's it's characterized by drop attacks to where you can really injure yourself because you just fall over because there's um an impairment in the muscle or the motor cortex. Look at you, I got it eventually. Reef epilepsy is the one that you might if you have ever like gotten a strobe light warning or heard of that Pokemon thing, which that legend is actually true. Yeah, I mean this this is

one that is triggered by something in the environment. Um. In fact, remember I told you I went to that David or was going to that David Byrne concert. We got a ticket holder's got emails the day before the show that said, you know, trigger warning, we use strobe lights in this show. So I think they for stuff like this that kind of are sending that stuff out now to them? Yeah, yeah, because I mean you can

have a seizure, even if you don't have epilepsy. You can have a seizure brought on by flashing lights and they're fast enough that just basically get your brain going and and it's off. Uh, not a seizure, but an intense strobe light situation. I think makes everyone feel a little off. It makes me dance. Where are the bubbles? Give me my glowstick? Uh temporal wait, hold on, let me give you one more about it. So, the reflects epilepsy, it doesn't have to just be from like flickering lights,

like the strobe lights can be touched there they like different. Basically, where you have reflects epilepsy, there's a part of your brain that receives sensory stimuli that is hyper sensitive. So whether it's your eyes, whether it's your ears, whether it's your skin, and it'll be like a very small region on your skin and it can be activated by tapping, scratching, rubbing, and toothbrushing. Interesting, which if you think about it, that is interesting. But also if you are going to trigger

a seizure from brushing your own teeth, that would suck. Yeah, you know, I bet there are some ways around that. Oh, surely there are, Like an electric toothbrush might have a different or something. I hope. So, although I've bet an electric toothbrushure would set it off more than anything. I

guess it depends. I don't know. Uh. Temporal low epilepsy the most common kinds of seizure here complex vocal, although there are other you know, seizures that can occur to And this is the one where I think it's like, well, it takes place in the in the temporal lobe, which controls emotion and memory. But I think these are the ones that are can be really interesting and hard to

describe by someone that's had one. Yeah, Like you'll have a bunch of memories come back all of a sudden at once, which, um, that's another thing another common device you'll see in movies, not necessarily with seizures, but when somebody's like like their brains being taken over or something like that. Um, the like just a bunch of different like visualizations will flash or whatever their life. Yeah, I

think that that's basically what happens with temporal lobe epilepsy. Interesting, yeah, or you can also have just be overwhelmed by a bunch of weird emotions good, bad, neutral that are not being brought on by anything but the seizure. Yeah. I at that David Burn show, I had a moment where I was so overwhelmed with the sound, the lights, the the emotion of the moment in the art that I felt like I was on ecstasy at one point. What song was it? That specific moment was during Once in

a Lifetime? So that was coming together with nostalgia to just like suck me in the face, But you know it was it had to do with other things as well. So I mean, while again did not have a seizure, I have no idea what that's like. It's interesting to feel the brain sort of get rocked a little bit to where you can feel it, but with positive feelings. Sure. See, that's what epilepsy should be. It should be like at ecstasy in your brain. Yeah uh. And then frontal lobe epilepsy.

It's the final kind, and this is the one where you're more likely to have like your body herking and jerking really stiff on one side. Right, Yeah, so you got me with the hurricane and Jerky always reminds me of the Mr. Show Herky Jerky Dancer. Um, should we take a break. I think so Mr Show made an appearance. So yeah, all right, we'll be right back. If you want to know then you're in luck. Just listen to Chuck.

One of the things I saw, I want to say that's not really apropos of what we're going to talk about next, but when um, someone is having a seizure, during the middle seizure part, they may um start start doing like involuntary movements, like everything from lip smacking to like playing at their buttons to actually undressing and dressing.

I thought that was really interesting. Yeah, that is interesting, especially when you remember Alien Hands syndrome, and that was the corpus closum, and I mean parts of the corpus closum are involved sometimes with the epilepsy too. One of the other things epilepsy bears a strong resemblance to, especially in the fact that it has an aura and an actual middle phase and then a recovery phase are migraines.

Oh yeah, very much related to migraines. And actually you can get migraines as a symptom of the recovery phase of the post eichtal phase, right, which that would really suck to have a huge seizure and then come out of it and have a migraine. Yes, that would not be good. It would not. Uh. The causes of epilepsy are It sort of depends. Sometimes you can have a brain injury. Sometimes, like if you get hit in the head. Sometimes you can have a tumor that's putting pressure on

the brain. Um. If you can determine the cause as a doctor, then it's called symptomatic epilepsy. If you're not quite sure what's going on, that's a head scratcher, yeah, or idiopathic epilepsy. It's so funny they have a name for it rather than I don't know sure. I mean, I guess that makes sense, but I don't know is really what that means. And then there's even another category, cryptogenic epilepsy. And that's when the doctor is like, well, I kind of have some information, but I'm not quite

sure if it's symptomatic or idiopathic. It's really specific, it is, unless it's idiopathic, then it's totally non specific. That's right. So UM. I found this really interesting the way that um epilepsy is diagnosed, because just because you have one seizure doesn't mean you have epilepsy. Yeah, if you have a seizure, you want to go to the doctor to find out if actually, no, you actually do have epilepsy. But there's a number of ways you can get You

can have a seizure. You if you're a infin or a kid and your temperature gets to a hundred point four degrees fahrenheit or higher I think thirty eight degrees celsius. That's called a febra febrile seizure feverish seizure. Doesn't mean you have epilepsy. You may never have another seizure. Again, Supposedly, if you are withdrawing from alcohol or some types of drugs, you can suffer seizures. But I saw another research of the literature that said this is not true. It's just

a legend. But like a medical legend um Supposedly, hypoglycemia, abnormal heart rhythm, panic attacks, all of those can bring on seizures or mimic seizures. And then there's something called a pseudo seizure, which to anybody's witnessing it would be like, that's a seizure, that person must have epilepsy. But if you had that person um undergoing an electro and cephalogram at the time a brain scan, you would see that their brain waves were not doing somebody who has epilepsy's

brain would be doing. And that's actually brought on by psychological distress, yeah, or like past abuse in your life or something like that, which is bad enough. Yeah, I mean that's yeah. Yeah. So you mentioned the e G. The electro cephalograph um. At this point, if if you're being hooked up to one of those machines, you've probably already gone to the doctor had some blood tests done. Um. It's interesting that, like the doctor, it's sort of like

bringing your car in. You're like, well it's not making that noise now, and the mechanics like, well, I don't know what to do then, right. Normally mechanics like, well, just let me take your car home for a week, right, And you gotta let them the same thing with your doctor. You have to move into your doctor's house until you have a seizure in front of That's not true, but they can and will try and induce the seizure sometimes

so they can really see what's going on. It's not so during an e G. They will try and to do the seizure. They may put the strobe light in front of your face. It'll take you to a David Burn show exactly WHI should be a great way to get treated, or they'll tell you to come in um and not having slept. Yeah, fatigue is one thing, lack

of sleep that can bring them on its trigger. Yeah, so they will try and induce the seizure A lot of times after an e G. They will go hole hog with a CT SCAN or an m R I. And what is that funny? I just imagine you having to ride a hog while you have the e G thing on your head. Uh, C T or an m R I. Um. Have you ever been to one of those parties where they have the whole hog cooked just like layd there looking like a hog? Yes, and I shouldn't go in any more detail because they're vegetarian and

vegan listeners would not be happy. But yes, I have all right, I have not it's something else. I bet. I can't imagine just sticking a fork in something that looks like an animal. Yeah, it says stick a fork in me. I'm done, all right, Yeah, we'll just move on. Uh. Yes, the C T R, m R I. UM. What they what they're trying to do there is just get an inside peak at exactly what's going on in the brain.

Like you were talking about. There could be a legion or something that they don't see and this will this will show all. Yeah. So again you come in, they say, so you head a seizure. Huh. Put this calander on your head and look into this light while I start flashing it and make sure you haven't slept in a day, and they try to trigger a seizure. And then they look at the e G. Read out of what your brain is doing when they say, yeah, this is an

epileptic seizure. This isn't just you know, uh, some other type of seizure. This is like epilepsy. And then yeah, they'll put you through the Wonder machine or something like that and look for lesions, weird um, oxygen concentrations, whatever to try to pinpoint where the problems coming from, because again it can just be one specific region of your brain, or it could be a generalized type of seizure in

your whole brain. And then based on these clues, they start deducing what type of epilepsy you might have, right uh, and then what you can do about it. Um, obviously you're not gonna eat a pigeon these days or drink dog bile. But um well you could eat pigeon, don't drink the dog bile. No. Uh. There is medication that you can take, but from what I read, it's it can be pretty rough on you and a lot of

bad side effects. So what you try to do, I think with a lot of like with a lot of hardcore medications like this, is find that balance of what do I need to try and control these seizures and still kind of be able to operate and have a

good quality of life. Yeah, And I think a lot like um if you've been diagnosed as say like bipolar or depressive disorder something like that, where there's a lot of different medications out there that do different things and you're probably going to have to try a different combination until you find the one that works best for you. Um as as this article put it, to balance quality of life and control of your seizures, that's what you're

looking for in a medication or combination of medications. Same thing with with epilepsy. Yeah, I mean you may not uh want the full dose and you may just want to limit your seizures and have an acceptable amount of seizures because the medication is so rough on you. Sure, yeah, that's the worst part. And they've actually come up with a device called the vegas nerves stimulator. Remember the vegas nerve, I don't remember it. Was it a female orgasm episode

that it played such a role in. I think we've it's a couple of them. We said God was either a woman or clearly favors women, because women's orgasms are triggered by vagus nerves and even if you become paralyzed, the vegas nervous still intact. That's right, only for women. Well, there's a device that's basically like a pacemaker for your brain, is what they call it. And it stimulates that vegas nerve and it just sends a little like t called pulse on like a regular um rhythm to your brain.

And they're like, this really works. It doesn't necessarily get rid of all of your seizures, but it brings the frequency of them down so much that you could just get by with a low dosage of medication. But they have no idea how it works. They think maybe it keeps the brain juiced on a normal basis. It's almost like a pacemaker. It is that. Well, like I said,

they call it the pacemaker. Okay, I said that. And then there's the well, I mean it sounds it sounds crazy, but if it is isolated in one part of your brain, they can actually go in and just remove that part of your brain in many cases and solve the problem. And no, not only no side effects. And they're not taking a stab in the dark, like they know what parts of the brain they can remove. They're not like,

well let's try this um. But sometimes you actually show intellectual improvements after the surgery, like when they remove the cryan from Homer's brain, remember that one. That was one of the best ones ever. There's also a corpus coloss to me, yeah, I'm saying it right, which is so remember you know there's a type of generalized seizures or the whole brain seizures. Well, the corpus colossum is the white matter that connects the two hemispheres of the brain.

So they just go in there and go and no more generalized brain seizures. Right. The thing is is there. I'm very curious what the side effects are of that. Because we developed a corpus colossum over time and there's this really interesting thing. We got to do this someday on a guy named Julian Jane came up with the bicameral mind, and he had this theory that before we had a corpus colossum and the two hemispheres talked to one another. That was back when we used to think

the gods were talking to us. One part of our brain was talking to us, and it seemed like it was coming from outside of our brain, like the angel and the devil on your shoulder, basedically or literally the gods having like a role in your daily life and guiding you through life. It was actually one side of your brain, but since it wasn't connected to the other side, it didn't seem like it was for coming from you. And so to cut the corpus colossom, I wonder if

it would have similar effects like that. Yeah, and I think that also was um for alien hand syndrome. The corpus clossum had a lot to do with it because one side like a malfunction of it because one side isn't talking to the other. Interesting um. There was also some types of epilepsy called intractable epilepsy where and this is like this is really high of people who have epilepsy,

have intractable epilepsy, Like it's not going away. Yeah, and it's really tough to control even when you're being treated, and you can actually die too. Um, I get the feelings. Is pretty rare, but sudden, unexplained death in epilepsy or

sued up is something that can happen. Yeah, they they again, they don't know how it works, but they think that maybe it has to do with a regular heartbeat that can result a regular breathing, or that someone gets trapped face down in something like betting and suffocated during a seizure, because a lot of seizures, a lot of types of seizures, especially tonic ones. It's the tonic that, um, yeah, that you're hap them while you're sleeping, and if you're sleeping

on your stomach, you could conceivably choke or suffocate. They think maybe that has something to do with it, but they're just not sure. I saw an obituary the other day for someone that died in their sleep, and that really struck me for the first time. Is like, that's a really nice way to say someone died in bed. Like, I don't think it ever happens where someone's just asleep and doesn't wake up right, Like, I think you're just

asleep in bed. You wake up and you're like, I'm dying, and then you die, and it's just it's like a really nice way to say they died in their sleep. We've talked about that before, about somebody, can you really die while you're asleep and I'm dying? We were talking about someone who woke up to die in pain. I think that's probably how it always rather than just dying in their sleep. No, I think people might pass real sleep.

I think you could. That's sweet, especially if you're on the dope, like they got you doped up, like in hospice or something like that. You can very easily just die in your sleep while you're kind of out of it. But I don't know. I hope you're wrong. Yeah, me too. Um, living with epilepsy, Uh, you know, it can be very tough. It's you have to think about everything from driving to going swimming, by yourself, raising an infant, if you're a

woman or a man or a man. Yeah, but yeah, this one, this one, Um specifically said, like, epilepsy can can be a challenge to I mean you know, when they're deciding whether to have kids or not, you know, they that's just I hadn't even thought about that. But you can't have a seizure while you're breastfeeding or something. What happens after that? Yeah? Or I mean if you're just a the lone caregiver to a child at home, uh, to a eighteen month old, and all of a sudden

you need treatment yourself. Yeah, that's a scary thing. All the all the states and the United States have different rules as far as driving. Uh, Like you know, sometimes it's you can't have had a seizure for the past twelve months or something. Yeah. You mediated a guy who had a couple of teachers and like he like had he lost his license because of it. Yeah, like think I think it was twelve months in Virginia or something.

Uh what else? Um, yeah, I think that's it. Oh well, I did look up celebrities with epilepsy, of course, because that's all anyone cares about, right, Prince know that um Adam Horovitz. I didn't know that from the BC Boys, Mr Danny Glover, I didn't know that Little Wayne, Big Wayne? Uh? Is there a medium? Wayne? And the Rock? No little Wayne uh Neil Young really the great Harriet Tubman, I

think we knew that. And then uh the NFL former NFL twins Tik and Ronde Barber, and there were twins who both had it, So that's oh yeah, they think there might be a genetic basis to it. Yeah, I don't think we even mentioned that. They've identified something like two hundred different gene deficiencies that could could possibly lead to epilepsy. And interestingly, if you were a child and you were diagnosed with epilepsy, your doctor may say, put

that kid on Atkins. Oh yeah, keytonic diets might have something that helps. Yeah, they think, well, like when you're when you have kind of gone through your fat stores, you go to key tones in your brain, and it's got to have something to do with that. Start burning keytones in your brain. That's got to have an impact on your electrical activity. Why it only works on kids rather than adults is it's a mystery to me. You got anything else? I got nothing else? Well, let's epilepsy everybody.

If you ever see somebody who's having a seizure, remember everything we told you and keep that spoon out of their mouth. And since I said that's time for listener mail. I'm gonna call this boy marathon ors we heard from them. We probably should have thought that through, Like we did a marathon episode asking for people to email. Yeah, I think we would have gotten the same amount of emails

for marathons, Like I love marathon. People who marathon love to talk about marathons, So we were asking for it even without asking for it. Well, and we also asked about the marathon high versus a marijuana high, and turns out a lot of marathon or smoke weed. I bet, I will, I can. I can imagine which one you selected. Well, actually I did not select one of those because they were kind of all the same. They were like one guy said, it's not the same. One guy said he

would get high and run. I saw that guy until the runners had kicked in, and he said, so I would be high the entire marathon. Yeah, yeah, like you're insane. His friends thought, he was, how would you even start? You know? He was probably should I eat combos today or run a marathon today. I had a friend who used to get super high and go to the end workout and lift weights like Kevin Spacey, Oh that's right, and America. That's always seems so bizarre to me. And

look what happened to him. Yeah, you want to stay away from the weed for the weightlifting combo? All right, here we go. Been listening for almost two years, guys, never missed an episode. I'm a former ultra marathon or typically in the fifty k distance, so definitely on the shorter end five thousand mile. Can you believe that a fifty k is a short one? Yeah? And I can speak to experience in both the runners high and hitting

the wall in the same race. In two thousand thirteen, I was competing in my last fift k, and while I was towards the back of the pack of these events always, I was feeling great when I reached the four hour mark, laughing and joking with aid station volunteers and having a great time. I felt like I was on top of the world at mile twenty and then it happened. I hit the wall hard. I had been able to cover twenty miles a pretty rugged trail in

four hours. Suddenly my legs went from feeling amazing and light feeling like sex of what submit that happens to me? At like mile point seven five? Uh? It took me another four hours in the final twelve miles of the race. Maybe it's time I start training for my next one. Guys, you're invited to join me. Maybe Chuck hats running because he hasn't found the right distance yet. Perhaps it's thirty two point five miles. Nope, Nope. That is from Sean

Riley in Columbia, South Carolina. Shaw and Riley, who is crazy. But thanks for writing in short ones. Um. Yeah, but we should say there is quite a difference apparently, between pot High and the Runners High. Yes, no one said that there were anything alike. No, most people said they were pretty different. Okay, cool, So we're done with marathoning. No need to email us more about marathons. We're good,

We got it. Okay. If you do have epilepsy or you know someone who does, though, I would love to hear from you and let us know what it's like to live with that. Um. If you want to get in touch with us, you can go to our website it's called Stuff you Should Know dot com, and there you will find links to all of our social media accounts. Or you can send us a plain old fashioned email to Stuff Podcast How Stuff Works dot com. For more

on this and thousands of other topics. Is It How stuff Works dot com