Epilepsy is a disease in which the affected person tends to have repeated seizures that start in the brain. Our brains function as our body's message center, and if there is a break in some or all of the brain functioning, a seizure can occur. The result of a seizure is that a person often collapses or faints. Sometimes, though, a person does not fall, but just "loses" time, unaware that they are being affected by a seizure. Seizures may cause problems with muscle control, movement, speech, vision, or awareness.
Since epilepsy actually starts inside the brain, it is considered to be a neurological condition. A person might only have one seizure in their whole lifetime, or they may have repeated seizures. Only people with repeated seizures are referred to as epileptic. Anyone can have epilepsy and it is not certain just why it occurs. What is known about the disease is that it affects people of all ages, races, and economic income.
The important fact to remember is that a person's "seizure threshold" plays a key role in the disease. Each of us has an individual level of resistance, or tolerance, to seizures. This threshold is part of everyone's genetics and the chance for developing epilepsy is dependent upon the seizure threshold of your parents. People with lower seizure thresholds are more likely to have seizures than those with high thresholds. Someone with a high threshold is more likely to have seizures unrelated to epilepsy, perhaps as a result of an environmental incident, such as a head injury. This person would not be considered an epileptic and is unlikely to have had the seizure due to a genetic predisposition.
Epilepsy, a disorder that causes the electrical pulses in the brain to become disturbed, affects approximately 50 million people worldwide. There are currently more than 40 known types of epilepsy and the most common types of epilepsy are childhood epilepsy, rolandic epilepsy, nocturnal epilepsy, idiopathic epilepsy, and partial epilepsy. The effects of epilepsy are most often seen in the form of seizures and are usually treated with medication.
Childhood epilepsy usually manifests itself with seizures and is often hard to diagnose in infants because the seizures resemble the startle reflex many babies show. The most common causes of childhood epilepsy are perinatal brain injury and a malformation of the central nervous system. Once a child is diagnosed, the physician may prescribe medication to control the generalized seizures. Generalized seizures are ones that originate in the brain and cause the child to suffer convulsions and possibly lose consciousness.
Rolandic epilepsy is considered one of the benign types of epilepsy and is most common in children. Most often the child will have only a partial seizure instead of a generalized seizure, and it usually affects just the facial area. As the child grows into a teen, the seizures may become significantly less frequent and in many cases stop altogether. This type of epilepsy is known as benign because of the number of children who outgrow the disorder.
Though there are several types of epilepsy, most do manifest with seizures. The seizures in nocturnal epilepsy, however, almost exclusively occur while the person is asleep. Most of these types of epileptics suffer from what is known as frontal lobe epilepsy. This form causes short, frequent seizures which when part of nocturnal epilepsy may be overlooked since the person is asleep. Treatment typically involves medication such as carbamazepine, clonazepam, ethosuximide, and phenobarbitol.
Idiopathic epilepsy is one of the types of epilepsy used when a diagnosis and cause is unclear. Physicians may use this diagnosis when there is a family history of epilepsy. When the brain shows no signs of malformations during a magnetic resonance imaging (MRI) but the patient does suffer from seizures, the doctor may indicate the patient is an idiopathic epileptic. Treatment is similar to that of other epileptics and includes anti-convulsive medication.
Partial epilepsy is one of the mildest types of epilepsy and is one of the more common types seen in patients. Partial epilepsy only affects a specific part of the brain, which then causes only one part of the body to have seizures or convulse. In partial epilepsy, the patient may drool, contract one hand, twitch their head to one side, or blink their eyes uncontrollably. This partial seizure is also known as a focal or local seizure since it only affects a specific area and not the entire body.
The main symptoms of epilepsy are repeated seizures. There are about 40 different types of seizure, and how they affect you depends on which areas of your brain are affected.
People with epilepsy can experience any of the varieties of seizures, although most people follow a consistent pattern of symptoms. This pattern is known as an epilepsy syndrome.
Doctors who treat epilepsy classify seizures by how much of the brain is affected. There are:
partial seizures, where only a small part of the brain is affected
generalized seizures, where most or all of the brain is affected
There are two types of partial seizure:
simple partial seizure, where you remain fully conscious throughout
complex partial seizure, where you lose your sense of awareness and can't remember what happened after the seizure has passed
Symptoms of a simple partial seizure include:
changes in the way things look, smell, feel, taste or sound
an intense feeling that events have happened before (déjà vu)
a tingling sensation, or 'pins and needles', in your arms and legs
a sudden intense emotion, such as fear or joy
the muscles in your arms, legs and face may become stiff
you may experience twitching on one side of your body
The symptoms of a complex partial seizure normally involve apparently strange and random bodily behavior, such as:
smacking your lips
rubbing your hands
making random noises
moving your arms around
picking at clothes
fiddling with objects
adopting an unusual posture
chewing or swallowing
During a complex partial seizure, you will not be able to respond to anyone else, and you will have no memory of the event.
Complex partial seizures are quite common and account for 2 in 10 of all seizures experienced by people with epilepsy.
In most cases, a person having a generalized seizure will be completely unconscious.
There are six main types of generalized seizure.
Absences
Absence seizures mainly affect children. They cause the child to lose awareness of their surroundings for up to 20 seconds. The child will seem to stare vacantly into space, although some children will flutter their eyes or smack their lips. The child will have no memory of the seizure.
Absences can occur several times a day. Although they are not dangerous, they may affect the child's performance at school.
Myoclonic jerks
These types of seizures cause your arms, legs or upper body to jerk or twitch, much like if you have received an electric shock. They often only last for a fraction of a second, and you should remain conscious during this time.
Myoclonic jerks often happen in the first few hours after waking up and can occur in combination with other types of generalized seizures.
Clonic seizure
This causes the same sort of twitching as myoclonic jerks, except the symptoms will last longer, normally up to two minutes. Loss of consciousness may occur.
Atonic seizure
Atonic seizures cause all your muscles to suddenly relax, so there is a chance you will fall to the ground. Facial injuries are common with this type of seizure.
Tonic seizure
Unlike an atonic seizure, tonic seizures cause all the muscles to suddenly become stiff. You can lose balance and fall over, so injuries to the back of the head are common.
Tonic-clonic seizure
A tonic-clonic seizure has two stages. Your body will become stiff and then your arms and legs will begin twitching. You will lose consciousness and some people will wet themselves. The seizure normally lasts between one and three minutes but they can last longer.
This is the most common type of seizure, and about 60% of all seizures experienced by people with epilepsy are tonic-clonic seizures.
Tonic-clonic seizures are what most people think of as an epileptic fit.
People who have epilepsy often get a distinctive feeling or warning sign that a seizure is on its way. These warning signs are known as auras, but they are actually simple partial seizures.
Auras differ from person to person, but some common auras include:
noticing a strange smell or taste
having a feeling of déjà vu
feeling that the outside world has suddenly become unreal or dreamlike
experiencing a sense of fear or anxiety
your body suddenly feeling strange
Although this warning cannot prevent the seizure, it can give you time to warn people around you and make sure you are in a safe place.
Status epilepticus is a seizure that lasts longer than 30 minutes or a series of seizures where the person does not regain consciousness in between. If a seizure lasts longer than five minutes, call 911 for an ambulance.
Status epilepticus can be treated with diazepam given as an injection or through someone's rectum. An alternative treatment is a medication called buccal midazolam. This comes in liquid form and it is administered by trickling the liquid onto the inside of your cheek. It is then absorbed into your bloodstream.
You do not have to be a healthcare professional to do this, but you do need the correct training as well as permission from the person who has epilepsy. If you care for someone with epilepsy, you can be trained to administer rectal diazepam or buccal midazolam in case status epilepticus occurs.
Epilepsy can have a number of causes. The brain is a delicate mix of neurons (brain cells), electrical impulses and chemicals, known as neurotransmitters. Any damage has the potential to disrupt the workings of the brain and cause seizures.
There are three main categories of epilepsy:
Symptomatic epilepsy - there is a known cause for a person's epilepsy, such as a head injury.
Idiopathic epilepsy - despite investigation, no apparent cause for epilepsy can be found.
Cryptogenic epilepsy - like idiopathic epilepsy, no apparent cause can be found. However, there is strong evidence that this type of epilepsy may be the result of brain damage, which may also cause other problems, such as learning difficulties.
Causes of symptomatic epilepsy include:
conditions that affect the structure of the brain, such as cerebral palsy
drug and alcohol misuse
birth defects
problems during birth which cause a baby to be deprived of oxygen, such as the umbilical cord getting twisted or compressed during labour
infectious conditions that can damage the brain, such as meningitis
head injuries
strokes
brain tumours
Where no apparent cause for epilepsy can be found, many researchers have suggested that small genetic changes in the brain could be the cause of epilepsy. Current research is looking for defects in certain genes that may affect electrical transmission in the brain.
While a number of studies have been carried out, no strong association has been found between any particular genes and the development of epilepsy.
The term cryptogenic epilepsy is used when no definite cause for epilepsy can be found but there is strong evidence that the symptoms are due to damage or disruption to the brain.
Evidence that suggests a person has cryptogenic epilepsy includes:
They have learning difficulties.
They have a developmental condition, such as autistic spectrum disorder.
They have unusual electroencephalogram (EEG) readings (an EEG is a device that measures the electrical activities of the brain).
Many people with epilepsy find that certain circumstances or substances can trigger a seizure. These triggers include:
stress
lack of sleep
alcohol, particularly binge drinking and during a hangover
drugs such as cocaine, amphetamines, ecstasy and any opiate-based drugs, such as heroin, methadone or codeine
health conditions that cause a high temperature (fever)
flashing lights (this is an uncommon trigger that affects only 5% of people with epilepsy, and is also known as photosensitive epilepsy)
Some women may be more prone to seizures just before, during or after their period. This is because the hormones released by the body during that time can affect the chemicals in the brain, making seizures more likely.
Most people with epilepsy have a seizure threshold. This is the point at which the brain's natural resistance to seizures is passed, triggering a seizure.
People with a low seizure threshold experience frequent seizures and are very sensitive to triggers. People with a high seizure threshold experience less frequent seizures and triggers will have less effect on them.
Certain factors may increase your risk of epilepsy.
Your age. The onset of epilepsy is most common during early childhood and after age 65, but the condition can occur at any age.
Your sex. Men are slightly more at risk of developing epilepsy than are women.
A family history. If you have a family history of epilepsy, you may be at an increased risk of developing a seizure disorder.
Head injuries. These injuries are responsible for many cases of epilepsy. You can reduce your risk by always wearing a seat belt while riding in a car and by wearing a helmet while bicycling, skiing, riding a motorcycle or engaging in other activities with a high risk of head injury.
Stroke and other vascular diseases. These can lead to brain damage that may trigger epilepsy. You can take a number of steps to reduce your risk of such diseases, including limiting your intake of alcohol and avoiding cigarettes, eating a healthy diet and exercising regularly.
Brain infections. Infections like meningitis, which causes an inflammation in the brain or spinal cord, can increase your risk of epilepsy.
Prolonged seizures in childhood. High fevers in childhood can sometimes be associated with prolonged seizures and subsequent epilepsy later in life, particularly for those with a family history of epilepsy.
The goal of treatments for epilepsy is decreasing the number and severity of seizures while minimizing potential side effects. Many forms of treatment involve medications that manage the symptoms of the condition. In cases where medications do not adequately control seizures, surgery may be considered. One option that has shown some success in children is a strict diet rich in fats and low in carbohydrates (known as a ketogenic diet).
Doctors generally start by treating epilepsy with medication. If that doesn't work, they may propose surgery or another type of treatment.
Medication
Most
people with epilepsy can become seizure-free by using a single
anti-epileptic drug. Others can decrease the frequency and intensity
of their seizures. More than half the children with
medication-controlled epilepsy can eventually stop medications and
live a seizure-free life. Many adults also can discontinue medication
after two or more years without seizures.
Finding the right medication and dosage can be complex. Your doctor likely will first prescribe a single drug at a relatively low dosage and may increase the dosage gradually until your seizures are well controlled.
All anti-seizure medications have some side effects. Mild side effects include:
Fatigue
Dizziness
Weight gain
Loss of bone density
Skin rashes
Loss of coordination
Speech problems
More severe but rare side effects include:
Depression
Suicidal thoughts and behaviors
Severe rash
Inflammation of certain organs, such as your pancreas or liver
To achieve the best seizure control possible with medication:
Take medications exactly as prescribed.
Always call your doctor before switching to a generic version of your medication or taking other prescription medications, over-the-counter drugs or herbal remedies.
Never stop taking your medication without talking to your doctor.
Notify your doctor immediately if you notice new or increased feelings of depression, suicidal thoughts or unusual changes in your mood or behaviors.
At least half of all people newly diagnosed with epilepsy will become seizure-free with their first medication. If anti-epileptic medications don't provide satisfactory results, your doctor may suggest surgery or other therapies.
Surgery
Surgery
is most commonly done when tests show that your seizures originate in
a small, well-defined area of your brain that doesn't interfere with
vital functions like speech, language or hearing. In these types of
surgeries, your doctor removes the area of the brain that's causing
the seizures.
If your seizures originate in a part of your brain that can't be removed, your doctor may recommend a different sort of surgery in which surgeons make a series of cuts in your brain. These cuts are designed to prevent seizures from spreading to other parts of the brain.
Although many people continue to need some medication to help prevent seizures after successful surgery, you may be able to take fewer drugs and reduce your dosages. In a small number of cases, surgery for epilepsy can cause complications such as permanently altering your cognitive abilities. Talk to your surgeon about his or her experience, success rates and complication rates with the procedure you're considering.
Therapies
Vagus nerve stimulation. This therapy involves a device called a vagus nerve stimulator that's implanted underneath the skin of your chest like a heart pacemaker. Wires from the stimulator are wrapped around the vagus nerve in your neck. The battery-powered device delivers short bursts of electrical energy to the brain through the vagus nerve. It's not clear how this inhibits seizures, but the device can reduce seizures by 20 to 40 percent and completely control seizures in about 5 percent of people. Most people still need to take anti-epileptic medication. Side effects of vagus nerve stimulation include hoarseness, throat pain, coughing, shortness of breath, tingling and muscle pain.
Ketogenic diet. Some children with epilepsy have been able to reduce their seizures by maintaining a strict diet that's high in fats and low in carbohydrates. This diet, called a ketogenic diet, causes the body to break down fats instead of carbohydrates for energy. Some children can go off the ketogenic diet after a few years and remain seizure-free.
Consult a doctor if you
or your child is considering a ketogenic diet. It's important to
make sure that a child doesn't become malnourished when taking the
diet. Side effects of a ketogenic diet may include dehydration,
constipation, slowed growth because of nutritional deficiencies, and
buildup of uric acid in the blood, which can cause kidney stones.
These side effects are uncommon if use of the diet is properly and
medically supervised.
Know your triggers
The more you know about the things that trigger your seizures and how to avoid them, the less debilitating your epilepsy will be. Keep a seizure diary to help you work out if you have any triggers.
Take your medication
Anti-epilepsy medication controls seizures in around 70% of people. Working with your specialist to find the medication that suits you best, and taking it exactly as prescribed, is probably the most effective way to live well with epilepsy.
Get enough sleep
Sleep deprivation is a powerful trigger of seizures. Be sure to get adequate rest every night.
Wear a medical alert bracelet
This will help emergency personnel know how to treat you correctly.
Regular reviews
You will have regular reviews of your epilepsy and treatment. This is usually carried out by the doctor, but sometimes it is done by your neurologist and their team. If your epilepsy is not well controlled, you may have more frequent reviews.
Self-care
Self-care is an integral part of daily life. It involves taking responsibility for your health and wellbeing with support from the people involved in your care. Self-care includes what you do every day to stay fit and maintain good physical and mental health, prevent illness or accidents and care more effectively for minor ailments and long-term conditions. People with long-term conditions can benefit enormously from being supported to self care. They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life and be more active and independent.