Epilepsy refers to a chronic neurological condition in which abnormal electrical brain activity causes recurrent seizures. Seizures mean brief attacks of abnormal involuntary movements in certain parts of the body or its whole. Altered sensations, autonomic functions (like defecation and micturition), and consciousness may occur with the attack. A seizure attack usually lasts for a short period, but during it, you may get injured seriously, like during driving or swimming. It’s a chronic and lifelong condition. But with the proper treatment, you can control it and get better over time.
Epilepsy is one of the most common neurological diseases worldwide; it affects about 50 million people worldwide and 3.5 million people in the USA. It affects people of all races, both sexes, and all ages. These patients are at higher risk of premature death three times than the general population. But, about 70% of them could also live seizure-free if they received the proper diagnosis and treatment. Epilepsy is more common among people in middle and low-income societies.
Epilepsy doesn’t have definitive causes in most cases (about 50%). But in others, it may occur secondary to head trauma, birth injuries, brain infections, stroke, brain abnormalities, and other causes. Some people are at high risk of epilepsy, such as those with a positive family history. Age and other diseases -like dementia- may also raise the risk.
Your brain controls all your activities, including motor abilities, coordination, sensations, autonomic functions, behavior, and consciousness. Thus, it affects any of these processes. Symptoms vary among patients, according to where the abnormal electrical activity of the brain starts and how it spreads. Seizures may occur in focal (in one area of the brain and affects part of the body) or generalized (involves the whole brain) forms. We will discuss both types and their subtypes in detail later.
As we said, seizure itself usually lasts for a short period then passes, but it can lead to circumstances that may threaten your life, such as falling, drowning, food choking, and car accidents. It’s also dangerous for a pregnant woman and her baby. Emotional and psychological issues may accompany epilepsy. Life-threatening complications rarely occur, such as status epilepticus and SUDEP (sudden unexpected death in epilepsy).
Diagnosing epilepsy is a complex process. Your doctor will start by taking a detailed medical history of your complaint, your general health, and your family history. Then, he will do a neurological examination to see how well your brain and nervous system are working. He will test your motor abilities, sensations, behavior, and mental functions. Then, he will order some investigations to confirm epilepsy and exclude other conditions that may cause seizures. These investigations include blood tests, EEG (electroencephalogram), and imaging techniques.
Treating epilepsy reduces the frequency of the seizures and may stop it completely. Your doctor has various treatment options, including medications, surgery, and other therapies. Your doctor will put your treatment plan and modify it, depending on your health, disease severity, and your response to the treatment. You may even stop taking medication.
Epilepsy is a significant problem for a lot of people worldwide; thus, let’s discuss it in more detail and answer the following questions about it:
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- What does cause epilepsy and increases the risk of it?
- What are its symptoms and complications, and what does trigger the seizures?
- How can your doctor diagnose epilepsy and exclude other similar conditions?
- What are the available treatment options, and how can your doctor manage your condition well?
Causes and risk factors of epilepsy
In about 50% of cases, there is no identifiable cause for epilepsy. But in the others, some conditions may put you at higher risk to develop it.
These conditions include:
☞ Head trauma: It may occur due to a car accident or other traumatic injuries.
☞ Brain infections -such as meningitis, viral encephalitis, and HIV- may lead to epilepsy.
☞ Brain abnormalities, such as brain tumors and congenital vascular malformations, may lead to brain damage that causes epilepsy.
☞ Stroke: It is the leading cause of epilepsy in those older than 35 years. Stroke restricts the oxygen supply to the brain, which damages it.
☞ Birth injuries: during and before delivery, babies are susceptible to many factors that may cause brain damage, such as poor maternal nutrition, maternal infections, and oxygen deficiency. These conditions put the baby at a higher risk of epilepsy.
☞ Dementia (Alzheimer’s disease) increases the risk of epilepsy in the elderly.
☞ Developmental and genetic disorders, like autism, may be associated with epilepsy.
☞ Age and family history: Epilepsy can occur at any age, but its onset is more common in children and the elderly over 60 years old. Also, you are at a higher risk if you have a positive family history of epilepsy.
Symptoms, complications, and triggers
The principal symptom of epilepsy is seizures, which are bursts of abnormal electrical activity that affect how the brain works. Seizures happen in attacks or episodes, and their symptoms vary, depending on where it begins in the brain and how it spreads. In most cases, the patient has the same type of seizures in each episode; thus, the symptoms will be the same each time.
Seizure symptoms may include:
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- Staring look into space
- Transient confusion and loss of awareness
- Unusual sensations, smells, tastes, sights, or sounds
- Jerky movements of the limps
- Stiff muscles
- Unusual behaviors and feelings like lips smacking, fear, and anxiety
Seizures may be focal or generalized, as follows:
Focal (partial) seizures:
Focal seizures occur due to abnormal activity of one brain area, and it may occur in two forms:
1. Simple focal seizers (with preserved awareness):
These seizures don’t affect consciousness but may alter sensations like taste, smell, hearing, and sight. You may feel tingling and dizziness and see light flashes. This type may also lead to involuntary stiffness or jerky movements of part of the body. You are awake and aware during the attack.
2. Complex focal seizures (with impaired or lost awareness):
During complex seizures, you seem like being in a dream. You lose your sense of awareness and can’t respond to your environment. You may stare blankly and do random and repetitive movements, such as chewing, swallowing, lips smacking, hand rubbing, making noises, and walking in circles.
You are unaware and can’t respond to anyone during the attack. After the attack, you can’t remember anything about it.
Generalized seizures:
This type involves the whole brain and affects all brain areas. Generalized seizures may occur in six forms, as follow:
1. Absence seizures (petit mal epilepsy)
This type typically occurs in children but may occur at any age. It causes a brief loss of consciousness, staring look, and repetitive movements like lips smacking and eye blinking. The attack of absence seizures usually lasts for 5 to 10 seconds and may occur in clusters (up to 100 times daily).
2. Tonic seizures:
In this type, your muscles become suddenly stiff and rigid in your arms, legs, and trunk. You may lose your balance and fall to the ground, which may be dangerous in some situations. This type may also affect consciousness.
3. Atonic seizures (drop seizures)
In this type, you lose your muscle tone (strength). Your muscles suddenly relax, including those of the legs, then you will collapse and fall. Atonic seizures are usually brief; you will stand up again and go, but falling may be dangerous.
4. Myoclonic seizures are sudden, brief, and jerky twitches that affect the arms and legs muscles. These seizures may occur in clusters.
5. Clonic seizures
In this type, your body shakes in a rhythmic jerking movement, including face, neck, and arms.
6. Tonic-clonic seizures (grand mal epilepsy)
It’s the most dramatic type. Most people think about it as typical epilepsy. The attack -of this type- usually passes by two stages, tonic then clonic.
At first, you lose your consciousness, then your muscles stiffen, and you may fall. Then, your limbs shake in jerky movement.
During the attack, you may lose control of your bowel and bladder, bite your tongue, and feel breathing difficulty. It lasts for a few minutes and sometimes longer. After the attack, you may have a headache and feel exhausted or confused for a period. You may not remember what happened.
Complications of epilepsy
Seizures usually last for a short time then pass, but the attack may put you in a dangerous situation for you and others.
For example, falling during seizures may lead to bone fractures and head injuries. During swimming, an attack of seizures may lead to drowning. While you are driving, seizures may cause car accidents. It may also lead to food and saliva choking.
Pregnancy and epilepsy
Epilepsy represents a danger for the pregnant woman and baby. Not only epilepsy but also its medications may increase the risk of congenital anomalies. Most females with epilepsy can get pregnant and deliver healthy babies. But, they need a careful plan throughout the pregnancy to monitor their condition and adjust their medications. Plan your pregnancy with your doctor.
Psychological and emotional health issues
Patients with epilepsy are at a higher risk of psychological problems like depression and anxiety. They also may have suicidal thoughts and behavior because they may find difficulties dealing with the disease or due to the side effects of medications. Patients with well-controlled conditions are also at high risk. Also, about 20% of patients with epilepsy may suffer from learning difficulties or intellectual disabilities.
Some rare, life-threatening complications may occur, such as:
Status epilepticus:
This term refers to any attack of seizures that lasts for a long time (more than 5 minutes) or repeated attacks that the patient can’t regain consciousness in between. This condition is a medical emergency and needs emergent care due to the risk of permanent brain damage and death.
Sudden unexpected death in epilepsy (SUDEP):
Patients with epilepsy are at a minor risk of sudden death without known causes. Some researchers think that it results from related respiratory and heart problems. It’s more common among patients with tonic-clonic seizures or those with severe epilepsy (unresponsive to the treatment). Follow your doctor’s instructions about medications and follow-up appointments to minimize the risk.
Seizures triggers
In most patients, seizures occur randomly without triggers. But some patients identify conditions that trigger the attacks, such as lack of sleep, stress, fever (or illness), bright light, light flashes, alcohol (or its withdrawal), specific meals (or drinks), some drugs, and menstrual periods.
It’s helpful to keep a diary of when the attack occurred and what you did before to know and avoid possible triggers.
Diagnosing epilepsy
If you have seizures, see your doctor as soon as possible because it may indicate severe disease. Your primary care doctor will provide you with initial care then refer you to a neurologist to diagnose you.
The diagnosis of epilepsy requires exclusion of other conditions that may also cause seizures, such as infectious diseases, migraine, panic attacks, and liver and kidney diseases.
Your doctor will start by taking your detailed medical history. He will ask you:
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- When did you have the 1st attack?
- What were you doing just before it?
- What did you feel before, during, and after the attack?
- How many times did you have seizures?
It’s helpful to tell your doctor with this information or take a person -who saw you- to do this. Your doctor will also ask you if you have any health issues or a family history of epilepsy.
Then, he will do a neurological examination to assess how your nervous system works. He will test your motor abilities (power, reflexes, coordination), walking skills, sensations, behavior, and mental functions (like thinking).
History and examination may suggest that you may have epilepsy. Thus, your doctor will order some investigations to confirm the diagnosis, such as:
EEG (Electroencephalogram)
It is the most common diagnostic test for epilepsy. It’s painless and non-invasive. Your doctor puts electrodes on your scalp to record the electrical activity of your brain. He may do this test during sleep or ask you to do some tasks. In epilepsy, this test shows abnormal patterns of electrical activity.
Blood tests
Your doctor may order blood tests to exclude other conditions that may cause seizures, such as infections, kidney diseases, and hypoglycemia.
Brain imaging techniques (CT scan – MRI)
Brain imaging reveals conditions that may cause seizures, like tumors, stroke, and brain scarring (as in infections).
Your doctor uses the information from history, examination, and investigation to reach a diagnosis. Diagnosis of epilepsy typically requires two or more seizures with 24 hours intervals. But, your doctor can diagnose you by one attack if you are at high risk.
Management of epilepsy
Treatment of epilepsy reduces the frequency or even stops them completely. Most patients need treatment for life, but you would have a chance to stop the treatment if the seizures had disappeared for a certain period. Your doctor will begin the treatment with anti-epileptic medications. If failed, he can use surgery or other procedures. The management plan will also consider the triggers (if you know them) and any other diseases you have.
1) Anti-epileptic medications:
These medications represent the cornerstone in treating epilepsy. They don’t cure epilepsy, but they affect the brain chemicals and prevent seizures.
Anti-epileptic medications include more than 20 different types. Your doctor will choose the drug, depending on the type of seizures you have. Your doctor will also consider your age, health condition, and the frequency of the attacks.
Your doctor will start with a single drug at a low dose, then raise the dosage or add another drug until reaching the desired control. While taking these drugs, talk to your doctor before taking any other medicines for any cause to avoid harmful drug interactions.
These medications may have side effects, such as drowsiness, fatigue, weight gain, hair loss (or unwanted growth), tremors, rash, or memory problems. Some severe side effects may rarely occur, like depression or suicidal thoughts and behaviors.
Take these medications exactly as your doctor prescribed. Discuss any side effects you feel with your doctor, but never stop treatment without talking to him. Also, commit to the follow-up appointments.
Your doctor might stop the treatment if you didn’t have seizures for a few years. But, don’t stop treatment alone. He will reduce the dose gradually over time.
2) Brain surgery:
Surgery may be the choice when:
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- Anti-epileptic medications can’t control seizures.
- A small part of your brain causes seizures due to any cause, like tumors or stroke.
The surgeon removes the affected part of your brain, but it should be safe to remove without harming you. In these cases, seizures may completely stop after surgery.
3) Other procedures:
If the medications can’t control your condition and surgery isn’t suitable for you, your doctor may consider other options, like:
Devices
Your doctor places devices under the skin of your chest (vagus nerve stimulation) or scalp (deep brain stimulation). These devices send electrical pulses to the brain to prevent seizures.
Ketogenic diet
It’s a high-fat, low-carb diet. It’s helpful in children and sometimes adults (more research is needed). But, it should be under the supervision of your doctor.
Finally, remember that:
Epilepsy is a common and chronic condition. But, various management options are available that may end in living without seizures. But, you should follow your doctor’s instructions and avoid activities that may put you and others in danger, like driving and swimming. Ask your doctor about the first aid for seizures and teach your family (or whoever lives with you). You can pass epilepsy or have a natural life with it, but you should want this before.