Epilepsy: Introduction, Types, Causes, Symptoms, Diagnosis, and Treatment

Epilepsy

Epilepsy, also called seizure disorder, is a brain condition that causes repeated seizures. There are many types of epilepsy. Sometimes doctors know the cause, but other times they don’t. Epilepsy is common. The Centers for Disease of Control and Prevention (CDC), says that 1.2% of people in the United States of America have active epilepsy. It affects people of all genders, races, ethnic, backgrounds, and ages. Seizure symptoms can be very different. Some people lose awareness during a seizure, while others don’t. Some might stare blankly for a few seconds, and others might have jerking movements in their arms or legs, called convulsions. Having one seizure doesn’t mean you have epilepsy. Epilepsy is diagnosed if you have had at least two seizures without a clear cause, at least 24 hours apart. Most people with epilepsy can control their seizures with medicine or sometimes surgery. Some people need treatment for their whole lives, while others may stop having seizures. Some children with epilepsy might outgrow it as they get older. For more research you can also visit the World Health Organization. 

What is Epilepsy?

Epilepsy is a brain condition that causes unprovoked, repeated seizures. A seizure is a sudden surge of unusual electrical activity in your brain. Doctors diagnose epilepsy when you have two or more seizures with no clear cause. According to the World Health Organization (WHO), epilepsy affects 50 million people worldwide. The Centers for Disease Control and Prevention (CDC) says nearly 3.5 million people in the United States of America have epilepsy. Anyone can get epilepsy, but it is most common in young children and older adults. Research from 2021 shows that men develop epilepsy more often than women, possibly due to higher exposure to risk factors like alcohol use and head injuries. There are two main types of seizures:

  • Generalized seizures
  • Focal seizures

A mild seizure might be hard to notice. It may only fast last a few seconds, and you may stay awake during it. Stronger seizures can cause muscle spasms and uncontrollable twitches. These can last from a few seconds to several minutes and might cause confusion or loss of consciousness. After a seizure, you might not remember it happening. There is no cure for epilepsy, but it can be managed with medications and other treatments.

What are the Types of Epilepsy?

Doctors can sometimes figure out why a person is having seizures. There are two main types of seizures based on whether the cause is known or not:

  • Idiopathic or Cryptogenic: There is no clear cause, or the doctor cannot identify one.
  • Symptomatic: The doctor knows the cause.

There are also three types of seizures based on where they start in the brain:

  • Partial Seizures
  • Generalized Seizures
  • Secondary Seizures

How a person experiences a seizure depends on the affected part of the brain and how quickly and widely the electrical activity spreads. The sections below explain partial, generalized, and secondary generalized seizures in more detail.

  • Partial Seizures: A partial seizure happens when the seizure activity occurs in one part of the brain. There are two type of partial seizures:
  • Simple Partial Seizures: The person stays conscious and is usually aware of their surroundings during the seizure.
  • Complex Partial Seizures: The person’s consciousness is affected, and they typically don’t remember the seizure well if at all.

Generalized Seizures:

A generalized seizure occurs when seizure activity affects both sides of the brain. The person usually loses consciousness during the seizure. There are several types of generalized seizures:

  • Tonic-clonic seizures: These cause loss of consciousness, body stiffness, and shaking. They were previously called grand mal seizures.
  • Absence seizures: Previously known as petit mal seizures, these involve brief lapses in consciousness where the person seems to be staring into space. They often respond well to treatment.
  • Tonic seizures: These cause the muscles to stiffen, and the person may fall.
  • Atonic seizures: These cause a sudden loss of muscle tone, leading to a sudden drop.
  • Clonic seizures: These cause rhythmic, jerking movements, usually in the face or one arm or leg.
  • Myoclonic seizures: These cause sudden jerks or twitches in the upper body or legs.

Secondary Generalized Seizures:

A secondary generalized seizure starts in one part of the brain as partial seizure and then spreads to both sides of the brain. As the seizure progresses they will lose consciousness.

What are the Causes of Epilepsy?

According to the WHO, the cause of epilepsy cannot be determined in about half of people with the condition. Many factors can contribute to the development of seizures, including:

  • Traumatic brain injury or other head trauma
  • Brain scarring after an injury (post-traumatic epilepsy)
  • Serious illness or very high fever
  • Strokes, which causes about half of epilepsy cases in older adults with no other identifiable cause, according to the CDC
  • Lack of the oxygen to the brain
  • Brain tumor or cyst
  • Dementia, including Alzheimer’s disease
  • Maternal use of certain drugs, prenatal injury, brain malformation, or lack of oxygen at birth
  • Infectious conditions like HIV, AIDS, and meningitis
  • Genetic or developmental disorders or neurological diseases
  • Epilepsy can develop at any age, but it is usually diagnosed in early childhood or after age 60.

What are the Symptoms of Epilepsy?

Seizures are the main symptoms of epilepsy. Symptoms can vary from person to person and depend on the type of seizure.

Focal (partial) Seizures:

A focal aware seizure, previously as a simple partial seizure, does not cause loss of consciousness. Symptoms may include:

  • Changes in taste
  • Smell
  • Sight
  • Hearing
  • Touch
  • Dizziness
  • Tingling
  • Twitching in limbs

A focal unaware seizure, previously called a complex partial seizure, a loss of awareness or consciousness. Other symptoms include:

  • Staring blankly
  • Being unresponsive
  • Repeating movements

Generalized Seizures Symptoms:

Generalized seizures affect the entire brain. Here are the different types:

  • Absence Seizures: These were previously called “petit mal seizures.” They cause a brief loss of awareness, a blank stare, and may involve repetitive movements like lip smacking or blinking.
  • Tonic Seizures: These cause sudden stiffness in the muscles of the legs, arms, or trunk.
  • Atonic Seizures: Also known as “drop seizures” these lead to a loss of muscle control, causing sudden falls.
  • Clonic Seizures: Characterized by jerky muscle movements in the face, neck, and arms.
  • Myoclonic Seizures: These cause quick, spontaneous twitching of the arms and legs, sometimes occurring in clusters.
  • Tonic-clonic Seizures: Formerly known as “grand mal seizures”. Symptoms include body stiffening, shaking, loss of bladder or bowel control, biting the tongue, and loss of consciousness.

What is the Diagnosis of Epilepsy?

If you think you’ve had a seizure, it’s important to see a doctor promptly as it could indicate a serious medical issue. Your doctor will use your medical history and symptoms to decide which tests are needed. They will likely conduct a neurological examination to assess your motor skills and mental abilities. To diagnose epilepsy and rule out other conditions that cause seizures, your doctor may perform older blood tests such as a complete blood count (CBC) and chemistry panel. These tests can check for signs of infections, liver and kidney function, and blood sugar levels. The most common test for diagnosing epilepsy is an Electroencephalogram (EEG). This painless test involves placing electrodes on your scalp to detect abnormal patterns in your brain’s electrical activity. Sometimes, you may be asked to perform specific tasks during the test or have it done while you sleep. Imaging tests like CT scans, MRIs, positron emission tomography (PET), and single-photon emission computerized tomography can reveal tumors or other abnormalities in the brain that may cause seizures. Epilepsy is typically diagnosed if you have recurring seizures without an obvious or reversible cause.

What is the Treatment of Epilepsy?

Treatment for epilepsy aims to reduce the frequency of seizures or stop them altogether. Your treatment plan depends on:

  • The severity of your symptoms
  • Your overall health
  • How well you respond to therapy

The treatment options include:

  • Anti-epileptic (anticonvulsant) Drugs: These medications can help decrease the number of seizures you experience. For some people, they can even stop seizures completely. It’s crucial to take these medications exactly as prescribed for them to work effectively.
  • Vagus Nerve Stimulator: This device is surgically implanted under the skin on your chest. It electrically stimulates the vagus nerve in your neck to prevent seizures.
  • Ketogenic Diet: Recommended by the Epilepsy Foundation, this high-fat, low-carbohydrate diet benefits more than half of children who do not respond well to medications.
  • Brain Surgery: In some cases, the part of the brain causing seizures can be surgically removed or altered if deemed appropriate by your healthcare team.

Ongoing research explores new treatments, such as:

  • Deep Brain Stimulation: This involves implanting electrodes into the brain and a generator into the chest. The generator sends electrical impulses to the brain to reduce seizures. The FDA approved this treatment in 2018 for adults over 18 with focal onset seizures who haven’t responded to at least three anti-epileptic medications.
  • Minimally Invasive Surgeries and Radiosurgery: These are also being studied as potential treatments for epilepsy. If you have epilepsy, work closely with your healthcare team to find the best treatment plan for your needs.

What are the Complications of Epilepsy?

Epileptic seizures disrupt the normal electrical activity in your brain, which can affect various parts of your body. Potential complications of epilepsy include:

  • Learning difficulties about 20% of people with epilepsy may have intellectual disabilities, according to a 2018 study.
  • Injuries from falling during a seizure
  • Accidents while driving or operating machinery
  • Depression
  • Brain damage from prolonged and uncontrolled seizures
  • Choking on food or saliva
  • Side effects from medications

Each year, about 1.16 out of every 1000 people with epilepsy experience sudden unexpected death in epilepsy (SUDEP), as reported by the CDC. SUDEP is a type of epilepsy-related death not caused by drowning, injury, or another known cause. It is believed to involve pauses in breathing, airway blockages, and abnormal heart rhythms. SUDEP is more common in people whose epilepsy is not well managed. Taking all your medications as prescribed and seeing your doctor regularly can help reduce your risk.

What are the Medications for Epilepsy?

The first-line treatment for epilepsy is anti-seizure medication. These drugs are meant to reduce how often seizures happen and how severe they are. They can’t stop a seizure that’s already started, and they don’t cure epilepsy. These medications are taken by mouth and absorbed into the bloodstream, where they travel to the brain. They work by affecting neurotransmitters to lessen the abnormal electrical activity that causes seizures. There are many types of anti-seizures drugs available. Your doctor may prescribe one or a combination of drugs on the types of seizures you have. Common medications for epilepsy include:

  • Levetiracetam (Keppra)
  • Lamotrigine (Lamictal)
  • Topiramate (Topamax)
  • Valproic acid (Depakote)
  • Carbamazepine (Tegretol)
  • Ethosuximide (Zarontin)

These medications come in tablets, liquids, or injectable and are usually taken once or twice a day. Your doctor will start with the lowest effective dose and adjust it as needed. It’s important to take these medications consistently as prescribed. Possible side effects may include:

  • Fatigue
  • Dizziness
  • Skin rash
  • Coordination problems
  • Memory issues

Rare but serious side effects can include depression, inflammation and psychological stress of the liver or other organs. Epilepsy varies for each person, but most people experience improvement with anti-seizure medication. Some children with epilepsy may eventually stop having seizures and no longer need medications.

What are the Triggers of Epilepsy?

Several factors can trigger seizures. A study from 2014 identified stress, sleep deprivation, and fatigue as the most common triggers among 104 participants. Additionally, seizures can be triggered by flickering lights and high levels of alcohol consumption. Stress is a well-known trigger for seizures, although the exact reason is not fully understood. Research published in 2016 in the Journal Science Signaling explored this trigger. The study focused on how the brain’s response to stress differs in rats with epilepsy compared to those without. The research revealed that the molecule responsible for typically supporting brain activity during stress actually increased activity instead. This altered response may contribute to the occurrence of seizures.  

Is There a Cure for Epilepsy?

Early treatment with medication can help reduce how often seizures occur and lower the risk of serious complications. For many people, epilepsy surgery is considered a potential cure. Around 30% of individuals with partial epilepsy and 25% with generalized epilepsy don’t respond well to medication. If medications are not effective, your doctor might suggest surgery or vagus nerve stimulation. There are two main types of brain surgery that can reduce or eliminate seizures. Resection surgery involves removing the part of the brain where seizures start. When the area of the brain causing seizures is too critical or extensive to remove, surgeons may perform a disconnection procedure. This involves cutting nerve pathways in the brain to prevent seizures from spreading. Ongoing research explores various causes, treatment, and potential cures for epilepsy. While there’s currently no cure, finding the right treatment can significantly improve your condition and quality of life.

FAQs:    

Is epilepsy hard to live with?  

Epilepsy can impact many areas of your life, including work, school, travel, and transportation. Both your diagnosis and the treatment you are in can influence how you manage these aspects and maintain your independence.

Is epilepsy genetic?

Experts believe that genetic predisposition combined with environmental factors often leads to epilepsy. About 30 to 40 percent of epilepsy cases are due to genetic factors. Close relatives (like parents, siblings, and children) of people with inherited epilepsy have a two to four times higher risk of developing it themselves.

At what age does epilepsy start?

It can start at any age, but it is most commonly diagnosed in children and people over 65. Some children with epilepsy have age-related epilepsy, meaning their seizures will stop by a certain age. Others may continue to have seizures into adulthood.

Can epilepsy be transmitted?

It is not contagious. You can’t catch epilepsy from someone else. Anyone can develop epilepsy. Seizures begin in people over 65 almost as often as they do in children.

Does epilepsy affect memory?

Epilepsy can seriously affect memory. People with epilepsy may struggle to remember words, facts, and even events from their own lives.

What is the first stage of epilepsy?

Prodromal refers to the period when early symptoms start, but before the more obvious, diagnosable symptoms appear. Common prodromal symptoms include confusion, anxiety, irritability, headache, tremor, and mood disturbances such as anger. 

Is milk good for epilepsy?

Milk might help protect against it because it contains calcium and vitamin D. In a group of epilepsy patients in Portugal, more than half were found to have a vitamin D deficiency. 

Which fruit is best for epilepsy patients?

Fruits and vegetables, to boost your antioxidant intake, regularly include a variety of colorful fruits and vegetables in your diet, such as berries, cherries, citrus fruits, tomatoes, spinach, kale, broccoli, and Brussels sprouts. 

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