Overview
Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations and sometimes loss of awareness. Anyone can develop epilepsy. Epilepsy affects both males and females of all races, ethnic backgrounds and ages.
Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others repeatedly twitch their arms or legs. Having a single seizure doesn't mean you have epilepsy. At least two seizures without a known trigger (unprovoked seizures) that happen at least 24 hours apart are generally required for an epilepsy diagnosis.
Treatment with medications or sometimes surgery can control seizures for the majority of people with epilepsy. Some people require lifelong treatment to control seizures, but for others, the seizures eventually go away. Some children with epilepsy may outgrow the condition with age.
What happens in your brain when you have epilepsy?
The cells in your brain send messages to and receive messages from all areas of your body. These messages are transmitted via a continuous electrical impulse that travels from cell to cell. Epilepsy disrupts this rhythmic electrical impulse pattern. Instead, there are bursts of electrical energy — like an unpredictable lightning storm — between cells in one or more areas of your brain. This electrical disruption causes changes in your awareness (including loss of consciousness), sensations, emotions and muscle movements.
Symptoms
Because epilepsy is caused by abnormal activity in the brain, seizures can affect any process your brain coordinates. Seizure signs and symptoms may include:
Temporary confusion
A staring spell
Stiff muscles
Uncontrollable jerking movements of the arms and legs
Loss of consciousness or awareness
Psychological symptoms such as fear, anxiety or deja vu
Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode.
Doctors generally classify seizures as either focal or generalized, based on how and where the abnormal brain activity begins.
Focal seizures
When seizures appear to result from abnormal activity in just one area of your brain, they're called focal seizures. These seizures fall into two categories:
Focal seizures without loss of consciousness. Once called simple partial seizures, these seizures don't cause a loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste or sound. Some people experience deja vu. This type of seizure may also result in involuntary jerking of one body part, such as an arm or leg, and spontaneous sensory symptoms such as tingling, dizziness and flashing lights.
Focal seizures with impaired awareness. Once called complex partial seizures, these seizures involve a change or loss of consciousness or awareness. This type of seizure may seem like being in a dream. During a focal seizure with impaired awareness, you may stare into space and not respond normally to your environment or perform repetitive movements, such as hand rubbing, chewing, swallowing or walking in circles.
Symptoms of focal seizures may be confused with other neurological disorders, such as migraine, narcolepsy or mental illness. A thorough examination and testing are needed to distinguish epilepsy from other disorders.
Generalized seizures
Seizures that appear to involve all areas of the brain are called generalized seizures. Six types of generalized seizures exist.
Absence seizures. Absence seizures, previously known as petit mal seizures, typically occur in children. They're characterized by staring into space with or without subtle body movements such as eye blinking or lip smacking and only last between 5-10 seconds. These seizures may occur in clusters, happening as often as 100 times per day, and cause a brief loss of awareness.
Tonic seizures. Tonic seizures cause stiff muscles and may affect consciousness. These seizures usually affect muscles in your back, arms and legs and may cause you to fall to the ground.
Atonic seizures. Atonic seizures, also known as drop seizures, cause a loss of muscle control. Since this most often affects the legs, it often causes you to suddenly collapse or fall down.
Clonic seizures. Clonic seizures are associated with repeated or rhythmic, jerking muscle movements. These seizures usually affect the neck, face and arms.
Myoclonic seizures. Myoclonic seizures usually appear as sudden brief jerks or twitches and usually affect the upper body, arms and legs.
Tonic-clonic seizures. Tonic-clonic seizures, previously known as grand mal seizures, are the most dramatic type of epileptic seizure. They can cause an abrupt loss of consciousness and body stiffening, twitching and shaking. They sometimes cause loss of bladder control or biting your tongue.
Who is more likely to have epilepsy and seizures?
Anyone can develop epilepsy. Epilepsy affects both males and females of all races, ethnic backgrounds, and ages.
The epilepsies have many possible causes, but as about half people living with epilepsy do not know the cause. In other cases, the epilepsies are clearly linked to genetic factors, developmental brain abnormalities, infection, traumatic brain injury (TBI), stroke, brain tumors, or other identifiable problems. Anything that disturbs the normal pattern of neuronal activity—from illness to brain damage to abnormal brain development—can lead to seizures.
The epilepsies may develop because of an abnormality in brain wiring, an imbalance of nerve signaling in the brain (in which some cells either over-excite or over-inhibit other brain cells from sending messages), or some combination of these factors. In some pediatric conditions abnormal brain wiring causes other problems such as intellectual impairment.
In other people, the brain's attempt to repair itself after a head injury, stroke, or other problem may inadvertently generate abnormal nerve connections that lead to epilepsy. Brain malformations and abnormalities in brain wiring that occur during brain development may also disturb neuronal activity and lead to epilepsy.
What are seizure triggers?
Seizure triggers are events or something that happens before the start of your seizure.
Commonly reported seizure triggers include:
Stress.
Sleep issues such as not sleeping well, not getting enough sleep, being overtired, disrupted sleep and sleep disorders like sleep apnea.
Alcohol use, alcohol withdrawal, recreational drug use.
Hormonal changes or menstrual hormonal changes.
Illness, fever.
Flashing lights or patterns.
Not eating healthy, balanced meals or drinking enough fluids; vitamin and mineral deficiencies, skipping meals.
Physical overexertion.
Specific foods (caffeine is a common trigger).
Dehydration.
Certain times of the day or night.
Use of certain medications. Diphenhydramine, an ingredient in cold, allergy and sleep over-the-counter products, is a reported trigger.
Missed anti-seizure medication doses.
How can I figure out my seizure triggers?
Some people discover that their seizures occur consistently during certain times of the day or around certain events or other factors. You may want to track your seizures — and the events around your seizures — to see if there’s a pattern.
In your seizure diary, note the time of day each seizure happened, the events or special circumstances happening around the time of the seizure and how you felt. If you suspect you’ve identified a trigger, track that trigger to find out if it’s really a trigger. For example, if you think caffeine is a seizure trigger, do you have a seizure after consuming every caffeinated food or beverage, after “x” number of caffeinated foods/beverages or at certain times of day after consuming caffeine? Caffeine may or may not be the trigger when thoroughly reviewed.
What causes epilepsy?
Most of the time (in up to 70% of cases), the cause of seizures is not known. Known causes include:
Genetics. Some types of epilepsy (like juvenile myoclonic epilepsy and childhood absence epilepsy) are more likely to run in families (inherited). Researchers believe that although there’s some evidence that specific genes are involved, the genes only increase the risk of epilepsy, and other factors may be involved. There are certain epilepsies that result from abnormalities that affect how brain cells can communicate with each other and can lead to abnormal brain signals and seizures.
Mesial temporal sclerosis. This is a scar that forms in the inner part of your temporal lobe (part of your brain near your ear) that can give rise to focal seizures.
Head injuries. Head injuries can result from vehicular accidents, falls or any blow to the head.
Brain infections. Infections can include brain abscess, meningitis, encephalitis and neurocysticercosis.
Immune disorders. Conditions that cause your immune system to attack brain cells (also called autoimmune diseases) can lead to epilepsy.
Developmental disorders. Birth abnormalities affecting the brain are a frequent cause of epilepsy, particularly in people whose seizures aren’t controlled with anti-seizure medications. Some birth abnormalities known to cause epilepsy include focal cortical dysplasia, polymicrogyria and tuberous sclerosis. There’s a wide range of other brain malformations known to cause epilepsy.
Metabolic disorders. People with a metabolic condition (how your body obtains energy for normal functions) can have epilepsy. Your healthcare provider can detect many of these disorders through genetic tests.
Brain conditions and brain vessel abnormalities. Brain health issues that can cause epilepsy include brain tumors, strokes, dementia and abnormal blood vessels, such as arteriovenous malformations.
How is epilepsy diagnosed?
Technically, if you experience two or more seizures that weren’t caused by a known medical condition — for example, from alcohol withdrawal or low blood sugar — you’re considered to have epilepsy. Before making a diagnosis, your healthcare provider (or epilepsy specialist) will perform a physical exam, take your medical history and may order blood work (to rule out other causes). They may ask about your symptoms during the seizure and conduct other tests, as well.
Your healthcare provider will ask you or your family member (who’s witnessed your seizure) if you experienced any of the following during a seizure:
Muscle jerks.
Muscle stiffness.
Loss of bowel or bladder control (you peed or pooped during the seizure).
Change in breathing.
Skin color turned pale.
Had a blank stare.
Lost consciousness.
Had problems talking or understanding what was said to you.
What tests will be done to diagnose this condition?
Tests include:
Electroencephalography (EEG): This test measures the electrical activity in your brain. Certain abnormal electrical patterns are related to seizures.
Brain scans: Magnetic resonance imaging (MRI) to look for such things as tumors, infections or blood vessel abnormalities.
How is epilepsy treated?
Treatments to control epilepsy include anti-seizure medications, special diets (usually in addition to anti-seizure medications) and surgery.
Anti-seizure medications
Anti-seizure medications can control seizures in about 60% to 70% of people with epilepsy. Anti-seizure medication treatment is individualized. The U.S. Food and Drug Administration (FDA) has approved more than 20 anti-seizure medications for treating epilepsy. Your healthcare provider may try one or more medications, doses of medications or a combination of medications to find what works best to control your seizures.
Choice of an anti-seizure medication depends on:
Seizure type.
Your prior response to anti-seizure medications.
Other medical conditions you have.
The potential for interaction with other medications you take.
Side effects of the anti-seizure drug (if any).
Your age
General health.
Cost.
Because some anti-seizure medications are linked to birth defects, let your healthcare provider know if you’re pregnant or planning to become pregnant.
If anti-seizure medications don’t control your seizures, your healthcare provider will discuss other treatment options, including special diets, medical devices or surgery.
Diet therapy
The ketogenic diet and the modified Atkins diet — diets high in fat, moderate in protein and low in carbohydrates — are the two most common diets sometimes recommended for people with epilepsy. Diets are mostly recommended for children where medication was not effective and who aren’t candidates for surgery. Low glycemic index diets may also reduce seizures in some people with epilepsy.
Surgery and devices
Your healthcare provider will consider surgery if anti-seizure medications don’t control your seizures, and if your seizures are severe and debilitating. Epilepsy surgery can be a safe and effective treatment option when more than two anti-seizure medication trials fail to control your seizures. It’s important to be evaluated at an epilepsy center to see if you’re a candidate for epilepsy surgery if anti-seizure medications don’t control your seizures.
Surgery options include surgical resection (removal of abnormal tissue), disconnection (cutting fiber bundles that connect areas of your brain), stereotactic radiosurgery (targeted destruction of abnormal brain tissue) or implantation of neuromodulation devices. These devices send electrical impulses to your brain to reduce seizures over time.
Is there a cure for epilepsy?
There’s no cure for epilepsy. But there are many options to treat epilepsy.
Will I always have seizures?
About 70% of people become seizure-free with proper treatment within a few years. The remaining 30% are considered to have drug-resistant epilepsy. These people should go to an epilepsy center to determine if they’re candidates for epilepsy surgery.
How long will I have to take anti-epileptic medications?
It depends on the type of epilepsy you have and your response to medication. Some people who remain seizure-free for several years may be able to stop their medication. Your healthcare provider makes this decision. They’ll consider a variety of factors when making this decision, including an absence of brain lesions on your MRI, EEG findings and your medical history. Some people may require life-long medication.
Sources:
https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093
https://www.ninds.nih.gov/health-information/disorders/epilepsy-and-seizures
https://my.clevelandclinic.org/health/diseases/17636-epilepsy
Prepared by Viktorija Stučytė based on online sources
#epilepsy # seizures # medications # consciousness # healthcare provider
