Epilepsy

Epilepsy is a chronic neurological condition that affects people of all ages. It is characterised by recurrent seizures, which are sudden, uncontrolled electrical disturbances in the brain. These seizures can cause a variety of symptoms, ranging from mild to severe, and can significantly impact a person's quality of life. Understanding the causes, symptoms, and treatment options for epilepsy is crucial for those living with the condition and their loved ones.

What is Epilepsy?

Epilepsy is a disorder where unusual electrical activity in the brain results in seizures. These seizures can manifest as sudden, involuntary movements such as jerking or twitching in the arms or legs. The severity and frequency of seizures vary from person to person, and doctors work closely with patients to find the most effective treatment to keep seizures under control.

What is a Prodrome?

A prodrome refers to a set of symptoms that may occur hours or even days before the onset of a seizure. These symptoms can include mood changes, sleep disturbances, anxiety, difficulty concentrating, and lightheadedness. Individuals who experience tonic-clonic seizures (previously known as grand mal seizures) seem to be more prone to experiencing prodrome signs.

Recognising the different types of epilepsy is essential for accurate diagnosis and selecting the most appropriate treatment plan. Here they are:

Generalised Epilepsy

• Affects both sides of the brain

• Includes absence seizures, tonic-clonic seizures, and myoclonic seizures

Focal Epilepsy

• Originates in one area of the brain

• Includes simple focal seizures and complex focal seizures

Idiopathic Epilepsy

• No identifiable cause

• Often has a genetic component

Cryptogenic Epilepsy

• Presumed to have a cause, but the cause is unknown

Symptomatic Epilepsy

• Caused by a known disorder such as brain injury, tumour, or infection

Being aware of these early signs can help in the timely diagnosis and treatment of epilepsy:

• Aura or warning signs: feelings of déjà vu, impending doom, fear, euphoria, or unusual sensations such as tingling or smearing of vision

• Behavioural changes: unusual behaviours like smacking lips, rubbing hands, making random noises, or picking at clothes

• Sensory alterations: strange smells or tastes, hearing abnormalities, or visual changes

• Physical symptoms: stiffening of the body, jerking movements of the arms and legs, loss of consciousness, or breathing problems

Epilepsy primarily manifests through repeated seizures, which are sudden bursts of electrical activity in the brain, affecting how it works temporarily. The symptoms experienced during a seizure can vary depending on the type of seizure and the individual.

• Simple Partial (Focal) Seizures: These seizures cause localised symptoms such as jerking of a limb, strange sensations, or visual disturbances without loss of consciousness.

• Complex Partial (Focal) Seizures: These involve loss of awareness and consciousness, leading to behaviours like smacking lips, rubbing hands, or making random noises.

• Tonic-Clonic Seizures (Grand Mal): characterised by body stiffening and jerking, loss of consciousness, and sometimes loss of bladder control.

• Absence Seizures (Petit Mal): These seizures briefly cause loss of awareness, staring blankly, and slight body movements like eye blinking.

• Myoclonic Seizures: Sudden brief jerks or twitches of the arms and legs, often without loss of consciousness.

Post-Seizure Symptoms

After a seizure, during the postictal phase, individuals may feel confused, tired, or irritable, and may experience headaches or difficulty remembering what happened. The severity and duration of these post-seizure symptoms can vary from person to person.

Understanding the different stages of epilepsy can help individuals and their caregivers better prepare for and manage seizures. Here they are:

Stage 1: Prodrome

• Changes in mood

• Trouble sleeping

• Anxiety

• Problems staying focused

• Feeling lightheaded

Stage 2: Aura

• Warning signs right before a seizure

• Symptoms come on quickly and may only last a few seconds

• May include sensory changes, such as seeing flashing lights or hearing buzzing sounds

Stage 3: Middle (Ictal)

• Intense electrical changes in the brain

• Loss of awareness (blacking out)

• Feeling confused

• Memory lapse

• Trouble hearing

• Odd smells or tastes

• Hallucinations

• Seeing flashing lights

• Trouble speaking

• Drooling

• Loss of muscle control

• Twitching

• Repeated movements like lip smacking or chewing

• Body convulsions

• Trouble breathing

• Racing heart

Stage 4: Ending (Postictal)

• Final stage where the brain tries to recover

• Symptoms can include confusion, fatigue, and headache

• May last from a few minutes to several hours

Several factors can cause epilepsy. These include:

Primary Causes

• Genetic Factors: About 1 in 3 people with epilepsy have a family member with the condition, suggesting a possible genetic link. Certain genetic mutations or abnormalities can increase the risk of developing epilepsy.

• Brain Damage: Damage to the brain, whether due to traumatic injury, stroke, tumours, or infections, can disrupt normal brain activity and lead to the development of epilepsy. This brain damage can occur at any age, but is more common in older adults.

Other Potential Causes

In some cases, the exact cause of epilepsy may remain unknown (idiopathic epilepsy). However, other factors that may contribute to the development of epilepsy include developmental disorders, such as autism or Down syndrome, and certain metabolic disorders that affect the body's ability to process and use energy.

Some of the risk factors for epilepsy include the following:

• Age: The risk of epilepsy is higher in children and older adults, but it can occur at any age.

• Family History: Having a family history of epilepsy or fever-related seizures increases the risk.

• Head Injuries: Serious brain injury or lack of oxygen to the brain can lead to epilepsy.

• Brain tumours and Vascular Conditions: Brain tumours and abnormal blood vessels, such as arteriovenous malformations and cavernous malformations, can cause epilepsy.

• Infections: Brain infections like meningitis, encephalitis, and some parasitic infections can increase the risk.

• Developmental Conditions: Conditions like autism, cerebral palsy, and intellectual and developmental disabilities are associated with a higher risk of epilepsy.

• Stroke and Vascular Diseases: Stroke and other blood vessel diseases can cause brain damage leading to epilepsy.

• Sleep Disorders: People with sleep disorders have a higher risk of epilepsy.

• Marital Status: Unmarried individuals have a higher risk of epilepsy compared to those who are married or living with a partner.

• General Health Condition: Individuals with fair or poor general health are at a higher risk compared to those with very good or good general health.

While these factors increase the risk of developing epilepsy, it's important to note that complications can arise for those already diagnosed with the condition.

Some of the complications associated with epilepsy include:

Physical Complications

Falling during a seizure can result in head injuries or broken bones. Drowning is also a significant risk, especially during swimming or bathing. Seizures that cause loss of awareness or control can be dangerous while driving or operating equipment, potentially leading to car accidents.

Mental Health Complications

Depression and anxiety are common mental health issues among people with epilepsy, which can be treated with counselling or medications. Some antiseizure medications used to treat mania and bipolar disorder can increase the risk of suicidal thoughts or actions.

Social and Quality of Life Complications

People with epilepsy often face social stigma, impaired dignity, and feelings of shame. Treatment-resistant epilepsy, especially when seizures start in early childhood, can lead to cognitive impairment.

Life-Threatening Complications

Status epilepticus, a potentially life-threatening condition characterised by an extended seizure or multiple seizures without regaining consciousness, requires immediate medical attention. Preventing epilepsy and its complications is crucial for those at risk or already diagnosed.

Some effective prevention strategies for epileptic seizures include:

Reducing Risk Factors

Protecting the head during high-risk activities, such as wearing a helmet while cycling or participating in contact sports, can help prevent head injuries that may lead to epilepsy. Treating cardiovascular diseases and maintaining a healthy lifestyle can lower the risk of stroke and vascular diseases, which are risk factors for epilepsy.

Prenatal Care

Proper prenatal care, including treatment for high blood pressure and infections during pregnancy, can help prevent brain damage in the developing baby, reducing the risk of epilepsy.

Vaccinations

Vaccinating against diseases like measles, mumps, and rubella can prevent brain damage caused by these infections, which may lead to epilepsy.

Safety Precautions

For those with epilepsy, taking safety precautions such as avoiding swimming alone, using a shower instead of a bath, and ensuring adequate supervision for children can help prevent accidents and injuries during seizures. Early diagnosis and appropriate treatment are essential for managing epilepsy effectively.

Accurate diagnosis of epilepsy is essential for determining the appropriate treatment plan. To diagnose epilepsy, here are some steps that might be performed:

Medical History and Neurological Examination

A doctor will review the patient's medical history and conduct a neurological examination to assess motor abilities, mental functioning, and behaviour. They will also inquire about the type, frequency, and duration of seizures experienced.

Electroencephalogram (EEG)

An EEG is a non-invasive test that records the electrical activity of the brain. It can help identify abnormal brain wave patterns associated with epilepsy and determine the type of seizures an individual experiences.

Imaging Tests

Brain imaging tests such as MRI (magnetic resonance imaging) or CT (computed tomography) scans can reveal abnormalities in the brain structure that may be causing seizures, such as tumours, scar tissue, or blood vessel malformations.

Blood Tests

Blood tests can help rule out other conditions that may cause seizures, such as infections, metabolic disorders, or genetic syndromes.

Anti-Epileptic Drugs (AEDs) are the primary treatment for epilepsy, helping to control seizures in approximately 70% of people with the condition. These medications work by altering the levels of chemicals in the brain. There are over 20 different AEDs available, and the choice of medication is based on several factors, including the type of seizures, the patient's age, and whether they plan to have a baby, as some AEDs can be harmful to an unborn child.

Fine-tuning the medication is often necessary, as each brain responds differently, and combinations of medications may be required to achieve optimal results while minimising side effects. Seeing a doctor regularly is essential to adjust the treatment plan and ensure the best possible outcomes.

It is crucial to consult a doctor if you or a loved one experiences seizures, as a proper diagnosis and prompt treatment initiation are essential. Doctors will typically start with AEDs and may recommend other treatments if seizures persist. If you are already on AEDs and experience side effects or find that the medication is not effective, you should see your doctor to adjust the treatment plan. In emergency situations, such as prolonged seizures, clusters of seizures, or seizures not controlled by current medications, seek immediate medical attention.

At-home rescue medications may be prescribed to prevent such emergencies. If AEDs are not effective, you may need to see a specialist to discuss alternative treatment options, such as surgery, dietary therapies, or neurostimulation devices.

• Epilepsy is a neurological disorder causing recurrent seizures due to abnormal brain activity, affecting around 50 million people worldwide.

• Seizures can include convulsions, loss of consciousness, and behavioural changes, varying in severity and frequency among individuals.

• Major types include generalised (affecting both brain hemispheres) and focal epilepsy (originating from one area), along with idiopathic, cryptogenic, and symptomatic forms.

• Seizures have stages: prodrome (early signs), aura (warning signs), ictal (active seizure), and postictal (recovery phase).

• Causes include genetic factors, brain damage from injuries or infections, and developmental disorders.

• Higher risks are associated with age, family history, head injuries, infections, and certain health conditions.

• Complications may involve physical injuries, mental health issues like depression, social stigma, and life-threatening conditions like status epilepticus.

• Diagnosis involves medical history review, neurological exams, EEGs, imaging tests (MRI/CT), and blood tests.

• Anti-Epileptic Drugs (AEDs) are the primary treatment for about 70% of patients; adjustments may be necessary based on individual responses.

• Preventive measures include avoiding head injuries, proper prenatal care, vaccinations, and safety precautions during activities.