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Epilepsy

Dr. Sandeep Borse
Neurologist

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Read in: हिन्दी

Epilepsy is a long-lasting brain disorder marked by the recurrent episodes of brief, sudden, and abnormal electrical activity in the brain. The epileptic episodes temporarily affect the thinking, movement and behaviour of the person. Such episodes are more commonly known as convulsions or seizures, which are of the following types: 

  1. Generalised seizures: This seizure type is produced because of abnormal electrical activity on both sides of the brain.
  2. Focal seizures (partial seizures): This seizure type is produced because of abnormal electrical activity that begins in a certain part of the brain.
  3. Combined generalised and focal seizures
  4. Seizure of unknown type

Epilepsy may develop because of abnormal brain development, illnesses or brain damage that disrupts the brain’s electrical activity. However, an isolated incidence of seizure because of alcohol withdrawal, diabetes, and fever does not necessarily qualify the person as epileptic. A person is considered to have epilepsy only if he/she has had at least two episodes of seizure.

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Symptoms

The primary symptom of epilepsy is seizures, which typically lasts for a few minutes. However, seizures may vary depending on the part and total area of the brain affected. The major type of seizures and symptoms observed in the corresponding types are discussed below:

  1. Primary generalised seizures:
    1. Tonic-clonic seizures (Grand mal seizure): This seizure type can make the affected person:
      1. Lose consciousness
      2. Fall to the ground
      3. Unable to temporarily breathe
      4. Have jerking movements
      5. Lose bowel or bladder control
The seizure lasts for a few minutes. On waking up after the seizure, the person may feel confused and lethargic for minutes or even hours. The person may even experience muscle soreness and headache.
  1. Absence seizure (Petit mal seizure): This type of seizure lasts for a few seconds. During the seizure, the affected person may be listed below:
    1. Loss consciousness briefly
    2. Blink rapidly
    3. Have a blank stare
    4. Move limbs rhythmically
    5. Make chewing movements
  1. Focal (partial) seizures:
    1. Simple focal seizures: Depending on the part of the brain affected, this type of seizure can cause:
      1. Nausea
      2. Strange smell or taste
      3. Twitching
      4. Jerking movements in a particular part of the body
      5. Unexplained fear, rage or other emotional symptoms
Usually, the affected person is aware and awake during the episode.
  1. Complex partial seizure: The affected person is usually aware but unresponsive for a few minutes. This type of seizure can cause the affected person:
    1. Have repetitive movements of the hand
    2. Make a blank stare
    3. To chew or smack lips
    4. Walking or aimlessly doing things 
Usually, the affected person has no recollection of the episode afterwards.
  1. Secondary generalised seizures: This type of seizure originates in a specific part of the brain but spreads throughout the brain. In other words, the seizure in the affected starts as a focal seizure, which turns in a generalised seizure.

Causes And Risk Factors

Causes The specific cause of epilepsy in the majority of cases is unclear. The conditions that can trigger epileptic episodes are listed below:

Risk Factors Certain people are predisposed to seizures because of illnesses and brain injury. In such people, the following factors or conditions can increase the risk of seizures:

Prevention

In many cases, doctors are unable to diagnose the cause of epilepsy. In certain cases, the disorder is passed on from parents to children. People who are predisposed to epileptic seizures should avoid the following because they can trigger an episode:

Diagnosis

The doctors may find it difficult to quickly diagnose epilepsy as other conditions such as migraines and fainting occur with similar symptoms. In most cases, epilepsy is diagnosed only when the person has had at least two seizures. The affected person may require to share the following details with the doctor:

The doctor may ask the affected person to undergo at least one of the following tests:
  1. Blood tests: It is performed to rule out possible causes of seizures such as diabetes or low blood sugar.
  2. Electroencephalogram (EEG): This test records the brain’s electrical activity.
  3. Magnetic resonance imaging (MRI): This test takes images of the brain and helps to confirm epilepsy as the cause of seizures.
  4. Video EEG: This test records a video while conducting a regular EEG. The video recording is performed in the hospital where the doctor closely monitors an individual's behaviour during a seizure.
  5. Electrocardiogram (ECG): This test is performed to record the heart’s electrical activity and rule out seizures caused because of heart-related problems. 
  6. Brain scan: This test is performed to examine the brain for damage, scarring or unusual growths.
  7. Positron emission tomography (PET) scans: This test takes images of the brain and records chemical changes in the brain and helps confirm epilepsy as the cause of seizures.
  8. Single photon emission computed tomography (SPECT): This test identifies the hotspots in the brain by verifying the part of the brain that has the highest blood flow. Generally, the regions with the most increased blood flow are at the spot where a seizure begins.

Treatment

Treatment for epilepsy is considered only when the affected person has had at least two seizures; however, in rare cases, treatment may be recommended after a single episode of seizure if the doctor feels that the person is at high risk of another episode. The treatment options for epilepsy include:

  1. Anti-epileptic drugs: These medicines are prescribed to prevent epileptic seizures. They work by reducing electrical activity in the part of the brain responsible for seizures. Because the dose of the medicine required to prevent seizure may vary from person to person, the affected person may require to attempt different doses. This will help the doctor identify a suitable dose that can prevent seizures with minimal side effects.
  2. Vagus nerve stimulation: This treatment involves the electrical stimulation of a nerve in the neck (left vagus verve) to calm the irregular electrical activity in the brain responsible for seizures. The affected person requires to wear a stimulator connected to the left vagus nerve. The device sends regular mild signals to the nerve to prevent seizures in people. However, the effect of the therapy usually does not immediately appear. It may take about two years for the effects on seizures to be visible.
  3. Surgery: Surgery for epilepsy involves the removal or separation of a specific part of the brain responsible for seizures. Surgery is considered if medicines have confirmed to be ineffective, and if surgical removal of the area of the brain responsible for seizures is possible.
  4. Deep brain stimulation: Usually, this therapy is recommended in people when medicines confirm to be ineffective and surgery is not possible. It involves a surgical procedure wherein electrodes are inserted in certain areas of the brain and stimulated with mild, regular electrical impulses. This therapy reduces the number of episodes but does not cure epilepsy.

Lifestyle/management

People with epilepsy can take the following steps to reduce seizure-related risks:

  1. Maintain a diary to record your experience during seizures.
  2. Avoid drinking alcohol because it can interact with anti-epileptic medicines and increase the seizure-related risk .
  3. Follow a regular sleep pattern.
  4. Share about their condition, i.e. epilepsy, with other specialists managing other health conditions such as heart disease and kidney disease as medicines used to treat epilepsy can create problems.
  5. Do not skip any doctor’s appointments.
  6. Continue driving only after consulting with the doctor.
  7. Follow a safe diet and exercise regimen. If required, take the help of the doctor to build a safe and healthy life.

Prognosis And Complications

Prognosis Epilepsy often affects the quality of life of people. It affects learning, employment, relationships, mobility and social interactions. Although many people are able to maintain epileptic seizures under control using medicines, some may require to undergo surgery or other treatments.  Complications People with epilepsy are at an increased risk of injury because they are prone to falls, become unconscious or breathe in saliva or food during seizure-related episodes. To avoid such complications, people with epilepsy may be advised to temporarily stop driving, working under water or at heights and using heavy machinery. However, children with epilepsy have trouble concentrating. Uncontrolled epileptic seizures can even lead to brain damage and death.

Alternative Treatments

Many people are able to successfully control their seizures with anti-epileptic drugs. However, certain people continue having seizures even after taking medicines. In such cases, the doctor may recommend treatment with a ketogenic diet, which is a low carbohydrate, high fat diet containing a controlled amount of protein. This diet is useful is children and in adults. The exact mechanism by which the treatment helps is unknown. People should always consult their doctor before starting a new diet.

References.

  1. Cleveland Clinic. Epilepsy [Internet]. Available at: https://my.clevelandclinic.org/health/diseases/17636-epilepsy. (https://my.clevelandclinic.org/health/diseases/17636-epilepsy)
  2. Harvard Health Publishing Harvard Medical School. Epilepsy [Internet] [Updated Feb, 2019]. Available at: https://www.health.harvard.edu/a_to_z/epilepsy-a-to-z. 2021. (https://www.health.harvard.edu/a_to_z/epilepsy-a-to-z)
  3. National Institute of Neurological Disorders and Stroke. Epilepsy information page [Internet] [Updated May 31, 2021]. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Epilepsy-Information-Page. (https://www.ninds.nih.gov/Disorders/All-Disorders/Epilepsy-Information-Page)
  4. Healthdirect. Epilepsy [Internet] [Updated Dec, 2019]. Available at: https://www.healthdirect.gov.au/epilepsy. (https://www.healthdirect.gov.au/epilepsy)
  5. Centers for Disease Control and Prevention. Types of seizures [Internet] [Updated on Sep 30, 2020]. Available at: https://www.cdc.gov/epilepsy/about/types-of-seizures.htm. (https://www.cdc.gov/epilepsy/about/types-of-seizures.htm)
  6. healthdirect. Alzheimer’s disease [Internet] [Updated Aug, 2020]. Available at: https://www.healthdirect.gov.au/alzheimers-disease. (https://www.healthdirect.gov.au/alzheimers-disease)
  7. familydoctor.org. Epilepsy [Internet] [Updated Sep 27, 2018]. Available at: https://familydoctor.org/condition/epilepsy/. (https://familydoctor.org/condition/epilepsy/)
  8. National Institute of Neurological Disorders and Stroke. Meningitis and encephalitis information page [Internet]. Available at: https://www.ninds.nih.gov/Disorders/All-Disorders/Meningitis-and-Encephalitis-Information-Page. (https://www.ninds.nih.gov/Disorders/All-Disorders/Meningitis-and-Encephalitis-Information-Page)
  9. American Association of Neurological Surgeons. Epilepsy [Internet]. Available at: https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Epilepsy. (https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Epilepsy)
  10. NHS. Epilepsy [Internet] [Updated Sep 18, 2020]. Available at: https://www.nhs.uk/conditions/epilepsy/diagnosis/. (https://www.nhs.uk/conditions/epilepsy/diagnosis/)
  11. epilepsy society. Tests for epilepsy [Internet] [[Updated Mar, 2018]. Available at: https://epilepsysociety.org.uk/about-epilepsy/diagnosing-epilepsy/tests-for-epilepsy. (https://epilepsysociety.org.uk/about-epilepsy/diagnosing-epilepsy/tests-for-epilepsy)
  12. epilepsy society. Epilepsy treatment [Internet]. Available at: https://epilepsysociety.org.uk/about-epilepsy/treatment. (https://epilepsysociety.org.uk/about-epilepsy/treatment)
  13. epilepsy society. Anti-epileptic drugs (AEDs) [Internet]. Available at: https://epilepsysociety.org.uk/about-epilepsy/anti-epileptic-drugs. (https://epilepsysociety.org.uk/about-epilepsy/anti-epileptic-drugs)
  14. epilepsy society. Vagus nerve stimulation [Internet] [Updated Sep, 2019]. Available at: https://epilepsysociety.org.uk/about-epilepsy/treatment/vagus-nerve-stimulation. (https://epilepsysociety.org.uk/about-epilepsy/treatment/vagus-nerve-stimulation)
  15. epilepsy society. Epilepsy surgery [Internet] [Updated Aug, 2017]. Available at: https://epilepsysociety.org.uk/about-epilepsy/treatment/epilepsy-and-brain-surgery. (https://epilepsysociety.org.uk/about-epilepsy/treatment/epilepsy-and-brain-surgery)
  16. epilepsy society. Deep brain stimulation [Internet] [Updated Apr, 2015]. Available at: https://epilepsysociety.org.uk/about-epilepsy/treatment/deep-brain-stimulation. (https://epilepsysociety.org.uk/about-epilepsy/treatment/deep-brain-stimulation)
  17. Winchester Hospital. Lifestyle changes to manage epilepsy [Internet]. Available at: https://www.winchesterhospital.org/health-library/article?id=19399. (https://www.winchesterhospital.org/health-library/article?id=19399)
  18. Epilepsy Foundation Eastern Pennsylvania. Living with epilepsy [Internet]. Available at: https://www.efepa.org/living-with-epilepsy/. (https://www.efepa.org/living-with-epilepsy/)
  19. epilepsy society. Ketogenic diet [Internet] [Updated Apr, 2019]. Available at: https://epilepsysociety.org.uk/about-epilepsy/treatment/ketogenic-diet. (https://epilepsysociety.org.uk/about-epilepsy/treatment/ketogenic-diet)
  20. Children’s Hospital of Pittsburgh. Electroencephalogram (EEG) and video EEG [Internet]. Available at: https://www.chp.edu/our-services/brain/neurology/patient-procedures/eeg. (Available at: https://www.chp.edu/our-services/brain/neurology/patient-procedures/eeg)
  21. Children’s Hospital of Pittsburgh. Positron Emission Tomography (PET) Scans [Internet]. Available at: https://www.chp.edu/our-services/brain/neurosurgery/epilepsy-surgery/patient-procedures/pet-scan. (Available at: https://www.chp.edu/our-services/brain/neurosurgery/epilepsy-surgery/patient-procedures/pet-scan)
  22. Children’s Hospital of Pittsburgh. Single Photon Emission Computed Tomography (SPECT) [Internet]. Available at: https://www.chp.edu/our-services/brain/neurosurgery/epilepsy-surgery/patient-procedures/spect. (https://www.chp.edu/our-services/brain/neurosurgery/epilepsy-surgery/patient-procedures/spect)

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