Epilepsy is a neurological disorder characterised by abnormal brain activity that leads to seizures or changes in behaviour, sensation, and consciousness. It is typically diagnosed after two or more unprovoked seizures that occur at least 24 hours apart. Treatment options include medication and surgery, and many people with epilepsy can have their seizures effectively controlled. Some people may outgrow the condition, particularly children
Epilepsy symptoms are caused by abnormal brain activity and can manifest as seizures that affect different processes coordinated by the brain. These seizures can cause a variety of symptoms such as temporary confusion, staring spells, muscle stiffness, uncontrollable jerking movements, loss of consciousness or awareness, and psychological symptoms like fear, anxiety, or déjà vu. The symptoms of seizures can vary depending on the type of seizure and a person with epilepsy usually has the same type of seizure each time, so the symptoms will be similar from episode to episode
Seizures are classified as either focal or generalised based on the location and onset of abnormal brain activity. Focal seizures, also known as partial seizures, occur when the abnormal activity is in one specific area of the brain and can cause changes in emotions, sensory perception, involuntary movement, and repetitive movements. Generalised seizures involve abnormal activity in all areas of the brain and can include absence seizures, tonic seizures, atonic seizures, clonic seizures, myoclonic seizures, and tonic-clonic seizures. Symptoms of seizures can be mistaken for other neurological disorders, so a thorough history taking and testing are needed to make the right diagnosis.
The causes may be attributed to various factors, such as:
- Genetic influence: Some types of epilepsy run in families and may have a genetic component. Certain genes may make a person more susceptible to environmental triggers that can cause seizures.
- Brain abnormalities: Abnormalities in the brain such as tumors or vascular malformations can cause epilepsy
- Stroke is a common cause of epilepsy in adults over the age of 35.
- Head trauma: Traumatic head injuries from accidents or other causes can lead to epilepsy.
- Infections: Certain infections such as autoimmune encephalitis can cause epilepsy
To diagnose epilepsy, doctors will review the patient's symptoms and medical history, and may order several tests to determine the cause and the type of epilepsy. The evaluation may include:
- A neurological exam: The doctor will test the patient's behaviour, motor abilities, mental function, and other areas to diagnose the condition and determine the type of epilepsy.
- Electroencephalogram (EEG): This is the most common test used to diagnose epilepsy. In this test, electrodes are attached to the scalp and record the electrical activity of the brain. If a person has epilepsy, it's common to have changes in their normal pattern of brain waves, even when not having a seizure. In some cases, an ambulatory prolonged EEG may be required, where the patient wears the EEG at home for one or a few days to record seizure activity.
- Magnetic resonance imaging (MRI): An MRI creates a detailed view of the brain and can detect lesions or abnormalities that could be causing seizures.
- Blood tests: A blood sample will be taken to check for signs of inflammation, genetic conditions, or other conditions that may be associated with seizures.
- Neuropsychological tests: These tests assess the patient's thinking, memory, and speech skills and help determine which areas of the brain are affected.
- Other tests, such as Functional MRI (fMRI), magnetoencephalography (MEG), single-photon emission computerised tomography (SPECT), positron emission tomography (PET), WADA test, and others, may be needed in specific conditions or for pre-surgical evaluation.
Epilepsy risks and complications:
Epilepsy can lead to several serious situations and complications, such as:
- Falling: resulting in injuries such as head trauma or broken bones.
- Drowning: People with epilepsy are at a higher risk of drowning while swimming or bathing, as seizures can occur unexpectedly in the water.
- Car accidents: Seizures that cause loss of awareness or control can be dangerous while driving or operating equipment.
- Pregnancy complications: Seizures during pregnancy can pose risks to both mother and baby, and certain anti-epileptic medications can increase the risk of birth defects. It is important to work with a doctor to plan a pregnancy if you have epilepsy.
- Emotional health issues: People with epilepsy are more likely to have psychological problems, such as depression and anxiety.
- Status epilepticus: This is a condition that occurs when a person is in a state of continuous seizure activity lasting more than five minutes, or if they have frequent recurrent seizures without regaining full consciousness in between them. Without immediate treatment this can result in permanent brain damage and death.
- Sudden unexpected death in epilepsy (SUDEP): People with epilepsy have a small risk of sudden unexpected death, although the cause is unknown. Some research suggests it may be related to heart or respiratory conditions. People with drug resistant epilepsy with frequent tonic-clonic seizures may be at a higher risk of SUDEP. About 1% of people with uncontrolled epilepsy die from SUDEP. It's important for people with epilepsy to work closely with their neurologist to control their epilepsy and minimise the risk of complications.
Treatment options for epilepsy vary depending on the type and severity of seizures, as well as the patient's overall health and medical history.
Anti-seizure medication, also known as anti-epileptic medication, is the first line of treatment for most people with epilepsy. These medications work by altering the electrical activity in the brain to prevent seizures. Medication is the most common form of treatment, and in many cases, it can effectively control seizures. Some people may need to take a combination of medications to achieve the best results. If medication is not effective in controlling seizures, surgery may be considered.
Epilepsy surgery for epilepsy involves removing the part of the brain that is causing seizures. This is only an option if the seizures are originating from a well-defined area of the brain, and if the area does not control vital functions such as speech, language, motor function, vision or hearing. In addition to medication and surgery, other therapies may be helpful in managing epilepsy such as
- Vagus nerve stimulation (VNS): A device similar to a pacemaker is implanted under the skin in the chest, and sends electrical impulses to the brain through the vagus nerve.
- Deep brain stimulation (DBS): This is a surgical procedure that involves implanting electrodes into specific areas of the brain and delivering electrical impulses to these areas to reduce seizures.
- Ketogenic diet: This is a high-fat, low-carbohydrate diet that has been found to be effective in reducing seizures in some people with epilepsy