What you should know about epilepsy

Epilepsy sufferers typically experience frequent seizures. These seizures are due to a disruption in the brain’s electrical activity, which momentarily disrupts the messaging systems between brain cells.

This article discusses the various forms of epilepsy, including symptoms, options for treatment, and prognoses.

Definition

Epilepsy is defined as “a common brain condition that causes repeated seizures,” by the Centers for Disease Control and Prevention (CDC).

Symptoms

Epilepsy lady
A person with epilepsy may experience short blackouts or confused memory.

Recurrent seizures are the primary symptom of epilepsy. When a person experiences one or more of the following symptoms, however, they should seek medical attention, as epilepsy may indicate:

  • a convulsion with no fever
  • short blackouts or confused memory
  • intermittent fainting spells, during which they lose bowel or bladder control, frequently followed by extreme tiredness
  • temporary unresponsiveness to instructions or questions
  • sudden stiffness for no apparent reason
  • sudden falling for no apparent reason
  • sudden bouts of blinking without apparent stimuli
  • sudden bouts of chewing without any clear reason
  • temporarily seeming dazed and unable to communicate
  • repetitive movements that seem involuntary
  • fearfulness for no apparent reason
  • panic or anger
  • peculiar changes in senses, such as smell, touch, and sound
  • jerking arms, legs, or body, which will appear as a cluster of rapid jerking movements in babies

When any of those symptoms arise regularly, it is important to seek treatment with a doctor.

The following conditions can cause similar symptoms to those mentioned above, and some people can confuse them for epileptic ones:

  • high fever with epilepsy-like symptoms
  • fainting
  • narcolepsy, or recurring episodes of sleep during the day
  • cataplexy, or periods of extreme muscle weakness
  • sleep disorders
  • nightmares
  • panic attacks
  • fugue state, a rare psychiatric condition in which a person forgets details about their identity
  • psychogenic seizures, or seizures with a psychological or psychiatric cause

Treatment

Some types of epilepsy do not actually receive cure.

A doctor can prescribe antiepileptic drugs (AEDs) to help in seizure prevention. If such medications do not function, then some other possible treatments include surgery, stimulation of the vagus nerve, or a special diet.

The goal of doctors is to prevent further seizures. They also seek to prevent side effects so that the individual can have a healthy and active life.

AEDs

According to the American Epilepsy Community, AEDs tend to help control seizures in around 60–70 percent of cases. The type of seizure a person has will determine which drug the doctor prescribes.

People take most AEDs by mouth. Popular epilepsy-treatment medicines include:

  • valproic acid
  • carbamazepine
  • lamotrigine
  • levetiracetam

It is important to remember that certain drugs in one person can prevent seizures but not in another. Also, even when a person finds the right medication, finding the optimal dose may take some time.

Surgery

If at least two medications were ineffective in controlling seizures, a doctor might consider prescribing surgery for epilepsy. A Swedish study in 2013 found that 62 per cent of adults and 50 percent of children with epilepsy had no seizures following epileptic surgery for around 7 years.

Some surgical options, according to the National Institute for Neurological Disorders and Stroke, include:

  • Lobectomy: During this procedure, a surgeon will remove the section of the brain in which seizures start. This is the oldest type of epilepsy surgery.
  • Multiple subpial transection: During this procedure, a surgeon will make several cuts to limit seizures to one part of the brain.
  • Corpus callosotomy: A surgeon will cut the neural connections between the two halves of the brain. This prevents seizures from spreading from one side of the brain to the other.
  • Hemispherectomy: In extreme cases, a surgeon may need to cut out a hemisphere, which is one half of the cerebral cortex of the brain.

Many people may undergo surgery to reduce the frequency and severity of seizures they have. Sometimes however, it is necessary to continue taking antiseizure medication after the procedure for several years.

Another surgical option is to have a device implanted in the chest to stimulate the lower neck vagus nerve. The device sends electrical stimulation preprogrammed into the brain to help reduce seizures.

Diet

Diet may be a part of raising seizures. A research review published in the journal Neurology in 2014 indicated that high-fat, low-carbohydrate diets could support children and adults with epilepsy.

Six of the study experiments used the ketogenic diet, while a further six used a modified version of Atkins. Typical foods in these diets include eggs, bacon, avocados, cheese, nuts, fish, and some vegetables and fruits.

The analysis showed that 32 per cent of research participants adhering to the ketogenic diet and 29 per cent of those adopting the modified Atkins diet reported at least 50 per cent decrease in seizure regularity. Many participants, however, had difficulty sustaining such diets.

Specific diets may be beneficial in some cases, but more research is needed to confirm this.

Causes

Messaging systems control every function in the human body inside the brain. Epilepsy occurs as a result of a disruption in the system that may arise from brain dysfunction.

For certain cases the exact cause would not be clear to health care professionals. Many people inherit genetic factors which are more likely to cause epilepsy. Other factors which may increase the risk include:

  • head trauma, such as from a vehicle accident
  • brain conditions, including stroke and tumors
  • infectious diseases, such as viral encephalitis
  • cysticercosis
  • AIDS
  • prenatal injury or brain damage that occurs before birth
  • developmental conditions, including autism and neurofibromatosis

Epilepsy is most likely to occur in children under 2 years of age, and adults over 65 years of age, according to CDC.

Is epilepsy common?

In 2015, the CDC estimated that about 1.2 percent of the U.S. population was affected by epilepsy. That’s around 3.4 million people including 3 million adults and 470,000 children.

World Health Organization (WHO) reports about 50 million people worldwide are affected by epilepsy.

Types

Occasionally, physicians may determine the cause of a person’s seizures. There are two major categories of seizures that depend on whether they can determine the cause or not:

  • Idiopathic, or cryptogenic: There is no apparent cause, or the doctor cannot pinpoint one.
  • Symptomatic: The doctor knows what the cause is.

There are also three generalized seizure descriptors — partial, generalized, and secondary — depending on which region of the brain the seizure originates in.

The experience of a person during a seizure will depend on the region of the brain affected and how quickly and rapidly the electrical activity in the brain spreads from that initial location.

The sections below deal in more detail with generalized partial, primary, and secondary seizures.

Partial seizure

A partial seizure happens in one part of a person’s brain when the epileptic activity happens. Partial seizure has two subtypes:

  • Simple partial seizure: During this type of seizure, the person is conscious. In most cases, they are also aware of their surroundings, even when the seizure is in progress.
  • Complex partial seizure: During this type, the seizure impairs a person’s consciousness. They will generally not remember the seizure. If they do, their memory of it will be vague.

Generalized seizure

A generalized seizure happens when both halves of the brain are impaired by epileptic activity. Usually the person will lose consciousness while the seizure is in progress.

There are many subtypes of generalized seizure, including: tonic-clonic seizures: Maybe the best-known type of generalized seizure, tonic-clonic seizures cause loss of consciousness, body stiffness, and shaking. Such grand mal seizures have been called by doctors previously.

  • Absence seizures: Previously known as petit mal seizures, these involve short lapses of consciousness wherein the individual appears to be staring off into space. Absence seizures often respond well to treatment.
  • Tonic seizures: In tonic seizures, the muscles become stiff, and the person may fall.
  • Atonic seizures: A loss of muscle tone causes the individual to drop suddenly.
  • Clonic seizures: This subtype causes rhythmic, jerking movements, often in the face or one arm or leg.
  • Myoclonic seizures: This subtype causes the upper body or legs to suddenly jerk or twitch.

Secondary generalized seizure

A secondary generalized seizure happens when the epileptic activity starts as a partial seizure but spreads to both brain halves. The person will lose consciousness as this seizure progresses.

Diagnosis

To diagnose epilepsy, a doctor must review the medical history of an patient and the symptoms they have encountered, including a summary and timeline of past seizures.

They can also ask for testing to assess the severity of epilepsy and the number of seizures the patient has. The doctor will be able to prescribe treatment choices based on these tests, such as antiseizure drugs.

Testing for epilepsy

An EEG can help doctors test for epilepsy.
An EEG can help doctors test for epilepsy.

A doctor can be able to detect epilepsy through different forms of imaging tests. These measures cover:

  • an EEG, to look for abnormal brain waves
  • CT and MRI scans, to detect tumors or other structural irregularities
  • functional MRI scans, which can identify normal and abnormal brain function in specific areas
  • single-photon emission CT scans, which may be able to find the original site of a seizure in the brain
  • a magnetoencephalogram, which can identify irregularities in brain function using magnetic signals. p

The doctor can also use blood testing to determine any problems underlying the epilepsy may be causing. Neurological tests can also help a doctor assess the type of epilepsy the patient has.

Is epilepsy genetic?

Approximately 70–80 percent of cases of epilepsy occur as a result of genetics, according to one 2015 research study.

A 2017 research review related more than 900 genes to epilepsy. As more studies take place, the number continues to rise.

Genes may directly contribute to epilepsy, brain anomalies that may lead to epilepsy, or other seizure-causing genetic conditions.

For certain cases genetic factors are inherited. Nevertheless, in humans without a family history of the disease, other genetic abnormalities can also cause epilepsy.

A doctor might often ask for genetic testing to assess the cause of the epilepsy.

Triggers

Seizures can result from a variety of factors. One research in 2014 reported stress, sleep deprivation and exhaustion among 104 participants as the most frequent triggers. Flickering lights and high alcohol intake also can cause seizures.

Stress is a common cause of seizures but it’s unclear why. This cause was the focus of 2016 study in the journal Science Signaling. The team found that the reaction to stress in the brain worked differently in epileptic rats than in those without.

The study has found that instead the molecule, which normally suppresses brain activity in response to stress, has increased activity. Which can aid in seizures.

Epilepsy vs. seizures

The primary symptom of epilepsy is seizures. In fact, epilepsy is described by Johns Hopkins Medicine as having “two or more unprovoked seizures.” Some people may have a single seizure, or they may have seizures not triggered by epilepsia.

Doctors may also misdiagnose nonepileptic seizures as epilepsy. Nonepileptic seizures however are not caused by irregular electrical activity in the brain. The causes of these may be physical, psychological or emotional.

There are also various forms of epilepsy that can vary among people suffering from epilepsy. For example, in two people with epilepsy the disorder can look different.

For this reason, the CDC describe epilepsy as a spectrum disorder.

Is it a disability?

The Americans with Disabilities Act (ADA) bans discrimination against disabled people, including epilepsy. This applies whether the person is able to use medicine or surgery to treat their seizures or not.

Persons with epilepsy are protected under the ADA by some occupational protections, including the following:

  • Employers may not ask about job applicants’ medical conditions, including epilepsy.
  • Job applicants do not need to inform an employer that they have epilepsy unless they need reasonable accommodation during the application period.
  • Employers may not cancel a job offer if the person can complete the primary functions of the job.

People with epilepsy can be eligible for disability compensation according to the Social Security Administration. This allows people to record the form and frequency of their seizures by taking all the prescribed medications.

Warning devices

Some devices can control seizures and alert caregivers, possibly improving treatment and preventing sudden unexpected epileptic death (SUDEP).

One such multimodality device, the Nightwatch, was compared to an Emfit bed sensor by a small 2018 study involving 28 participants, the findings of which appeared in the journal Neurology. The Nightwatch recorded 85 percent of all serious seizures compared to the bed sensor’s 21 percent. Every 25 nights it also missed only one serious attack.

According to one report in 2017, approximately 70 percent of SUDEP cases occur during sleep. This means that the use of accurate nighttime warning systems may be of potential benefit.

Is it contagious?

All may develop epilepsy but it is not contagious. A research review in 2016 illustrated several misconceptions and stigma about epilepsy, including the false belief that epilepsy would spread amongst people.

The authors of the study note that people with lower rates of education and socioeconomic status had a high rate of misconceptions, as did those who did not encounter any individuals with epilepsy.

As a consequence, therapies and other educational initiatives can be useful in reducing epileptic stigma and improving awareness of the disorder.

Prognosis

Epilepsy will affect a person’s life in several ways and the outlook may depend on various factors.

Sometimes, seizures can be fatal, depending on the circumstances. However, many people with epilepsy use antiseizure drugs to treat their seizures.

The alleged relationship between seizures and brain damage needs to be confirmed by further studies.

Is epilepsy fatal?

Seizures can lead to drowning, falling, car accidents or other fatal injuries. Although it is uncommon, it may also occur at SUDEP.

Cases of SUDEP usually occur during or immediately after a seizure. For instance, the seizure could cause the person to go too long without breathing, or it could lead to heart failure.

SUDEP’s exact cause is unknown but a 2018 animal study indicated that it could be explained by acid reflux.

SUDEP did not occur in the rats which the researchers examined after blocking acid from entering the esophagus. However, it’s not obvious if this has any significance to humans.

Individuals are at higher risk of SUDEP if they have had epilepsy for several years, or if they have frequent seizures, according to the CDC. Following those steps can help to reduce SUDEP’s risk:

  • taking all doses of antiseizure medication
  • limiting alcohol intake
  • getting sufficient sleep

Taking the prescribed medication daily can also help avoid epileptic status, a disorder in which seizures last longer than 5 minutes.

A research carried out in 2016 showed that treating the epileptic condition within 30 minutes decreased the risk of death.

Will seizures continue?

A research review in the Brain journal in 2013 found that 65–85 percent of people may experience long-term seizure remission.

Nevertheless, seizures with an apparent cause are more likely to occur.

Other factors which affect remission chances include:

  • access to treatment
  • response to treatment
  • other health conditions a person may have

The majority of people with epilepsy will be able to control their seizures with the proper use of antiseizure drugs.

Can epilepsy lead to brain damage?

Research into whether seizures can cause brain damage or not has provided mixed findings.

A 2018 study examined at postoperative brain tissue from people with recurrent seizures. The authors identified no signs of brain damage in people with other forms of epilepsy.

Several other studies, however, have indicated that serious, long-lasting seizures may cause brain injury. For example, one study in 2013 showed that seizures may lead to anomalies in the brain, with epileptic status causing permanent brain lesions.

Many studies have explored cognitive changes in children as they mature, with or without epilepsy. Results suggest that epilepsy is associated with worse cognitive outcomes.

However, it is unclear whether:

  • epilepsy causes the impairment
  • a similar structural change causes both epilepsy and the impairment
  • antiepileptic drugs have an effect

This is an area that needs further research.

Other effects

Epilepsy can affect various aspects of a person’s life, including their:

  • emotions and behavior
  • social development and interaction
  • ability to study and work

The scale of impact on these areas of life will depend largely on the frequency and severity of their seizures.

Life expectancy of people with epilepsy

Researchers from Oxford University and University College London, both in the UK, reported in 2013 that people with epilepsy are 11 times more likely to suffer premature death than those without it.

When the individual also has a mental health disorder, the risk tends to be greater. Suicide, injuries, and attacks were responsible for 15.8 percent of early deaths. Most individuals affected by these have had been diagnosed with a disease of mental wellbeing.

Lead researcher Seena Fazel says, “Our findings have important public health consequences, as about 70 million people worldwide have epilepsy, and they emphasize that actively identifying and treating psychiatric conditions as part of routine tests in [people] with epilepsy may help to minimize the risk of premature death in these patients.”

“Our study,” he adds, “also highlights the importance of suicide and nonvehicle accidents as major preventable causes of death in people with epilepsy.”

Risk factors

Several factors may have correlations with an increased risk of epilepsy. Such factors include, according to a research review in the journal NeuroToxicology in 2017,:

  • age, with new cases occurring more frequently in young children and older adults
  • brain injuries and tumors
  • genetics and family history
  • alcohol consumption
  • perinatal factors, such as stroke and preterm birth
  • central nervous system infections, such as bacterial meningitis, viral encephalitis, and neurocysticercosis

Some risk factors, such as alcohol intake, can be changed when attempting to prevent epilepsy from developing.

Is it curable?

There is currently no treatment for epilepsy but it is generally possible for people with the condition to control their symptoms.

According to the WHO, antiseizure drugs will reduce their seizure frequency and severity by up to 70 percent in people with epilepsy. After 2 years without a stroke, about half of all people with epilepsy will be able to avoid taking medicine.

In certain cases, surgery can also minimize or remove seizures where there is ineffectiveness of medications.

That can have benefits in the long term. In one study in 2018, 47 percent of participants reported no serious seizures 5 years after surgery, and after 10 years 38 percent reported the same.

Prevention

The WHO states that nearly 25 percent of cases of epilepsy are preventable. By following those steps, people can reduce the risk of developing epilepsy:

  • wearing a helmet when riding a bicycle or motorcycle, to help prevent head injuries
  • seeking perinatal care, to prevent epilepsy from birth injuries
  • managing risk factors for stroke and heart disease, which could cause brain damage that results in epilepsy
  • practicing good hygiene and preventative methods to avoid cysticercosis, an infection that is the most common cause of epilepsy around the world, according to the CDC.

A 2015 research review in the journal Seizure also indicated that routine physical activity could help prevent epilepsy development and that how often seizures occur.

Most forms of epilepsy are not preventable. Taking the above measures can however help to reduce the risk.

Complications

Seizures can result in negative outcomes, such as drowning or vehicle accidents, depending on the situation. Long lasting seizures, or epileptic status, can also result in brain injury or death.

Those with epilepsy are eight times more likely to suffer many other health disorders like dementia, migraine, heart disease and depression than those without it. Any of those conditions may even trigger seizures.

Many problems can occur because of the side effects of antiseizure drugs. For example, one study in 2015 showed that 9.98 per cent of people taking the lamotrigine (Lamictal) antiseizure drug developed a skin rash.

Many AEDs, like phenytoin (Dilantin) and phenobarbital, can also cause rash. The rash normally vanishes as soon as the person stops taking the medicine. However, 0.8 percent of adults –1.3 percent developed a severe rash that could be fatal.

Question:

Does a person with epilepsy typically experience one type of seizure, or multiple types?

Answer :

Most people who have epilepsy will experience only one type of seizure. However, some people with epilepsy experience more than one type of seizure — especially those who have seizures caused by epilepsy syndromes, which usually begin during childhood. Heidi Moawad, M.D.

Answers represent our medical experts’ opinions. All material is purely informational and the medical advice should not be considered.

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