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Epilepsy

Epilepsy is a neurological disorder characterised by recurrent, unprovoked seizures, which are sudden bursts of electrical activity in the brain that temporarily affect how it functions. It is one of the most common neurological conditions, affecting approximately 1 in 100 people in Australia.

Epilepsy can begin at any age and its severity and impact on life vary widely among individuals.

What is Epilepsy?

Epilepsy is a chronic disorder of the brain that causes repeated seizures. A seizure occurs when there is a sudden, excessive electrical discharge in a group of brain cells. These discharges can lead to a variety of symptoms, depending on the part of the brain affected. While some people may experience brief moments of confusion or staring spells, others may lose consciousness and have violent convulsions.

Types of Epileptic Seizures

Seizures are broadly classified into two main categories: focal (partial) seizures and generalised seizures, depending on where in the brain they originate.

Overview
Focal seizures start in one specific area of the brain and can be either simple or complex, depending on whether or not consciousness is affected.

  • Simple Focal Seizures: These seizures affect a small area of the brain and do not impair consciousness. Symptoms may include twitching, unusual sensations, or sudden emotional changes.
  • Complex Focal Seizures: These seizures originate in one area of the brain but involve altered awareness or consciousness. The person may appear awake but behave in a strange or repetitive manner, such as picking at clothes or smacking lips.

Symptoms

  • Unusual sensations (tingling, hallucinations, or feelings of déjà vu)
  • Sudden, uncontrollable jerking of a body part (such as an arm or leg)
  • Unexplained fear, anxiety, or joy
  • Altered awareness or consciousness
  • Repetitive movements, such as lip-smacking or hand-rubbing

Overview
Generalised seizures involve abnormal electrical activity in both hemispheres of the brain from the onset. These seizures can be further classified into several types:

  • Absence Seizures (Petit Mal): Brief episodes of staring or “blanking out” that last for a few seconds. The person may appear to be daydreaming and is unaware of their surroundings during the seizure.
  • Tonic-Clonic Seizures (Grand Mal): The most well-known type of seizure, involving a loss of consciousness, stiffening of the body (tonic phase), followed by rhythmic jerking movements (clonic phase).
  • Myoclonic Seizures: Sudden, brief jerks or twitches of the muscles, usually occurring on both sides of the body.
  • Atonic Seizures: Sudden loss of muscle tone, causing the person to collapse or fall to the ground (“drop attacks”).
  • Tonic Seizures: Generalised stiffening of the body muscles, often leading to falls.
  • Clonic Seizures: Repeated, rhythmic jerking of muscles, usually affecting the arms, neck, and face.

Symptoms

  • Sudden loss of consciousness
  • Muscle stiffness or jerking
  • Falling to the ground without warning
  • Brief episodes of staring or blinking
  • Sudden muscle twitches or jerks
  • Loss of bladder or bowel control

Causes

In many cases, the exact cause of epilepsy is unknown, particularly when the condition is idiopathic (arising spontaneously without a known cause). However, several factors have been identified as potential causes or contributors to epilepsy:

  • Genetic Factors: A family history of epilepsy can increase the risk of developing the condition. Certain genetic mutations have been linked to specific types of epilepsy.
  • Head Injuries: Traumatic brain injuries, such as those sustained in accidents or falls, can lead to epilepsy.
  • Brain Conditions: Stroke, brain tumours, or brain infections (such as meningitis or encephalitis) can cause epilepsy.
  • Prenatal Brain Damage: Injury to the developing brain during pregnancy, due to factors such as maternal infection, poor nutrition, or oxygen deprivation, can result in epilepsy.
  • Developmental Disorders: Conditions such as autism and neurofibromatosis are associated with an increased risk of epilepsy.

Diagnosis

Diagnosing epilepsy involves a thorough evaluation by a neurologist, including a detailed medical history, a description of the seizures, and several diagnostic tests. The aim is to determine whether the seizures are caused by epilepsy or another underlying condition.

  • Medical History and Seizure Description: A detailed history of the patient’s symptoms, family history, and any prior medical conditions is essential. Witness accounts of the seizures can also provide valuable information.
  • Neurological Examination: A physical and neurological examination helps assess brain function and rule out other neurological conditions.
  • Electroencephalogram (EEG): An EEG records the electrical activity of the brain and is one of the most important tools in diagnosing epilepsy. Abnormal patterns on an EEG can indicate a tendency for seizures.
  • Imaging Tests: MRI or CT scans can help identify structural abnormalities in the brain, such as tumours, lesions, or scarring, that may be causing seizures.
  • Blood Tests: Blood tests can identify metabolic or genetic conditions that may be linked to epilepsy.

Treatment Options

While epilepsy cannot always be cured, effective treatments can help control seizures and allow individuals to lead a full and active life. Treatment is tailored to the individual and may include medications, lifestyle changes, and in some cases, surgery.

Medications are the mainstay of epilepsy treatment and are effective in controlling seizures in about 70% of people with the condition. There are many different AEDs available, and the choice of medication depends on the type of seizures, the patient’s age, and other individual factors.

  • Common AEDs: Include sodium valproate, carbamazepine, lamotrigine, levetiracetam, and topiramate. Each works in a different way to reduce or prevent seizures by stabilising the electrical activity in the brain.
  • Side Effects: AEDs can have side effects, which may include drowsiness, dizziness, weight gain, and mood changes. It’s important to work closely with a neurologist to find the right medication and dosage.

For individuals with epilepsy that does not respond to medication (drug-resistant or refractory epilepsy), surgery may be considered. The goal of surgery is to remove the area of the brain where seizures originate or to interrupt the pathways through which seizure activity spreads.

  • Types of Surgery
    • Resective Surgery: Involves removing the part of the brain where seizures begin, typically the temporal lobe.
    • Laser Interstitial Thermal Therapy (LITT): A less invasive option that uses a laser to target and destroy the seizure focus.
    • Corpus Callosotomy: A procedure that severs the nerve connections between the two halves of the brain to prevent seizures from spreading.
    • Responsive Neurostimulation (RNS): A device is implanted in the brain to detect and respond to seizure activity, preventing the seizure from occurring.
  • VNS is a treatment option for people with epilepsy who do not respond well to medications. It involves implanting a device under the skin in the chest that sends electrical impulses to the vagus nerve in the neck. These impulses help to reduce the frequency and severity of seizures.
  • The ketogenic diet is a high-fat, low-carbohydrate diet that has been shown to reduce seizures in some people with epilepsy, particularly children with difficult-to-treat seizures. The diet alters the brain’s metabolism and is thought to help stabilise electrical activity.

Making certain lifestyle changes can help manage epilepsy and reduce the risk of seizures:

  • Regular Sleep: Maintaining a regular sleep schedule is important, as lack of sleep can trigger seizures.
  • Stress Management: Stress and anxiety can be seizure triggers, so finding effective ways to manage stress is crucial.
  • Avoiding Triggers: Identifying and avoiding specific seizure triggers, such as alcohol, flashing lights, or certain foods, can help prevent seizures.
  • Driving and Safety: In Australia, individuals with epilepsy must meet specific medical standards before being allowed to drive. It’s important to discuss driving and other safety concerns with a healthcare professional.

Living with Epilepsy ​

Epilepsy is a long-term condition that can have a significant impact on daily life, but with the right treatment and support, many people with epilepsy can live independently and pursue their goals. Support from family, friends, and healthcare professionals is essential, and there are many organisations and support groups available to provide information, resources, and community for those living with epilepsy.

Epilepsy is a complex and varied neurological disorder that requires a personalised approach to diagnosis and treatment.

With advances in medical treatment and ongoing research, many people with epilepsy can achieve good seizure control and lead fulfilling lives.

If you or someone you know is experiencing seizures, it is important to seek medical advice from a neurologist who can provide a thorough evaluation, accurate diagnosis, and a tailored treatment plan.

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