Symptoms, causes, and treatment of epilepsy
The Centers for Disease Control and Prevention (CDC) describe epilepsy as "a common neurological condition characterized by recurrent seizures."
This article will explain the types, symptoms, treatment, and prognosis of epilepsy.
Here are some key points about epilepsy.
- Epilepsy is a neurological disorder.
- Primary symptoms commonly include seizures.
- Seizures have a range of severity depending on the individual.
- Treatments include anti-seizure medications.
Epilepsy is a neurological condition.
The main symptom of epilepsy is repeated seizures. If one or more of the following symptoms are present, the individual should see a doctor, especially if they recur:
- a convulsion with no temperature (no fever)
- short spells of blackout, or confused memory
- intermittent fainting spells, during which bowel or bladder control is lost, which is frequently followed by extreme tiredness
- for a short period, the person is unresponsive to instructions or questions
- the person becomes stiff, suddenly, for no apparent reason
- the person suddenly falls for no clear reason
- sudden bouts of blinking without apparent stimuli
- sudden bouts of chewing, without any apparent reason
- for a short time the person seems dazed and unable to communicate
- repetitive movements that seem inappropriate
- the person becomes fearful for no apparent reason; they may even panic or become angry
- peculiar changes in senses, such as smell, touch, and sound
- the arms, legs, or body jerk, in babies these will appear as a cluster of rapid jerking movements
The following conditions need to be eliminated. They may present similar symptoms and are sometimes misdiagnosed as epilepsy:
- high fever with epilepsy-like symptoms
- narcolepsy, or recurring episodes of sleep during the day
- cataplexy, or periods of extreme muscle weakness
- sleep disorders
- panic attacks
- fugue states, a rare psychiatric disorder
- psychogenic seizures
Causes: How does a person get epilepsy?
A person with epilepsy will have recurrent seizures.
Every function in the human body is triggered by messaging systems in our brain. Epilepsy results when this system is disrupted due to faulty electrical activity.
In many cases, the exact cause is not known. Some people have inherited genetic factors that make epilepsy more likely to occur.
Other factors that may increase the risk include:
- head trauma, for instance, during a car crash
- brain conditions, including stroke or tumors
- infectious diseases, for instance, AIDS and viral encephalitis
- prenatal injury, or brain damage that occurs before birth
- developmental disorders, for instance, autism or neurofibromatosis
It is most likely to appear in children under 2 years of age, and adults over 65 years.
What a patient with epilepsy experiences during a seizure will depend on which part of the brain is affected, and how widely and quickly it spreads from that area.
The CDC note that the condition "is not well understood." Often, no specific cause can be identified.
Is epilepsy common?
In 2015, epilepsy affected 1.2 percent of the population in the United States, or 3.4 million people, including 3 million adults and 470,000 children.
The World Health Organization (WHO) estimate that epilepsy affects 50 million people worldwide.
There is currently no cure for most types of epilepsy. However, surgery can stop some kinds of seizure from occurring, and in many cases, the condition can be managed.
If an underlying correctable brain condition is causing the seizures, sometimes surgery can stop them. If epilepsy is diagnosed, the doctor will prescribe seizure-preventing drugs or anti-epileptic drugs.
If drugs do not work, the next option could be surgery, a special diet or VNS (vagus nerve stimulation).
The doctor's aim is to prevent further seizures from occurring, while at the same time avoiding side effects so that the patient can lead a normal, active, and productive life.
Anti-epileptic drugs (AEDs)
The majority of AEDs are taken orally. The type of seizure the patient is having will decide which drug the doctor may prescribe. Patients do not all react in the same way to drugs, but AEDs appear to help control seizures in 70 percent of cases.
Drugs commonly used to treat epilepsy include:
- sodium valproate
Some drugs may stop seizures in one patient, but not in another. Even when the right drug is found, it can take some time to find the ideal dose.
Types of epileptic seizures
There are three diagnoses a doctor might make when treating a patient with epileptic seizures:
- Idiopathic: There is no apparent cause.
- Cryptogenic: The doctor thinks there is most probably a cause, but cannot pinpoint it.
- Symptomatic: The doctor knows what the cause is.
There are three descriptions of seizures, depending on where in the brain the activity started.
A partial seizure means the epileptic activity took place in just part of the patient's brain. There are two types of partial seizure:
- Simple partial seizure - the patient is conscious during the seizure. In most cases, the patient is also aware of their surroundings, even though the seizure is in progress.
- Complex partial seizure - the patient's consciousness is impaired. The patient will generally not remember the seizure, and if they do, their memory will be vague.
A generalized seizure occurs when both halves of the brain have epileptic activity. The patient's consciousness is lost while the seizure is in progress.
Tonic-clonic seizures (previously known as grand mal seizures): Perhaps the best known type of generalized seizure. They cause a loss of consciousness, body stiffness, and shaking.
Absence seizures: Previously called petit mal seizures, these involve short lapses in consciousness where the individual appears to be staring off into space. Absence seizures often respond well to treatment.
Tonic seizures: Muscles become stiff, and the person may fall.
Atonic seizures: A loss of muscle control causes the individual to drop suddenly.
Clonic seizures: This is associated with rhythmic, jerking movements.
Secondary generalized seizure
A secondary generalized seizure occurs when the epileptic activity starts as a partial seizure, but then spreads to both halves of the brain. As this development happens, the patient loses consciousness.
Epilepsy vs. seizures
Seizures are the only symptom of epilepsy. Epilepsy is defined as having "two or more unprovoked seizures," according to Johns Hopkins Medicine.
Some people have a single seizure, or seizures that are not linked to epilepsy. According to the United Kingdom's Epilepsy Society, nonepileptic seizures are not due to electrical activity in the brain. The causes can be physical, emotional, or psychological.
There are also different types of seizure. Seizures may vary between people with epilepsy, so in two individuals, the condition may look different. For this reason, it can be called a spectrum disorder.
Epilepsy can affect a person's life in multiple ways, and the outlook will depend on various factors.
Will seizures continue?
If the cause is clearly identifiable, seizures are more likely to continue.
Other factors affecting the chances of remission include:
- access to treatment
- response to treatment
- age when symptoms started
- other neurological condition the person may have
Can epilepsy lead to brain damage?
A study published in 2005 suggested that people with severe epilepsy who continue to experience seizures were more likely to have difficulties with cognitive ability and brain function. Longer periods of remission were linked with fewer cognitive problems.
A review published in 2006 concluded that there may be a "mild but measurable" decline in some people in intellectual performance" of adults and children.
However, the researchers point out that there is little reliable research in this area, and that "Due to many confounding variables, the effect of seizures per se is difficult to estimate, but appears limited."
If there is a risk, say the authors, it appears to be higher among those with generalized symptomatic types of epilepsy, with frequent seizures that started at an early age, and a high level of antiepileptic drug use.
Recent studies have looked at cognitive changes in children as they age, either 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 the epilepsy and the impairment
- antiepileptic drugs have an effect
This is an area that needs further research
Epilepsy can affect various aspects of a person's life, including:
- emotions and behavior
- social development and interaction
- ability to study and work
The impact on these areas of life will depend largely on the frequency and severity of seizures.
Life expectancy of people with epilepsy
In 2013, researchers from the University of Oxford and University College London in the U.K. reported that people with epilepsy are 11 times more likely to experience premature death, compared with the rest of the population.
The risk appears to be greater if the person also has a mental illness. Suicides, accidents, and assaults accounted for 15.8 percent of early deaths. Most people affected by these had also been diagnosed with a mental disorder.
Head researcher, Seena Fazel said:
"Our results have significant public health implications, as around 70 million people worldwide have epilepsy, and they emphasize that carefully assessing and treating psychiatric disorders as part of standard checks in persons with epilepsy could help reduce the risk of premature death in these patients. Our study also highlights the importance of suicide and non-vehicle accidents as major preventable causes of death in people with epilepsy."