Epilepsy

Source: Adapted from Family Medical Adviser, Reader’s Digest

What is epilepsy?

Epilepsy is characterized by recurrent seizures that occur suddenly for no apparent reason. The seizures are the result of excessive and disordered electrical activity in the brain, which produces a brief change in consciousness, behaviour, emotion, movement or sensation. Epilepsy seizures are triggered by alcohol, stress, illness, skipping meals or occasionally by flashing lights, although they can occur without an identifiable trigger.

Who is at risk for epilepsy?

A tendency to develop epilepsy can be inherited, but there are numerous other causes, including strokes, brain tumours, head injury and meningitis. Epilepsy can also be brought on by alcohol and certain drugs. It is most common among children and the elderly. Some children stop having seizures as they get older.

Symptoms of epilepsy

Symptoms of epilepsy range from small areas of numbness and tingling to widespread muscle spasms and convulsions, depending on the type of epilepsy. However, such symptoms can be due to other conditions ‘ for example, certain heart conditions, panic attacks and breathing problems ‘ and so anyone who is experiencing epilepsy-like seizures should be referred as soon as possible to a neurologist or other epilepsy specialist.

Some people with epilepsy know when they are about to have a seizure because they experience an aura ‘ restlessness or an unpleasant feeling ‘ before an attack.

There are two types of epileptic seizures: generalized and partial. The whole body is affected by generalized seizures, which are the result of abnormal electrical activity over a wide area of the brain. There are several types of generalized seizure.

‘ Tonic-clonic (grand mal) seizures cause a person to lose consciousness and fall to the ground. At first the muscles contract and the body stiffens (the tonic phase), then the limbs twitch rhythmically for a time (the clonic phase) as the person goes into a deep sleep. Gradually the person regains consciousness, remembering nothing about what has happened. About 60 per cent of people with epilepsy have this type of seizure.

‘ Absence seizures (also known as petit mal) occur mainly in children. There is a sudden, brief loss of conscious activity. The condition can easily go unnoticed as it may appear as though the sufferer is merely daydreaming. Other subtle symptoms include small chewing movements, fluttering eyelids or trembling of the hands.

‘ Myoclonic seizures produce a sudden brief single or repetitive muscle contraction, involving the whole body or just one part.

‘ Atonic seizures are known as drop attacks because the brief loss of consciousness that they bring on causes children to drop to the ground for short periods. The sudden falls may result in head or other injuries.

‘ Partial seizures, also called focal seizures, are caused by abnormal activity in a small part of the brain. The location of the seizure in the body depends on which part of the brain is affected. However, a seizure can start in one part of the body and then spread. Partial seizures are subdivided into simple and complex types. During a simple partial seizure, there is no loss of consciousness ‘ a person may have muscle spasms, numbness or tingling for several minutes, but remains aware throughout. During a complex partial seizure, a person loses conscious contact with his or her surroundings for one or two minutes. The person may stare into space, move purposelessly and repetitively, make unintelligible sounds or appear confused. Usually the person will not be able to recall the episode.

Treatment for epilepsy

People with epilepsy get to know which situations bring on a seizure and so to some extent can reduce the frequency of attacks by avoiding their own particular triggers. All but the mildest of cases will need treatment.

Medications for epilepsy

The aim of drug treatment is to control seizures with minimal side effects, preferably with a single drug. The exact choice and dose depends on the type of seizure, but most patients are likely to start with either sodium valproate or carbamazepine. Other drugs that may be used include the newer anti-epileptic drugs, lamotrigine and gabapentin. The older drug phenytoin tends to be reserved for hard-to-treat cases because of its unpleasant side effects.

Other drugs used in the treatment of epilepsy include tranquillizers and antidepressants, either to help to control primary symptoms or to relieve the side effects of treatment. Some types of complementary therapy, such as relaxation techniques, massage, yoga and aromatherapy may be helpful in this respect.

Related procedures for epilepsy

Epilepsy is diagnosed mainly by the doctor listening carefully to a description of the way the seizure occurred, preferably by someone who saw it. An EEG (electroencephalogram) of electrical activity in the brain and a brain scan, usually by magnetic resonance imaging (MRI), provide additional information.

A growing number of people are having surgery for epilepsy. This is especially true of younger people with simple partial seizures, originating in the temporal lobes of the brain cortex, which do not respond to drug treatment. MRI scans and other tests help to locate the precise area of the brain affected so that it can be removed.

Living with epilepsy

Between attacks, most people with epilepsy lead perfectly normal lives, and can work or go to school or college, and take part in everyday sports and activities.

Drug therapy stops seizures in about one-third of people with epilepsy and reduces their frequency in another third. The drugs are reduced gradually over time and about two-thirds of people with well-controlled seizures can eventually stop their drugs without having a relapse. It is not known why some people stop having seizures while others continue.

Women taking anti-epileptic drugs should take medical advice before becoming pregnant as their treatment may need to be changed to avoid harming the unborn child.

Very few jobs are unsuitable for people with epilepsy, although many of those affected find it hard to overcome employer fears and prejudices. Driving restrictions may make some jobs difficult.