Epilepsy: Symptoms, Causes, Diagnosis and Treatment
Epilepsy is a neurological condition that affects the brain and causes recurrent seizures. This occurs due to a disruption of electrical activity in the brain, which temporarily disturbs the messaging systems between brain cells.
Epilepsy is one of the most common neurological disorders that can affect people of all ages, gender and ethnic background, but the incidence of epilepsy is slightly higher in men compared to women, and is most likely to develop in children under 2 years and adults over 65 years.
According to the WHO, approximately 50 million people worldwide live with epilepsy, and nearly 80% of people with epilepsy live in low- and middle-income countries.
Types of Seizures and Their Symptoms
People who had epilepsy may experience recurrent seizures, which is the main symptom of epilepsy. Seizures can affect people in different ways, depending on which part of the brain is affected.
Some seizures cause the body to shake and jerk, while others cause problems like loss of awareness or unusual sensations.
The specific symptoms you have will depend on your type of epilepsy. The following are some of the common types of seizures and their symptoms.
Partial (focal) seizures
This occurs when the epileptic activity takes place in one part the person’s brain. There are two types of partial seizures:
Simple partial seizure
In 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.
Symptoms of a simple partial seizure include:
- Alterations to sense of smells or taste
- Tingling and twitching of limbs
- An intense feeling of fear or joy
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.
Symptoms of a complex partial seizure include:
- Staring blankly
- Making random noises
- Adopting an unusual posture
- Fiddling with objects
- Performing repetitive movements
- Chewing or swallowing
This occurs when the epileptic activity takes place in both sides of the brain. There are six different types of generalized seizures:
Also known as petit mal seizures, they mainly affect children but can happen at any age. Symptoms of absence seizures include:
- Stare blankly into space for a few seconds
- Eyelid flutters
- Chewing motions
- Small movements of both hands
Tonic seizures can cause the muscles become stiff, and the person may fall. They happen most often during sleep. The symptoms include:
- Muscles in the arms, legs, and back suddenly become stiff.
- Possible loss of consciousness and falling.
Myoclonic seizures often happen in the first few hours after waking up and can occur in combination with other types of generalized seizures. It can cause your arms, legs or upper body to jerk or twitch, much like if you have received an electric shock. They often only last for a fraction of a second, and you should remain conscious during this time.
Clonic seizures can cause rhythmic, jerking movements, mostly in the face, or one arm or leg.
This causes the same symptoms as myoclonic seizure, except the symptoms will last longer, normally up to two minutes. Loss of consciousness may occur.
Tonic-clonic (grand mal) seizures is the most common type of generalized seizure that involves the entire body. As implied by the name, they combine the characteristics of tonic and clonic seizures. The seizure normally lasts between one and three minutes but they can last longer. Symptoms may include:
- Stiffening of the body
- Screaming or crying out involuntarily
- Biting of the tongue
- Loss of consciousness
Often called as drop seizures, atonic seizures cause all your muscles to suddenly relax, so there is a chance you will fall to the ground. Possible symptoms include:
- Briefly losing consciousness
- Sudden loss of muscle tone
What Causes Epilepsy?
The causes of epilepsy can be complex and sometimes hard to identify. However, there are several factors that may increase the risk, including:
- A severe head injury
- Brain tumor
- Lack of oxygen to the brain
- An infection of the brain, such as meningitis, encephalitis or neurocysticercosis
- Dementia or Alzheimer’s disease
- Certain genetic syndromes
- Prenatal injury or brain damage that occurs before birth
How is Epilepsy Diagnosed?
In order to diagnose epilepsy, your GP may refer you to a specialist called a neurologist (a doctor who specializes in conditions that affect the brain and nerves. The doctor will ask about your medical history and the symptoms you have experienced.
Your doctor will also order some tests to determine the causes and type of epilepsy. These tests can include blood tests, an EEG (recording of the brainwaves) and a brain scan.
This test to measure red and white blood cell counts, and to evaluate liver and kidney function. These are helpful in ruling out a chemical cause of your seizures.
This is the most common test used in diagnosing epilepsy. It is used to check for unusual electrical activity in the brain that can happen in people with epilepsy.
During the test, small sensors are attached to your scalp to pick up the electrical signals produced when brain cells send messages to each other.
These signals are recorded by a machine and are looked at to see if they’re unusual. The results of an EEG can help doctors to make the right diagnosis and decide on the best treatment.
A brain scan can help to find the cause of your epilepsy such as:
- Brain tumour
- Damage to the brain, such as damage caused by a stroke
- Scarring in the brain
The two common used brain scan are magnetic resonance imaging (MRI) and computed tomography (CT) scan.
- Magnetic resonance imaging (MRI). An MRI uses a magnetic field and radio waves to create a detailed image of your brain. It can detect abnormalities or lesions in your brain that could be causing your seizures. MRI is considered the best imaging method for epilepsy because it’s especially sensitive to detecting a variety of seizure causes.
- Computerized tomography (CT) scan. A CT scan uses X-rays to create cross-sectional images of your brain. CT scans can be used to find obvious problems in your brain such as bleeding, tumors, cysts, or structural abnormalities.
How is Epilepsy Treated?
Epilepsy is usually treated with prescription drugs to control seizures, but if medications don’t treat the condition, treatment may also involve surgery, nerve stimulation, or special diets, depending on your situation and how well your seizures are controlled with medication.
Medications such as anti-epileptic drugs (AEDs) are often used to treat epilepsy. About 70% of people with epilepsy have their seizures controlled with AEDs. The aim of this treatment is to reduce the frequency of seizures, rather than curing the underlying condition.
The choice of which drugs to be prescribed and at what dosage depend on your age, the type of seizures and your overall health.
Like many drugs, antiepileptic drugs may have side effects. Some common side effects of AEDs include drowsiness, dizziness, mood disorders, poor coordination, irritability, or skin rash. Your doctor will discuss potential side effects and how long they may affect you.
If the medications do not seem to control seizures, or the seizures are due to a brain lesion or tumor, brain surgery may be performed to treat the problem. The goal is to identify an abnormal area of brain cortex from which the seizures originate and remove it without causing any major functional impairment.
During the surgery, the surgeon makes a small cut in your scalp and creates an opening in your skull so they can remove the affected part of the brain.
If the area of the brain is too big or important to remove, there’s another procedure called multiple subpial transection where the surgeon makes cuts in the brain to interrupt the nerve pathway. This keeps seizures from spreading to other areas of the brain.
There are risks to any surgery, including bleeding and infection. Surgery of the brain can sometimes result in cognitive changes. Discuss with your surgeon about the possible risks before having surgery.
Vagus nerve stimulation
This treatment involves implantation of a device called vagus nerve stimulator beneath the chest skin with its wires connected to the vagus nerve in the neck. It works by sending electrical pulses to the brain through the vagus nerve. Although it’s not clear how this stops the seizures, but it was shown to reduce seizures by 20 to 40 percent.
Most people may need to take anti-epileptic medication after treatment, although some people may be able to lower their medication dose. You may experience side effects from vagus nerve stimulation, such as coughing, shortness of breath, or throat pain.
The ketogenic diet is usually advised for children with seizures that are difficult to control or did not respond to AEDs.
A ketogenic diet is a low-carb, high-fat diet, which make seizures less likely to occur by altering the levels of chemical in the brain. It’s especially helpful for certain epilepsy syndromes and makes it possible for some people to take lower doses of medications. But, isn’t widely used in adults because a high-fat diet is linked to serious health conditions, such as cardiovascular disease and diabetes.
It should only be used under the supervision of an epilepsy specialist with the help of a dietitian.