Everything You Need to Know About Epilepsy

The brain is the centre that regulates and controls all the voluntary and involuntary responses in the body. It consists of nerve cells that communicate with each other through electrical activity. Whenever there is a burst of abnormal electrical signals in part(s) of the brain that hampers normal electrical brain functioning, a seizure occurs.

Epilepsy is such a neurological condition that makes people susceptible to having recurrent unprovoked seizures. It is one of the most common disorders of the nervous system and affects people of all ages, races and ethnic backgrounds. 

What is Epilepsy?

Epilepsy is a brain disorder characterised by improper signalling of nerve cells, leading to seizures. Seizures are sudden and uncontrolled bursts of electrical activity in the brain that can cause changes in behaviours, sensations, feelings, muscle movements and consciousness levels. When an individual experiences two or more seizures with no known cause at a gap of 24 hours, it is diagnosed as epilepsy. 

Although epilepsy cannot be completely cured, there are various treatment options available. Medications are the primary approach, helping nearly 70% of people manage their epilepsy. Other treatments, such as dietary changes, neurostimulation and surgery, may be recommended based on individual needs. Effective management can significantly improve seizure control and overall well-being.

Epilepsy Symptoms

The primary epilepsy symptom is recurring seizures. The symptoms, however, may vary depending on the type of seizure experienced. Seizure signs and symptoms include:

• Momentary loss of consciousness

• Blank stare

• Unrestrained jerking movements of arms and legs

• Faster heart rate or breathing

• Problems in talking or understanding

• Changes in hearing, vision, smell, taste, feelings of numbness or tingling

• Lip-smacking, rubbing hands

• Psychological symptoms such as fear or anxiety

Types of Epilepsy

Doctors classify epilepsies by their seizure types. Seizure types are categorised based on where they originated in the brain, the level of awareness during a seizure or the presence or absence of muscle movements.

Focal (Partial) Epilepsy

This type of seizure originates due to activity in just one area or one side of the brain. It is primarily of two types:

1. Focal onset aware seizures or simple partial seizures: They do not cause a loss of consciousness. During these seizures, individuals remain awake and aware, experiencing changes in behaviours, sensations, feelings, muscle movements and levels of consciousness.

2. Focal onset impaired awareness seizures or complex partial seizures: They usually cause a change or loss of consciousness or awareness. During these seizures, people stare into space or feel dreamy and perform repetitive movements like eye blinking, hand rubbing and lip-smacking. 

Symptoms

Focal epilepsy symptoms include:

• Emotional changes

• Changes in senses like taste, smell or sound perception

• Unrestrained muscle jerks usually in arms and legs

• Visualising flashing lights, feeling dizzy or having a tingling sensation

• Staring into space and not responding in typical ways to the environment

• Performing repetitive movements such as hand rubbing or finger motions, lip smacking or chewing, eye-blinking and walking in circles

Generalised Epilepsy

This type of seizure simultaneously involves multiple areas or regions of the brain. There are six types of generalised seizures as described below:

1. Absence Seizures or Petit Mal Seizures: They typically occur in children in clusters as frequently as 100 times a day. During these seizures, children lose awareness. 

2. Tonic Seizures: During these seizures, individuals typically experience muscle stiffening in the arms, legs, back or entire body, which may lead to a loss of consciousness and falling in extreme cases.

3. Atonic Seizures or Drop Seizures: During these seizures, individuals typically experience a sudden loss of muscle control or weakness in the legs, leading to sudden collapsing or falling to the ground.

4. Clonic Seizures: They usually cause frequent or rhythmic jerking muscle movements, which affect the face, neck and arms of an individual.

5. Myoclonic Seizures: They generally appear as abrupt transitory jerks or twitches, affecting the upper body, arms and legs of an individual.

6. Tonic-Clonic Seizures or Grand Mal Seizures: These seizures are the most dramatic and result in loss of consciousness. Individuals experience body stiffening, twitching, and jerking lasting for one to five minutes. It may also lead to loss of bladder control or biting of the tongue.

Symptoms

Generalised epilepsy symptoms include:

• Brief shocks like muscle jerks or twitches

• Losing consciousness and falling off to the ground

• Muscle stiffening

• Biting the tongue

• Losing muscle control of the bowels or bladder

• Drooping of eyelids or head

• Blank stare or staring into space

• Minor muscle movements like lip smacking, chewing motions, hand motions or rubbing fingers

Idiopathic Epilepsy

Idiopathic epilepsy refers to a type of epilepsy where the underlying cause is unknown. It is characterised by recurrent seizures without any identifiable brain abnormalities or other known factors contributing to the condition. However, this is mostly an inherited type of epilepsy, which is observed in 6 of 10 cases.

Symptoms

Idiopathic epilepsy symptoms include:

• Temporary confusion

• Blank stare

• Stiffening of muscles

• Uncontrollable jerking movements of arms and legs

• Psychological symptoms like anxiety and fear

• Loss of consciousness

Cryptogenic Epilepsy

Cryptogenic epilepsy has an unknown cause like idiopathic epilepsy, but it is not inherited. It is believed to be primarily triggered by brain damage or birth injury.

Symptoms

Cryptogenic epilepsy symptoms are similar to that of idiopathic epilepsy. However, some additional neurological problems like mental retardation and cerebral palsy may often be observed in people suffering from this type of epilepsy. 

What Causes Seizures?

Seizures result from disrupted communication between neurons through electrical impulses. Epilepsy is the most common cause, but not all seizures indicate epilepsy. Other possible causes include:

• An infection in the brain like meningitis

• A high fever (febrile seizure)

• Lack of sleep

• Certain medications that treat pain or depression

• Brain injury

• Use of legal or illegal drugs

Is There a Way to Figure out What Triggers Seizures?

Individual seizure triggers vary significantly between people. However, several common factors can act as triggers, including:

• Missed medication

• Lack of sleep

• Stress

• Excessive alcohol consumption

• Menstruation

• Physical stresses like a common cold, flu or sinus infection

• Nutrient deficiencies, especially Vitamin B6

Epilepsy Diagnosis

 The diagnosis of epilepsy involves several tests, including:

• Neurological exam to assess behaviour, motor abilities and mental function

• Blood tests to detect signs of infections or genetic conditions

• Genetic testing

• Brain imaging tests such as electroencephalograms (EEG) to measure the brain's electrical activity

• Computerised tomography (CT) scan to obtain cross-sectional images of the brain

• Magnetic resonance imaging (MRI) to visualise the detailed structure of the brain and identify abnormalities like tumours or infections

• Positron emission tomography (PET) using radioactive material to visualise the brain's metabolic activity.

Treatment of Epilepsy

The treatments that may control epilepsy include:

Medications

The anti-seizure medications can effectively control seizures in about 60% to 70% of people. The U.S. Food and Drug Administration (FDA) has already approved more than 20 anti-seizure medications that can treat epilepsy in patients. Doctors try one or more medications, doses of medications or a combination of medications to find which works best in controlling seizures.

Surgery

Surgery is an option only when medications fail to control seizures. Surgery options include surgical resection (removal of abnormal tissue), stereotactic radiosurgery (targeted destruction of abnormal brain tissue), disconnection (cutting fibre bundles that connects areas of the brain) or implantation of neuromodulation devices that can effectively help in managing or controlling seizures and thus epilepsy.

Vagus Nerve Stimulation (VNS)

VNS therapy is an epilepsy treatment that stimulates the vagus nerve with electrical or manual impulses. This helps to prevent or shorten the duration of seizure attacks. 

Ketogenic Diet

A strict ketogenic diet consisting of high fat and low carbohydrates can effectively help children and adults manage epilepsy by reducing their frequency of seizures. This is a good option when medicines fail to control epilepsy.

Responsive Neurostimulation (RNS)

This is an implantable device that reduces seizures in epileptic patients. It analyzes brain activity patterns, detects seizures, and delivers electrical charges to stop seizures before they cause impairment, providing long-term relief.

Conclusion

Recent reports indicate that epilepsy affects nearly 10 million people in India. Individuals with epilepsy frequently experience recurrent seizures, which can lead to permanent brain damage and unexpected sudden death. Therefore, it is crucial to effectively manage epilepsy through measures such as adhering to a proper ketogenic diet, taking prescribed medications and considering surgeries in severe cases.

FAQs

Q1: What Are The Risks Of Having Epilepsy?

• Falling or drowning off

• Increased car accidents due to loss of awareness or control

• Problems with sleep

• Pregnancy complications

• Memory problems 

Q2: How Does Epilepsy Affect Daily Life?

People with epilepsy are more likely to have psychological problems including depression, anxiety and suicidal thoughts, which might affect their daily life.  

Q3: Can Epilepsy Be Prevented?

 To prevent epilepsy:

• Avoid traumatic brain injuries.

• Maintain a healthy lifestyle to reduce the risk of stroke or heart disease.

• Ensure proper vaccination to prevent diseases that may increase the risk of developing epilepsy.

Q4: Are There Any Natural Remedies For Epilepsy?

Certain dietary changes including the ketogenic diet can effectively decrease seizures in epileptic patients. 

Q5: What Should You Do If Someone Is Having A Seizure?

1. Move them away from any potential danger.

2. Place a cushion or something soft under their head if they are on the ground.

3. Loosen any tight clothing around their neck to ensure proper breathing.

4. Once the convulsions stop, turn them onto their side.

Q6: Who Does Epilepsy Affect?

Certain factors that increase the likelihood of being affected by epilepsy include:

1. Family history of epilepsy

2. Age, with higher prevalence in children and older adults

3. History of head injuries

4. Stroke or other blood vascular diseases

5. Dementia

6. Brain infections

Q7: How Common Is Epilepsy?

Nearly 50 million people worldwide are affected with epilepsy, making it one of the most common neurological diseases globally.

Q8: What Happens In Your Brain When You Have Epilepsy?

During an epileptic episode, the electrical activity in the brain becomes disrupted, causing imbalances in its rhythms. These imbalances can lead to the occurrence of recurrent seizures.