Epilepsy: Symptoms, Causes, & Treatments

What is Epilepsy?

Epilepsy, a chronic neurological disorder, is a medical condition that affects individuals across all age groups, from infants to the elderly. This disorder is characterised by recurrent, unpredictable seizures, which are essentially sudden surges of electrical activity within the brain. These seizures can manifest in a variety of ways, causing a wide range of symptoms. These symptoms can be as minor as brief lapses in attention or sudden, involuntary muscle jerks. On the other end of the spectrum, they can also be as severe as prolonged convulsions that can last for several minutes. In addition to these physical symptoms, epilepsy can also lead to changes in a person’s behaviour, as well as fluctuations in their levels of consciousness or awareness. These changes can be subtle or significant, depending on the severity of the seizure and the individual’s unique response to it.

Prevalence

Epilepsy’s prevalence varies globally, influenced by environmental risks, healthcare quality, and sociocultural dynamics.

Demographic Variations

  • Ethnicity and Socioeconomic Status: Prevalence estimates are higher among certain ethnic groups, individuals in poor health, and those in socially deprived situations.
  • Sex and Age:
    • The incidence and prevalence of epilepsy are slightly higher in men than in women, possibly due to differences in risk factor prevalence and underreporting due to sociocultural reasons in some regions.
    • Age-wise, the incidence is highest in the youngest (86 per 100,000 per year in the first year of age) and oldest age groups (up to 180 per 100,000 in those over 85), with a notable peak in children, especially in LMICs.

Influencing Factors

The prevalence and incidence of epilepsy are influenced by several factors:

  • Local Distribution of Risk and Etiologic Factors: Environmental and genetic factors play a significant role in determining the prevalence across different regions.
  • Demographic Structure: The age distribution within a population affects epilepsy rates, with higher incidences noted at the extremes of age.
  • Quality of Health Management: Access to and the quality of healthcare can significantly impact the diagnosis, treatment, and management of epilepsy, affecting prevalence rates.

Epilepsy is a condition that is influenced by a combination of genetic, environmental, demographic, and healthcare-related factors. It is important to understand these factors in order to develop targeted interventions and support systems for individuals affected by epilepsy, especially in areas with higher prevalence rates. This condition not only varies in occurrence across different populations but also presents a wide range of symptoms, which can make managing the condition challenging. As we explore the complexities of epilepsy, it is crucial to highlight its symptoms, as they play a crucial role in diagnosing and effectively treating this neurological condition.

Causes of Epilepsy

root causes of epilepsy
Known causes of epilepsy

Epilepsy has no identifiable cause in about half of those with the condition. In the other half, the condition may be traced to various factors, including:

  • Genetic influence: Some types of epilepsy, which are categorised by the type of seizure you have or the part of the brain that is affected, run in families. In these cases, it’s likely that there’s a genetic influence.
  • Head trauma: Head trauma as a result of a car accident or other traumatic injury can cause epilepsy.
  • Brain conditions: Brain conditions that cause damage to the brain, such as stroke or tumours, can cause epilepsy.
  • Infectious diseases: Infectious diseases, such as meningitis, AIDS and viral encephalitis, can cause epilepsy.
  • Prenatal injury: Before birth, babies are sensitive to brain damage that could be caused by several factors, such as an infection in the mother, poor nutrition or oxygen deficiencies. This brain damage can result in epilepsy or cerebral palsy.

Symptoms of Epilepsy

Epilepsy is characterised by the occurrence of spontaneous seizures, which can vary greatly in their presentation from one individual to another. These symptoms play a critical role in the diagnosis and management of epilepsy, highlighting the importance of understanding the wide spectrum of manifestations. Some of the common symptoms include:

  • Temporary Confusion: This symptom involves a short period where the individual may feel disoriented or puzzled. It often occurs before, during, or after a seizure. The duration can vary from a few seconds to several minutes, affecting the person’s ability to understand what is happening around them or to respond appropriately to their environment.
  • Uncontrollable Jerking Movements of the Arms and Legs: This symptom is characterised by sudden, involuntary muscle contractions that can cause vigorous jerking or shaking movements. These movements are typically seen in a type of seizure known as a “convulsive” or “tonic-clonic” seizure. The severity can vary, and the movements can involve either a specific part of the body or can be generalised, affecting both the arms and legs.
  • Loss of Consciousness or Awareness: Individuals experiencing this symptom may either completely lose consciousness or just become unaware of their surroundings, despite appearing awake. This can be particularly dangerous if the person is in a hazardous situation, such as driving or operating machinery. The loss of consciousness is more common in certain types of seizures, such as tonic-clonic seizures, whereas a partial loss of awareness may occur in focal seizures.
  • Psychic Symptoms such as Fear, Anxiety, or Déjà Vu: Psychic symptoms refer to disturbances in perception, emotion, or thought during a seizure. Individuals may experience intense emotions like fear or panic without an apparent reason. They might also encounter feelings of familiarity (déjà vu) or unfamiliarity (jamais vu) with their surroundings or people they know well. These symptoms are more typical of focal seizures affecting the temporal lobe of the brain, which is involved in processing emotions and memory.

Understanding these symptoms is crucial for early detection and intervention. Recognising the signs not only aids in timely diagnosis but also in tailoring treatment approaches that best suit the individual’s needs.

Diagnosis of Epilepsy

Diagnosing epilepsy is a multi-step process. It usually involves a medical history assessment, a neurological examination, and a series of diagnostic tests. These tests can include:

What to Do if Someone is Having a Seizure

When witnessing someone having a seizure, it’s crucial to know how to respond effectively to ensure their safety and provide the necessary support. Here are the steps you should follow:

First aid during seizure: how to help a person during epileptic seizure
Quick steps to help someone experiencing a seizure
  1. Stay Calm and Assess the Situation: Quickly assess the surroundings to remove any objects that could harm the individual during the seizure, such as sharp objects or furniture.
  2. Time the Seizure: Keep track of how long the seizure lasts. If the seizure continues for longer than five minutes, or if another seizure begins soon after the first, call emergency services immediately.
  3. Ensure Safety, Not Restraint: Gently guide them to the floor and place them on their side to maintain an open airway and prevent choking. Do not attempt to hold them down or stop their movements.
  4. Cushion Their Head: Place something soft under their head, such as a folded jacket or a pillow, to prevent head injury.
  5. Check for Medical ID: Look for any medical identification that could inform you of their condition and any necessary precautions or medications.
  6. Stay With Them: Remain with the person until the seizure ends naturally. It’s important to provide reassurance as they regain consciousness.
  7. After the Seizure: Once the seizure has ended, help the person to a sitting position and offer comfort and assurance as they may feel confused or embarrassed. Check for injuries incurred during the seizure.
  8. Do Not Offer Food or Drink: Until they are fully alert, do not give them anything to eat or drink.
  9. Seek Medical Advice: If this is their first known seizure, if they have difficulty regaining full consciousness, or if they have sustained injuries, seek medical attention.

Understanding and following these steps can make a significant difference in managing the situation safely and effectively. It’s important for both bystanders and caregivers to remain calm and supportive during and after a seizure.

Epilepsy Treatment Options

Treatment options for epilepsy
Treatment options for epilepsy

Medications

How Medications Work as a Treatment for Epilepsy:

  • Mechanism of Action: Anti-seizure medications work by altering the electrical activities in the brain. They achieve this by modifying the activity of neurotransmitters, which are chemicals that neurons use to communicate with each other. These medications can increase the activity of inhibitory neurotransmitters, which can help to calm the brain and prevent seizures. Alternatively, they can decrease the activity of excitatory neurotransmitters, which can reduce the likelihood of a seizure starting.
  • Types and Selection: There are many different types of anti-seizure medications, each with its own mechanism of action. The choice of medication, or combination of medications, is tailored to the individual based on the type of seizures they have, their age, potential side effects, and whether they have other health conditions.
  • Outcome: The goal is to achieve seizure freedom or at least a significant reduction in seizure frequency and intensity, with minimal side effects.

Surgery

physical training for parkinson's disease
Physical training for Parkinson’s Disease

How Surgery Works as a Treatment for Epilepsy:

  • Goal: The primary aim of epilepsy surgery is to remove or alter the area of the brain where seizures originate, without disrupting critical functions like speech, memory, or motor skills.
  • Types: The most common type of surgery is resective surgery, where a specific area of the brain known to cause seizures is removed. Another type is disconnective surgery, which involves cutting the pathways that allow seizure activities to spread across the brain.
  • Candidate Selection: Surgery is generally considered when medications are not effective, and when there is a clear identifiable focus or area in the brain causing the seizures that can be safely removed.
  • Outcome: Surgery can significantly reduce seizure frequency or even result in seizure freedom for many individuals. However, it carries risks and requires thorough evaluation and testing before proceeding.

Dietary Therapies

How Dietary Therapies Work as a Treatment for Epilepsy:

  • Mechanism: The ketogenic diet (high-fat, low-carbohydrate) and the modified Atkins diet (similar but less restrictive than the ketogenic diet) are thought to work by altering the body’s energy metabolism. By using fats instead of carbohydrates as the primary energy source, these diets may alter the levels of certain neurotransmitters or their receptors in the brain, which can help to stabilise neuronal activity and reduce seizures.
  • Application: These diets are often used in children but can also be effective in adults. They require careful planning and monitoring by healthcare professionals.
  • Outcome: Dietary therapies can be an effective treatment option for some individuals with epilepsy, particularly those who have not responded to medications.

Neurostimulation Therapies

How Neurostimulation Therapies Work as a Treatment for Epilepsy:

  • Mechanism: Neurostimulation therapies aim to regulate abnormal electrical activity in the brain that leads to seizures. This is achieved by delivering electrical impulses to specific areas of the brain or nerves.
    • Vagus Nerve Stimulation (VNS): Involves implanting a device that sends electrical impulses to the brain via the vagus nerve.
    • Responsive Neurostimulation (RNS): Involves a device that monitors brain activity and delivers electrical stimulation when it detects abnormal patterns that could lead to a seizure.
    • Deep Brain Stimulation (DBS): Involves placing electrodes in specific brain areas to deliver electrical impulses that regulate abnormal brain activity.
    • Trigeminal Nerve Stimulation (TNS): Involves a device that stimulates the trigeminal nerve, which is believed to have an effect on areas of the brain involved in seizures
  • Outcome: These therapies can reduce the frequency of seizures in some people with epilepsy, particularly in those for whom medications are not effective.

Medical Cannabis

How Medical Cannabis Works as a Treatment for Epilepsy:

  • Mechanism: The exact mechanism by which cannabis or its extracts might help control seizures is not fully understood. It is believed that certain compounds in cannabis, such as cannabidiol (CBD), can affect the brain in ways that may reduce seizure activity. These effects could be due to interactions with neurotransmitter systems, modulation of ion channels, or anti-inflammatory effects.
  • Research and Use: Research into medical cannabis for epilepsy has primarily focused on its safety and efficacy in treating specific forms of epilepsy, such as Dravet syndrome and Lennox-Gastaut syndrome. The use of medical cannabis or its extracts requires careful consideration and monitoring by a healthcare professional.
  • Outcome: For some individuals with specific types of epilepsy, medical cannabis may reduce the frequency and severity of seizures.

Living with Epilepsy

Epilepsy has the potential to significantly impact numerous aspects of an individual’s life. These areas can range from personal safety, due to the unpredictability of seizure occurrences, to interpersonal relationships, which may be strained due to misunderstandings or fear related to the condition. Additionally, professional life, the ability to drive, and even recreational activities can be affected by epilepsy.

Moreover, individuals living with epilepsy are often more susceptible to psychological challenges. These can include, but are not limited to, depression and anxiety, which can further complicate their daily lives. However, there are various support mechanisms and coping strategies available to these individuals. These may involve becoming part of a support group, where they can share experiences and learn from others facing similar challenges. Focusing on overall health, including diet and exercise, can also be beneficial. Effective stress management techniques can help in reducing seizure triggers, and regular medical visits ensure that their condition is being closely monitored and managed.

Written by

Priyom holds a Ph.D. in Plant Biology and Biotechnology from the University of Madras, India. She is an active researcher and an experienced science writer. Priyom has also co-authored several original research articles that have been published in reputed peer-reviewed journals. She is also an avid reader and an amateur photographer.

Written by

Priyom holds a Ph.D. in Plant Biology and Biotechnology from the University of Madras, India. She is an active researcher and an experienced science writer. Priyom has also co-authored several original research articles that have been published in reputed peer-reviewed journals. She is also an avid reader and an amateur photographer.

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