Epilepsy

Epilepsy is a common neurological disorder in which the normal activity of brain cells is sometimes disturbed. This can result in strange sensations, emotions and behaviour. Epilepsy can also cause convulsions, muscle spasms and a loss of consciousness.

How common is epilepsy?

Around 50 million people have epilepsy worldwide; it is especially prevalent in childhood, adolescence and old age. Epilepsy is the most common serious brain disorder worldwide.

What causes epilepsy?

Brain function is made possible by millions of tiny electrical charges passing between nerve cells in the brain and to all parts of the body. Epilepsy interrupts this normal pattern of charges with excessive electric discharges of nerve cells (also known as neurons).This can affect a person’s consciousness, movements or sensations for a brief period of time.

Epilepsy is classified into three main types:

• Idiopathic: where there is no apparent cause, but it is possible that there may be a genetic link
• Symptomatic: where a cause has been found. Causes can include: head injury, brain damage at birth, stroke, brain infection and occasionally brain tumour
• Cryptogenic: where doctors believe there is likely to be a cause but they are unable to find it.

60% of people with epilepsy have idiopathic epilepsy.

Introduction to seizures

Seizures types may vary from a very brief lapse in attention or muscle jerk to severe and prolonged convulsions. Seizures can also vary in frequency, from less than one a year to several per day.

What are the different types of seizures?

Doctors have described more than 30 different types of seizures. Symptoms vary with each seizure type, but can include muscle jerking, convulsions, memory loss, eye blinking, muscle stiffening or loosening (which can cause the person to fall), a blank stare, and loss of consciousness.

Seizures can be divided into two main categories:

• Partial seizures: start in, and affect, just one part of the brain. Partial seizures are also referred to as ‘focal’ seizures because the seizure occurs in just one area
• Generalised seizures: are the result of simultaneous abnormal activity in the whole of the brain.

What are the different types of epilepsy syndromes?

There are many different types of epilepsy and doctors have identified over one hundred different epilepsy syndromes which are characterised by specific signs and symptoms depending on where in the brain they originate. Specific classification is important as it guides treatment and determines prognosis.

How is epilepsy diagnosed?

For a diagnosis of epilepsy a person must have had two or more unprovoked seizures. But making a definitive diagnosis is not easy as there is no single test that can diagnose the disease.The first step towards diagnosing epilepsy is identifying the type of seizure and the precipitating factors.
If there is a possibility that a person has epilepsy their General Practitioner may refer them to a neurologist, who specialises in conditions affecting the brain and nervous system. Healthcare professionals use a range of tools and investigational techniques to help diagnosis including: taking a detailed patient history, witness accounts (e.g. from a family member), video recording, EEG and or neuroimaging.

How is epilepsy treated?

In most cases epilepsy is treated using antiepileptic drugs (AEDs).The goal of epilepsy treatment is to achieve freedom from seizures with minimal side effects. Monotherapy is the ideal treatment approach but 30% to 40% of patients will need combination therapy to control seizures.
Antiepileptic drug treatment should be tailored to the needs of the individual patient.The choice of which drug to prescribe and at what dosage depends on many factors including: the type of seizures a person has and how frequent they are, a person’s lifestyle and age and, for women, the likelihood of pregnancy. People with epilepsy should follow their doctor’s advice and share any concerns they may have about their medication with their doctor.