Epilepsy – Symptoms, Risks, Causes and Treatment

WHO states that epilepsy affects around 50 million people worldwide, and nearly 80% of people with epilepsy live in low and middle-income countries. Further, it leads to significantly greater mortality in these areas, and it's estimated that the majority of these deaths could be prevented by better diagnosis and treatment. In addition, deaths caused by falls, drowning, burns and prolonged seizures are more prevalent in low- and middle-income countries. But what actually epilepsy is, read on to know.

Epilepsy is a neurological disorder in which the brain acts abnormally. It gives rise to activities such as loss of awareness, seizures, periods of unusual sensation and behaviours. Further, epilepsy disease is devoid of gender, race, background and age as anyone can develop its symptoms. Though seizure attacks characterise it, a single seizure does not necessarily mean epilepsy. There must be at least two seizures without obvious triggers that happen at least 24 hours apart to qualify as a case of epilepsy.

The doctors classify Epilepsy into four categories. They are as follows -

• Generalised Epilepsy - This type of epilepsy occurs when seizures affect the brain simultaneously on both sides or when it affects the networks of brain cells on either side.

• Focal Epilepsy - Partial seizures characterise this epilepsy type. These seizures originate in certain networks or areas of brain cells on a single side of the brain. Further, it is also termed "partial seizures."

• Focal and Generalised Epilepsy - Just going by the name, it is clear that under this type of epilepsy, people may suffer from both generalised as well as focal seizures.

• Unknown if Focal or Generalised Epilepsy - Doctors often classify a person's epilepsy as focal or generalised, but they don't always know which type it is. This can happen when someone is alone during a seizure attack, so no one else can describe the situation. Further, if the test doesn't reflect clear results, the doctor may classify it as "unknown if generalised or focal epilepsy".

The seizure attacks can either be focal or generalised, based on the point of activity inside the brain. There are 2 types of seizures related to epilepsy, that are as follows -:

1. Focal Seizures

Focal seizures are those caused by abnormal activity in just one area of your brain. These seizures are divided into two categories:

a. Seizures without loss of consciousness – The patient retains consciousness during an aware focal seizure, previously called a simple partial seizure. Symptoms include –

• Change of taste, hearing, smell, touch or other sensations.
• Feeling of dizziness.
• Tingling and twitching sense in the limbs.

b. Focal seizures with impaired awareness – Focal unaware seizures involve a failure to be aware of one's surroundings while they are occurring. The symptoms include –

• Staring blankly
• Unresponsiveness
• Performing some repetitive movements

2. Generalised Seizures

A generalised seizure occurs with the involvement of all areas of the brain. It is of six types, and they are as follows -

• Absence seizures - Absence seizures are also known as petit mal seizures. They cause short episodes of loss of awareness, a blank stare, and repetitive movements such as blinking and lip-smacking.
• Tonic seizures - Tonic seizures are characterised by sudden stiffness or involuntary movements in the muscles of your trunk, arms, or legs.
• Atonic seizures - A sudden loss of muscle reflexes causes atonic seizures. They can also cause you to lose muscle control and fall suddenly to the ground.
• Clonic seizures - A person having a clonic seizure may exhibit repeated involuntary contractions of the muscles in the face, neck and limbs.
• Myoclonic seizures - It can cause a person's arms and legs to twitch quickly. These seizures may occur spontaneously or as clusters.
• Tonic-clonic seizures – Previously called grand mal seizure, is characterised by the following symptoms –

Stiffening of the body

Shaking

Loss of bladder or bowel control

Biting of the tongue

Loss of consciousness

The signs and symptoms of epilepsy are as follows –

• Temporary confusion
• A staring spell
• Stiff muscles
• Uncontrollable muscle movements or jerking of legs and arms
• Loss of awareness about the surroundings and consciousness
• Psychological symptoms like fear, anxiety or others

The common causes of epilepsy are as follows –

• Genetic influence – Certain genes can make people highly sensitive to environmental conditions that trigger epilepsy.
• Head trauma – Head injuries incurred through accidents or other traumatic incidents.
• Brain abnormalities – Vascular malformations like cavernous malformation and AVMs (arteriovenous malformations) or brain tumours can cause epilepsy.
• Infections – Some parasitic infections like HIV, meningitis and viral encephalitis can also cause this disease.
• Prenatal injury – A child's brain damage occurs before birth due to a mother's lack of nutrition or infection.
• Developmental disorders – Autism can lead to epilepsy as well.

The factors that can increase the risk of epilepsy are as follows

• Age - Epilepsy typically develops during childhood or old age or during a period of brain development.
• Family history - People with a family history of seizure disorder are more likely to develop epilepsy.
• Head injuries - People with a history of head injury are at an increased risk of developing epilepsy. People can reduce their risk of developing epilepsy by wearing seat belts while driving a car and helmets while skiing, or riding a bicycle or motorcycle. Further, safety measures should be maintained while engaging in activities with a high risk of head injury.
• Certain vascular diseases and stroke - People who have suffered a stroke or other vascular diseases are at increased risk of developing epilepsy. To lower your chances of having a stroke, avoid the use of alcohol, tobacco products and excessive amounts of certain foods. Exercise regularly, maintain a healthy weight and limit the amount of sodium you eat.
• Dementia - Older adults with dementia are more likely to develop epilepsy than those without the disease.
• Brain infections - People with infections such as meningitis, which causes inflammation in the spinal cord or brain, are at higher risk for developing epilepsy.
• Seizures in childhood - High fevers in childhood can sometimes cause seizures. Children who have febrile (fever-related) seizures are not likely to develop epilepsy, but if the seizure does not stop within about five minutes, it may be a sign of a more serious condition that could lead to epilepsy.

Some common complications related to epilepsy are as follows –

• People may have an intellectual disability or have a learning difficulty.
• Injury incurred after falling during a seizure attack
• Someone can get injured while operating a machine or automobile
• Depression
• Prolonged and uncontrolled seizures can damage the brain.
• Choking on saliva and food.
• Side effects of different medications.

After a thorough physical exam, a physician may prescribe various blood tests and neurological imaging tests to get to the root of the problem. The blood samples are collected to gain knowledge on –

• Signs and symptoms of any pre-occurring infectious diseases.
• Functioning of liver and kidney
• Glucose levels in the blood

Further, doctors prescribe imaging tests to patients to know the severity of the disorder, this includes –

• An electroencephalogram is a test that provides an abnormality pattern of the brain's electrical activity.
• CT scan
• MRI
• positron emission tomography (PET)
• single-photon emission computerised tomography

Epilepsy treatment depends on the severity of the symptoms. Generic epilepsy treatment methods undertaken by doctors are as follows –

• Anti-epileptic drugs - Anti-epileptic medications help prevent epileptic seizures in most people who take them as prescribed.
• Vagus nerve stimulator - Vagus nerve stimulator (VNS), a device placed under the skin on your chest, can help to reduce the frequency and intensity of seizures.
• Ketogenic diet - Ketogenic diets, high in fat and low in carbohydrates, are particularly effective for children who do not respond well to medications.
• Brain surgery - The part of the brain causing seizure activity can be surgically treated to alleviate symptoms.
• Medications – Some common medications for epilepsy include –

Levetiracetam (Keppra)

Lamotrigine (Lamictal)

Topiramate (Topamax)

Valproic acid (Depakote)

Carbamazepine (Tegretol)

Ethosuximide (Zarontin)

Though early treatment can help curb seizure attacks, but certain steps can be taken to prevent the signs further, they are as follows –

• Keeping a seizure log can help identify possible triggers and modify the routine accordingly to avoid them.
• People with epilepsy should wear medical-alert bracelets to ensure that they receive prompt medical treatment if a seizure occurs.
• It is important to teach those people close to you what to do if someone they care about has a seizure.
• One should consult a mental health professional if he or she is experiencing symptoms of depression or anxiety.
• People who have seizure disorders can join support groups to learn more about and share experiences with other people.
• Individuals should indulge in health-promoting activities that include eating a well-balanced diet and regular exercise.

Epilepsy affects people in different ways. But to realise that staying well-informed about the condition and keeping a positive attitude is very important. Furthermore, working closely with a healthcare team is essential to curb seizures so that an individual can lead a full and balanced life.