Epilepsy

What is epilepsy?

Epilepsy is a chronic disorder of the brain, which causes recurrent, unprovoked seizures. Seizures occur when sudden bursts of uncontrolled electrical energy spread across the brain typically resulting in abnormal jerking movements and impairments in consciousness.

To be diagnosed with epilepsy, one usually needs to have at least 1 unprovoked seizures,

Or 1 unprovoked seizure, but investigations show that they are at high risk of getting more seizures.

What causes epilepsy?

In about half of the people with epilepsy, there is no identifiable cause. However, there are some factors that can contribute to epilepsy: 

• Genetics – some types of epilepsy run in families.
• Head trauma – due to an accident or other traumatic injuries. 
• Brain conditions – such as tumours or strokes. Stroke is a leading cause of epilepsy in adults above age 35. 
• Infectious diseases – such as tuberculosis, meningitis, acquired immunodeficiency syndrome (AIDS) and viral encephalitis.
• Prenatal injury – a baby is sensitive to brain damage before birth. The brain damage could be caused by infections in the mother, poor nutrition or lack of oxygen. This brain damage later shows up as epilepsy or cerebral palsy. 
• Developmental disorders – such as autism and neurofibromatosis (tumour growth in the nervous system). 

What are the symptoms of epilepsy?

When there is abnormal activity in the brain, the seizures they cause can affect any process coordinated by the brain. Signs and symptoms of seizures may include:

• Temporary confusion 
• A staring spell 
• Uncontrolled jerking and shaking of the arms and legs (a “fit”)
• Stiffness of the body
• Collapsing
• Strange sensations such as a rising feeling in the tummy, unusual smells or tastes, or tingling sensations in the arms or legs 
• Loss of consciousness
• Emotional disturbances such as fear, anxiety or deja vu

There are two main types of seizures. When seizures happen due to abnormal activity in one area of the brain, it is called focal (partial) seizures. These seizures can occur without the loss of consciousness or with impaired consciousness. 

• Focal seizures without loss of consciousness

These seizures may change your emotions or sensations of how things look, smell, taste, feel or sound. They may cause involuntary movements like jerking, or sensory symptoms like tingling, dizziness and flashing lights. 

• Focal seizures with impaired consciousness 

When you have impaired consciousness, you may stare into space and not respond as per normal to your environment. It may cause you to perform repetitive movements such as hand rubbing, chewing, swallowing or walking in circles.

Symptoms of focal seizures may be misinterpreted as other conditions like migraines, narcolepsy or mental illness, and a thorough examination is therefore needed to properly diagnose and distinguish epilepsy. 

The other type of seizure is known as generalised seizures where the seizures involve all areas of the brain. 

What can trigger epilepsy?

Certain situations in the environment may increase the likelihood of seizures. These are triggers and knowing yours will help you to manage or prevent seizures. 

Some triggers include: 

• Sleep deprivation 
• Missing your medication 
• Being sick
• Feeling stressed out 
• Medications that may interfere with your seizure medication 
• Lack of vitamins or minerals 
• Menstrual cycles or hormonal changes like puberty or menopause
• Flashing lights or specific visual patterns like in video games (photo convulsive epilepsy) 
• Certain foods 
• Certain noises 
• Heavy drinking or alcohol withdrawal 
• Using recreational drugs 

Who is at risk for epilepsy?

The most common risk factors for epilepsy include:

• Age – epilepsy can start at any age but it tends to occur more frequently in children and older adults.
• Dementia (older adults) 
• Family history – if any of your family members have epilepsy, the likelihood of you developing it may be higher.
• History of head injuries – head trauma can cause seizures in hours, days, months or even years after the injury. 
• Seizures in childhood – your risk of epilepsy is higher if you have had a prolonged seizure or other neurological conditions in childhood. 
• Birth factors
  • Small size at birth 
  • Deprived of oxygen before, during or after birth 
  • Seizures in the first month after birth
  • Brain abnormalities at birth

How is epilepsy diagnosed?

If you have a seizure, you may wish to be referred to a specialist like a neurologist to conduct further tests. 

Your doctor may carry out some tests like:

A neurological examination 

Your doctor usually takes a thorough history and conducts a physical examination to determine if you be having epilepsy and to determine the type of epilepsy it may be.

Blood tests

Your doctor may draw your blood to check for infections, genetic conditions, or other conditions that may have caused the seizures. 

Your specialist may check your brain activity using an electroencephalogram (EEG) or a brain scan. 

Electroencephalogram (EEG) 

An EEG can check for unusual electrical activity in the brain in epileptic patients. Small sensors are attached to your scalp to pick up the electrical signals that the brain cells send for communication. The signals are recorded and analysed by the specialist to look for abnormalities.

Brain scans

A brain scan such as a magnetic resonance imaging (MRI) scan can use magnetic fields to create an image of the brain. This can help to detect causes of epilepsy in the brain such as:

• An unusual growth like a brain tumour 
• Damage to the brain such as a traumatic injury or effects of stroke 

Other brain scans such as a functional MRI (fMRI) or positron emission tomography (PET) may also be used. 

How is epilepsy treated?

Epilepsy can be treated with medicines (main treatment), surgery, or special diets. These may help you have fewer seizures or stop having seizures completely. Some people may need life-long treatment, but it is possible for the seizures to disappear completely in some people. It is also possible for some children to outgrow epilepsy as they age. 

Treatments include: 

• Medicines called anti-epileptic drugs 
• Surgery to remove a small part of the brain that causes the seizures 
• A procedure for a small electrical device inserted in the body that controls seizures
• A special diet such as keto diet (diet consisting only of ketones, an alternative fuel for the body) to help control seizures