Epilepsy
Epilepsy is a chronic noncommunicable disease of the brain that affects people of all ages. It is characterized by recurrent seizures, which are brief episodes of involuntary movement that may involve a part of the body (partial) or the entire body (generalized) and are sometimes accompanied by loss of consciousness and control of bowel or bladder function.
Seizure episodes are a result of excessive electrical discharges in a group of brain cells. Different parts of the brain can be the site of such discharges. Seizures can vary from the briefest lapses of attention or muscle jerks to severe and prolonged convulsions. Seizures can also vary in frequency, from less than one per year to several per day.
One seizure does not signify epilepsy. Epilepsy is defined as having two or more unprovoked seizures.
Two main types of seizures
Generalized seizures begin with sudden abnormal electrical activity throughout the entire brain at once. These seizure types include tonic-clonic convulsions (“grand mal” seizures) and absence seizures (“petit mal” or staring seizures).
Partial seizures begin with abnormal electrical activity in just one part of the brain. Although the activity starts in a specific area of the brain, this activity can spread to other parts as well. These seizure types include simple partial seizures, complex partial seizures, and secondarily generalized seizures.
Risk factors
Certain factors may increase your risk of epilepsy:
Age: The onset of epilepsy is most common in children and older adults, but the condition can occur at any age.
Family history: If you have a family history of epilepsy, you may be at an increased risk of seizures.
Vascular diseases: Cause brain damage.
Dementia: Dementia can increase the risk of epilepsy in older adults.
Seizures in childhood: High fevers in childhood can sometimes be associated with seizures. Children who have seizures due to high fevers generally won’t develop epilepsy. The risk of epilepsy increases if a child has a long fever-associated seizure, another nervous system condition or a family history of epilepsy.
Causes
Epilepsy is not contagious. Many underlying disease mechanisms can lead to epilepsy. The causes of epilepsy are divided into the following categories: structural, genetic, infectious, metabolic, immune and unknown. Examples include:
Brain damage from prenatal or perinatal causes (e.g. a loss of oxygen or trauma during birth, low birth weight)
Congenital abnormalities or genetic conditions with associated brain malformations
Severe head injury
Stroke that restricts the amount of oxygen to the brain
Infection of the brain such as meningitis, HIV, viral encephalitis or neurocysticercosis
Certain genetic syndromes
Brain tumour
However, if you have experienced a seizure, please note that many times, none of these diagnoses are made. In most cases, no clear cause of the seizure can be determined. Please consult with your physician about your personal situation.
Seizure triggers
Seizures can be triggered by things in the environment. Seizure triggers don’t cause epilepsy, but they may trigger seizures in people who have epilepsy. Most people with epilepsy don’t have reliable triggers that always cause a seizure. However, they often can identify factors that make it easier to have a seizure. Possible seizure triggers include:
Skipping doses of antiseizure medicines or taking more than prescribed
Hormone changes during the menstrual cycle
Lack of sleep
Skipped meals
Flashing lights
Stress
Dehydration
Alcohol
Illicit drug use
Illness
Signs and symptoms
Characteristics of seizures vary and depend on where in the brain the disturbance first starts, and how far it spreads. Temporary symptoms occur, such as loss of awareness or consciousness, and disturbances of movement, sensation (including vision, hearing and taste), mood, or other cognitive functions.
Complications
Having a seizure at certain times can be dangerous to yourself or others.
Trouble with sleep: People who have epilepsy may have trouble falling asleep or staying asleep, known as insomnia.
Memory loss: People with some types of epilepsy have trouble with memory.
Falling: If you fall during a seizure, you can injure your head or break a bone.
Accidents: A seizure that causes either loss of awareness or control can be dangerous if you’re driving a car or operating other equipment.
Drowning: People with epilepsy are more likely to drown while swimming or bathing than people without epilepsy. The risk is higher because you might have a seizure while in the water.
Pregnancy complications: Seizures during pregnancy pose dangers to both mother and baby. Also, certain anti-seizure medicines increase the risk of birth defects. If you have epilepsy and you’re considering becoming pregnant, get medical help as you plan your pregnancy. Most women with epilepsy can become pregnant and have healthy babies. You need to be carefully monitored throughout pregnancy. Your medicines may need to be adjusted.
Emotional health issues: People with epilepsy are more likely to have mental health conditions. They may be a result of dealing with the condition itself as well as medicine side effects. But even people with well-controlled epilepsy are at increased risk. Emotional health problems that may affect people with epilepsy include:
Depression
Anxiety
Suicidal thoughts and behaviours
Other life-threatening complications of epilepsy are not common but may happen. These include:
Status epilepticus: This condition occurs if you’re in a state of continuous seizure activity lasting more than five minutes or it may occur if you have seizures without regaining full consciousness in between them. People with status epilepticus have an increased risk of permanent brain damage and death.
Sudden unexpected death in epilepsy (SUDEP): People with epilepsy also have a small risk of sudden unexpected death. The cause is unknown, but some research shows that it may occur due to heart or respiratory conditions. People with frequent tonic-clonic seizures or people whose seizures aren’t controlled by medicines may be at higher risk of SUDEP. It’s most common in those with severe epilepsy that doesn’t respond to treatment.
Managing Epilepsy Well Checklist
Epilepsy can get in the way of life, mostly when seizures keep happening. You can learn how to manage your epilepsy to feel better and have a more active and full life. Practice these self-management strategies to better control your seizures and your health. Self-management is what you do to take care of yourself.
You manage your epilepsy well if you:
Know about your condition
Take your seizure medicines as prescribed
Check with your doctor before taking other medicines or supplements
Keep a record of your seizures and seizure triggers to track patterns and learn how to avoid seizure triggers
Get at least 7 to 8 hours of sleep each night
Exercise regularly and safely each day
Follow a well-balanced diet and keep a healthy weight
Don’t use tobacco, drink alcohol excessively, or abuse other substances
Practice ways to lower stress
Keep in touch with friends and family for support
Talk to your doctor about health concerns
Keep other health conditions in check
Get help for emotional problems
Use memory strategies to help with memory problems
Seizure First Aid
First aid for any type of seizure
Most seizures end in a few minutes
Stay with the person until the seizure ends and he or she is fully awake. After it ends, help the person sit in a safe place. Once they are alert and able to communicate, tell them what happened in very simple terms.
Comfort the person and speak calmly
Check to see if the person is wearing a medical bracelet or other emergency information
Keep yourself and other people calm
Offer to call a taxi or another person to make sure the person gets home safely
First aid for generalized tonic-clonic (grand mal) seizures
When most people think of a seizure, they think of a generalized tonic-clonic seizure, also called a grand mal seizure. In this type of seizure, the person may cry out, fall, shake or jerk, and become unaware of what’s going on around them.
Here are things you can do to help someone who is having this type of seizure:
Ease the person to the floor
Turn the person gently onto one side. This will help the person breathe.
Clear the area around the person of anything hard or sharp. This can prevent injury.
Put something soft and flat, like a folded jacket, under his or her head
Remove eyeglasses
Loosen ties or anything around the neck that may make it hard to breathe
Stop! Do NOT
Knowing what NOT to do is important for keeping a person safe during or after a seizure.
Do not hold the person down or try to stop his or her movements
Do not put anything in the person’s mouth. This can injure teeth or the jaw. A person having a seizure cannot swallow his or her tongue.
Do not try to give mouth-to-mouth breaths (like CPR). People usually start breathing again on their own after a seizure.
Do not offer the person water or food until he or she is fully alert
An ambulance should be called if:
The person does not have a history of seizures
The seizure happened in the water
The person is not wearing any medical ID, and there is no way of knowing whether or not the seizure is caused by epilepsy
The person has a health condition like diabetes, or heart disease, or is pregnant
The seizure continues for more than five minutes
A second seizure starts shortly after the first has ended
If the individual exhibits challenges in breathing or regaining consciousness after the seizure has ceased
The person is injured
If the ambulance arrives after the person has returned to consciousness, the person should be asked whether the seizure was associated with epilepsy and whether emergency care is needed.
Prevention
Preventing head injury, for example, by reducing falls, traffic accidents and sports injuries, is the most effective way to prevent post-traumatic epilepsy.
Adequate perinatal care can reduce new cases of epilepsy caused by birth injury.
The use of drugs and other methods to lower the body temperature of a feverish child can reduce the chance of febrile seizures.
The prevention of epilepsy associated with stroke is focused on cardiovascular risk factor reduction, e.g. measures to prevent or control high blood pressure, diabetes and obesity, and the avoidance of tobacco and excessive alcohol use.
Elimination of parasites in the environment and education on how to avoid infections can be effective ways to reduce epilepsy, for example, those cases due to neurocysticercosis.
Social impacts
Pervasive myths that epilepsy is incurable, contagious, or a result of morally bad behaviour can keep people isolated and discourage them from seeking treatment.
