Epilepsy, also referred to as a seizure disorder, occurs when a person has two or more seizures a day or more apart. A seizure is caused by abnormal electrical activity in the brain, either in one part of the brain or in the entire brain. If someone were to have one isolated seizure, that would not mean they had epilepsy. Epilepsy comes with a wide range of symptoms due to the various types of the disorder. It affects about 1 in 26 people worldwide of all backgrounds and may require lifelong treatment with medication or surgery, while some may outgrow their epilepsy.
Symptoms of epilepsy vary widely depending on what type of seizures a person has.
Common symptoms include:
A person with epilepsy may also experience symptoms before and after the seizure. Many people with epilepsy that only affects the part of the brain dealing with the perception of sensation experience what are known as auras. People who experience auras may experience feelings of dread or see specific colours right before the onset of a seizure.
Many people with epilepsy also experience what’s called a postictal state. This refers to the period of time after the seizure is over, in which those with epilepsy may experience short-term memory loss and confusion. These symptoms are temporary.
In approximately 50% of people with epilepsy, there is no apparent cause. In the other 50%, the disorder can be linked to genetics, head trauma, brain tumours or malformations, infections affecting the brain, or foetal brain damage. Some types of epilepsy have a genetic component and tend to run in families. However, a genetic mutation can occur for the first time in a person with epilepsy without them having inherited it from their parents.
Risk factors for epilepsy include age, a family history of a seizure disorder, head injuries, stroke, dementia, and infections in the brain.
A healthcare provider will take a medical history, do a physical exam, including a comprehensive neurological exam, and go over the symptoms you’ve been experiencing. They will likely order several tests to confirm a definitive diagnosis and start treatment.
These may include blood tests to detect any infections and genetic testing to see if a genetic component is at play. They may also order a magnetic resonance imaging (MRI) scan or computerised tomography (CT) scan to visualise your brain and ensure no apparent abnormalities.
An electroencephalogram (EEG) is most frequently done to diagnose epilepsy and involves temporarily gluing electrodes that can record the electrical activity in your brain to your scalp. An EEG can be done in your doctor’s office or at home. You may be asked to try and do activities that might trigger a seizure, such as sleeping as little as possible.
Your provider may follow up on these initial diagnostic tests with other imaging tests, like a positron emission tomography (PET) scan, if they think it’s necessary.
Complications of epilepsy are often related to injuries that occur when someone has a seizure, and they include:
If you have epilepsy, you can prevent seizure-related injuries by knowing your triggers and ensuring that those close to you know that you have epilepsy and what to do in the event of a seizure. Maintain open communication with your care team.
Anti-epileptic drugs (AEDs) are always tried first to treat epilepsy, although other treatment options exist. There are several AEDs you and your doctor can try. About 70% of people with epilepsy control their epilepsy with medication, either with one AED or a combination that works for them.
Surgery is an appropriate option for people with seizures that originate in a focused area of the brain and may be considered if all other treatment options have been exhausted.
Seizure devices can also provide relief by working with your body’s physiology in real time to prevent a seizure or make a seizure less severe. Three standard devices are the vagus nerve stimulator (VNS), responsive nerve stimulator (RNS), and deep brain stimulation, which involves implanting electrodes in the brain to help modify severe seizure activity.
The ketogenic diet is also considered a therapy for epilepsy. It’s not fully understood why the ketogenic diet helps reduce seizures. The ketogenic diet can be very difficult to navigate, and it’s essential to receive qualified medical help from a dietician while you use it.
Many of these therapies are used in combination with medication.