Epilepsy

What is epilepsy?

Epilepsy is a chronic disorder of the central nervous system characterized by abnormal brain activity, resulting in seizures, its primary feature. Other associated symptoms include loss of consciousness, unusual sensations, and some periods of unusual behavior.

Who are at risk for epilepsy?

Epilepsy affects all ages, genders, and races. However, some types of epilepsies have a genetic component and may be inherited. Infections, stroke, and head trauma may also predispose a patient to develop seizures.

Why do seizures occur?

The central nervous system, primarily the brain sends out electrical signals to different parts of the body – the muscles, the organs, and even to the different parts of the brain. That is how we are able to move the muscles, experience the five senses, and perform all normal bodily functions. When the activity of one area of the brain becomes abnormal, these signals are given out in a haphazard or excessive manner, resulting in the symptoms of epilepsy.

What are the symptoms of epilepsy?

There are different types of epilepsy, causing a multitude of symptoms. The most commonly seen symptoms are:

• Loss of consciousness
• Confusion
• Uncontrollable jerky movement of the arms and legs
• Staring spells/blank stares
• Anxiety

Not all patients with epilepsy will experience all these symptoms. Some experience only confusion and staring spells, while some patients will tend to lose consciousness and have uncontrolled movements of the extremities. In a patient with epilepsy, the symptoms will usually be similar during each episode.

What are the different types of epilepsy?

Seizures are generally categorized whether they are simple or complex, and whether they are partial (focal) or generalized. In some cases, a seizure will start out as focal and may become generalized. The classification of seizures may sometimes be difficult to understand, but here are some key features of each type of seizure:

Generalized seizures (all areas of the brain are affected)

Tonic-clonic seizures are also called “grand mal” seizures and are characterized by two stages:

• Tonic phase – the patient loses consciousness, body goes rigid, and the patient may fall to the floor
• Clonic phase – there are violent, jerking movements of the limbs, breathing difficulty, and possible loss of bladder or bowel control

The seizure will normally stop on its own after a few minutes without any intervention. Afterwards, the patient may experience headache and confusion.

Absence seizures are also known as “petit mal” seizures and does not exhibit the involuntary violent movements usually associated with seizures. A patient experiencing an absence seizure may show the following:

• Blank stares into space
• Fluttering of the eyes
• Slight jerking movements of the body or extremities

These types of seizures may last for only a few seconds and may occur several times in a day. The patient will not be able to remember what happened afterwards.

Other types of seizures include myoclonic, clonic, tonic, and atonic seizures. Status epilepticus is a name given to any type of seizure that lasts a longer time than usual and constitutes a medical emergency.

In 2017, the International League Against Epilepsy (ILAE) revised the classifications of seizures based on where the seizures began in the brain, the level of awareness during a seizure, and other features of the seizure.

ILAE 2017 Classification of Seizure Types

What are seizure triggers?

Seizures may be affected by certain factors called “triggers”. The presence of these triggers may cause some seizures to occur. The most common ones include:

• Stress
• Alcohol intake
• Inadequate sleep
• Menstrual periods
• Bright flashing lights

Identifying these triggers and avoiding them if feasible may help in controlling the disease. A seizure diary to record the instances of seizures and their circumstances may help in recognizing these triggers.

How is epilepsy diagnosed?

A neurological examination is performed to test mental function, motor abilities, and behavior. Blood tests to check the presence of infections or metabolic abnormalities may also be requested. To analyze the electrical activity of the brain, an electroencephalogram (EEG) can detect any abnormal brainwave patterns.

Other tests such as cranial tomography (CT) scan and magnetic resonance imaging (MRI) can detect the tumors or any other abnormality in the central nervous system.

Aside from avoiding seizure triggers, medications called anti-epileptic drugs (AEDs) such as perampanel, zonisamide, etc. may be prescribed by your doctor. These drugs work by regulating the electrical activity of the brain and is effective in most patients. However, most patients with epilepsy may need to take these drugs for life.

In taking medications, patients should remember to:

• Follow the doctor’s prescription as to the dose, frequency, and duration of treatment
• Not to stop taking medications unless advised by the physician
• Not switch to other brands or generic versions unless cleared by the physician
• Consult the doctor before taking other drugs or supplements
• Inform the doctor if there are untoward effects felt such as changes in mood or behavior
• Inform the doctor if seizures are not controlled and if migraines are experienced

In some cases where a specific lesion in the brain has been identified as a focus for the seizures, surgery may be performed to control or eliminate the seizures.

Ketogenic diets have also been proven to be helpful in controlling seizures.

A patient with the following should seek immediate medical attention

• Diabetes
• Pregnancy
• High fever
• Prolonged seizures lasting more than five minutes
• Consciousness or breathing not returning after the attack
• A second seizure following closely after the attack
• Injury due to the seizure
• Heat exhaustion

For more information on Epilepsy, consult your physician.