Epilepsy: Symptoms, Treatments and Causes

November is National Epilepsy Awareness Month. Epilepsy Action, one of the UK’s leading charities supporting those with Epilepsy, state that there are around 600,000 people living with epilepsy in the UK. It affects approximately 1 in every 100 people and represents 87 new diagnoses every day.

What is Epilepsy?

Epilepsy is a condition that affects the brain causing a person to experience epileptic seizures. Seizures can occur at any time however, in some cases they may have specific triggers. A seizure is defined as bursts of electrical energy within the brain that affect how it works temporarily. 

Epilepsy is usually diagnosed in children or in those over the age of 65 though it can develop at any time. Epilepsy is usually a lifelong condition once diagnosed however, it can get better over time and symptoms can be managed with proper treatment.

What are the Symptoms of Epilepsy?

The main symptom of epilepsy is repeated seizures. Seizures themselves can cause a wide range of symptoms which may vary from person to person or even seizure to seizure. 

Possible symptoms of an epileptic seizure  include:

• Uncontrollable movement or shaking, often known as a ‘fit’
• A lack of awareness, staring blankly into space
• Stiffness of the body
• Unusual sensations such as a "rising" feeling in the tummy, unusual smells or tastes, or tingling in your arms or legs
• Collapsing
• Passing out with no recollection of what has happened on awakening

Seizures can occur at any time, even during sleep. There are some common triggers found amongst those with epilepsy. 

Common triggers include:

• Feeling stressed
• Tiredness
• Waking up
• Alcohol
• Medication or use of illegal drugs
• Monthly periods (women only)

Many people often associate flashing lights with epileptic seizures; whilst this can trigger seizures in those with epilepsy, it is actually a rather uncommon trigger.

If you experience any of the above symptoms, you should visit your GP immediately.

Types of Seizures

When we think about epilepsy, we often think about fits however in reality there are many different types of seizures.

Tonic-Clonic Seizure

Tonic-clonic seizures are likely what most people are thinking of when they envision an epileptic seizure. They happen in 2 stages, the tonic and the clonic stage. 

• Tonic stage - A person will lose consciousness and their body will become stiff.  They may fall to the floor at this point.
• Clonic stage - during this stage,  the limbs will start to shake and jerk uncontrollably.  The person may also bite their tongue or cheek, struggle to breathe and may lose control of their bladder or bowel.

Tonic-clonic seizures usually last for a few minutes but can last longer. On waking up the person may not remember what happened, and may also feel confused, tired and have a headache.

It is also possible to have tonic and clonic seizures independent of one another. For example, in a clonic seizure, the body will not go stiff beforehand but it will begin to jerk uncontrollably.

Partial Seizures

There are 2 types of partial seizure: simple and complex.

• Simple partial seizures -  the person will remain awake throughout this kind of seizure and will be able to respond to and interact with those around them.  They may experience a strange feeling that is hard to describe, a rising feeling in the stomach, deja vu, odd smells or tastes or tingling in the limbs. Stiffness or twitching may also occur in part of the body, such as the hands. Simple partial seizures often serve as a warning for a more serious type of seizure to come.
• Complex partial seizures - during complex partial seizures a person will be unaware of their surroundings and will have no memory of the seizure. They may experience random involuntary body movements including lip-smacking, hand rubbing, fiddling, chewing or swallowing and arm movement. They may also make involuntary noises.

Absence Seizures

Absence seizures usually occur in children, but they can affect people of all ages. During this type of seizure a person will lose awareness,  they may stare into space, flutter their eyes and make slight jerking movements. They usually only last for a short time and the person will have no recollection of the seizure afterwards.

Myoclonic Seizures

Myoclonic seizures last for only a fraction of a second, however they can happen within quick succession of one another. They usually occur upon just waking up. During a myoclonic seizure, the body or part of the body will suddenly twitch or jerk.

Atonic Seizures

Atonic seizures are also usually very brief. They occur when the muscles in the body suddenly relax causing someone to fall. They will usually be able to stand up again straight after the seizure has occurred.

Status Epilepticus Seizures

This is the most dangerous kind of seizure. Status epilepticus refers to any seizure that goes on for a prolonged period of time or multiple seizures in quick succession for which the person does not regain consciousness in between. If this occurs you should call an ambulance immediately. Prolonged seizures are those that last for 5 minutes or longer.

What Causes Epilepsy?

Epilepsy is a condition in which sudden bursts of electrical energy in the brain affect how it works. The signals become scrambled resulting in seizures. It is thought that genetics could play a role in the development of epilepsy; around a third of people with epilepsy have a family member who also has epilepsy. 

Epilepsy in some cases can also be a result of trauma or damage to the brain such as a stroke, a brain tumour or infection, a head injury, drug abuse or alcoholism or a lack of oxygen to the brain during birth.

What to do if Someone is Having a Seizure

If you suspect someone is having a seizure you should call the emergency services immediately if;

• This is the first time the person has had a seizure
• The seizure lasts for more than 5 minutes
• The person with the seizure does not regain full consciousness
• A person has multiple seizures without regaining consciousness
• The person becomes injured during the seizure

Diagnosis of Epilepsy

If you, or somebody you know, has had a seizure you should visit a  GP who will then refer you to a specialist if they suspect you may have epilepsy. They will usually make a referral to a neurologist who should see you within 2 weeks of the referral. They will ask questions about the seizure and may run some tests.

If you have only had one seizure, you may not be diagnosed with epilepsy right away. Other conditions such as migraines and panic attacks can also cause seizures. Epilepsy can only be confirmed when you have had more than one seizure and you will be asked to describe the experience in detail including possible triggers, your memory of the event and feelings before and after. They may also want to speak to somebody who witnessed the seizure.

If they suspect you do have epilepsy they may also carry out an EEG and a brain scan. An EEG will detect unusual activity in the brain whilst the brain scan may detect abnormalities in the brain such as tumours or damage that may result in epilepsy.

Epilepsy Treatments

Whilst epilepsy does not have a cure, treatment can help to reduce the number of seizures or even help people to stop having seizures altogether. In some cases  the seizures may disappear over time naturally meaning that you no longer need treatment. If you have specific triggers that can easily be avoided you may also not require any treatment.

Anti-epileptic Drugs (AEDs)

One of the most common treatments for epilepsy, they work to change the chemical levels in the brain in order to reduce seizures. They are an effective method of controlling seizures in 70% of people.

There are different types of AED so finding the best one for you may take some time and will depend on your age, the types of seizures you are experiencing and if you are thinking of having a baby.

Your doctor will prescribe AEDs if you require them and will give instructions on how often you should take them and at what dose. You should always read the instruction leaflet and box supplied with your medication before use and ask your doctor for advice if you are unsure of anything.

Anti-epileptic drugs can also result in side effects including drowsiness, headaches, irritability, tremors, hair loss or unwanted hair growth, swollen gums or rashes. If you experience any of the above side effects after taking AEDs, speak to your doctor for advice. If you develop a rash you should speak to your doctor as soon as possible as this may signal you are having a serious reaction to the medication.

If seizures subside all together your doctor may take you off AEDs however this will be done gradually and only on the instruction of your doctor if it is safe to do so. 

Surgery

Surgery may be advised if AEDs are not effectively controlling your seizures or if there is an abnormality in your brain thought to be causing the seizures. During surgery, the part of the brain thought to be causing seizures would be removed. After surgery seizures may not subside right away therefore AEDs may still be required for a couple of years. Surgery can also result in complications or changes to your temperament, vision or memory.

Before undergoing surgery you will have many tests to ensure you are a suitable candidate. You should always speak to your doctor or surgeon about the associated risks before undergoing surgery as this is a more severe treatment option.

Vagus Nerve Stimulation (VNS)

If you are unsuitable for brain surgery and AEDs are not effective, VNS can help to control seizures by changing the electrical signals in your brain. In order to do this, a small electrical device will be placed under the skin of your chest. This will then send electrical impulses along a wire that is connected to the vagus nerve in your neck. Whilst VNS usually does not completely stop seizures it can help to make them less severe and less frequent. AEDs are usually taken alongside VNS.

Deep Brain Stimulation (DBS)

Similar to VNS, DBS changes the electrical signals in the brain however rather than the wire being connected to the vagus nerve, it is connected directly to the brain. As a relatively new procedure, it is unclear how effective this is at controlling seizures and can also result in bleeds on the brain, depression and memory problems. This procedure should be discussed at length with your doctor before being undertaken as the associated risks are high.

Ketogenic Diet

Often promoted in the media as a diet to aid weight loss, the ketogenic diet was used to treat epilepsy before AEDs. High in fat and low in carbohydrates and protein, the keto diet is thought to make seizures less likely by changing the chemical levels in the brain. It is not recommended for use by adults in order to control seizures as high-fat diets have been linked to numerous other health conditions however, it is sometimes recommended for children whose symptoms are not controlled by AEDs. This treatment should only be used under the supervision of an epilepsy specialist and dietitian.

Living with Epilepsy

Epileptic seizures can be damaging to your health and wellbeing. You may seriously injure yourself during a seizure and therefore taking appropriate steps to manage your seizures is essential. Seizures can also result in a sudden unexpected death. Sudden unexpected death in epilepsy (SUDEP) is rare however you can reduce your risk further by ensuring that seizures are under control.

• Identify triggers - in doing this you are able to avoid potential seizure triggers in the future thus reducing their likelihood 
• Take medication - if you have been prescribed AEDs by your doctor, ensure you take them in line with the advice
• Reviews - you should have regular reviews with your doctor to ensure you are on the most appropriate and effective treatment for your condition
• Inform the DVLA - you must not drive and must inform the DVLA if you have had a seizure. You may not be able to drive until you haven’t had a seizure for a year
• Home safety - whilst at home you should do your best to avoid injury due to a seizure by covering sharp edges, take a bath instead of a shower, do not lock the bathroom door, install radiator covers, place pans at the back of the hob with the handles facing away from you, etc.
• Sports - you should not go swimming or do any other water sports alone, you should also ensure you wear a helmet when doing activities such as horse riding or cycling. You should also speak to staff at the gym before using equipment to ensure it is safe for you to do so. 
• Getting pregnant - whilst epilepsy does not affect your ability to get pregnant, you should speak to your doctor before doing so as certain AEDs have the potential to harm an unborn baby. They may therefore switch your medication.
• School - if you have a child with epilepsy, they are able to attend school as normal however you should ensure that their teacher is aware of their condition, knows what medication they are on and how to spot and deal with a seizure should one occur.
• Work - if your seizures are managed then epilepsy should not affect your work-life drastically however you may ask your employer to make reasonable adjustments to ensure your safety. For example, you may request that you do not have to drive within your role or you may require extra time off for medical appointments.
• Free prescriptions - taking AEDs entitles you to free prescriptions. Ask your doctor for an exemption certificate.
• Support - there are a number of epilepsy support groups available that help people living with epilepsy to find information and advice about the condition.

For more information on epilepsy, contact your GP. 

For advice on general healthcare, please do not hesitate to get in touch with us or visit us at one of our local branches.

Sources

https://www.nhs.uk/conditions/epilepsy/

https://www.nhs.uk/conditions/epilepsy/symptoms/

https://www.nhs.uk/conditions/epilepsy/diagnosis/

https://www.nhs.uk/conditions/epilepsy/treatment/

https://www.nhs.uk/conditions/epilepsy/living-with/

https://www.epilepsy.org.uk/press/facts