Epilepsy is a chronic condition characterized by recurrent seizures that can range from brief attention lapses or muscle jerks to severe and prolonged seizures. According to the World Health Organization, more than 50 million people worldwide have epilepsy and 80% of those people live in developing regions. The Centers for Disease Control and Prevention (CDC) estimates that 3.4 million people in the United States have active epilepsy. While the symptoms of epilepsy may vary between cases, the disorder always causes seizures, which are periods of sudden irregular electrical activity in the brain that can affect a person’s behavior.
Epilepsy seizures, symptoms and causes
Epilepsy is classified into four categories, said Dr. Jacqueline French, a neurologist who specializes in the treatment of epilepsy at NYU Langone Health. Idiopathic epilepsy (also called primary or intrinsic epilepsy) is not associated with another neurological disease and has no known cause, except possibly a genetic one. This type of epilepsy constitutes a third of all cases, according to the Epilepsy Foundation. Acquired (or secondary) epilepsy can arise from prenatal complications, traumatic brain injuries, strokes, tumors and cerebrovascular diseases.
Within each of these two categories, there is a generalized or mixed epilepsy, which involves electrical instabilities in many areas of the brain; and focal epilepsy, in which instability is limited to one area of the brain.
According to the CDC, different types of seizures are common to each category of epilepsy. Generalized seizures vary in severity: absence seizures can cause a person to look into space or blink rapidly, while tonic-clonic seizures cause muscle shaking and loss of consciousness. Focal seizures, on the other hand, can cause a person to experience a strange taste or smell or act dazed and unable to answer the questions.
In each case, epileptic symptoms occur because normal signaling between neurons (nerve cells in the brain) has been interrupted. This may be due to abnormalities in brain wiring, an imbalance of nerve signaling chemicals called neurotransmitters or a combination of both. It is known that the temporal lobe of the brain works differently in people with epilepsy compared to healthy individuals, suggesting that it plays a role in the condition, said Dr. Brian Dlouhy, a neurosurgeon and researcher at the University of Iowa.
Epilepsy can develop at any time during a person’s life and sometimes it can take years after a brain injury for signs of epilepsy to appear, French said.
“There is a huge approach by [the National Institutes of Health] and others to find a way to intervene” before the condition arises, he said, but currently, there is no way to prevent or cure it completely.
While the predominant symptoms of epilepsy are seizures, having a seizure does not always mean that a person has epilepsy. Seizures can also be the result of head injuries due to falls or other traumas, but epileptic seizures are strictly caused by irregular electrical activity in the brain.
During seizures spontaneous and temporary symptoms may occur, such as confusion, muscle pulls, spells, loss of consciousness and alterations in mood and mental functions.
How is epilepsy diagnosed?
Doctors can measure and identify abnormal electrical activity in the brain with electroencephalography (EEG). People with epilepsy often show abnormal patterns of brain waves even when they are not experiencing a seizure. Therefore, routine or prolonged EEG monitoring can diagnose epilepsy, according to Johns Hopkins Medicine.
EEG monitoring, along with video surveillance during periods of wakefulness and sleep, can also help rule out other disorders such as narcolepsy, which may have symptoms similar to those of epilepsy. Brain images such as PET, MRI, SPECT and CT scans look at the structure of the brain and map damaged areas or abnormalities, such as tumors and cysts, which may be the underlying origins of seizures, according to the Mayo Clinic.
Epilepsy treatment and medication
People with epilepsy can be treated with medications, surgery, therapies or a combination of the three. The World Health Organization (WHO) estimates that, in general, 70% of people with epilepsy could control their seizures with antiepileptic drugs or surgery, but 75% of people with epilepsy living in developing regions do not receive Treatment for your condition. This is due to the lack of trained caregivers, the inability to access medications, social stigma, poverty and the lack of prioritization of epilepsy treatment.
30% of cases that cannot be completely managed with medication or surgery are included in the category of intractable or drug resistant epilepsy. Many forms of drug-resistant epilepsy occur in children, French said.
Anticonvulsant medications are the most commonly prescribed treatment for epilepsy, according to French. There are more than 20 epileptic medications available in the market, including carbamazepine (also known as Carbatrol, Equetro, Tegretol), gabapentin (Neurontin), levetiracetam (Keppra), lamotrigine (Lamictal), oxcarbazepine (Trileptal), oxcarbazepine (Trileptal) (Trinaptal) Lyrica), thiagabine (Gabitril), topiramate (Topamax), valproate (Depakote, Depakene) and more, according to the Epilepsy Foundation.
Most of the side effects of anticonvulsants are relatively minor, such as fatigue, dizziness, difficulty thinking or mood problems, French said. In rare cases, medications can cause allergic reactions, liver problems and pancreatitis.
As of 2008, the Food and Drug Administration (FDA) ordered all epilepsy medications to carry a warning label about the increased risk of suicidal thoughts and behaviors. A 2010 study that followed 297,620 new patients treated with an anticonvulsant found that certain medications, such as gabapentin, lamotrigine, oxcarbazepine and thiagabine, were associated with an increased risk of suicidal acts or violent deaths.
Coping and management
Patients with epilepsy may need to adjust certain elements of their lifestyle, such as recreational activities, education, occupation or transportation, to accommodate the unpredictable nature of their attacks, according to the Mayo Clinic.
Epilepsy can be deadly, French said. In addition to SUDEP, a person suffering from a seizure may fall and bump his head or dive while swimming; People with epilepsy are 15 to 19 times more likely to drown than non-epileptic people, according to the Mayo Clinic. People with epilepsy may also have an increased risk of suicide due to associated mood disorders or as a side effect of their medications, French said.
Intractable epilepsy from an early age can cause a child to be behind in development, since seizures can cause him to lose school, which impairs his learning and IQ, Dlouhy said.
However, many patients with epilepsy can still lead a healthy and socially active life, especially after educating themselves and the people around them about the facts, misconceptions and stigma surrounding the disease.
Anyone can develop epilepsy, at any time in life. It happens in people of all ages, races and social classes. Epilepsy is most often diagnosed in children and in people over 65 years. There are more than half a million people with epilepsy in the United Kingdom, so about 1 in 100 people.