Epilepsy

Epilepsy is a neurological disorder characterized by recurrent, unprovoked seizures. A seizure is a sudden surge of electrical activity in the brain that can cause changes in behavior, movements, feelings, or consciousness.

Having a single seizure doesn't mean you have epilepsy. Epilepsy is diagnosed when someone has had two or more unprovoked seizures. It affects people of all ages, and with proper treatment, most people with epilepsy can control their seizures and lead normal lives.

The main symptom of epilepsy is recurrent seizures. Seizure symptoms vary depending on the type:

Focal (Partial) Seizures (affect one area of brain):

• Simple focal seizures:
  • Altered emotions
  • Unusual sensations (smell, taste, sound)
  • Twitching in one part of body
  • No loss of consciousness
• Complex focal seizures:
  • Loss of awareness
  • Staring blankly
  • Repetitive movements (hand rubbing, chewing)
  • Confusion after seizure

Generalized Seizures (affect whole brain):

• Absence seizures (petit mal):
  • Brief loss of awareness
  • Staring blankly
  • May have subtle movements
  • Common in children
• Tonic-clonic seizures (grand mal):
  • Loss of consciousness
  • Stiffening (tonic phase)
  • Jerking movements (clonic phase)
  • May bite tongue
  • May lose bladder control
• Tonic seizures: Muscle stiffening
• Atonic seizures: Loss of muscle tone (drop attacks)
• Myoclonic seizures: Brief jerking movements

After Seizure:

• Confusion
• Fatigue
• Headache
• Memory loss of seizure
• Sore muscles

Call Emergency Services (112 in Sweden) if:

• Seizure lasts more than 5 minutes
• Second seizure occurs immediately
• Person doesn't regain consciousness
• Person is injured during seizure
• Seizure occurs in water
• Person has difficulty breathing after seizure
• Person is pregnant or has diabetes

Managing epilepsy involves:

1. Take Medications as Prescribed:

   • Most important aspect of management
   • Take at same times each day
   • Don't skip doses
   • Don't stop without doctor's approval
   • Report side effects

2. Identify and Avoid Triggers:

   • Sleep deprivation: Get adequate sleep
   • Stress: Practice stress management
   • Flashing lights: Avoid if photosensitive
   • Alcohol: Can lower seizure threshold
   • Illness: Treat fevers and infections promptly
   • Menstruation: Some women have seizures around period
   • Medications: Some medications can trigger seizures

3. Safety Precautions:

   • Swimming: Only with supervision
   • Bathing: Shower instead of bath (if alone)
   • Driving: Follow local regulations
   • Cooking: Use back burners, be careful
   • Heights: Avoid if seizures not controlled
   • Sports: Some may need modifications

4. Seizure First Aid (for others):

   • Stay calm
   • Don't restrain person
   • Don't put anything in mouth
   • Clear area of hazards
   • Place something soft under head
   • Turn person on side
   • Time the seizure
   • Stay with person until alert

5. Keep Seizure Diary:

   • Record seizures
   • Note triggers
   • Track medication adherence
   • Note side effects
   • Helps doctor adjust treatment

6. Healthy Lifestyle:

   • Regular sleep schedule
   • Balanced diet
   • Regular exercise (as approved)
   • Stress management
   • Avoid alcohol and drugs

7. Wear Medical Alert:

   • Medical alert bracelet or necklace
   • Important information for emergencies
   • Contact information

• Seizure lasting more than 5 minutes
• Multiple seizures without regaining consciousness
• Difficulty breathing after seizure
• Seizure in water
• Injury during seizure
• Person is pregnant or has diabetes
• First-time seizure (if severe)

• New or worsening seizures
• Side effects from medications
• Need to adjust treatment
• Questions about medications
• Planning pregnancy
• Seizures not controlled
• Concerns about safety

• Seizures well-controlled
• Following treatment plan
• Regular follow-up scheduled
• No new concerns

Diagnosing epilepsy involves:

1. Medical History:

   • Detailed description of seizures
   • Witness accounts helpful
   • Family history
   • Medical history

2. Neurological Examination:

   • Check reflexes, coordination
   • Assess mental function
   • Look for other neurological signs

3. Electroencephalogram (EEG):

   • Records brain's electrical activity
   • May show seizure patterns
   • May be normal between seizures
   • Sleep-deprived EEG may help

4. Brain Imaging:

   • MRI: Detailed brain images
   • CT scan: If MRI not available
   • Looks for structural causes

5. Blood Tests:

   • Check for infections
   • Check for genetic conditions
   • Check medication levels
   • Assess overall health

6. Other Tests (if needed):

   • Neuropsychological testing
   • SPECT or PET scans
   • Genetic testing

Treatment aims to control seizures with minimal side effects:

1. Anti-seizure Medications (antiepileptic drugs):

   • First-line: Carbamazepine, lamotrigine, levetiracetam, valproic acid
   • Usually start with one medication
   • May need to try different medications
   • May need combination therapy
   • Must take regularly

2. Vagus Nerve Stimulation (VNS):

   • Device implanted under skin
   • Sends electrical impulses to brain
   • Used when medications don't work
   • Can reduce seizure frequency

3. Ketogenic Diet:

   • High-fat, low-carbohydrate diet
   • Used mainly in children
   • Can be effective for some types
   • Requires medical supervision

4. Surgery (if medications don't work):

   • Remove seizure focus
   • Disconnect brain pathways
   • Only if seizures originate in one area
   • Requires extensive evaluation

5. Responsive Neurostimulation:

   • Device monitors brain activity
   • Delivers stimulation when seizure detected
   • Used for focal seizures

6. Lifestyle Modifications:

   • Regular sleep
   • Stress management
   • Avoid triggers
   • Healthy lifestyle

Most cases of epilepsy cannot be prevented, but you can:

• Prevent Head Injuries: Wear helmets, seat belts
• Treat Infections Promptly: Especially brain infections
• Prenatal Care: Good care during pregnancy
• Vaccinations: Prevent infections that can cause epilepsy
• Manage Other Conditions: Control diabetes, high blood pressure
• Avoid Triggers: If you have epilepsy, avoid known triggers

In epilepsy:

1. Abnormal Electrical Activity: Brain cells fire abnormally
2. Seizure: Sudden surge of electrical activity
3. Symptoms: Depending on affected brain area
4. Recovery: Brain returns to normal function

Causes:

• Genetics: Some types run in families
• Brain injury: Head trauma
• Brain conditions: Tumors, strokes, infections
• Developmental disorders: Some are associated
• Infections: Meningitis, encephalitis
• Prenatal injury: Brain damage before birth
• Unknown: In many cases, cause is unknown

• Can develop at any age
• Some types are childhood-specific
• May outgrow some types
• School accommodations may be needed
• Family education important

• Can develop at any age
• May affect work and driving
• Pregnancy considerations
• Medication management important

• Can develop later in life
• Often due to strokes or other conditions
• May have other health conditions
• Medication interactions important

Some types can be outgrown, and surgery can cure some cases. For most people, epilepsy is managed with medications, and many achieve good seizure control.

With proper treatment, many people achieve good seizure control. Some may become seizure-free. It depends on the type of epilepsy and response to treatment.

Laws vary by location. Generally, you need to be seizure-free for a certain period (often 6-12 months) and have medical clearance. Check local regulations.

Yes, but it requires planning. Some medications can affect the baby, so you'll need to work with your doctor to adjust medications before and during pregnancy.

Stay calm, don't restrain them, don't put anything in their mouth, clear the area, place something soft under their head, turn them on their side, and time the seizure. Call emergency services if it lasts more than 5 minutes or if they don't regain consciousness.