What epilepsy is?

Epilepsy is a common neurological disorder that causes recurring, unprovoked seizures and can affect anyone. It is a condition wherein the brain activity results in bouts of aberrant behaviour, sensations, and, in rare cases, loss of consciousness. The disease can affect people of all races, ethnicities, and ages. Seizures are uncontrolled electrical bursts that affect the senses, behaviours, awareness, and physical movements. It is essential to know that epilepsy is a spectrum disorder. Also, there are various forms of seizures and a range of epilepsy disorders.

Epilepsy treatment gaps

A treatment gap occurs when epilepsy patients do not obtain effective therapy in many underdeveloped nations. It is the number of patients with active epilepsy who have not received any diagnostic, therapeutic, or insufficient therapy. The disparity is caused by variables such as a lack of access to or awareness about anti-epilepsy medicines (AEDs), poverty, cultural beliefs, stigma, inadequate health-care infrastructure, and a paucity of qualified specialists. Many individuals are influenced by superstitions and cultural beliefs prefer to be treated by traditional healers rather than having seeking treatment with a neurologist consultation.

About epilepsy seizures

A seizure is the common symptom is epilepsy. It is an unexpected electrical breakdown in the brain. It is a frequent condition that can affect the patient’s behaviour, movements, emotions, and degree of awareness. Seizures happen in several ways, with varying symptoms and intensity. They can differ regarding where they originate in the brain and how far they go. Most epilepsy seizures last a few seconds to up to two minutes. A seizure lasting more than five minutes is a medical emergency. A stroke, a head trauma, an infection, or another condition can all trigger epilepsy seizures. However, the exact aetiology of a seizure is unknown.

The seizure symptoms may vary across episodes. During an episode, patients may exhibit symptoms like staring blankly, or twitching their limbs or legs frequently. An individual bout is not indicative of epilepsy, and not everyone who has a seizure has epilepsy–a diagnosis indicates a minimum of two seizures 24 hours apart to be identified as epilepsy.

Causes: Is genes linked to epilepsy?

Since the late 1990s, scientists have established a relationship between genes and epilepsy. Since then, they have uncovered over 500 genes involved in its formation. Evidence has linked various genes to certain forms of epilepsy. People with Dravet syndrome (a type of epilepsy syndrome) for example, frequently have unusual alterations in their SCN1A gene (a gene that helps regulate the electrical balance in the body). 

Not all epilepsy-related genes are passed on to the next generation. Certain gene mutations emerge in offspring even when neither parent has them. While other types of epilepsy are more frequent in persons with a family history. However, most offspring of people with epilepsy do not get the condition. If a child has an immediate relative like a mother, father, brother, or a sister who has the condition, the odds of developing the illness by the age of 40 are below five per cent. If an extended relative has epilepsy, the odds of acquiring the condition increases. 

In the case a parent develops epilepsy from a trigger like a stroke, this has no influence your chances of getting seizures. Seizures can be caused by uncommon illnesses, including tuberous sclerosis and neurofibromatosis. Epilepsy related seizures can run in families. Some may be predisposed to seizures caused by environmental triggers due to genetic factors. In the case you have it and are thinking about creating a family, you can think about meeting with a genetic counsellor. However, for most people, genes account for just a portion of the aetiology of epilepsy. Specific genes may predispose an individual to environmental factors that cause epilepsy seizures.

In nearly half of those who have epilepsy, there is no recognised aetiology. In the other half, the condition can be caused by any of the following factors:

• Head trauma:  A well-known cause of epilepsy seizures is traumatic brain injury. Epilepsy can be caused by head trauma from a vehicle accident or another traumatic event. Seizures might develop within the first week of a brain injury or more than a week later. Epilepsy seizures that occur early may be an indication of the recent damage. Trauma can occur because of a car collision, a sports injury, a skull fracture, physical abuse, or a gunshot wound. Late-onset seizures are more likely to recur and develop in epilepsy.
• Brain abnormalities. Epilepsy can be caused by brain irregularities such as brain tumours or vascular abnormalities such as arteriovenous malformations and cavernous malformations. Stroke is the most common cause of epilepsy in persons over 35. Congenital disabilities or genetic disorders with related brain deformities can also cause epilepsy.
• Infections: Infection is a common trigger for epilepsy worldwide, although it is more prevalent in developing countries. Any bacterial infections of the central nervous system, like meninges and the cerebral parenchyma and some parasitic infections, can result in acute symptomatic seizures and later acquired epilepsy.
• Prenatal injury. Babies are prone to brain damage before birth, which can be caused by various factors, such as the mother contracting an illness, poor nutrition, or a lack of oxygen. Brain damage can cause epilepsy or cerebral palsy.

Epilepsy symptoms

Epilepsy is characterised by recurrent seizures caused by aberrant electrical impulses triggered by damaged brain cells. An epilepsy seizure is caused by an uncontrolled burst of electrical activity inside brain cells. Changes in your awareness, muscular control (your muscles may twitch or jerk), feelings, emotions, and behaviour, emotions, and muscle movements, can all be epilepsy seizure symptoms. Your brain’s cells transmit and receive information from all parts of your body. These signals are sent from cell to cell through a constant electrical impulse. This repetitive electrical impulse pattern is disrupted by epilepsy. Instead, there are bursts of electrical activity between cells in one or more locations of your brain, like a lightning storm. Seizures can cause the body to jolt and tremble or a ‘fit’, while others produce issues such as loss of consciousness or strange feelings, which pass by in a few moments. 

Types of epilepsy seizures

The kind of seizure is determined by which brain area is affected and what happens during the episode. The symptoms can be mistaken for other neurological illnesses, such as migraines or mental illnesses. A comprehensive examination and tests help identify epilepsy from other conditions. Enlisted below are forms of epilepsy seizures within the following categories:

• Focal seizures

Epilepsy seizures that are triggered by abnormal activity in one part of the brain are known as focal seizures. The seizures are divided into two categories:

• Focal onset aware seizure (Simple partial seizure): In this form of epilepsy seizure, you are awake, attentive, and aware throughout the event. Symptoms depend on the area of the brain that is affected, and the symptoms escalate from there. If the unusual electrical brain function is in the occipital lobe or the back part of the brain involved with vision, the sight can be different. Sometimes, even a muscle groups are affected, like the toes or fingers or the arms and legs. Other symptoms include: (1) changes in your senses, such as how you taste, hear, and smell things, (2) changes in your emotions, (3) twitches or muscular jerks, and (4) feeling dizzy, seeing flashes, and feeling tingly. You can also sweat and experience nausea, but the individual remains conscious throughout the seizure.
• Focal onset impaired awareness seizure (Complex partial seizure): Seizures of this type occur in the brain’s temporal lobe, which regulates emotion and memory function. A simple focal seizure, also known as aura, is frequently followed by a complex focal seizure lasting up to 2 minutes. Patients may stare into space or exhibit automatisms or repeated motions, which are types of symptoms that are frequent in adults. Individuals experiencing this sort of seizure may seem to be daydreaming or looking blankly. They might be unaware of their surroundings. The seizure typically lasts between one and two minutes. Loss of awareness does not always imply that the patient is unconscious; rather, the patient ceases to be aware of what is happenings around them. The youngster may appear awake but exhibit a range of behaviours. The behaviours include gagging, lip-smacking, fleeing, yelling, sobbing, and/or laughing. When the patient regains consciousness, they may complain of tiredness or sleepiness following the seizure, known as the postictal interval.
• Generalised seizures

A generalised seizure burst in a patient occurs across both hemispheres of the brain, with symptoms occurring throughout the body. Previously, this type of epilepsy was known as generalised convulsive epilepsy, generalised tonic-clonic seizure, or grand mal seizure. The following is the pattern of generalised seizures: (1) the muscles contract and become rigid, (2) the patient experiences intense muscular contractions in which the muscles move in quick and random convulsions. The patient may go unconscious. Other symptoms include: (1) biting your face or tongue, (2) locking your jaw, and (3) losing bladder or bowel control. The patient may notice unexpected changes in the senses before the seizure. 

The type of epilepsy seizures, have the following sub-types.

• Absence seizures: Petit mal seizures, as they were once named, are most common in children. Daydreaming, eye blinking, or lip smacking are common symptoms that last only a few seconds. The epilepsy seizures may occur in clusters, several times in a day, when you lose awareness of your surroundings briefly.
• Tonic seizures. The seizures trigger stiff muscles, and the patient may lose consciousness. The stiffness characterised by jerking and twitching, which lasts for a few seconds, and may also occur during sleep. The epilepsy seizures usually cause your trunk, back muscles, arms, and legs to lose control while standing, and you may fall. After the seizure, you are likely to feel tired or disoriented.
• Atonic seizures. Drop seizures, as they are also called, cause all your muscles to suddenly relax. The type of epilepsy seizure usually affects the legs and consequently you can collapse or fall. Atonic seizures can begin in one area of the brain with a loss of tone or muscle in another. This is referred to as a focused motor atonic seizure.
• Clonic seizures. The seizures are common and often occur in babies and infants. Clonus means ‘fast’, so like its name, you will experience repeated rapid twitch and jerk movements i.e., relaxing and tensing of the muscles of the body, occasionally accompanied by sensations like losing any feeling in the body or tingling. You may know what is going on if the seizure is a focused or partial episode. However, if you have a generalised seizure, you may lose consciousness.
• Myoclonic seizures. Myoclonic seizures cause spontaneous, quick twitching of the arms and legs. At times, the epilepsy seizures can occur in clusters. It happens when the muscles contract suddenly, leading to rapid twitches. It usually affects one side of the body and involves the neck, shoulders, upper arms, and sometimes, the entire body.
• Tonic-clonic seizures. This seizure type is characterised by muscular rigidity (tonic) and repetitive, rhythmic muscle jerks (clonic). Doctors may refer to this epilepsy seizure as a convulsion, which was earlier referred to as a grand mal seizure. The patient loses consciousness, falls to the ground, and the muscles tense and twitch for a few minutes. You may bite your tongue, drool, or lose control of your intestines or bladder, causing you to defecate or pee.

Diagnosis

A neurologist diagnoses epilepsy. To begin, they will conduct a thorough exam to determine how your nervous system functions. They will ask questions concerning your symptoms and medical history. The medical team will review your blood tests, MRI scans, and EEGs to evaluate whether you have the condition. To facilitate your diagnosis, a complete description of the symptoms, including the frequency of occurrences, will be helpful when you make an appointment for a neurologist consultation. If feasible, record a video of the seizure to assist them in making a diagnosis. To identify tonic and clonic seizures, specialists will most likely employ imaging tests such as:

1. a) Magnetic resonance imaging (MRI): The scan uses magnetic fields and radio waves to create an image and help spot issues in the brain that can cause epilepsy, like a tumour, damage caused by stroke or scarring.
2. b) Electroencephalography (EEG): To diagnose unusual electrical activity in the brain, which happens in people with epilepsy.
3. c) Basic full body check-up: This includes blood and routine or specialised tests to eliminate conditions with overlapping symptoms.

It would be beneficial to your expert if you could explain your epilepsy seizure in as much detail as possible, including things like (1) the time of the event or “When” the event happened, (2) The activity before the seizure, or “What” happened” and (3) Your sensory experience or “How” you felt before the seizure started and after your recovered.

• Treatment for epilepsy

The brain is a complex organ, and everyone reacts differently to drugs, it may take numerous trials to find the most appropriate medication and dose to treat epilepsy. During a neurologist consultation, your doctor will analyse your medical history and prescribe the most suitable anti-seizure medicine for treatment, as well as calculate and change the dose to help manage your epilepsy seizures.

Your specialists will treat all epilepsy seizures the same way. The specific therapy for treatment will be determined by numerous criteria, including (1) your age, (2) the frequency with which you experience epilepsy seizures, (3) how severe your case is, and (4) your general health.

With medication, most epilepsy symptoms can be controlled, and in rare cases, with surgery. Some epilepsy patients require lifetime therapy to control their seizures, while others have their episodes resolved. Children with epilepsy may outgrow their disease as they grow older. Although the condition cannot be cured, there are several therapeutic options available. Medication can control epilepsy in up to 70% of patients.

The most common therapy for hereditary epilepsy is an anti-seizure medication, elected based on the spectrum of seizures. Some genetic alterations cause metabolic problems, and a particular supplement or diet can help. Certain medicines may potentially lessen additional issues associated with the conditions, such as learning difficulties and intellectual disabilities, as well as improve seizures. Therapies targeting rare genes, on the other hand, are still in the research phase and are not currently accessible for these rare types of epilepsy.

• Medications: Anti-epilepsy medicines (AED) prevent seizures in patients receiving treatment. During a neurologist consultation. doctors prescribe AEDs in various formulations, including syrups, liquids, tablets, and capsules, and you must take them regularly. Your expert will begin your treatment with a low dose and progressively increase it until your seizure symptoms reduce. If the first medication you try does not work, your doctor may prescribe an alternative medicine. You must follow any recommendations regarding when and how much AEDs to take. Never abruptly discontinue the usage of an AED; doing so may result in a seizure. If you have not had an epilepsy seizure in a few years, ask your doctor if you may discontinue your therapy. If they believe it is safe, your doctor will gradually lower your dose. The following epilepsy seizure medications are used to treat myoclonic seizures: (1) valproic acid, (2) levetiracetam, (3) zonisamide, and (4) benzodiazepines. You may need a few trials with your meds and dosages over time to find the appropriate med or med combination. There are several approaches to treating seizures or epilepsy. Your doctor will discuss which therapy will be effective based on your diagnosis. 
• Food on your plate Epilepsy is a prevalent neurological condition that produces seizures. Typically, anticonvulsant drugs are the first line of defence against the disorder. Even while there is no fixed diet to minimise episodes, a whole-food diet can improve your general well-being and lessen the symptoms. Certain diets may assist people who do not benefit from medication or surgery to reduce the frequency of seizures. During a neurologist consultation, doctors prescribe food or diet plans based on the type of epilepsy a person has. If you have epilepsy, there are no specific foods to consume or avoid; nonetheless, it is crucial to promote your health while managing the illness by eating a balanced diet.
• Surgery: When AEDs are ineffective in managing your epilepsy seizures, the patient may require surgery in rare cases. If your doctor determines that it is the best treatment for your disease and has no risks, the portion of the brain that produces seizures can be removed.

Prevention

Many epilepsy triggers are uncontrollable and unpreventable. You may, however, cut down the risk of having a few seizures that may lead to epilepsy, such as: 

(1) Preventing head injury: Wear a seatbelt to minimise your risk of traumatic brain damage from impacts on your head that can trigger epilepsy symptoms.

(3) Therapy: Seek drug abuse treatment. Alcohol and other illicit substances can cause brain damage and epilepsy.

(4) Care: Adequate perinatal care can help to limit the number of new instances of epilepsy induced by birth trauma. Using medications and other techniques to decrease a feverish child’s body temperature can minimise the likelihood of seizures.

(5) Monitor Vitals: The prevention of epilepsy linked with stroke focuses on reducing cardiovascular risk factors, such as efforts to prevent or manage high blood pressure, diabetes, and obesity, as well as avoiding cigarettes and excessive alcohol consumption and a regular basic full body check-up.

Living & managing epilepsy

It is not always simple to live with epilepsy. The physical, mental, and emotional impacts of both, seizures and drugs can take a daily toll on the person with epilepsy, causing issues that others may not see. The general public’s lack of awareness about the condition adds another difficulty for persons with epilepsy. However, living with the condition may offer benefits, such as defying others’ expectations, establishing a full, balanced, and meaningful life, and motivating those with epilepsy to follow their own goals and desires. 

In addition to regular neurologist consultations, follow your treatment plan, and follow the enlisted coping strategies to manage epilepsy: 

(1) Keep a record: Keep a seizure journal to help you discover and avoid potential epilepsy triggers.

(2) Get help: Wear a medical alert bracelet to inform people that you have epilepsy to receive the proper medical attention if you have a seizure and are unable to talk.

(3) Raise awareness: Teach your loved ones about epilepsy seizures and what to do in an emergency.

(4) Be active: Engage in health-promoting activities such as eating a nutrient-rich, balanced diet and exercising regularly.

(5) Take medications regularly: Take your medicines exactly as directed by your doctor during your neurologist consultation. If you miss a dosage, contact your doctor straight away.

(6) Get enough sleep: Get enough sleep (typically seven to nine hours a night).

(7) Cut down on stress. Stress stimulates the production of chemicals in parts of your brain that are more susceptible to seizures. Yoga, meditation, deep breathing techniques, biofeedback, and other relaxation practices can help you reduce stress.

(8) Regular exercise: Exercise for about 30 minutes a day, five days a week.

(9) Avoid triggers: Recognize and avoid epilepsy seizure triggers, such as heavy alcohol consumption.

(10) Keep your doctor updated: Inform all your doctors that you have epilepsy. If another doctor suggests additional drugs, consult your primary neurological specialists who handles your condition. Some medicines, such as antidepressants, antihistamines, and stimulants, might reduce the efficacy of the medications or produce adverse effects.

(11) Seek support: Get professional treatment if you are experiencing anxiety or depression.

(12) Participate: Join an epilepsy support group in your area for support to expand your social connections with people in similar situations.