What is epilepsy?
Epilepsy is a brain condition causing a person to have seizures or fits affecting around 1 in 100 people in the UK.
Epilepsy attacks are divided into two main types:
- Generalised (involving the entire brain)
- Partial (originating in one area of the brain).
Within these categories, seizures are further identified according to the pattern of the attack. The two most common forms of seizure are both of the generalised type:
- Absence (petit mal) seizures
- Tonic/clonic (grand mal) seizures.
Among the partial types are "simple" seizures (without impairment of consciousness), such as motor or Jacksonian seizures, and "complex" seizures (with impairment of consciousness), such as temporal lobe seizures.
The first signs of epilepsy are usually seen in childhood or adolescence. Epilepsy may also begin in the elderly and in that case often implies an old stroke or a tumour.
In most instances, the cause of epilepsy is unknown.
Sometimes, however, there may be a genetic cause. Other cases may be traceable to birth trauma, lead poisoning, brain infection during foetal development, head injury, alcohol or drug addiction, or the effects of organ disease. In someone with epilepsy, triggers for the attacks also vary widely. Among the factors that can bring on attacks are certain chemicals or foods, sleep deprivation, stress, flashing lights, menstruation, some prescription and over-the-counter medications, and possibly oral contraceptives.
How do I know if I have epilepsy?
Your doctor will take a detailed medical history (including a family history of seizures), gather information about your behaviour before, during, and after the episode, and do a physical examination. An electroencephalogram (EEG) - brain wave study - performed on a sleep-deprived individual can reveal abnormal brain waves characteristic of epilepsy, and imaging tests such as an MRI or CT scan can identify brain abnormalities that may be causing seizures.
What are the treatments for epilepsy?
Epilepsy can often be well controlled by medication. A recommended precaution for those with epilepsy is to wear a medical bracelet so that other people can quickly recognise what is happening during a seizure and lend effective assistance.
Surgery may be recommended for the minority of patients whose seizures can't be controlled with medication. The most successful procedures are those in which the diseased area of the brain is identified and can be removed. There are other operations that involve disconnecting pathways between parts of the brain to prevent the seizure from spreading. In vagus nerve stimulation, a device that electronically stimulates the vagus nerve (which controls activity between the brain and major internal organs) is implanted under the skin, reducing seizure activity in some patients with partial seizures.
Stress may increase seizure activity in some people. Relaxation techniques and yoga may be helpful when used with medications.
Though controversial, a ketogenic diet - a high-fat, low protein and carbohydrate regime - is sometimes used to treat children aged one to 10 who have not responded to treatment. It may have some long-term benefits since some children can stop the ketogenic diet after several years and still remain seizure free. Close medical supervision is required.
In the great majority of cases, seizures can be reduced in frequency and severity, or eliminated altogether, with regular medication; side effects vary, but most are mild. There are a growing number of anticonvulsant medications available that can be used alone or in combination to treat seizures that are resistant to standard treatment.