Epilepsy is a complex neurological condition that affects millions of people worldwide. If you or a loved one is experiencing epilepsy for the first time, it is likely that you are looking for additional information about what this condition is, and how it can affect daily life. Let’s take a closer look at some of the most commonly asked questions when it comes to epilepsy.
What Is Epilepsy?
Epilepsy, which is sometimes referred to as a “seizure disorder”, is a neurological condition that causes recurrent seizures. These seizures can affect a wide variety of mental and physical functions. Most often a person will be diagnosed with epilepsy after experiencing two or more seizures that are more than twenty-four hours apart, so long as the seizures were not triggered by any particular event such as a stroke, brain injury, infection etc. These seizures are caused by aberrant electrical activity in the brain that occurs suddenly.
What is A Seizure?
Simply put, a seizure is a disturbance in the normal regulation pattern in the electrical activity of the brain. Seizures can have a variety of causes and effects, however the most common characteristic is a wave of uncontrolled electrical activity that spreads throughout the body.
A person having a seizure will usually exhibit external symptoms as a result of abnormal brain activity. Muscle spasms, mental confusion, loss of consciousness, and/or uncontrolled or aimless body motions are some of the most common signs and symptoms of a seizure. Some seizures might resemble a staring spell, while others may cause a person to collapse, shake uncontrollably, and loose awareness of their surroundings.
The underlying causes of a seizure can be complex and can be caused by a range of triggers including but not limited to:
- Misuse of medication
- Flashing lights
- Poor sleep habits
- Misuse of alcohol or drugs
- Alcohol or drug withdrawal
- Changes in blood sugar
- High fevers
Typically seizures will last anywhere from a few seconds to a few minutes and then fade away on their own; this will depend on the type of seizure, which will be determined by where it begins and then extends across the brain.
What Types of Seizures Are There
Seizures can be classified into two different groups. It’s important to note that a person with epilepsy can experience more than one kind of seizure.
Generalized seizures are seizures that start with a sudden burst of irregular electrical activity that quickly spreads over the entire brain. Tonic-clonic convulsions (also known as “grand mal” seizures) and absence seizures (“petit mal” or staring seizures) are two forms of generalized seizures.
Partial seizures (also known as focal seizures) start with abnormal electrical activity in only one area of the brain. Although the activity begins in one section of the brain, it can expand throughout. Simple partial seizures, complicated partial seizures, and secondarily generalized seizures are among these seizure types.
If I Have Had A Seizure, Does That Mean I Have epilepsy?
Epilepsy is a long-term condition that changes how electrical activity and connections in the brain operate. Because epilepsy is characterized by spontaneously recurring seizures, a single seizure does not always indicate epilepsy. Although seizures are the primary symptom of epilepsy, they can be caused by various other medical issues.
What Causes Epilepsy? Who Is At Risk?
While the specific origins of epilepsy are not entirely known, epilepsy and seizures are thought to be caused by abnormal signals sent by neurons (a type of brain cell) in the brain. For two-thirds of people with diagnosed cases of epilepsy, the root cause is unknown. This type of epilepsy is categorized as cryptogenic or idiopathic. These types of cases account for 40% of cases worldwide.
Research indicates that epilepsy can be hereditary in some cases, meaning that it is the result of mutations in a person’s genes. Different conditions that impact a person’s brain can also induce epilepsy. Some known causes include:
- Severe head trauma
- Infectious diseases
- Brain infections from parasites such as malaria and neurocysticercosis
- Brain infections from various viruses, and bacteria
- Brain tumors
- A loss of oxygen (during birth, for example)
- Down Syndrome
- Other neurological diseases such as Alzheimer’s disease
- Other brain structure abnormalities
What Risk Factors Are Associated with Epilepsy?
It’s important to know that epilepsy is not uncommon and that the condition can affect anyone. That being said, there are certain risk factors that can increase your risk of developing epilepsy:
- Age: Onset epilepsy is most common in children and older adults
- Family History: Genetics can play a role in the development of epilepsy
- Head Trauma: Severe head injuries have been linked to developing cases of epilepsy
- Stroke and Other Vascular Disease: These can lead to brain damage that can trigger epilepsy to develop.
- Dementia and Other Neurological Diseases: These affect brain activity and cause brain damage.
- Brain Infections: These can cause inflammation in the brain/spinal cord
- Other Nervous System Conditions: Can affect brain activity
How Common Is Epilepsy?
Epilepsy is one of the most common neurological disorders, affecting more than 5.1 million in the United States and 50 million individuals worldwide. Research indicates that epilepsy affects one out of every 26 people at some point in their lives.
According to the latest estimates, about 0.6% of children aged 0-17 years have active epilepsy. For reference, this would mean that out of 1,000 children—six of them could be affected by the neurological condition.
How Is Epilepsy Diagnosed?
Epilepsy is diagnosed most commonly when a person has two or more seizures that occur more than twenty-four hours apart and are not triggered by a specific event such as a stroke, brain injury, infection, fever, or blood sugar problems.
This diagnosis neurologist or an epileptologist ( a doctor that specializes in epilepsy) after undergoing a series of tests, and reviewing your medical history. This review should include a detailed recounting of any seizures that have occurred. The neurological examination most commonly includes an EEG ( electroencephalogram) and an MRI (magnetic resonance imaging). This often takes place over the course of several appointments.
It’s important for a person who has had a seizure for the first time to talk to a primary care provider as they can provide more information about next steps.
If I Have Epilepsy, Will I Still be Able to Drive? Play Sports? Exercise?
The answers to these questions will vary from person to person based on the severity of their epilepsy and their own specific triggers. If you have been diagnosed with epilepsy or have a history of seizures, it’s best to consult with your doctor prior to operating heavy machinery or participating in high risk or strenuous activities.
In America, most states (as well as the District of Columbia) will not grant a driver’s license to someone with epilepsy unless they can show proof that they haven’t had a seizure in a certain amount of time. Depending on your location, the seizure-free time requirement can be anywhere from a few months to over a year. They may even require a letter from a doctor that states that the person’s seizures:
- are nocturnal seizures (meaning that they only occur during sleep)
- would not be a distraction from driving
- typically present warning signs ahead of time
When it comes to playing sports and other potentially strenuous activities, it can be reassuring to know that exercise is rarely a trigger for seizure activity. In fact, many doctors encourage experience as studies indicate that it can improve seizure control as well as improve your physical and mental well-being. That being said, it is important to avoid sports or exercise-related injuries as these can trigger seizures.
How Is Epilepsy Treated?
There are numerous things that a physician and a person with epilepsy can do to help prevent and reduce recurrent seizures. Beyond anti-seizure medication, the most prevalent epilepsy treatments are surgery, vagus nerve stimulation, and changes in diet. Researchers and scientists still have several investigational interventions in development meaning that new forms of treatment may be available in the future.
Anti-seizure medications are the current cornerstone of epilepsy treatment. These medications limit the spread of seizures in the brain. Recent developments in these medications have provided more effective results as well as better side effect profiles. Studies have shown that these medications work for 2 out of 3 people with epilepsy.
There are several different types of surgeries that can assist with the management of epilepsy. One type of neurosurgery that can be used to treat epilepsy involves removing the portion of the brain that is suspected to be the source of the seizures. Removing that area may prevent future seizures or make them simpler to control with medication. Another type involves disconnecting the seizure-causing region of the brain from the rest of the brain. Around 70% of people who have temporal lobe surgery discover that it ends their seizures and they become seizure-free, while another 20% find that their seizures are decreased as a result of the procedure.
Vagus Nerve Stimulation
The vagus nerves are two nerves that originate in the brain and go throughout the body. They transmit information from the brain to the rest of the body. Vagus Nerve Stimulation therapy is an epilepsy treatment that incorporates a stimulator (or ‘pulse generator’) that is attached to the left vagus nerve in the neck. Regular, mild electrical stimulations are sent across this nerve by the stimulator which helps regulate the erratic electrical brain activity that causes seizures. This treatment option is less invasive and is typically used when surgery and medications are not viable options.
For children or adults with epilepsy whose seizures are not controlled by Antiepileptic medications, the ketogenic diet is one treatment option. The diet may help to minimize the number of seizures and their severity, as well as have other beneficial effects. The ketogenic diet (KD) is a high-fat, low-carbohydrate, low-protein diet that has been used to treat epilepsy since the 1920s.
Normally, the body gets its energy from glucose (a type of sugar) found in carbs (things like sugar, bread, and pasta). When the body burns fat for energy (a process known as ketosis), chemicals called ketones are produced. When you follow a ketogenic diet, your body will mostly rely on ketones for energy rather than glucose. Decanoic acid, a type of fatty acid, has been linked to the way the diet operates, according to research.
This type of medical treatment is usually considered only after at least two other treatments have failed. It’s important to note that this diet is not suitable for everyone. Discuss this with your neurologist as well as a certified dietician before moving forward with this treatment option.
Can Epilepsy Be Self-Managed?
Self-management is something that can be done in conjunction with your epilepsy treatment and is an effective way to help manage seizures while still living a full and active life. When it comes to self-managing your epilepsy it is imperative that you:
- Take the proper doses of your medication and take them at the right times
- Discuss any questions or concerns you have with your primary care physician, neurologist, or epileptologist
- Recognize your own specific seizure triggers (such as flashing or bright lights)
- Keep a record of your seizures either in a diary or on your devices
- Maintain a consistent sleep schedule
- Do what you can to lower stress levels
For more information on epilepsy or to help fund epilepsy research, consider my most recent affiliation: The Cameron Boyce Foundation, which aims to cure epilepsy via research, education, and awareness campaigns in honor of Cameron Boyce’s legacy: https://www.thecameronboycefoundation.org/.