Epilepsy, from the ancient Greek meaning to seize, possess or afflict, is a neurological condition that can affect brain activity. Although we typically associate epilepsy with somebody having a seizure and writhing around on the floor, this is not the only way epilepsy can manifest. Symptoms of epilepsy can vary and in some individuals cause loss of awareness, unusual sensations or strange behaviour.
Epilepsy can affect both males and females of any ethnicity and age, although it is most commonly diagnosed in children and people over 65. According to the World Health Organisation over 50 million people worldwide have been diagnosed with epilepsy. However, it is important to note that one seizure does not mean you have the condition; about 10% of people who have a seizure may never experience another. It is only when a person has two or more seizures that a diagnosis of epilepsy is suspected. There are about 12 different forms of epilepsy and two main types of seizure: focal and generalised, which influence the symptoms.
Focal onset seizures start in one area of the brain but can spread to both sides. There are two types of focal seizures: focal aware and focal impaired. Depending on where the seizure takes place in the brain, the symptoms may either be motor or non-motor. Motor symptoms can include smacking your lips; repetitive movements such as pulling at clothes or fiddling with objects; jerking movements; making random noises or becoming very limp or very stiff. Non-motor symptoms can cause feelings of déjà vu, getting an unusual smell or taste in your mouth, feelings of euphoria or anxiety, twitching, numbness or tingling and, in some cases, experiencing hallucinations.
In focal aware seizures a person is usually conscious during the attack and is conscious of everything happening during and after the episode. On the other hand, focal impaired seizures affect a larger part of one side of the brain, causing confusion whereby the person may not be fully aware of his or her surroundings or able to understand what is being said to them. The confusion may last for some time after the seizure and it may leave the person feeling drained and in need of rest.
Generalised onset seizures affect both sides of the brain, with no warning signs. A person will become unconscious and will not remember anything about the seizure. There are six types of generalised seizures: absence seizures; tonic seizures; atonic seizures; clonic seizures; myoclonic seizures; tonic-clonic seizures.
Two extreme examples are absence and tonic-clonic. Absence seizures, previously known as petit-mal seizures, are more common in children than in adults. This type of seizure typically lasts for just a few seconds and the afflicted person becomes quiet and unresponsive. In most cases he or she stops what they are doing and has a blank facial expression; or they may rapidly flutter their eyelids. However, in some cases they may continue with their task but be unaware of what they are doing, or their environment.
Tonic-Clonic seizures, once known as grand-mal seizures, are what we commonly associate with epilepsy. The affected person will lose consciousness, go stiff and may bite their tongue. Conversely, they writhe about, as their muscles rhythmically relax and contract. There may also be signs of pallor, their breathing pattern may change and, in some cases, there may be loss of control of the bowel or the bladder. After the seizure their breathing and colour return to normal but they may feel drained and confused and need to sleep.
In about 50% of cases the cause of epilepsy (a non-communicable disease) is not known; in the remainder of cases causes have been linked to: genetics, drug or alcohol abuse, head injury, damage to the brain (such as strokes or tumours), infectious diseases, pre-natal injury and developmental disorders.
To confirm a diagnosis of epilepsy your doctor will take a thorough medical history and extract blood samples. In some cases an electro-encephalogram (EEG) is arranged to detect abnormal electrical activity in the brain. Accurate diagnosis and identifying the type of seizure increases the chances of finding the most effective treatment. In most cases medication is the first choice of treatment but getting the correct dose may take some time and may even change over time. Some people find that once the medication has controlled the seizures, they are able to stop taking medication without any further episodes of seizures. If medication is not successful at controlling seizures, then your doctor may recommend alternative options such as adopting a ketogenic diet, vagus nerve stimulation, deep brain stimulation or even surgery.
Although many cases of epilepsy are not preventable, there are measures that can be taken to minimise the risk of a seizure. The first step, if seizures are already present, is to regularly take any prescribed medication; the next step is to avoid known triggers, such as:
• Stress
• Fatigue and lack of sleep
• Alcohol and drugs
• Flashing lights
• Missing meals
• Monthly periods
• High temperature
Seizures can occur at any time, whether you are walking, swimming, driving a car or sitting quietly. The following are important steps and first aid tips to be aware of:
• Carefully position the person onto their side and place something soft under their head.
• Loosen any clothing, especially around the neck.
• Never place your fingers in anybody’s mouth.
• Never try to restrain somebody having a seizure.
• Remove all hazardous or breakable objects from the area to minimise injury.
• Call for medical assistance and stay with the person until help arrives. It may help medical personnel if you time the seizure and mention what you observed. Because of the unexpected nature of epilepsy and the lack of warning signs of an impending seizure, it is important to know the above in order to minimise harm and prevent serious injury if you ever find yourself in a situation where somebody experiences a seizure. Above all, stay calm.
