Epilepsy is a common condition that affects the brain and causes frequent seizures. It to last a lifetime but is still likely to get better over time. It’s important to get the right care early to get the most effective control of the disease.
What is epilepsy?
Epilepsy is a central nervous system disorder in which brain activity becomes abnormal. This causes seizures or episodes of abnormal sensory and behavior, sometimes with loss of consciousness.
According to the World Health Organization (WHO), this disease affects about 50 million people worldwide. According to the Centers for Disease Control and Prevention (CDC), about 3.5 million people in this country have epilepsy.
Anyone is likely to develop epilepsy. However, its onset is most common in young children and the elderly. According to a study published in 2021, men tend to develop the condition more often than women. This may be due to higher exposure to risk factors such as alcohol use or head trauma.
A mild seizure can be difficult to spot. It usually lasts a few seconds and you may remain awake while it happens. Meanwhile, stronger seizures can often cause uncontrollable muscle spasms and twitches. They can last from seconds to minutes and are likely to be accompanied by confusion or loss of consciousness. You may then no longer remember the seizure that happened.
So far there is no cure for epilepsy. However, the use of medications and other strategies can help control the disease. Thereby helping patients to be safe and ensure a better quality of life when living with this disease.
Causes of Epilepsy
In fact, more than half of people with epilepsy have no clear cause. For the rest, the condition is likely caused by a variety of factors. Include:
- Gene influence: Researchers have linked some types of epilepsy to specific genes. For most people, however, genes are only part of the cause. Certain genes may make some people more sensitive to the environmental conditions that trigger seizures.
- Head trauma: Head trauma from a car accident or other trauma can increase a person’s risk of developing epilepsy.
- Brain abnormalities: Abnormalities in the brain, including blood vessel malformations, tumors, etc. can cause epilepsy. Stroke has been identified as the leading cause of this condition in adults over 35 years of age.
- Prenatal trauma: Before birth, babies are susceptible to brain damage caused by a number of factors. For example, the mother has an infection, lack of oxygen or poor nutrition. This brain damage can lead to the development of epilepsy or cerebral palsy.
- Infections: Meningitis, HIV, viral encephalitis, and some parasitic infections can also increase the risk of epilepsy.
- Developmental Disorders: Epilepsy can in some cases be associated with developmental disorders, such as autism spectrum disorder.
Symptoms of Epilepsy
As analyzed, epilepsy often occurs due to abnormal activity in the brain. Seizures can affect any process the brain regulates. Signs and symptoms of a seizure may include:
- Temporary confusion
- Uncontrollable jerky movements of arms and legs
- Loss of awareness or consciousness
- Psychological symptoms such as anxiety, fear
- Staring into space
Depending on the type of seizure, symptoms can vary from person to person. In most cases, however, a person with epilepsy will have the same type of seizure every time. Therefore, the symptoms will be the same from time to time.
Based on how and where abnormal brain activity begins, experts often classify seizures as focal or generalized. As follows:
1. Focal epilepsy
When seizures are caused by abnormal activity in only one area of the brain, they are called focal seizures. These seizures are divided into 2 types, including:
Focal seizures without loss of consciousness: This was once called a simple partial seizure. These seizures do not cause loss of consciousness. They can change how you feel or how things look, smell, taste, or sound. Some people even experience Déjà vu. This type of seizure can also lead to unintentional partial body twitching. For example, jerking arms or legs accompanied by spontaneous sensory symptoms such as dizziness, tingling.
Focal seizures with cognitive impairment: This was once called complex partial seizures. Seizures are associated with a change or loss of consciousness/awareness. This type of seizure can be similar to that in a dream. In focal seizures with cognitive impairment, you may be staring into space, not responding normally to your environment, or performing repetitive movements. Such as rubbing hands, walking in circles, chewing or swallowing.
The symptoms of focal seizures can be confused with some other neurological disorder. Such as narcolepsy, migraine or mental illness. Careful examination and testing is required to make the distinction clear.
2. Generalized convulsions
Seizures that appear to involve all regions of the brain are called generalized seizures. According to the analysis, there are 6 types of generalized seizures identified including:
- Absence seizures: Formerly known as petit mal seizures, it occurs mostly in children. The feature is gazing into space, without subtle body movements such as smirking or blinking, and lasts only about 5-10 seconds. These seizures can occur in clusters, as often as 100 times per day, and cause short-term loss of consciousness.
- Spastic seizures: Seizures that cause muscle stiffness and potentially affect consciousness. These seizures usually affect the muscles in the back, legs, and arms. They can make you fall to the ground.
- Atonic seizures: Also known as hypotonic seizures, cause loss of muscle control. This condition usually affects the legs the most, so it can cause you to suddenly collapse.
- Clonic seizures: This condition is associated with repetitive or rhythmic jerky muscle movements. These seizures usually affect the neck, face, and arms.
- Myoclonic seizures: Myoclonic seizures often appear as sudden, brief seizures. They tend to affect the upper body, arms, and legs.
- Tonic-clonic seizures: Hyperechoic seizures, formerly known as grandeur – the most dramatic type of seizure. They can cause sudden loss of consciousness, body stiffness, convulsions, and tremors. Sometimes they cause loss of bladder control or bite on the tongue.
Is epilepsy dangerous?
Having seizures at certain times can be dangerous for yourself or others. Possible problems include:
- Falling: If you fall during a seizure, you may end up injuring your head or breaking a bone.
- Drowning: If you have epilepsy, you are 13-19 times more likely to drown while swimming than the rest of the population due to the possibility of a seizure triggering in the water.
- Accidents: Convulsions that cause loss of consciousness or control can be dangerous if you are driving a car or operating other equipment.
- Pregnancy complications: Seizures during pregnancy can be risky for both mother and baby. Some antiepileptic drugs have the potential to increase the risk of birth defects.
- Mental health problems: People with epilepsy are more likely to develop psychological problems. Such as depression, anxiety disorders, suicidal ideation and behavior.
Other life-threatening complications of epilepsy, although uncommon, are possible. Such as:
- Intermittent status epilepticus: This occurs if you are in a state of intermittent convulsions that last more than 5 minutes or you have frequent recurrent seizures without fully regaining consciousness between them. People with this condition are at risk of permanent brain damage and death.
- Sudden sudden death in epilepsy (SUDEP): The cause is unknown, but some studies indicate that this condition can occur with heart or breathing problems. People who have frequent tonic-clonic seizures or whose seizures are not controlled with medication have a higher risk of developing SUDEP.
Diagnosis of epilepsy
If you suspect you have a seizure, take the initiative to see your doctor as soon as possible. Seizures can be a warning symptom of a serious medical problem that needs to be treated early.
Your doctor will use your medical history and symptoms to determine what tests are helpful. They may give you a neurological exam to check your motor skills and mental functioning.
To diagnose epilepsy, it is necessary to rule out other conditions that cause seizures. Your doctor will order additional complete blood count (CBC) and blood chemistry tests.
Blood tests may be used to look for:
- Liver and kidney function
- Blood sugar level
- Signs of an infectious disease
An electroencephalogram (EEG) is the most common test used to help diagnose epilepsy. This is a non-invasive, painless test that involves placing electrodes on the scalp to look for abnormal patterns in the brain’s electrical activity.
During an EEG test, you will likely be asked by your doctor to perform a specific task. However, in some cases, this test will be done while you sleep.
In addition, imaging tests will also help find tumors or other abnormalities that can cause seizures. These tests usually include:
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI)
- Functional MRI (fMRI)
- Positron emission tomography (PET)
- Single-photon emission computed tomography (SPECT)
Along with the test results, your doctor may use them in conjunction with analytical techniques to help determine where the seizures started. The analytical techniques mentioned may include:
- Statistical Parametric Mapping (SPM)
- Power Supply Image (ESI)
- Magnetic Brain Recording (MEG)
Epilepsy will usually be diagnosed if you have seizures without an obvious or reversible cause. Accurately diagnosing the type of seizure and where it started is the best way to find an effective treatment.
How to treat epilepsy
Treatment for epilepsy usually begins with medication. However, if medication doesn’t help, your doctor may recommend surgery or another form of treatment.
The principles of treatment are as follows:
- A definitive diagnosis of seizures must be made before prescribing the drug to a patient.
- Once the diagnosis is confirmed, the appropriate drug will be selected for the patient.
- Usually a certain drug is used for treatment.
- Monitor clinical progress and secondary manifestations of the drug to promptly stop the drug or adjust the dose accordingly.
- Depending on each case, in addition to oral medication, the patient must have an appropriate diet and lifestyle.
- If the drug does not respond, then another treatment method is suggested.
Specific methods commonly used in the treatment of epilepsy include:
1. Anti-epileptic drugs
Antiepileptic drugs (AEDs) are the most commonly used treatment for epilepsy. AEDs work by changing the levels of chemicals in the brain. Although it does not cure epilepsy, AEDs can prevent seizures from occurring.
According to WHO, up to 70% of people with epilepsy can reduce the frequency and severity of seizures when taking antiepileptic drugs. About half of people with epilepsy are able to stop taking the drug after 2 years without having seizures again.
Classic antiepileptic drugs:
Valproate Sodium (deparkine, encorate) is effective for all types of epilepsy. Meanwhile, Phenytoin (Hydantoin, Dihydan, ..) and Carbamazepine (Tegretol) are indicated in simple partial, complex partial, spasm and convulsion but not effective in absence of consciousness.
Barbiturics (phenobarbital, gardenal, ..) are effective in many types of seizures but are also ineffective in absence of consciousness. This class of drugs is less commonly chosen because of their drowsiness, mental retardation, and increased risk of personality disorders.
- Barbituric: Use 2-3mg/kg body weight/day.
- Carbamazepine: 10 to 15 mg/kg body weight/day.
- Valproate Sodium: Use a dose of 20-25mg/kg body weight/day.
- Diazepam: Use 0.5mg/kg body weight/day.
- Phenytoin: Use a dose of 3-4mg/kg body weight/day.
– New generation antiepileptic drugs:
The advantage of this group of drugs is that it has few side effects and works well on many types of seizures. Here are the dosages of some commonly prescribed by doctors:
- Levetiracetam (keppra,..): Use at a dose of 500mg x 2 times/day
- Oxcarbamazepine (trileptal,…): Use at a dose of 50mg x 2-3 times/day.
- Lamotrigine (Lamictal, ..): Use at a dose of 25-100mg x 2 times/day.
- Topiramate (Topamax, pharmapir…): Use at a dose of 50-300mg/day.
Other combination treatments:
- Rehydration, electrolytes and vitamins: Sodium chloride 0.9% is usually used and hypertonic glucose can be used when the patient has test results without diabetes. Give high doses of vitamin B1 to alcoholics. In addition, it is necessary to compensate for calcium, sodium, and potassium if there is suspicion or clinical evidence of deficiency of these substances.
- Anti-cerebral edema: This condition should be considered when status epilepticus persists, and consciousness is impaired with local neurologic signs. Mannitol is believed to be the drug of choice. In addition, corticosteroids may be chosen in the case of status epilepticus where the cause is a brain tumor.
- Pain relief: Preparations of tramadol, paracetamol or NSAIDs can be used.
- Sedation: In case the patient has insomnia or has agitation, psychosis, drugs such as aminazin, diazepam, amitriptyline, sulpiride, and streptomycin will be considered.
- Other psychoactive drugs: Piracetam, cinnarizine, flunarizine, magnesium B6.
Usually, the drug can be discontinued in cases where the patient has been seizure-free for 2 to 3 years and no longer detects seizure waves on the EEG. Seizures caused by structural brain damage usually require lifelong treatment. When stopping the drug, it is necessary to gradually reduce the dose.
2. Brain surgery
Surgery to remove part of your brain may be an epilepsy treatment option if:
An AED cannot help control your seizures.
Tests showed that the seizures were caused by a problem with a small part of the brain. It can be removed without serious effects.
In these cases, it is more likely that the seizures may stop completely after surgery. Concerns about epilepsy surgery include:
If your epilepsy is not well controlled after taking certain types of AEDs, you may be referred to a specialist to be checked to see if surgery is possible.
This usually involves performing a number of tests, including:
- Brain scan
- Electroencephalogram (EEG)
- Memory test
The results of these tests will help the specialist determine if surgery is indeed a good option for you. Also predict what the outcome of the surgery might be.
What happens during surgery:
Epilepsy surgery is usually performed under general anesthesia. The surgeon will make a small incision in your scalp and make an opening in your skull. This allowed them to remove the affected part of the brain. The openings in the skull and scalp will be closed at the end of surgery.
– Recovery and risk:
After surgery, it may take a few weeks or months to recover. The seizures may not stop immediately. You may therefore still need to continue using the AED for 1 to 2 years.
Surgery can carry a potential risk of complications. Such as problems with memory, mood or vision. These problems may improve gradually over time, but they are also likely to be permanent. So before having surgery, you need to make sure you talk to your doctor about the possible risks.
3. Other tricks
If AEDs aren’t controlling your seizures and brain surgery isn’t right for you, there are other methods that can help. As follows:
– Vagus nerve stimulation (VNS):
To perform this procedure, your doctor will place a small electrical device similar to a pacemaker under the skin of your chest. The device is attached to a wire that goes under the skin and connects to the vagus nerve in the neck. The electrical currents will be transmitted along the wire leading to the nerve.
Studies suggest that VNS may help control seizures by altering electrical signals inside the brain. Although VNS does not completely stop seizures, VNS can make them less severe and less frequent.
Side effects of VNS can include sore throat, cough, and hoarseness when the device is activated. This tends to happen every 5 minutes and usually lasts for about 30 seconds.
Deep brain stimulation (DBS):
This method is implemented similarly to VNS. However, the device is placed in the chest and will be connected to nerves that run directly into the brain. The electrical currents generated along these wires help prevent seizures by altering electrical signals in the brain.
Deep brain stimulation (DBS) is a relatively new procedure and is not used very often. Therefore, it is still unclear how effective it is for epilepsy. In addition, DBS also has some serious risks. Such as depression, memory problems and bleeding to the brain.
4. Ketogenic diet
Ketogenic refers to a diet high in fat, low in protein and carbohydrates. For children, the diet is thought to reduce seizures by altering levels of chemicals in the brain.
The ketogenic diet is considered one of the primary treatments for epilepsy prior to AED. However, it is not currently widely used in adults. Because a high-fat diet has been linked to serious health conditions. For example, heart disease, diabetes, etc.
In some cases, the ketogenic diet is still sometimes recommended for children with seizures that do not respond to AEDs. However, it should only be used under the supervision of a specialist and with the support of a nutritionist.
5. Complementary therapy
There are a number of complementary therapies that some people with epilepsy find beneficial for them. However, these therapies have not been shown to clearly reduce seizures in medical studies. You should therefore be cautious about advice from anyone other than your doctor.
In addition, herbal remedies should also be used with caution. Because some of their ingredients can interact with antiepileptic drugs. Furthermore, some strong scents such as rosemary, marjoram, dill, etc. can cause seizures in some people.
For some people with epilepsy, stress can trigger seizures. Therefore, relaxation and stress reduction measures such as exercise, meditation and yoga can provide many benefits.
Living safely with epilepsy
In fact, epilepsy can affect people in different ways. Furthermore, each person’s experience with the condition is different. However, understanding some of the following issues can help you improve your quality of life and ensure safety during a seizure:
1. Seizure Control
Seizures can be dangerous, so it’s important to try to control them to the best of your ability. Some things you can do include:
– Make sure to take the medicine exactly as directed:
Antiepileptic drugs (AEDs) can be very effective in stopping or reducing the frequency of seizures. If you have been prescribed an AED, be sure to take it daily as prescribed by your doctor.
Tell your doctor if the medicine causes you to experience unpleasant side effects. Do not skip doses or stop taking them without medical advice as this may cause you to have a seizure.
Identify and avoid seizure triggers:
Common seizure triggers include lack of sleep, stress, and alcohol consumption. Keep a seizure diary, detailing when you had the seizure and what you did before. This helps you determine if there are any triggers for a seizure.
If you do identify any triggers, do what you can to avoid them. This will help reduce the number of seizures you have. It’s best to manage stress well, take care of your sleep, and cut down on alcohol.
– Regular assessment of the disease:
The evaluation will usually be done by your doctor at least once a year. You may also need to be evaluated more often if your condition is not well controlled. These appointments are a great opportunity for you to talk to your doctor about all that goes on during treatment.
2. Stay safe
Having a seizure can sometimes put you or others at risk of harm. Especially if they happen when you are driving, swimming or cooking. If your seizures are not well controlled, there are a few things you can do to reduce the danger:
– At home:
Tips to help you stay safer at home include:
- Install a smoke detector to let you know that your food is on fire if you sometimes forget what you are doing or have a seizure that causes you to lose consciousness.
- Cover any sharp or protruding furniture edges or corners.
- Take a shower instead of a bath.
- Do not lock the bathroom door.
– Sports and entertainment:
Most people with epilepsy can still participate in sports and other recreational activities. However, some precautions are necessary if your seizures are not well controlled. Such as:
- Avoid swimming or doing water sports alone.
- Wear a helmet when riding a bicycle or riding a horse.
- Avoid using certain types of exercise equipment.
3. Pregnancy and contraception problems
Women need to pay special attention to this issue if they are living with epilepsy.
Seizures do not affect your ability to have children. And you can still have a healthy pregnancy if you have it. However, if you’re trying to have a baby, discuss your plans with your doctor.
Some antiepileptic drugs (AEDs) can harm an unborn baby. Your doctor may recommend switching to a different AED just to be on the safe side. If you suddenly find out that you are pregnant, you should contact your doctor for advice as soon as possible.
Using birth control:
If you don’t want to get pregnant, learn and use a reliable form of birth control. It’s best to ask your doctor about the right birth control method because some AEDs can interfere with certain birth control methods.
4. Schools and Education
Children with epilepsy can still attend a public school and participate fully in school activities. However, make sure the school and teachers know about your child’s condition. Include:
- What medication is your child taking?
- Detecting and Coping with Seizures
- The impact of epilepsy on children’s school attendance
5. Work problems
If your epilepsy is well controlled, it probably won’t affect your work. Take the initiative to talk to your supervisor if your medical condition makes it difficult for you to work.
Your boss needs to make reasonable adjustments to your job duties to allow you to continue working. This may include:
- Change your working hours
- Make sure you don’t have to drive as part of your job
- Give written instructions instead of direct speech
- Allows you to have more time to rest as well as rest when you have medical appointments
Epilepsy is a disease that can impair a person’s life in many different ways. Although there is no definitive cure to date, proper intervention with medication or other methods can significantly improve the condition and quality of life.