What is epilepsy?
Epilepsy is a chronic neurological condition characterized by recurrent seizures, which may involve convulsions and the loss of consciousness. A seizure happens when abnormal discharges of electrical activity in the brain cells causes abnormal behaviors such as involuntary muscle movements, unusual perceptions, or a disturbed level of consciousness. Epilepsy can affect anyone at any age, but having one seizure does not signify epilepsy. Epilepsy is defined as having two or more unprovoked seizures.1
Epilepsy is one of the most common neurological diseases and is very prevalent worldwide, affecting more than 50 million people.2 Epilepsy is very common in the Kingdom of Saudi Arabia, with a prevalence of 6.54 per 1000.3
What causes epilepsy?
Epilepsy can be caused by many different conditions that affect a person’s brain. Examples of these conditions include:4
- Genes: Hereditary (genetic) factors have been shown to make a person more sensitive to environmental conditions that trigger seizures.
- Brain injuries: Brain conditions such as injuries caused by blows to the head, stroke, high fever or tumors can cause epilepsy.
- Infectious diseases: Infections such as meningitis and acquired immune deficiency syndrome (AIDS) can cause epilepsy.
- Abnormal brain development: Prenatal brain damage or injuries and complications during childbirth can result in epilepsy.
- Often, no definite cause of epilepsy can be found.
What triggers a seizure?
Certain epilepsy syndromes termed as reflex epilepsy need specific triggers for seizures to occur like:4
- Flashing lights
- Emotional stress
- Sleep deprivation
- Sleep itself
- Heat stress
- Physical or emotional stress
- Too much caffeine
- Missed medications
What are the symptoms of epilepsy?
There are two types of epilepsy characterized by different syndromes:
- Generalized seizures: They are caused by electrical discharges from the entire brain. The most common types of generalized seizures and the accompanied symptoms are the following:5
- Tonic clonic: Loss of consciousness, fall, convulsions, muscle rigidity
- Absence: Brief loss of consciousness and staring
- Myoclonic: Isolated jerking movements
- Clonic: Repetitive jerking movements
- Tonic: Muscle stiffness, rigidity
- Atonic: Loss of muscle tone
- Partial seizures: They are caused by a relatively small part of the brain. The most common types of partial seizures and the accompanied symptoms are the following:5
- Simple partial motor: Jerking, muscle rigidity, spasms, head-turning
- Simple sensory: Unusual sensations affecting either the vision, hearing, smell, taste or touch
- Simple autonomic: Simple autonomic: It causes changes in the part of the nervous system that automatically controls body functions. These seizures may include gastric and intestinal disturbances and strange or unpleasant sensations in the stomach.
- Simple psychological: Memory or emotional disturbances
- Complex: Automatisms such as lip smacking, chewing, fidgeting, walking and other repetitive involuntary movements
How is epilepsy diagnosed?
An epilepsy diagnosis is generally made when seizures occur more than once without an identifiable reason, such as fever or injury. Upon the examination, the doctor can determine whether the seizures are being caused by epilepsy or another condition. The major steps in the process include:6
- Detailed medical history. It may include questions regarding the patient’s medical history (head injury, high fever, etc.) and the family history with epilepsy.
- Detailed description of the seizures: It is advised that the person who was present at the time of the seizure communicate with the doctor.
- A complete physical and neurological examination: This examination includes assessment of cardiac, neurological and mental status to better understand the cause of the seizures.
- Blood test: It helps identifying potential causes or other significant illness.
- CAT (Computerized Axial Tomography) or (Computed tomography) CT scan: This can help to determine whether seizures are caused by an acute or chronic brain lesion.
- EEG (Electroencephalogram): This is the only test that directly detects electrical activity in the brain. This can be used to assess the risk of seizure recurrence, and it is useful to determine the type of epilepsy. EEG also helps determine where seizures are coming from in the brain.
- MRI (Magnetic Resonance Image): This could identify the cause of the seizures.
How is epilepsy treated?
Treatment for epilepsy is used to control seizures, reduce their occurrence and strength. It may sometimes be possible to control the epilepsy solely by avoiding triggers discussed above (section: What triggers a seizure?).
- Medication7: Antiepileptic drugs are usually the first choice of treatment for epilepsy. The treatment should be started with one drug only. Ideally, the choice of the drug depends on the type of epilepsy and the seizure.
- Surgery7: In some cases surgery could be indicated especially when long-term appropriate antiepileptic therapy has not controlled the seizures and if the brain’s focal lesion has been clearly defined.
How to manage a person during a seizure?
Although a person may feel helpless around someone having a seizure, there are many things that he or she can do to help:7
- Move patient away from fire, traffic or water
- Take away any objects that could harm the patient
- Loosen tight clothing around the person's neck and waist
- Remove glasses
- Put something soft under the head
- Turn patient on his or her side, so that saliva and mucus can run out of the mouth
- Remain with the patient until he or she regains consciousness
- Let the patient rest and then resume whatever activity he was doing, if he feels like it
- Not try to put anything into the patient’s mouth
- Not offer anything to drink or eat until the person is fully awake and alert.
- Not try to stop the jerking, or restrain the movements
- Epilepsy (WHO).
- Scott, Robert A., Samden D. Lhatoo, and Josemir WAS Sander. "The treatment of epilepsy in developing countries: where do we go from here?." Bulletin of the World Health Organization 79.4 (2001): 344-351.
- Al Rajeh, S., et al. "The prevalence of epilepsy and other seizure disorders in an Arab population: a community-based study." Seizure 10.6 (2001): 410-414.
- Kandar, Hirak Kumar Mukhopadhyay Chandi Charan, et al. "Epilepsy and its Management: A Review." Journal of PharmaSciTech 1.2 (2012): 20-26.
- Benbadis, Selim, and Leanne Heriaud. "Understanding Seizures & Epilepsy." University of South Florida, Tampa. Web. 18 Nov. 2015
- "Epilepsy & My Child Toolkit A Resource for Parents with a Newly Diagnosed Child." Epilepsy Foundation. Web. 18 Nov. 2015.
- Dekker, P. A. "Epilepsy: a manual for medical and clinical officers in Africa." (2002).