Epilepsy:
Symptoms, Causes, Risk Factors, Diagnosis & Treatment

3.Symptoms of Epilepsy

Unpredictable seizures are the main epilepsy symptoms. But symptoms of fits can vary on a case-by-case basis depending on the particular type of fits. The different types of epilepsy along with their respective symptoms are given below:

There is change in the classification of epilepsy recently in 2017 and as per ILAE

Seizures are classified as

Focal when seizures begin one area of brain and remain in one side of the brain.The term Focal has replaced the previous term Partial. Focal onset seizures are subdivided into those with retained and impaired awareness. Focal aware seizures correspond to the old classification as ‘’simple partial seizures” and focal impaired awareness seizures to the previous designation “complex partial seizure. Awareness means consciousness in new definition. Focal onset seizures further classified as motor versus non-motor. A seizure that starts focally and then spreads to bilateral tonic clonic movement is called a focal to bilateral tonic-clonic seizure, corresponding to the old phrase “secondarily generalized tonic-clonic seizure”

Focal Seizures or Partial Seizures

Focal epilepsy is the type of seizure when the abnormal activity originates from only one area of the brain. Further classification of seizures that occur partially are:

● Simple partial seizures: Focal seizures that do not involve loss of consciousness are referred to as simple partial seizures. Signs and symptoms of epilepsy generate in only one part of the brain are:

• These epilepsy types lead to alteration of emotions and other physical sensations like smell, taste or sound, among others
• Involuntary jerking of body parts such as arms and legs occurs along with spontaneous seizure disorder symptoms like feelings of dizziness, unusual tingling and twitching of limbs and flashing lights in front of the eyes

● Complex partial seizures: Originating in one part of the brain, focal seizures that lead to fits disease symptoms such as complete lack of consciousness or awareness of the surroundings are called complex partial seizures. Neurological problem symptoms associated with this condition are:

• Patients tend to stare at space or at a certain point blankly for a long period of time
• Epilepsy patients who faced a complex epilepsy attack do not respond normally to their environment
• Instances of patients performing repetitive movements such as chewing, walking around in circles, hand rubbing and swallowing have been seen.

Generalized Seizures

when the clinical or EEG findings suggest onset in both hemispheresof brain . Generalized onset seizures are categorized as motor and non-motor (absence) seizures. The generalized onset tonic clonic seizure, colloquially referred to as “grand mal,” has retained its place in new classification. There are six main types of seizures disease:

● Absence seizures: One of the most common types of seizures in children, absence seizures were previously known as petit mal seizures. Fits in children caused by this disorder often occur in clusters and show the following symptoms:

• Blankly staring into space
• Lack of awareness
• Random and subtle body movements such as lip-smacking and eye blinking

● Tonic seizures: This type of seizures cause stiffness of the muscles. This generally affects the muscles at your arms, legs, and back. These epilepsy fits are so strong that they may cause the patient to fall down due to a lack of muscle movement.

● Atonic seizures: Atonic seizures show fits disease symptoms in adults in which case, there occurs a complete loss of muscle control leading to the patient suddenly collapsing and falling down.

● Clonic seizures: Such types of seizures are associated with repetitive or rhythmic jerking movements of the body muscles. This generally affects the neck, face, and arms.

● Myoclonic seizures: Myoclonic epilepsy usually occurs with sudden brief jerks of the body muscles that cause unpredictable and involuntary twitching in the arms and legs.

● Tonic-clonic seizures: One of the most dramatic types of epileptic seizures, various unprovoked incidences can take place on its occurrence. Previously known as grand mal seizures, the symptoms include:

• Abrupt and random loss of consciousness
• Extreme stiffening of muscles
• Involuntary shaking of the body
• Loss of urinary bladder and bowel control
• Random acts like tongue biting

6.Risk Factors of Epilepsy

The exact cause or trigger of epilepsy has not yet been understood by doctors, but there are certain factors that increase the risks of epilepsy. They are:

• Age - Epilepsy is seen most commonly in children and older adults but it can happen to patients of any age
• Family history - Family genetic history of epilepsy leads to an increased risk of epileptic seizures in patients due to the presence of specific genes
• Head injury or trauma due to an accident
• Seizures in childhood
• Brain diseases - Certain brain conditions such as Dementia and Alzheimer’s disease can increase the risk in cases of older adults
• Brain infections - Viral infections such as encephalitis, AIDS or meningitis which causes inflammation in the brain or spinal cord lead to epilepsy
• Stroke and other vascular diseases - Such conditions cause brain damage which may, in turn, lead to occurrences of seizures and acute epilepsy

9.Stages of Epileptic Seizures

There are three phases of a seizure known as Aura, Ictus and Postictal

• Aura - The 1st stage of a seizure, in this phase, patients experience vision loss, numbness, tingling of muscles and buzzing sounds, flickering lights and hallucinations and dark spots among other similar experiences.
• Ictus - The ictus phase or peak stage manifests in different ways for different people depending on whether the seizure is focal or generalized. Common occurrences are confused looks, blackouts, loss of awareness and consciousness, repetitive blinking and sudden collapse.
• Postictal - This is the recovery phase of the seizure when people still tend to experience certain side-effects. They involve dizziness, hypertension, difficulty walking or talking, lack of bladder control and headaches.

10.Treatment and Management

Medicines

Epilepsy symptoms and treatment may vary on a case-by-case basis. Doctors generally begin the first line of treatment with medications. These are generally available in tablet, liquid, and injectable forms that travel to the bloodstream and affect neurotransmitters that regulate the electrical activity in the brain.

Antiepileptic medications include the following drugs:

• Levetiracetam
• Lamotrigine
• Topiramate
• Valproic acid
• Carbamazepine
• Ethosuximide

Antiepileptic meaning is that these medicines help act against seizures in the brain. But they also have certain side-effects. Such problems involve:

• Fatigue and dizziness
• Loss of coordination and balance
• Memory problems
• Skin rashes

More severe side-effects have also been seen which include depression, suicidal thoughts, and inflammation of vital organs of the body. More than half of the population affected by epileptic seizures tend to become seizure-free after the first dosage of prescribed medications.

Surgery

Surgery is another means of fits disease cure. In cases where medications fail to provide a cure for seizures, doctors may recommend surgeries.

Resection - The procedure involves the removal of the part of the brain that causes seizures. This is only performed when:

• The epileptic seizure originates in a very small area of the brain
• When doctors are sure that the surgery will not affect vital functions of the body like speech, vision, sense of smell and sound, language and motor capabilities.

Multiple Subpial Transection or Disconnection - This is done when the affected area of the brain is large. In this procedure, the doctor makes cuts in the brain to interrupt the nerve pathway that can help stop the spread to seizures in the brain.

Side-effects of epilepsy surgery may involve permanent damage to cognitive abilities and hence it is only performed in rare cases.

Therapy

Apart from medications and surgical procedures, certain therapies are also available as an alternative option for the treatment of epilepsy. Such therapies include:

• Vagus nerve stimulation - In this procedure, the doctor implants a device underneath the skin of the chest which has wires connected to the vagus nerve of the neck. This battery-powered device sends bursts of electrical activities to the brain which helps reduce seizures by 20 to 40 percent.
• Deep brain stimulation - In this case, surgeons implant electrodes inside the specific parts of the brain, usually the thalamus. These electrodes are connected to the generator implanted in the chest or skull that sends electrical signals to the brain which reduces seizures.

9.Epilepsy FAQs: All your concerns addressed

Q.  What is the meaning of epilepsy?

1. Epilepsy means the occurrence of more than one unpredictable and unprovoked seizures that happens due to abnormal activities in one or more regions of the brain.

Q.  What is meant by epileptic fits?

1. The term epileptic meaning is that it is associated with incidences of epilepsy. Epileptic fits meaning is the recurrent seizures that lead to lack of vision and other sensations and causes random, involuntary jerking of the muscles of the body.

Q.  What is the neurology definition?

1. Neurology means the branch of medicine or biology that deals with the anatomy, functions, and disorders of the nerves and the central nervous system as a whole.

Q.  What is the difference between Seizure and Epilepsy?

1. The primary difference between epilepsy and seizure is that the latter is a single occurrence whereas the former is a proper neurological disorder characterized by two or more episodes of seizures.

Q.  Is epilepsy fatal?

1. The risk of sudden death in epilepsy is very rare and it is only seen happening in 1% of the population affected by neurological disease.

Q.  Is epilepsy hereditary?

1. Certain research links specific genes to epilepsy. But in many cases, it is seen that parents with epilepsy do not always have children with the same fits disorder. If pregnant mothers suffer from epilepsy, then antiepileptic medications can affect the unborn baby and cause prenatal damage to their brain.

Q.  Is there a cure for epilepsy?

1. There is no exact cure for epilepsy but early identification, treatment, and management can help affected individuals live near-normal life. Antiepileptic medicines help control the occurrences of seizures to a great extent but they have severe side-effects. Two types of surgeries are also performed in which the defective area of the brain is removed that can permanently eliminate events of epilepsy.

Q.  What is the recovery period of surgery for epilepsy?

1. It is found that almost 81 percent of people who underwent surgery for epilepsy have been seizure-free after six months of the procedure. After 10 years, 72 percent of such population still live seizure-free, almost normal lives.

Q.  What are the main causes of epilepsy?

1. For up to 70% of the epilepsy cases among children and adults, no cause can be discovered. The Epileptic condition may be traced to various factors, including:
• Low oxygen during birth
• Head injuries during birth or from accidents
• Brain tumours
• Genetic influence from family
• Abnormal level of sodium or blood sugar which results in a chemical imbalance
• Certain toxic chemicals or drugs of abuse
• Alcohol withdrawal
• Developmental disorders, such as autism and neurofibromatosis
• Infectious diseases, like AIDS, viral encephalitis, meningitis, encephalitis can cause epilepsy.
• Brain conditions like Alzheimer’s disease can also cause seizures

Q.  What does having epilepsy mean for your everyday life?

1. Epilepsy is a medical condition in which a person has recurrent seizures. A seizure is an abnormal, disorderly discharging of the brain's nerve cells, resulting in a temporary disturbance of motor, sensory, or mental function. This hampers life skills such as driving and swimming due to the high risk if a seizure happens during this time.

Q.  What are the first signs of a seizure?

1. Some warning signs of possible seizures may include:
• Odd feelings, often indescribable
• Unusual smells, tastes, or feelings
• Unusual experiences – "out-of-body" sensations; feeling detached; situations or people look unexpectedly familiar or strange body looks or feels different
• Feeling spacey, fuzzy
• Temporary confusion
• Periods of forgetfulness or memory lapses
• Psychic symptoms such as fear, anxiety or deja vu
• Daydreaming episodes
• Jerking movements of an arm, leg, or body
• Falling
• Sudden loss of consciousness or awareness
• Tingling, numbness, or feelings of electricity in part of the body
• Headaches
• Unexplained sleepiness, weakness
• Losing control of urine or stool unexpectedly

Q.  Can you feel a seizure coming on?

1. Often termed as aura, the warning or the first symptom of seizure is an indescribable feeling. The aura can also occur as a focal onset aware seizure, which is a partial seizure without much change in awareness. In most epilepsy cases, people do not feel any aura or warning; the seizure starts with a loss of consciousness or awareness.

Q.  What are the different types of seizures?

1. It is found that almost 81 percent of people who underwent surgery for epilepsy have been seizure-free after six months of the procedure. After 10 years, 72 percent of such population still live seizure-free, almost normal lives.

Focal (or partial) seizures occur in a limited part of the brain hemisphere. There is a specific site or a focus where the seizure begins. There are two types of focal seizures:

• Focal seizures with retained awareness
• Focal seizures with a loss of awareness

Generalized seizures are a widespread seizure activity in the left and right hemispheres of the brain. The different types of generalized seizures are:

• absence seizures
• tonic-clonic or convulsive seizures
• atonic seizures
• clonic seizures
• tonic seizures
• myoclonic seizures

Infantile Spasms is an epileptic seizure which is neither focal nor generalized seizure. It starts at an early stage of life, usually around three to seven months of age.

Psychogenic non-epileptic seizures are not exactly due to epilepsy but may look very similar to an epilepsy seizure.

Q.  Can epilepsy kill you?

1. Epilepsy can be fatal but its completely undetectable or unpredictable. After a seizure, one might die in sleep. The condition is called SUDEP - sudden unexpected death in epilepsy. There's a condition called status epilepticus, where the patient can have single or multiple seizures that lasts more than five minutes. 30% of such patients die within 30 days.
   
   Also, Epileptic patients are 5 times more likely to take their own lives than the general population. Most deaths in epilepsy are accidents rather than a medical condition. Seizure during drowning, car accidents, falls, burns or cardiovascular problems can be fatal.

Q.  If I have Seizure, does that mean I have epilepsy?

1. Not really. Seizures disorder may also occur when you have other medical conditions such as:
   • A high fever.
   • Low blood sugar.
   • Alcohol or drug withdrawal

Q.  How is epilepsy disease diagnosed?

1. A person who has a seizure for the first time should talk to a primary health care provider. Your healthcare provider would look into what happened and the underlying cause of it. People who have seizures may need to undergo tests like brain scans for a closer look.

Q.  Who gives epilepsy treatment?

1. If you have epilepsy, you may need to consult a physician who can make a diagnosis of epilepsy and later on you may be referred to a neurologist or epileptologist. Neurology is a branch of medicine that deals with disorders related to the brain and nervous system. An epileptologist is also a neurologist who specializes in epilepsy. In case of seizures that are difficult to control or need advanced care, you may be shifted to an epilepsy centre. The healthcare team would comprise of:
   • Epileptologists and neurologists.
   • Nurses.
   • Psychologists

13.Living with Epilepsy

This chronic neurological disorder affects many walks of life other than the health factor. Since a seizure is unpredictable and can occur at any moment, common activities like driving and crossing a busy road are often dangerous. This ultimately leads to a loss of independence. Other than these social issues, there are other health complications that might occur. These include:

• Status epilepticus - Severe seizures that last more than five minutes pose the risk of permanent brain damage or death. This also includes a series of recurring seizures without gaining consciousness in between.
• In very rare cases, sudden unexplained death has also been seen.

People suffering should follow a proper, doctor-recommended recovery plan to cure epileptic seizures permanently.