Understanding Epilepsy: Signs, Symptoms, and Treatments

Epilepsy is one of the most common neurological conditions in the world, affecting more than 65 million people. While this chronic condition is among the most common, many people are unaware of what epilepsy is, and what it isn’t. When you think of epilepsy, you probably think of violent, uncontrollable seizures. While this may be true for some with epilepsy, there are many different kinds of epileptic seizures, each with its causes and symptoms.

Below, we’ll take a look at everything you need to know about epilepsy, including the different types of seizures, symptoms, and treatments.

What Is Epilepsy?

Epilepsy is a chronic disorder that affects the central nervous system (CNS). The effects cause abnormal brain activity which leads to seizures or unusual behavior, sensations, and sometimes loss of awareness.

Epilepsy is the fourth most common neurological condition—only migraine, stroke, and Alzheimer’s disease occur more frequently. In the United States alone it’s estimated that nearly 2.2 million people suffer from epilepsy (about 7.1 per 1,000). Anyone can develop epilepsy, and there does not appear to be any one demographic that is more likely to develop the condition. That said, epilepsy is more commonly diagnosed in young children than adults.

The hallmark symptoms of epilepsy are unprovoked, recurrent seizures. These seizures can vary widely from person to person, which can make diagnosing epilepsy difficult. Some people with epilepsy will simply stare blankly for a few seconds during a seizure, while others may twitch or flail their arms or legs. Having a single seizure does not mean you have epilepsy. Rather, epilepsy is defined as having at least two seizures without a known trigger that happen at least 24 hours apart.

The majority of patients with epilepsy can be treated using a variety of medications, surgeries, or therapies. Some may require lifelong treatment to control their symptoms, but for others, their seizures may simply go away on their own.

Now that we’ve covered the basics of what epilepsy is, it’s time to cover the common symptoms associated with it.

What Are the Symptoms of Epilepsy?

Since epilepsy is caused by abnormal activity in the brain, seizures can affect many of the brain’s processes. There are two main types of epileptic seizures: generalized and focal. Symptoms of an epileptic seizure will differ from person to person and according to what type of seizure they are having. Let’s take a look at the symptoms of each, and how you can tell them apart.

Focal (Partial) Seizures

A focal seizure is a type of seizure that results from abnormal activity in just one part of the brain. This is why they are sometimes called partial seizures. One of the key differences between a focal seizure and a generalized seizure is that focal seizures rarely result in loss of consciousness. These types of seizures fall into two categories:

• Focal Seizures Without Loss of Consciousness: These types of epileptic seizures, as the name suggests, do not result in the loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste, or sound. Some people who have a focal seizure will experience deja vu. Focal seizures may also result in involuntary jerking of body parts such as arms or legs, and spontaneous sensory symptoms such as tingling, dizziness, and flashing lights.
• Focal Seizures with Impaired Awareness: Often referred to as complex partial seizures, these types of seizures involve a change or loss of consciousness or awareness. To many, these types of seizures feel like a dream. During these types of seizures, you may stare into space and not respond normally to your environment. You may also perform repetitive, involuntary movements such as hand rubbing, chewing, swallowing, or walking in circles.

Generalized Seizures

Generalized seizures are seizures that appear to involve all areas of the brain. There are six known types of generalized seizures, each with its symptoms and causes. These include:

• Absence Seizures: These types of seizures used to be known as “petit mal seizures.” These types of seizures are common in children, and can often occur in clusters of up to 100 times a day. They are characterized as causing repetitive movements like lip smacking or blinking, blank stares, and sometimes a brief loss of consciousness.
• Tonic Seizures: Tonic seizures cause stiff muscles and may result in loss of consciousness. They usually affect the muscles in the back, arms, and legs.
• Atonic Seizures: Atonic seizures, also known as drop seizures, cause a loss of muscle control. They get the name drop seizure because they typically affect the muscles in the legs, which causes you to suddenly collapse or fall.
• Clonic Seizures: Clonic seizures are classified as causing repeated jerking muscle movements. These seizures usually affect the neck, face, and arms.
• Myoclonic Seizures: Myoclonic seizures usually cause sudden brief jerks or twitches, and usually appear in the upper body, arms, or legs.
• Tonic-Clonic Seizures: Tonic-clonic seizures, previously known as “grand mal seizures,” are the most severe and dramatic type of epileptic seizure. They cause an abrupt loss of consciousness and body twitching. They can also cause loss of bladder control and biting of the tongue.

What Causes Epilepsy?

For nearly six out of ten people, the exact cause of their epilepsy is unknown. In the other half, the condition is thought to be caused by several factors, the most common being genetics. Below are what scientists have determined to be the most likely causes of epilepsy.

• Genetics: Genetic influence is thought to be one of the more likely causes of epilepsy. Certain types of epilepsy, which is determined by the type of seizure you experience, run in families. In these cases, scientists believe there is a genetic influence. There are over 500 genes that are thought to be associated with epilepsy. Researchers have linked some of these genes to specific types of epilepsy, but for most people, genetics play little to no role in their condition. Certain genes may make a person more sensitive to environmental conditions that trigger seizures.
• Head Trauma: Trauma sustained from things such as a car accident, serious injury, or other similar instances can cause epilepsy.
• Infections: Certain infections can cause epilepsy. The most notable of which include meningitis, HIV, viral encephalitis, and certain parasites.
• Brain Abnormalities: Brain tumors, vascular malformations such as arteriovenous malformations (AVMs), and cavernous malformations can all cause epilepsy.
• Prenatal Injury: While in the womb, a fetus is very sensitive to brain damage. This could be caused by several factors, such as an infection in the mother, poor nutrition, or oxygen deficiency. These can all cause brain damage, which can result in epilepsy.
• Developmental Disorders: In certain cases, epilepsy has been associated with certain developmental disorders such as autism.

Now that we’ve covered what epilepsy is, what symptoms you should look out for, and what the potential causes are, it’s time to look at what treatments are available.

Treating Epilepsy

There is currently no known cure for epilepsy. However, most people with epilepsy can manage their symptoms with a variety of treatment options. Depending on your symptoms, age, health, and how well you respond to therapy, treatment for epilepsy can look very different. Doctors will generally start epilepsy treatment with medication. If medications don’t help, they may then propose surgery or other types of treatment.

Below are some of the most common treatment methods for epilepsy, starting with medications.

Epilepsy Medications

Medications are the first line of treatment for epilepsy. These types of medications are known as antiseizure medications, and they can help reduce the frequency and severity of seizures. While these drugs can’t stop a seizure that’s already in progress, they can help you better manage life with epileptic seizures.

There are many different antiseizure medications on the market. Depending on your condition, your doctor may prescribe any of the following medications:

• Levetiracetam (Keppra)
• Lamotrigine (Lamictal)
• Topiramate (Topamax)
• Valproic Acid (Depakote)
• Carbamazepine (Tegretol)
• Ethosuximide (Zarontin)

Common side effects of antiseizure medications include fatigue, dizziness, poor coordination, and memory problems. Should medications not work, doctors may recommend undergoing surgery to help manage your symptoms.

Surgery

The most common surgery used to treat epilepsy is a resection. This surgery involves removing the part of the brain where the seizures start. Oftentimes, this is the temporal lobe, which is responsible for processing emotions, language, and certain aspects of visual perception. In some instances, this can stop seizure activity.

As with any surgery, there are risks associated with this type of procedure. These include negative reactions to anesthesia, bleeding, and infection. Surgery of the brain can also result in cognitive changes. It’s always important to talk with your doctor about the pros and cons of surgery before making a decision.

Other Treatment Options

Certain therapies have been shown to help patients with epilepsy. These include things like vagus nerve stimulation (VNS), deep brain stimulation (DBS), and a ketogenic diet. These therapies are all aimed at treating epileptic seizures, and depending on your condition, can be effective alternatives to medications or surgery.

• Vagus Nerve Stimulation: VNS is a type of therapy in which a small electrical device, similar to a pacemaker, is placed under the skin of your chest. The device is attached to a wire that connects to a nerve in your neck called the vagus nerve. Bursts of electricity are sent through this device to the nerve. It’s thought that this can help control seizures by intercepting and altering the signals sent to your brain. VNS does not stop seizures altogether, but it can make them less frequent.
• Deep Brain Stimulation: DBS is similar to VNS. However, a DBS device is wired directly to the brain, rather than a nerve. Like VNS, the electrical signals sent via the device are thought to be effective at intercepting and altering signals sent to the brain. DBS is a fairly new procedure that’s not used very often, so it’s not yet clear how effective it is for epilepsy.
• Ketogenic Diet: A ketogenic diet is a diet high in farms and low in carbohydrates and protein. This diet is often recommended for children with epilepsy, where it has been shown to make seizures less likely to occur. While the ketogenic diet was popular before the use of antiseizure medications, they are now widely used in adults because a high-fat diet is linked to several serious health conditions including diabetes and cardiovascular disease.

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