Epilepsy | Causes, Symptoms, and Treatment Options
What is epilepsy?
Epilepsy is a long-term (chronic) disease that causes recurrent seizures due to abnormal electrical signals produced by damaged brain cells. A seizure occurs due to an uncontrolled burst of electrical activity within brain cells. Seizures can involve changes in consciousness, muscle control (your muscles may twitch or shake), sensations, emotions, and behavior. Epilepsy is also known as a seizure disorder.
What happens in the brain during epilepsy?
Brain cells send and receive messages to all areas of the body. These messages are transmitted through a continuous electrical impulse that travels from one cell to another. Epilepsy disrupts this rhythmic pattern of electrical impulses.
Instead, bursts of electrical energy—like an unexpected lightning storm—occur between cells in one or more areas of the brain. This electrical disturbance causes changes in consciousness (including loss of consciousness), sensation, emotions, and muscle movements.
What are the types of epilepsy and the associated seizure symptoms?
Healthcare providers classify epilepsy types based on the type of seizure. Seizure categories depend on where the seizure starts in the brain, the level of awareness during the seizure, and the presence or absence of muscle movements.
There are two main groups of seizures:
Focal onset seizures:
Focal onset seizures begin in one area or network of cells on one side of the brain. These seizures were previously known as partial seizures. There are two types of focal seizures:
- Focal aware seizure: This means you are awake and aware during the seizure. Healthcare providers used to call this type of seizure a “simple partial seizure.” Symptoms may include:
- Changes in the senses—how you taste, smell, or hear things.
- Emotional changes.
- Uncontrolled muscle twitching, usually in the arms or legs.
- Seeing flashing lights, feeling dizzy, or having tingling sensations.
- Focal impaired awareness seizure: This means you are confused or lose awareness or consciousness during the seizure. This type of seizure was known as a “complex partial seizure.” Symptoms may include:
- Fixed staring.
- Repetitive movements like blinking, lip-smacking, chewing, hand rubbing, or finger movements.
What are other types of epilepsy?
Other types of epilepsy do not fall under the focal category, such as generalized seizures, where widespread electrical disturbances occur in the brain, affecting overall awareness and often causing significant muscle movements on both sides of the body.
Generalized onset seizures: Generalized onset seizures affect a wide network of cells on both sides of the brain simultaneously. There are six types of generalized seizures:
- Absence seizures: These seizures cause a blank stare or “staring into space” (a brief loss of consciousness). There may be minor muscle movements, including blinking, lip-smacking, chewing, or hand movements. Absence seizures are more common in children, lasting only a few seconds (usually less than 10 seconds) and are often mistaken for daydreaming. This type of seizure was previously called “petit mal seizures.”
- Atonic seizures: The word “atonic” means “without tone.” An atonic seizure means you’ve lost muscle control, or your muscles have become weak during the seizure. Parts of your body may droop or fall, such as your eyelids or head, or you may fall to the ground during this brief seizure (usually less than 15 seconds). This type of seizure is sometimes called a “drop seizure” or “drop attack.”
- Tonic seizures: The word “tonic” means “with tone.” A tonic seizure means that your muscle tone has increased significantly. Your arms, legs, back, or your entire body may become tense or stiff, which could cause you to fall. You may be conscious or experience a slight change in consciousness during this brief seizure (usually less than 20 seconds).
- Clonic seizures: “Clonus” means rapid repeated stiffening and relaxing of a muscle (spasms). A clonic seizure occurs when muscles twitch continuously for a few seconds to a minute or stiffen and spasm for a few seconds up to two minutes.
- Tonic-clonic seizures: This seizure combines muscle stiffening (tonic) and repetitive rhythmic muscle spasms (clonic). Healthcare providers may call it a convulsion. It was previously called a “grand mal seizure.” Tonic-clonic seizures are what most people think of when they hear the word “seizure.” You lose consciousness, fall to the ground, your muscles stiffen and spasm for one to five minutes. You may bite your tongue, drool, and lose control of your bowel or bladder, causing you to defecate or urinate.
- Myoclonic seizures: This type of seizure causes short, shock-like muscle twitches or movements (where “myo” refers to muscle, and “clonus” refers to muscle spasms). Myoclonic seizures usually last only a few seconds.
What are seizure triggers?
Seizure triggers are events or conditions that occur before a seizure begins. Knowing your seizure triggers can help you avoid them or better manage them.
Common seizure triggers include:
- Stress: Psychological pressure can increase the likelihood of seizures.
- Sleep problems: Such as poor sleep, insufficient sleep, fatigue, and sleep disorders like sleep apnea.
- Alcohol use: Or alcohol withdrawal, and recreational drug use.
- Hormonal changes: Including hormonal changes related to the menstrual cycle.
- Illnesses and fever: Illnesses like the flu or fever can trigger seizures.
- Bright lights or patterns: Such as flashing lights or repetitive patterns.
- Unhealthy diet: Not eating balanced meals or drinking enough fluids, vitamin and mineral deficiencies, and skipping meals.
- Physical stress: Excessive physical activity.
- Certain foods: Such as caffeine, which is a common trigger.
- Dehydration: Lack of fluids can trigger seizures.
- Specific times of the day or night.
- Certain medications: Diphenhydramine, found in over-the-counter products treating colds, allergies, and sleep problems, is a reported trigger.
- Missing doses of anti-seizure medications.
How can I identify my seizure triggers?
Some people find that their seizures occur regularly at certain times of the day or around specific events or factors. You may want to track your seizures and the events that occur around the time of the seizure to see if there is a specific pattern.
In your seizure diary, note the time each seizure occurred, any special events or conditions occurring around the time of the seizure, and how you felt. If you suspect you’ve identified a trigger, track this trigger to see if it is indeed a trigger. For example, if you think caffeine is a trigger, do seizures occur after consuming any food or drink containing caffeine, after a “certain number” of caffeinated foods and drinks, or at specific times of the day after consuming caffeine? Caffeine may or may not be a trigger upon thorough review.
Signs and symptoms of epileptic seizures
The main symptom of epilepsy is recurrent seizures. Symptoms vary depending on the type of seizure you have.
Signs and symptoms of seizures include:
- Temporary loss of consciousness: Or full awareness.
- Uncontrolled muscle movements: Muscle twitching, loss of muscle tone.
- Blank stare
- Temporary confusion: Slow thinking, trouble speaking, and understanding.
- Changes in hearing, vision, taste, or smell: Or a feeling of numbness or tingling.
- Trouble speaking or understanding.
- Stomach disturbance: Waves of heat or cold, chills.
- Chewing movements, hand rubbing, or finger movements.
- Psychological symptoms: Including fear, dread, anxiety, or déjà vu (feeling of false familiarity).
- Increased heart rate and/or breathing.
Most people with epilepsy tend to have the same type of seizure, so they have similar symptoms with each seizure.
What causes epilepsy?
In most cases (up to 70% of cases), the exact cause of seizures is unknown. Known causes include:
- Genetics:
Certain types of epilepsy (like juvenile myoclonic epilepsy and childhood absence epilepsy) are more likely to be inherited (genetic). Researchers believe that while there is some evidence for the involvement of specific genes, these genes only increase the risk of epilepsy, and other factors may be involved. Certain types of epilepsy result from abnormalities affecting how brain cells communicate with each other, leading to abnormal brain signals and seizures. - Mesial temporal sclerosis:
This is a scar that forms in the inner part of the temporal lobe (a part of the brain near the ear) that can lead to focal seizures. - Head injuries:
Head injuries can result from traffic accidents, falls, or any blow to the head. - Brain infections:
Infections can include brain abscesses, meningitis, encephalitis, and neurocysticercosis. - Immune disorders:
Conditions where the immune system attacks brain cells (also known as autoimmune diseases) can lead to epilepsy. - Developmental disorders:
Congenital abnormalities affecting the brain are a common cause of epilepsy, especially in people whose seizures are not controlled by anti-seizure medications. Some known congenital abnormalities that cause epilepsy include focal cortical dysplasia, polymicrogyria, and tuberous sclerosis. There is a wide range of other known brain abnormalities that cause epilepsy. - Metabolic disorders:
People with a metabolic condition (how your body gets energy for its normal functions) can develop epilepsy. A healthcare provider can detect many of these disorders through genetic testing. - Brain conditions and vascular abnormalities:
Brain health problems that can cause epilepsy include brain tumors, strokes, dementia, and abnormal blood vessels like arteriovenous malformations.
Diagnosis and tests
How is epilepsy diagnosed?
Technically, if you’ve had two or more seizures that were not caused by a known medical condition—such as alcohol withdrawal or low blood sugar—you are considered to have epilepsy. Before making a diagnosis, a healthcare provider (or epilepsy specialist) will perform a physical exam, take your medical history, and may order blood tests (to rule out other causes). They may ask you about your symptoms during the seizure and conduct other tests as well.
A doctor or family member (who witnessed your seizure) may ask if you experienced any of the following during the seizure:
- Involuntary muscle movements
- Muscle stiffness
- Loss of bowel or bladder control (urinating or defecating during the seizure)
- Change in breathing
- Pale skin color
- Blank stare
- Loss of consciousness
- Speech problems or difficulty understanding what was said to you
What tests will be done to diagnose epilepsy?
Tests include:
- Electroencephalogram (EEG):
This test measures electrical activity in your brain.
Some abnormal electrical patterns are associated with seizures. - Brain scans:
Magnetic resonance imaging (MRI) to look for tumors, infections, or vascular abnormalities.
How is epilepsy treated?
Epilepsy is treated using several methods, including:
- Surgery:
The doctor will consider surgery if anti-seizure medications do not control your seizures and if your seizures are severe and debilitating.
Epilepsy surgery can be a safe and effective treatment option when more than two trials of anti-seizure medications fail to control seizures.
It is important to evaluate your condition at an epilepsy center to see if you are a candidate for epilepsy surgery if anti-seizure medications do not control your seizures.
- Resective surgery:
This aims to remove the brain area responsible for generating seizures.- Anterior temporal lobectomy: Part of the temporal lobe is removed, which is most commonly used to treat temporal lobe epilepsy.
- Resection of a defined focus: When there is a defined epileptic focus in another part of the brain.
- Corpus callosotomy:
By cutting the nerve fibers in the corpus callosum (which connects the two halves of the brain) to prevent the spread of seizures from one half of the brain to the other.
Suitable cases: Often used for children with severe drop attacks or generalized seizures. - Vagus nerve stimulation (VNS):
By implanting a device that stimulates the vagus nerve with electrical pulses to regulate electrical activity in the brain.
Suitable cases: For patients who are not candidates for traditional surgery or as an adjunct to medication therapy. - Deep brain stimulation (DBS):
Implanting electrodes in specific parts of the brain, stimulated by electrical pulses to reduce seizure activity.
Suitable cases: For patients who do not respond to other treatments and may have multiple epileptic foci. - Responsive neurostimulation (RNS):
Implanting a device that responds to epileptic activity and stimulates the brain to prevent seizures.
Suitable cases: When the epileptic focus is known but located in sensitive areas that cannot be removed.- Multiple subpial transection:
Making surgical incisions in specific areas of the brain’s cortex without removing tissue to prevent the spread of epileptic activity.
Suitable cases: When tissue resection is risky due to its location in areas with vital functions. - Hemispherectomy:
Removing or disabling one hemisphere of the brain. This type of surgery is rare and usually used for children with severe, progressive epilepsy affecting an entire hemisphere.
Suitable cases: Particularly for children with severe seizures originating from one half of the brain. - Focused ultrasound ablation:
Using high-energy sound waves to destroy epileptic tissue without open surgery.
Suitable cases: For patients with a clearly defined epileptic focus who do not wish to or cannot tolerate traditional surgery.
- Multiple subpial transection:
- Anti-seizure medications:
Anti-seizure medications can control seizures in about 60% to 70% of people with epilepsy.
Anti-seizure medication treatment is tailored to each individual.
The doctor may try one or more medications, doses, or combinations of medications to find what works best for controlling seizures.
Choosing an anti-seizure medication depends on:
- The type of seizure.
- Your previous response to anti-seizure medications.
- Other medical conditions you have.
- The possibility of interaction with other medications you are taking.
- The side effects of the anti-seizure medication (if any).
- Your age.
- Your overall health.
- If anti-seizure medications do not control your seizures, the doctor will discuss other treatment options, including special diets, medical devices, or surgery.
- Dietary therapy:
The ketogenic diet and the modified Atkins diet—high-fat, moderate-protein, and low-carbohydrate diets—are the most common diets sometimes recommended for people with epilepsy.
Diets are often recommended for children who have not responded to medications and are not candidates for surgery.
Low glycemic index diets may also reduce seizures in some people with epilepsy.
How to manage epilepsy seizures
To effectively manage epilepsy seizures, the following guidelines can be followed:
- Take medications exactly as prescribed by your healthcare provider.
- If you miss a dose, contact your healthcare provider immediately.
- Get enough sleep, generally between seven to nine hours per night.
Stress releases certain chemicals in the areas of your brain most susceptible to seizures.
To reduce stress, try:
-
- Yoga
- Meditation
- Deep breathing exercises
- Biofeedback
- Other relaxation techniques
- Exercise regularly:
Engage in regular exercise, about 30 minutes a day, five times a week. - Avoid excessive alcohol use:
Alcohol can affect anti-seizure medications and increase the risk of seizures. - Certain medications: Including antidepressants, antihistamines, and stimulants, can interfere with the effectiveness of seizure medications or cause side effects.
Turkey Healthcare Group stands out with a team of distinguished medical experts in Turkey, who always strive to provide the best healthcare services to patients.
If you are looking for exceptional healthcare or need medical consultation from top doctors, feel free to contact us.
We also invite you to view our leading medical staff and get to know their qualifications and experiences up close.
We are here to ensure you receive the best possible healthcare.
