Understanding Epilepsy: Exploring Types, Causes and Symptoms

Epilepsy is a neurological disorder marked by recurrent seizures. These seizures stem from temporary disruptions in the brain's electrical activity. Normally, brain cells (neurons) communicate through orderly electrical impulses. In epilepsy, this balance goes awry, causing sudden bursts of synchronized electrical energy. These bursts affect consciousness, movement, or sensations, depending on the seizure type.

Diagnosing epilepsy typically requires at least two unprovoked seizures. If a seizure originates from a specific brain region, the initial symptoms might reflect that area's function. For instance, a seizure starting in the right brain's movement control area could cause jerking in the left hand (controlled by the right brain).

Epilepsy: A Worldwide Overview

According to NIH, 50 million people globally grapple with epilepsy, with a significant portion residing in developing countries. India alone is home to roughly 10 million cases.

While epilepsy affects 50 million people worldwide, WHO reports a troubling disparity. Nearly 80% of cases reside in low- and middle-income countries. This lack of access to proper diagnosis and treatment is heartbreaking, as up to 70% of people with epilepsy could potentially live seizure-free. Tragically, the risk of premature death for those with epilepsy is three times higher compared to the general population.

What are seizures? 

Seizures are sudden bursts of uncontrolled electrical activity in the brain. This surge disrupts the brain's normal functioning, leading to a variety of symptoms depending on the seizure type and the part of the brain affected. Epilepsy presents with a diverse range of seizures, prompting specialists to continually refine classification. Two main categories exist: primary generalized and partial seizures. The key difference lies in their origin.

• Primary Generalized Seizures: These involve widespread electrical discharges affecting both brain hemispheres simultaneously. Often, genetic factors play a significant role.
• Partial Seizures: These originate from a specific brain region. Head injuries, infections, strokes, or tumours can trigger them, but in many cases, the cause remains unknown.

A crucial distinction within partial seizures is whether consciousness is affected. While seemingly straightforward, consciousness impairment can vary greatly.

Factors Affecting Seizure Risk:

Several factors can increase seizure risk in individuals:

• Stress
• Sleep deprivation or fatigue
• Skipping meals
• Alcohol or drug misuse
• Not taking prescribed anti-seizure medications

The likelihood of future seizures depends on various factors. Roughly half of those experiencing a single, unexplained seizure will have another within six months. This risk increases with a known brain injury or abnormality. Two seizures significantly raise the chance of future occurrences (around 80%). Additionally, seizures coinciding with brain injuries or infections are more likely to progress to epilepsy compared to those without such triggers.

Epilepsy and Seizures: Understanding the Symptoms

Epilepsy is a neurological disorder characterized by recurrent seizures. Seizures themselves are caused by abnormal electrical activity in the brain, and the resulting symptoms can vary greatly depending on the seizure type and the affected brain region.

Common Seizure Symptoms:

• Temporary confusion

• Staring spells

• Stiff muscles

• Uncontrollable jerking movements

• Loss of consciousness

• Psychological changes like fear, anxiety, or deja vu

Focal vs. Generalized Seizures:

Seizures are broadly classified into two categories: focal and generalized. This distinction is based on where the abnormal electrical activity originates in the brain.

Focal Seizures: These arise from activity in a specific brain region. They can further be classified based on awareness during the seizure:

• Focal Seizures with Awareness: Previously called simple partial seizures, these don't cause a loss of consciousness. Symptoms may include altered emotions, changes in perception (smell, taste, sight, sound), deja vu, or involuntary muscle jerks.
• Focal Seizures with Impaired Awareness: Formerly known as complex partial seizures, these involve a change or loss of consciousness. Symptoms might resemble being in a dream, with staring spells, repetitive movements (hand rubbing, chewing), or walking in circles.

Generalized Seizures: These involve abnormal electrical activity across both brain hemispheres, causing symptoms that affect the entire body. Several types of generalized seizures exist:

• Absence Seizures: Often seen in children, these involve brief periods of staring with or without subtle body movements (blinking, lip smacking) lasting 5-10 seconds. They may occur in clusters and cause short lapses in awareness.
• Tonic Seizures: These cause stiff muscles and may affect consciousness, often involving the back, arms, and legs, and potentially leading to falls.
• Atonic Seizures (Drop Seizures): These involve sudden loss of muscle control, most commonly affecting the legs and causing falls.
• Clonic Seizures: Characterized by repeated or rhythmic jerking of muscles, typically in the neck, face, and arms.
• Myoclonic Seizures: These appear as brief jerks or twitches, usually affecting the upper body, arms, and legs.
• Tonic-Clonic Seizures (Grand Mal Seizures): The most dramatic type, these involve sudden loss of consciousness, body stiffening, twitching, shaking, and sometimes loss of bladder control or tongue biting.

Importance of Diagnosis

It's crucial to note that seizure symptoms can sometimes be mistaken for other neurological conditions. A thorough medical evaluation is necessary to determine the cause of symptoms and ensure proper diagnosis and treatment.

What causes Epilepsy?

While the cause of seizures remains unknown in up to 70% of cases, researchers have identified several contributing factors:

• Genetics: Certain epilepsy types, like juvenile myoclonic epilepsy, show a familial link. While specific genes are likely involved, they seem to increase the risk rather than guarantee epilepsy. Other factors may play a role. Additionally, some epilepsies stem from abnormalities in how brain cells communicate, leading to abnormal signals and seizures
• Mesial temporal sclerosis: Scarring in the temporal lobe (near the ear) can trigger focal seizures.
• Birth defects: Malformations affecting brain development can be a cause, especially in cases resistant to medication. Examples include focal cortical dysplasia, polymicrogyria, and tuberous sclerosis.
• Brain Injury and Infection: Trauma from accidents or falls, infections like meningitis or encephalitis, and parasitic infections (neurocysticercosis) can contribute to epilepsy.
• Immune System Dysfunction: Autoimmune diseases that attack brain cells can increase seizure risk.
• Metabolic Disorders: Issues with how the body processes energy can be a factor. Genetic testing can help identify such conditions.
• Brain Conditions and Blood Vessel Abnormalities: Brain tumours, strokes, dementia, and abnormal blood vessel formations (arteriovenous malformations) can also play a role.

Diagnosing and Treating Epilepsy

Diagnosing epilepsy involves a multi-pronged approach by a doctor. They consider a patient's symptoms, physical signs, and results from tests like EEG (electrical brain activity), CT scans (detailed X-rays), or MRI scans (detailed 3D images).

Accurate Diagnosis is Key

Accurately identifying both the epilepsy type and seizure type is crucial. Different seizure classifications often point to specific forms of epilepsy.

Treatment Options

The primary treatment options for epilepsy include medications, dietary therapy, and surgery.

• Medications: Antiepileptic drugs (AEDs) are the initial treatment for most patients experiencing recurring seizures. In rare cases, a single seizure with low recurrence risk might not require medication. It's important to remember that AEDs manage the seizures (symptoms) rather than cure the underlying condition. Fortunately, they are highly effective, controlling seizures completely in around 70% of patients. These medications work by preventing abnormal electrical signals in the brain that trigger seizures.
• Finding the Right Medication: With a vast array of AEDs available, choosing the most suitable option can be complex. Factors like seizure and epilepsy type, potential side effects, existing medical conditions, interactions with other medications, age, gender, and cost all influence this decision.
• Open Communication is Essential: Before prescribing any medication, a doctor will discuss the potential benefits, side effects, and risks with the patient to ensure informed decision-making.

Conclusion 

Epilepsy, while a significant neurological condition, doesn't have to define your life. With proper diagnosis and treatment, many people with epilepsy can lead fulfilling lives. There's been ongoing research in epilepsy treatment, offering hope for even better management options in the future. If you or someone you know experiences seizures, consult a healthcare professional for guidance. Remember, you're not alone on this journey. Epilepsy organisations and support groups can provide valuable resources and connections.

Frequently asked questions

Is epilepsy contagious? 

No, epilepsy is not contagious. You cannot catch epilepsy from another person. Epilepsy is a neurological condition caused by abnormal electrical activity in the brain. It's not caused by viruses or bacteria, which are the usual culprits behind contagious diseases.

Can epilepsy be cured?

Currently, there's no cure for epilepsy. However, with proper treatment, many people with epilepsy can live seizure-free lives.

Can I still live a normal life with epilepsy?

Yes! Many people with epilepsy manage their condition effectively and live full, active lives. There are things you can do to manage your epilepsy, such as taking medications as prescribed, getting enough sleep, and avoiding triggers that might bring on seizures.

Can I still drive if I have epilepsy?

Driving regulations for people with epilepsy vary by location. It's crucial to consult with your doctor to understand if your epilepsy is controlled well enough for safe driving and to follow the specific guidelines in your area.

What are the long-term effects of epilepsy?

The long-term effects of epilepsy can vary depending on the severity and type of epilepsy, as well as how well it's controlled with treatment.