What Is Epilepsy?

Epilepsy is a medical condition in which a person is predisposed to recurrent seizures. Seizures are brief episodes of involuntary movements and/or changes in consciousness that occur due to an alteration of brain activity.

Epilepsy is caused by a variation in brain structure or function, which might be detected with imaging studies or diagnostic tests of electrical activity in the brain.

Recurrent seizures can cause physical injuries and may interfere with day-to-day life. Additionally, prolonged seizures and frequent seizures can cause harm to the brain, leading to worsening epilepsy or cognitive changes.

This article will discuss the symptoms of epilepsy, types of seizures, diagnosis, treatment, and living with epilepsy.

Types of Seizures

There are many different types of seizures. They are defined based on the symptoms and the location in the brain where they begin.

Some of the common seizure types include:

• Absence seizures: These episodes consist of brief staring spells without any awareness of the episode. Absence seizures are generalized seizures that do not involve involuntary movements or changes in muscle tone.
• Focal onset seizures: These affect one brain region on one side. Symptoms may include jerking or stiffening of one limb, sensory changes, and partial loss of awareness. The episodes may begin and end as partial seizures or spread to both sides of the brain, causing effects on both sides of the body and loss of consciousness. A person who experiences recurrent focal seizures will generally experience the same symptoms every time.
• Generalized onset seizures: A generalized onset seizure begins on both sides of the brain, leading to loss of awareness. Some generalized seizures cause involuntary movements on both sides of the body. An absence seizure is a type of generalized onset seizure that doesn't involve involuntary movements.
• Secondarily generalized seizures: A focal seizure may spread to other areas of the brain, causing symptoms of a generalized seizure.
• Myoclonic seizures: This type of seizure causes recurrent jerking of one extremity and may impact awareness. Usually, it involves one arm. It commonly occurs upon waking from sleep.
• Tonic-clonic seizures: The involuntary stiffening and jerking of a tonic-clonic seizure can occur with focal or generalized seizures.
• Temporal lobe seizures: Focal seizures that begin in the brain's temporal lobe may involve unusual perceptions or changes in consciousness, often without complete loss of consciousness. Sometimes temporal lobe seizures can make a person feel like something is "not right" or they have a sense of déjà vu.

The classification and definitions of seizures can overlap. People who have epilepsy experience one or more seizure types.

Symptoms of Epilepsy

Epilepsy is a condition characterized by recurrent seizures. The seizures cause symptoms that correspond to the area of the brain that’s affected during the seizure. Usually, a person who has epilepsy will continue to experience the same symptoms and type of seizures, and will rarely develop a new type of seizure.

Symptoms of a seizure may include:

• Jerking of one limb on one side of the body
• Facial twitching
• Stiffening of one area of the body or the whole body
• Unusual noises or grunting
• Falling
• Diminished awareness
• A complete lack of awareness

Typically, a seizure will last for only a few seconds and will include one or more of the symptoms. Some people may have a specific sequence of symptoms. For example, a seizure may begin with grunting and progress to involve facial twitching.

Seizures are typically defined as having phases or stages that occur in a sequence:

• Some people experience a prodrome for hours or days prior to having a seizure. This can involve feeling sick or tired. People who have recurrent seizures may begin to recognize their own prodrome symptoms.
• A seizure aura includes symptoms that can last for seconds or minutes prior to more recognizable seizure symptoms.
• The ictal seizure phase is what is usually described as the “seizure” and it may involve changes in consciousness or involuntary jerking or stiffening.
• The post-seizure phase, sometimes called a postdrome generally involves fatigue. A person may fall asleep for several hours after having a seizure. Some people who have focal seizures with limb jerking or stiffening may also experience a period of weakness of the affected limb, described as Todd’s paralysis.

What Causes Epilepsy?

Epilepsy is caused by abnormal electrical discharges in the brain. A predisposition to seizures is usually associated with one or more areas of brain damage.

The location of brain damage is usually the same location where the seizure began in the brain, also called the seizure focus. It may manifest with specific and limited symptoms, but a focal seizure can spread so quickly that the focal symptoms corresponding to the damaged area of the brain might not be apparent.

The damage that causes recurrent seizures can occur due to head trauma, an episode of extremely low oxygen to the brain, problems during fetal development or infancy, a stroke, or an infection. Sometimes epilepsy can be caused by genetic predisposition.

There are many neurodevelopmental conditions (involving the development of the brain) associated with epilepsy. Some of these include:

• Cerebral palsy
• Rett syndrome
• Down syndrome
• Adrenoleukodystrophy

Is Epilepsy Hereditary?

Epilepsy can be hereditary. A person who has seizures during early childhood may have a genetic predisposition to epilepsy or may have experienced issues during early fetal development or early childhood that are not genetic or hereditary.

Common Seizure Triggers

Certain factors can trigger seizures. A seizure trigger is a health condition, environmental factor, or substance that can cause instability in the brain's electrical function, increasing the sensitivity of a seizure focus.

Most people who have epilepsy experience unprovoked seizures, which are seizures that occur without a trigger. Additionally, people who have epilepsy are especially sensitive to seizure triggers.

How to Identify Your Triggers

If you have epilepsy, it is best to avoid common seizure triggers, which include:

• Alcohol
• Drugs
• Sedatives
• Lack of sleep 
• Skipping meals
• Flashing lights
• Hyperventilation (rapid, deep breathing)
• Electrolyte imbalances (high or low values for sodium, chloride, calcium, potassium, or phosphate in the blood)
• Dehydration
• Infections
• Severe illness

Additionally, you may also notice that you are especially sensitive to specific triggers, even if they aren’t common. This may include particular foods, sounds, or smells.

How Is Epilepsy Diagnosed?

Epilepsy is diagnosed based on the symptoms and diagnostic tests. A history of recurrent seizures, especially unprovoked seizures, is consistent with a diagnosis of epilepsy.

Sometimes changes are detected during a neurological examination, but the physical examination is often normal for people with epilepsy.

Diagnostic tests can help identify whether epilepsy involves focal or generalized seizures. Common tests used in an epilepsy diagnosis include:

• Electroencephalogram (EEG): This noninvasive test detects abnormal electrical activity in the brain. Sometimes the changes occur during a seizure, and sometimes certain areas of the brain show abnormal patterns when a person is not experiencing a seizure. Sleep deprivation and hyperventilation are more likely to bring out seizure activity during the test.
• Brain imaging: A brain computed tomography (CT) or magnetic resonance imaging (MRI) scan can identify structural abnormalities in the brain or its blood vessels that may predispose a person to seizures if they are present.
• Blood tests: Screening tests can detect electrolyte abnormalities that can trigger a seizure. Depending on the medical history, certain blood tests may be ordered. Specialized blood tests can identify metabolic abnormalities or genetic changes associated with seizure syndromes.

Treatment for Epilepsy

Epilepsy is customarily treated with anti-epilepsy medication and avoidance of seizure triggers. For most people, these approaches are effective. Sometimes other interventions, such as surgery or brain stimulation, may be needed.

Medication

Medications indicated for treating epilepsy include those that are taken daily to prevent seizures. Some anti-epilepsy drugs are used on an emergency basis to help stop a prolonged seizure.

The selection of anti-epilepsy medication is based on the type of seizures and other medication or health problems that might affect treatment.

Surgery

Brain surgery procedures can help reduce the number or severity of certain types of seizures. Epilepsy surgery may involve cutting into or removing an area of the brain that causes seizures or promotes the generalization of seizures.

Testing prior to epilepsy surgery involves EEGs, imaging tests, and an evaluation of the function of the target area of the brain.

Brain and Nerve Stimulation

Certain surgically implanted devices can be used to treat epilepsy. These devices provide internal electrical stimulation that helps regulate the electrical activity in the brain to prevent a seizure. The vagal nerve stimulator is an example of a device used in surgical brain stimulation for epilepsy.

Diet and Lifestyle

Anybody who has epilepsy should maintain a consistent diet and lifestyle:

• Eat regularly to avoid high or low blood sugar.
• Avoid dehydration, which can alter electrolyte levels.
• Avoid infections and head trauma.
• Get enough rest.
• Don’t use alcohol or drugs.

The ketogenic diet for epilepsy is a special dietary regimen that is sometimes used to prevent seizures by people who have medication-resistant epilepsy. This diet involves maintaining a high-fat, low-carbohydrate intake, which leads to metabolic changes that can help prevent seizures.

However, the diet must be strictly adhered to because any intake of carbohydrates will alter the metabolic process that inhibits seizures. Therefore, this diet is used by people who are unable to obtain carbohydrates on their own, or who are extremely self-motivated.

Living With Epilepsy

Living with epilepsy requires making adjustments to day-to-day life to avoid seizure triggers. For some people, certain accommodations might be necessary for safety. 

Managing Seizures

Managing epilepsy involves taking medication as prescribed. Skipping anti-epilepsy medication or taking it irregularly can cause frequent seizures.

Some anti-epilepsy medications have side effects. It’s important to speak with your healthcare team about any side effects so you can work together to manage them. This can involve completely switching to a different prescription or taking treatment to alleviate side effects.

Do not make changes in your anti-seizure medications on your own, because that can lead to seizures. 

Devices That Help With Epilepsy

Specialty equipment can help improve quality of life. Depending on the type of seizures you experience and their impact on your life, you might consider using a device designed to help people who have epilepsy.

Examples of epilepsy devices and aids are:

• Epilepsy watch: Specialized watches are programmed to detect changes in the body, such as temperature or heart rate. If you tend to experience any of these changes before having a seizure, the watch may alert you so that you can get to a safe place before having a seizure.
• Alert or alarm: You might benefit from wearing or carrying an alarm so you can call for help if you feel that you need assistance.
• Epilepsy service dog: While a dog is not a device, a canine companion that’s trained to recognize signs of epilepsy can help protect you from harm or call for help in the event of a seizure.

Complications

Epilepsy can cause several complications, such as:

• An injury, such as a fall or bumping part of the body during a seizure
• Danger to self or others when using equipment or driving during a seizure
• Status epilepticus, a prolonged seizure that can cause brain damage, as well as systemic damage to the whole body

Emotional Impact

There are many emotional aspects of living with epilepsy. It can be difficult to adjust to the limitations of living with epilepsy, such as not driving or being unable to independently participate in certain activities, such as swimming.

Sometimes it can be difficult to regularly attend school or work due to seizures or medication side effects. These issues can lead to a sense of isolation or helplessness, and epilepsy is associated with a higher than average risk of depression.

If you are experiencing emotional complications due to epilepsy, you can seek professional support to help you talk through your feelings and learn to cope.

Can You Drive With Epilepsy?

Many states have regulations regarding driving for people who have epilepsy. Policies may consider factors such as how much time has passed since the most recent seizure or the use of medications.

You and your healthcare provider will have to discuss the regulations and the safest decision for you. Even if your state does not have restrictions that affect your permission to drive, your healthcare provider might recommend that you don’t drive as a safety precaution for yourself and others.

Outlook

Epilepsy is a medical condition with a wide variation in severity. The outlook varies considerably. Some people have very good seizure control with a tolerable medication dose. Many people remain seizure free while taking anti-epilepsy medication.

However, some people with epilepsy continue to have seizures despite medication, surgery, and dietary interventions.

You can get some guidance regarding the anticipated outlook for your seizure type, which can help you understand what you should expect. Your situation is unique, and your outlook depends on how well your seizures are controlled, the cause of your seizures, and whether you also have other medical issues that might affect your epilepsy.