What is epilepsy?
Epilepsy is a chronic disorder of the brain characterised by recurrent, unprovoked epileptic seizures. A seizure is the result of a sudden, excessive and disorganised electrical discharge of brain cells.
Epilepsy is one of the most common neurological disorders and can begin at any age. A single seizure does not in itself mean epilepsy: a one-off seizure caused by a high temperature, a sharp drop in blood sugar, alcohol withdrawal or sleep deprivation is assessed differently. Read more: Not every seizure is epilepsy.
What are the causes and risk factors of epilepsy?
The causes of epilepsy vary. In some cases the condition has a hereditary, genetic basis. Any damage that interferes with the normal functioning of the brain can also become a source of seizures. In clinical practice the condition is generally divided into two groups.
- Genetic (idiopathic) epilepsy — no structural damage is found in the brain; the condition is linked to an inherited predisposition and often begins in childhood or adolescence.
- Structural (symptomatic) epilepsy — the seizures result from a specific lesion in the brain.
Structural causes include abnormalities of brain development in the womb, infections and toxic substances to which the foetus was exposed, lack of oxygen during birth, brain infections (meningitis, encephalitis), traumatic brain injuries, brain tumours, stroke and brain haemorrhage, metabolic disorders and alcohol dependence. In some cases no cause is found despite all investigations.
What are the symptoms of epilepsy?
What a seizure looks like depends on which part of the brain is involved. The familiar picture of loss of consciousness and convulsions of the whole body is only one type of seizure.
- Generalised tonic-clonic seizure — loss of consciousness, stiffening of the body followed by rhythmic jerking; sometimes the tongue is bitten and there is involuntary loss of urine.
- Absence — a few seconds of “freezing” with a fixed stare; especially in children it may be mistaken for inattention.
- Focal seizure — jerking or numbness in one arm or leg, a strange taste or smell, repetitive automatic movements; consciousness may be preserved or impaired.
- Myoclonic and atonic seizures — sudden jerks, or falls caused by loss of muscle tone.
The vast majority of seizures occur suddenly. Some patients notice irritability, anxiety, dizziness or headache a few hours before a seizure. Sometimes an aura appears just before the seizure — a feeling of numbness, ringing in the ears, flashes of light, a strange taste in the mouth or a sensation of warmth. An aura is in fact the first subjective sign of a focal seizure and in some cases may be the only manifestation of the condition. A patient with an aura may sense that a seizure is approaching and try to sit or lie down so as not to fall and be injured.
When is emergency help needed?
Call 103 immediately in the following situations.
- The seizure lasts longer than 5 minutes, or seizures follow one another without the person regaining consciousness.
- It is the person’s first ever seizure.
- The person has been seriously injured during the seizure, the seizure happened in water, or breathing does not return to normal.
- The seizure occurred during pregnancy or in a person with diabetes.
During a seizure, protect the person from injury, put something soft under their head, do not try to open their mouth or prise their teeth apart, and once the seizure is over, lay them on their side. Read more: First aid for epilepsy.
How is epilepsy diagnosed?
Diagnosis is based on a detailed description of the seizure. Because patients often do not remember the seizure, information from someone who witnessed it — and, if possible, a phone video of the seizure — is very valuable. This is followed by a detailed neurological examination.
The most important instrumental test is electroencephalography (EEG) — it can show epileptic changes in the electrical activity of the brain. A normal EEG does not completely rule out epilepsy, so a sleep EEG or long-term video-EEG monitoring is sometimes needed. An MRI scan is ordered to look for a structural cause in the brain, and in some cases blood tests and a heart assessment (to rule out fainting).
How is epilepsy treated?
The mainstay of treatment is antiepileptic (anti-seizure) medication. According to international experience, seizures can be controlled in the vast majority of patients with correctly chosen treatment. The type of medication, the dose and the duration of treatment are chosen individually by the doctor according to the type of seizures, age, other conditions and life plans (for example, pregnancy).
Stopping medication or changing the dose on your own is dangerous — it can lead to seizures, including prolonged seizures. Where medication does not work, the patient may be assessed at a specialist centre for surgery, nerve stimulation or a special diet.
Everyday life with epilepsy
- Take your medication at the same time every day, without missing doses.
- Keep a regular sleep pattern — lack of sleep is one of the main seizure triggers.
- Avoid alcohol.
- Keep a seizure diary: date, duration, possible trigger.
- Avoid swimming alone, working at heights and operating dangerous machinery on your own.
- If you are planning a pregnancy, discuss it with your doctor in advance.
Most people with epilepsy study, work and lead full lives. On misconceptions about the condition in society: We are aware of epilepsy.
Frequently asked questions
Is epilepsy hereditary?
Some forms of epilepsy have a genetic predisposition, but a parent having epilepsy does not mean a child will definitely have it. The risk depends on the form of the condition and is discussed individually with the doctor.
Is epilepsy a mental illness?
No. Epilepsy is a neurological disorder of the brain. It is not an indicator of intelligence and it is not contagious.
When can treatment be stopped?
In some patients who have been seizure-free for a long time, gradually reducing the medication may be discussed. Only the doctor makes this decision, assessing the clinical picture and EEG results together.
Should a spoon be put in the mouth during a seizure?
No. This can break teeth, injure the mouth and hurt the person helping. A person does not “swallow” their tongue during a seizure.