Epilepsy

Overview

Epilepsy, also known as a seizure disorder, is a chronic brain condition characterized by recurring seizures. There are various types of epilepsy, and while the cause can be identified in some individuals, it remains unknown in others. This neurological disorder is relatively common, affecting people of all genders, races, ethnic backgrounds, and ages, with an estimated 1 in 26 individuals developing the disorder according to the Epilepsy Foundation.

Seizure symptoms can vary significantly among individuals. Some may experience a loss of awareness during a seizure, while others may not. Certain seizures may involve brief episodes of blank staring, while others can manifest as convulsions or spasms, marked by repetitive twitching of the arms or legs. It’s important to note that having a single seizure does not necessarily indicate epilepsy. A diagnosis of epilepsy typically requires the occurrence of at least two unprovoked seizures, separated by at least 24 hours, without a clear underlying cause.

Treatment for epilepsy often involves the use of medications or, in some cases, surgical intervention to manage and control seizures. While some individuals may require lifelong treatment, others may eventually become seizure-free. It is worth mentioning that children with epilepsy may potentially outgrow the condition as they age. Epilepsy arises from damaged brain cells, which generate abnormal electrical signals leading to bursts of uncontrolled electrical activity within the brain. Seizures can result in various changes to a person’s awareness, muscle control, sensations, emotions, and behavior, contributing to the condition’s complexity and impact on daily life.

Symptoms

The symptoms of seizures can vary depending on the type of seizure a person experiences. Epilepsy, which is characterized by abnormal brain activity, can affect various brain processes, leading to a range of seizure symptoms. Seizure signs and symptoms can manifest in various ways, including:

• Temporary loss of awareness or consciousness.
• Uncontrolled muscle movements, such as jerking or loss of muscle tone.
• Exhibiting a blank stare or appearing to be “staring into space.”
• Temporary confusion, slowed thinking, and difficulties with speaking and understanding.
• Changes in sensory perception, such as alterations in hearing, vision, taste, smell, or experiencing numbness or tingling sensations.
• Impaired speech or understanding of language.
• Physical sensations like an upset stomach, waves of heat or cold, or goosebumps.
• Repetitive actions like lip-smacking, chewing motions, hand rubbing, or finger movements.
• Psychic symptoms, such as feelings of fear, dread, anxiety
• Increased heart rate and/or breathing rate.

Warning signs of seizures

Seizures can be accompanied by warning signs known as auras, which are experienced by some individuals with focal seizures. These auras can manifest as various sensations, emotions, or perceptions. They may include stomach sensations, feelings of fear, déjà vu, taste or smell changes, visual disturbances like steady or flashing lights, colors, or shapes, as well as dizziness, loss of balance, and hallucinations.

Seizures are classified as either focal or generalized, depending on where and how the abnormal brain activity starts.

Focused seizures

Focused seizures are those that appear to be caused by activity in a single area of the brain. There are two types of these seizures:

• Focal seizures without losing consciousness. These seizures, which were once known as simple partial seizures, don’t result in unconsciousness. They may modify feelings or affect how objects appear, feel, sound, or smell. Some people have déjà vu. An arm or a leg may twitch uncontrollably during this sort of seizure, and sensory symptoms including tingling, vertigo, and flashing lights may also appear suddenly.
• Focal seizures with impaired awareness. These seizures, which were once known as complex partial seizures, include a shift or loss of consciousness or awareness. This kind of seizure could make you feel like you’re dreaming. People who are having focal seizures and have diminished consciousness may stare off into space and not react to their surroundings as they normally would. Additionally, they could do repetitive movements like rubbing their hands together, eating, swallowing, or walking in circles.

Symptoms of focal seizures can sometimes be mistaken for those of other neurological conditions such as migraines, narcolepsy, or mental illness. To differentiate epilepsy from these other illnesses, a comprehensive examination and diagnostic tests are necessary. These evaluations help in accurately identifying and diagnosing epilepsy while ruling out other potential causes.

Focal seizure types include:

• Frontal lobe seizures.  Frontal lobe seizures originate in the frontal area of the brain, which is responsible for controlling movement. These seizures can result in individuals tilting their heads and shifting their eyes towards one side. They may exhibit unresponsiveness to verbal cues and could display involuntary vocalizations like screaming or laughing. Additionally, they might extend one arm while flexing the other, and engage in repetitive actions like rocking or mimicking bicycle pedaling.
• Temporal lobe seizures. Temporal lobe seizures originate in the temporal lobes of the brain, which are responsible for processing emotions and playing a role in short-term memory. Individuals experiencing these seizures commonly have an aura, which can manifest as a sudden emotional shift like fear or joy, an abrupt taste or smell, a sense of déjà vu, or a rising sensation in the stomach. During the seizure itself, people may become unaware of their surroundings, exhibit a vacant gaze, make repetitive actions such as smacking their lips, swallowing or chewing repeatedly, or display unusual movements of their fingers.
• Occipital lobe seizures. Occipital lobe seizures originate in the occipital lobe, which is responsible for vision and visual processing. Individuals experiencing this type of seizure may encounter hallucinations or experience a partial or complete loss of vision during the seizure. Additionally, these seizures can manifest as eye blinking or abnormal movements of the eyes.

Generalized seizures

Generalized seizures appear to affect all parts of the brain and are distinguished from focal seizures. Among generalized seizures are:

• Absence seizures. Petit mal seizures, also referred to as absence seizures, usually affect young children. Staring into space, with or without slight body movements, is one of the symptoms. Movements only last 5 to 10 seconds and could include mouth smacking or eye blinking. These seizures can happen in bunches, up to 100 times every day, and they can briefly knock you out of it.
• Tonic seizures. Muscles become tight during tonic seizures, and consciousness may be impacted. The back, arms, and legs are typically affected by these seizures, which can result in falls to the ground.
• Atonic seizures. Muscle control is lost during atonic seizures, commonly referred to as drop seizures. Since the legs are most frequently affected, it frequently results in a sudden collapse or a fall to the ground.
• Clonic seizures. Muscle jerking that is repetitive or rhythmic is a symptom of clonic seizures. The arms, face, and neck are typically affected by these seizures.
• Myoclonic seizures. The upper torso, arms, and legs are typically affected by myoclonic seizures, which typically present as quick, short jerks or twitches.
• Tonic-clonic seizures. The most severe kind of epileptic seizures are tonic-clonic seizures, also referred to as grand mal seizures. They may also cause the body to jerk, twitch, or shake, as well as an abrupt loss of consciousness. They can occasionally result in tongue biting or a lack of bladder control.

It is important to seek urgent medical assistance if any of the following situations arise:

• The seizure lasts for more than five minutes.
• Breathing or consciousness does not return after the seizure ends.
• Another seizure occurs immediately after the first.
• You have a high fever.
• You are pregnant.
• You have diabetes.
• You sustain an injury during the seizure.
• You continue to experience seizures despite taking prescribed anti-seizure medication.

If you experience a seizure for the first time, it is advisable to seek medical advice.

Causes

About half of those who suffer from epilepsy have no known cause. The condition in the other half can be attributed to a number of things, such as:

• Genetic.  Epilepsy can have a genetic component, with certain types running in families due to specific genes. However, it is also possible for genetic changes to occur spontaneously in an individual without being inherited. In most cases, genetics only play a partial role in epilepsy, as environmental factors can also trigger seizures, and certain genes may make a person more susceptible to these triggers. While some forms of epilepsy have been linked to specific genes, it is believed that these genes increase the risk rather than being the sole cause, as other factors are likely involved. Abnormalities affecting brain cell communication can also lead to epilepsies characterized by abnormal brain signals and seizures.
• Head trauma. Epilepsy can be caused by head trauma resulting from various incidents such as car accidents, traumatic injuries, falls, or any impact to the head.
• Immune disorders. Epilepsy can result from illnesses that trigger your immune system to assault brain cells (also known as autoimmune diseases).
• Factors in the brain. Epilepsy can be caused by brain tumors. The way blood arteries develop in the brain could possibly contribute to epilepsy. Seizures can occur in people with blood vessel disorders such cavernous and arteriovenous malformations. Additionally, stroke is the main cause of epilepsy in persons over the age of 35.
• Infections. Epilepsy can be brought on by meningitis, HIV, viral encephalitis, and various parasite illnesses.
• Injury before birth. Babies are vulnerable to brain injury that could be brought on by a number of events even before birth. They could be oxygen deficiency, inadequate nourishment, or an infection in the mother. Epilepsy or cerebral palsy may be the result of this brain injury.
• Developmental disorders. There are situations when epilepsy coexists with developmental problems. Epilepsy is more common in people with autism than in the general population. Additionally, studies have shown that patients with epilepsy are more likely to have attention-deficit/hyperactivity disorder (ADHD) and other developmental issues. The epilepsy and developmental problem genes may be linked in those who have both illnesses.

Risk factors

Your risk of epilepsy may be impacted by the following factors:

• Age. Although epilepsy can develop at any age, it most frequently does so in children and older individuals.
• Family history. You may be more likely to develop a seizure problem if you have a family history of epilepsy.
• Head injuries. Some cases of epilepsy are caused by head injuries. Wearing a seatbelt in a car and a helmet while biking, skiing, riding a motorbike, or taking part in other sports that carry a high risk of head injuries will lower your risk.
• Stroke and other vascular diseases. Brain injury can be brought on by blood vessel conditions like stroke. Epilepsy and seizures may be brought on by brain injury. Several actions can be taken to lower your chance of developing chronic illnesses, such as limiting your alcohol intake, quitting smoking, maintaining a healthy diet, and engaging in regular exercise.
• Dementia. In elderly persons, dementia can raise the risk of epilepsy.
• Brain infections. You have a higher risk if you have an infection like meningitis, which causes inflammation in the brain or spinal cord.
• Seizures in childhood. Seizures with high fevers in children can occasionally coexist. Most kids who experience seizures because of high fevers won’t go on to have epilepsy. If a kid has experienced a prolonged fever-related seizure, has another nervous system disorder, or has a family history of epilepsy, their risk of developing epilepsy rises.