Epilepsy is a neurological disease that results in abnormal electrical activity of the brain. It mainly affects children, adolescents and the elderly to varying degrees. The causes are in some cases genetic, but in most cases they are not identified.
Definition of epilepsy
Epilepsy is characterized by a sudden increase in electrical activity in the brain, causing a temporary disruption of communication between neurons. Usually, they are short-lived. They can occur either in a specific area of the brain or as a whole. These abnormal nerve impulses can be measured during an electroencephalogram (EEG), an examination that records brain activity.
Contrary to what one might think, epileptic seizures are not always accompanied by jerky movements or convulsions. They may indeed be less spectacular. They are then manifested by unusual sensations (such as olfactory or auditory hallucinations, etc.) with or without loss of consciousness, and by various manifestations, such as a gaze or involuntary repetitive gestures.
Importantly, seizures must be repeated for epilepsy. Thus, having a single seizure crisis in one’s life does not mean one is epileptic. It takes at least two for a diagnosis of epilepsy to be made. An epileptic seizure can occur in many circumstances: head trauma, meningitis, stroke , drug overdose, withdrawal from a drug, etc.
|It is not uncommon for young children to have convulsions during a fever episode. Called febrile seizures, they usually stop when they are 5 years old or 6 years old. It is not a form of epilepsy. When such convulsions occur, it is still important to consult a doctor.|
Causes of epileptic seizure
In about 60% of cases, doctors are not able to determine the exact cause of seizures. It is assumed that about 10% to 15% of all cases would have a hereditary component since epilepsy seems more prevalent in some families. Researchers have linked certain types of epilepsy to the malfunction of several genes. For most patients, genes are only part of the cause of epilepsy. Some genes can make a person more sensitive to environmental conditions that trigger seizures.
On rare occasions, epilepsy may be due to a brain tumor, a sequel to a stroke or other brain trauma. Indeed, a scar can form in the cerebral cortex, for example, and modify the activity of neurons. It should be noted that several years can elapse between the accident and the appearance of epilepsy. And remember that for epilepsy, seizures must occur repeatedly and not once. Stroke is the leading cause of epilepsy in adults over 35 years of age.
Infectious diseases. Infectious diseases, such as meningitis, AIDS and viral encephalitis, can cause epilepsy.
Prenatal lesion. Before birth, babies are susceptible to brain damage that could be caused by a number of factors, such as maternal infection, poor nutrition or poor oxygen supply. These brain lesions can lead to epilepsy or cerebral palsy.
Developmental disorders. Epilepsy can sometimes be associated with developmental disorders, such as autism and neurofibromatosis.
Who is affected?
In North America, about 1 in 100 people suffer from epilepsy. Among neurological diseases, it is the most common after migraine. Up to 10% of the world’s population may have a unique crisis at some point in their life.
Although it can occur at any age, epilepsy usually occurs during childhood or adolescence, or after age 65. In the elderly, increased cases of heart disease and stroke increase the risk.
Types of crises
There are 2 main types of epileptic seizures:
- Partial seizures, limited to a specific region of the brain; the patient may be conscious during the crisis (simple partial crisis) or his consciousness may be altered (complex partial crisis). In the latter case, the patient will not usually remember his convulsions.
- Generalized seizures, extended to all areas of the brain. The patient loses consciousness during the crisis.
It happens that a crisis, initially partial, spreads to the whole brain and thus becomes widespread. The type of sensation felt during a crisis gives an indication to the doctor of its origin (the frontal lobe, the temporal lobe, etc.).
Seizures can be of origin:
- Idiopathic. This means that there is no apparent cause.
- Symptomatic. This means that the doctor knows the cause. He may also suspect a cause without identifying it.
There are three descriptions of seizures, depending on which part of the brain the epileptic activity started:
They are limited to a restricted area of the brain.
- Simple partial seizures (formerly called “focal seizures”). These fits usually last a few minutes. During a simple partial crisis, the individual remains conscious.
The symptoms depend on the area of the brain affected. The person may feel tingling, an uncontrollable movement of body tension, experiencing olfactory, visual or taste hallucinations, or an unexplained emotion.
Symptoms of simple partial seizures can be confused with other neurological disorders, such as migraine, narcolepsy or mental illness. A thorough examination and tests are needed to distinguish epilepsy from other disorders.
- Complex partial seizures (formerly called “psychomotor crises”). During a complex partial crisis, the individual is in a state of altered consciousness.
He does not respond to stimulation and his gaze is fixed. He may have automatisms, that is to say that he makes involuntary repetitive gestures such as pulling on his clothes, snapping his teeth, etc. Once the crisis is over, he will not remember at all or very little of what happened. He may be confused or fall asleep.
This type of crisis involves the whole brain.
- Generalized absences. This was formerly known as the “little evil”. The first seizures of this type of epilepsy usually occur during childhood, from the age of 5 to 10 years. They last a few seconds and can be accompanied by brief blinking of eyelids. The person loses contact with his environment, but retains his muscle tone. More than 90% of children with this type of epileptic seizure are in remission as young as 12 years old.
- Tonicoclonic crises. They used to be called “great evil”. It is this type of seizure that is usually associated with epilepsy because of their spectacular appearance. The crisis usually lasts less than 2 minutes. It is about generalized convulsions which take place in 2 phases: tonic then clonic.
– During the tonic phase , the person can scream and faint. Then, his body stiffens and his jaw tightens. This phase usually lasts less than 30 seconds.
– Then, in the clonic phase, the person enters convulsions (uncontrollable and jerky muscular twitches). The breathing, blocked at the beginning of the crisis, can become very irregular. This usually lasts less than 1 minute.
Once the seizure is over, the muscles relax, including those in the bladder and intestines. Afterwards, the person may be confused, disoriented, have headaches and want to sleep. These effects have a variable duration, from twenty minutes to several hours. Muscular pains sometimes persist for a few days.
- Cyclonic crises. Rarer, they are manifested by sudden jerks of arms and legs. This type of attack lasts from one to a few seconds depending on whether it is a single shock or a series of jolts. They usually do not cause confusion.
- Atonic crises. During these uncommon seizures, the person suddenly collapses due to a sudden loss of muscle tone. After a few seconds, she regains consciousness. She is able to get up and walk.
Seizures can result in personal injury if the person loses control of their movements.
Individuals with epilepsy can also experience significant psychological impacts, including unpredictable seizures, prejudices, adverse drug reactions, and more.
Seizures that are protracted or that do not end with a return to normal must absolutely be dealt with urgently . They can cause significant neurological sequelae at any age. Indeed, during a prolonged crisis, certain areas of the brain lack oxygen. In addition, damage can be caused to neurons due to the release of excitatory substances and catecholamines associated with acute stress.
Some crises can even be fatal. The phenomenon is rare and unknown. It is called ” Unexpected Unexplained Sudden Death in Epilepsy ” (MSIE). It is believed that a seizure could alter the heart rate or stop breathing. The risk would be higher for epileptics whose seizures are not well treated.
Having a crisis at times can be dangerous for yourself or others.
Fall. If you fall during a seizure, you may be injured in the head or fracture a bone.
Drowning. If you have epilepsy, you are 15 to 19 times more likely to drown while bathing or bathing than the rest of the population because of the risk of having a seizure in the water.
Car accidents. A crisis that causes a loss of consciousness or control can be dangerous if you drive a car. Some countries impose driving license restrictions related to your ability to control your convulsions.
Emotional health issues. People with epilepsy are more likely to have psychological problems, especially depression, anxiety and, in some cases, suicidal behavior. The problems can result from difficulties related to the disease itself as well as the side effects of the drug.
|A woman with epilepsy planning for pregnancy should take special precautions. She should see a doctor at least 3 months before conception. For example, the doctor may adjust the medication because of the potential for congenital malformation of some antiepileptic drugs. In addition, many antiepileptic drugs are not metabolized the same way during pregnancy, so the dosage may change. Note that epileptic seizures themselves can put the fetus at risk by temporarily depriving them of oxygen.|
In general, if the person is well cared for, she can lead a normal life with some restrictions . For example, driving and the use of technical equipment or machinery in the course of employment may be prohibited at the start of treatment. If the epileptic has not had a seizure for a certain period of time, the doctor can re-evaluate his situation and issue him a medical certificate to put an end to these prohibitions.
Epilepsy Canada recalls that people with epilepsy have fewer seizures when they lead an active lifestyle. “So you have to encourage them to look for a job,” says their website.
Epilepsy can last a lifetime, but some people with epilepsy will eventually have no seizures. Experts estimate that about 60% of untreated people no longer have seizures for 24 months after their first seizure.
Having had her first young attacks seems to favor remission. About 70% go into remission for 5 years (no convulsions for 5 years).
About 20 to 30 percent develop chronic epilepsy (long-term epilepsy).
For 70% to 80% of people with persistent disease, medications manage to eliminate seizures.
British researchers have reported that death is 11 times more common among people with epilepsy than in the rest of the population. The authors added that the risk is even greater if a person with epilepsy also has a mental illness. Suicides, accidents and assaults accounted for 16% of early deaths; a majority had been diagnosed with a mental disorder.
Symptoms and people at risk of epileptic seizure
Recognize epileptic seizure
Because epilepsy is caused by abnormal electrical activity of neurons, seizures can affect all functions coordinated by the brain. Signs and symptoms of seizures may include:
- Periods of loss of consciousness or altered consciousness. Sometimes, the eyes remain open, with a fixed gaze: the person does not react anymore.
- Sudden fall of the person for no apparent reason.
- In some cases, convulsions: prolonged and involuntary muscle contractions of the arms and legs.
- Sometimes transformed perceptions (taste, smell, etc.).
- Noisy breathing
- The person becomes frightened for no apparent reason; she may even panic or get angry.
- Sometimes an aura precedes the crisis. The aura is a sensation that varies from one person to another (an olfactory hallucination, a visual effect, a feeling of déjà vu, etc.). It can be manifested by irritability or agitation. In some cases, the affected person can recognize these typical sensations of the aura and if he has the time, lie down to prevent a fall.
In most cases, a person with epilepsy tends to have the same type of seizure every time, so the symptoms will be similar from one episode to the next.
It is necessary to seek immediate medical assistance if any of the following situations occur:
- The convulsion lasts more than five minutes.
- Breath or state of consciousness does not come back once the crisis is over.
- A second convulsion follows immediately.
- The patient has a high fever.
- He feels exhausted.
- The person is pregnant.
- The person is diabetic.
- The person was injured during the convulsion.
- This is the first epileptic seizure.
People at risk for epileptic seizure
- People with a family history of epilepsy. Heredity may play a role in many forms of epilepsy.
- People who have suffered a brain injury as a result of a violent stroke , stroke , meningitis, etc. are slightly more at risk.
- Epilepsy is more common in early childhood and after age 60.
- People with dementia (eg Alzheimer’s disease). Dementia can increase the risk of epilepsy in the elderly.
- People suffering from a brain infection. Infections such as meningitis, which causes inflammation of the brain or spinal cord, can increase the risk of epilepsy.
Diagnostic of epileptic seizure
The doctor will examine the patient’s symptoms and medical history and will perform several tests to diagnose epilepsy and determine the cause of seizures.
Neurological examination. The doctor will evaluate the patient’s behavior, motor skills, mental function and other factors that will determine the type of epilepsy.
Blood tests. A blood sample can be taken to determine signs of infection, genetic mutations, or other conditions that may be associated with seizures.
The doctor may also suggest tests to detect brain abnormalities, such as:
- The electroencephalogram. This is the most common test used to diagnose epilepsy. In this test, doctors place electrodes on the scalp of the patient that record the electrical activity of the brain.
- A scanner.
- A tomography. A tomography uses X-rays to obtain images of the brain. It can reveal abnormalities that could cause seizures, such as tumors, bleeding and cysts.
- Magnetic resonance imaging (MRI). An MRI can also detect lesions or abnormalities in the brain that could cause seizures.
- Positron emission tomography (PET). PET uses small amounts of radioactive substances that are injected into a vein to visualize active areas of the brain and detect abnormalities.
- Computer tomography by simple photon emission (SPECT). This type of test is used mainly if MRI and EEG have not identified in the brain the origin of convulsions.
- Neuropsychological tests. These tests allow the doctor to evaluate the cognitive performance: memory, fluent verbal etc. and determine which areas of the brain are affected.
Prevention of epileptic seizure
|Can we prevent?|
|Since, in most cases, the cause of epilepsy remains unknown, it is difficult to make recommendations to prevent it.
At the very least, cases of epilepsy caused by head trauma can be avoided by applying standard safety precautions . For example, use a seatbelt by car, wear a bicycle helmet, wear a helmet when doing risky activities (climbing a wall, carrying out construction work, driving a motorcycle), etc.
|Measures to reduce the frequency of seizures|
|If it is impossible to prevent the onset of epilepsy, it is sometimes possible to reduce the frequency of seizures by avoiding exposure to the factors that trigger their onset as much as possible. However, it seems that the majority of sufferers can link their attacks to particular events .
Most common triggers
Other possible triggers
Having a healthy lifestyle is an important complement to medical treatments to better control seizures. Here are some basic tips.
Medical treatment of epileptic seizure
|It is not necessary to see a doctor at each crisis, but consultation is required in the following cases:
Taking an anticonvulsant drug can completely stop seizures in the majority of epileptics. If this is not the case, it can at least reduce the number of seizures, as well as their intensity.
Usually, the use of a single drug is sufficient. However, one must often try several medications before finding the right one. Anticonvulsants often cause fatigue, drowsiness and weight gain or loss. Other possible side effects include depression, loss of coordination, slurred speech and fatigue.
Phenytoin (such as Dilantin), carbamazepine (such as Tegretol) and valproic acid (Epival, Novo-Valproic) have been used for many years. Others are newer, such as gabapentin (Neurontin), lamotrigine (Lamictal), topiramate (Topamax) and levetiracetam (Keppra). Pregabalin (Lyrica) is an analog of gabapentin that causes little fewer side effects .
Some anticonvulsants (Dilantin, Tegretol and Epival) increase the elimination of vitamin D , which can in the long term cause osteoporosis. A calcium and vitamin D supplement is usually prescribed to prevent this problem.
In some cases, if there have been no seizures for 2 or 3 years, it is possible to undertake a withdrawal of drugs, in agreement with his doctor. A complete remission sometimes happens.
In the early 1920s, doctors observed that children who fasted had fewer epileptic seizures. They attribute this effect to the accumulation of ketones in the blood system. For reasons that are misunderstood, a high level of ketones in the blood (ketosis) is indeed associated with a reduction of seizures.
The ketogenic diet is low in carbohydrates (sugars of all kinds). Total calorie intake is maintained by increasing the consumption of fat (mostly) and protein. It creates an effect similar to fasting because carbohydrate restriction increases the production of ketones. Especially effective in children, this diet requires medical follow-up.
This particular diet has been neglected because of its difficulty of application and the arrival of anticonvulsants. In recent years, it has been used again to treat epileptic children who do not respond well to conventional treatments . According to a review of studies published in 2006, the ketogenic diet would reduce by half the frequency of seizures in about a third of children who follow . Two subsequent clinical studies also support the efficacy of this diet.
Some issues , however, remain unresolved. It is not clear how long this plan should be followed. In some studies, children – for whom it has been effective – have been able to return to normal nutrition after 2 to 3 years without having seizures and without having to take medication. Moreover, it is not known if it is as effective in adults.
Admittedly, this diet is very rich in fat, but the calories are calculated scrupulously. Therefore, if properly followed, this diet does not result in weight gain.
Unfortunately, it can have some long-term side effects: dehydration, gastrointestinal disorders, kidney stones, liver toxicity, etc. It can also cause many deficiencies: it therefore requires the intake of vitamin and mineral supplements. Hence the importance of following such a diet under strict medical supervision .
If it is a partial seizure and the medication does not bring tangible results, it is sometimes possible to perform surgery . Surgery involves making an incision in the part of the brain related to seizures, or removing the entire part if the risk of causing a neurological deficit can be ruled out. The evaluation that precedes the surgery can last several months, as it includes multiple examinations (imaging tests, electroencephalograms, and neuropsychology assessments).
The Gamma Knife is a still experimental radiosurgery for epilepsy. This method involves irradiating the area causing epilepsy using a very high radiation power. Non-invasive, this technique has the advantage of destroying only the diseased cells. Note that this method can be used only to treat small brain lesions (less than 3 cm in diameter).
Stimulation of the vagus nerve by an implant
Approved in the United States and Canada, this technique would help reduce or control seizures that do not respond to surgery or medication. This is a device – implanted under the skin of the chest – that stimulates the vagus nerve by producing an electrical impulse every 5 minutes. Once set correctly, the device works automatically, but this process requires a long period of adjustments (it takes 12 months to 18 months).
Manage your condition on a daily basis
- Take your medicine properly. Do not adjust the dosage before talking to the doctor. If you think your medicine should be changed, talk to your doctor.
- Make sure to rest well. Lack of sleep can trigger seizures.
- Wear a medical alert bracelet. This will allow the medical staff to properly treat you.
- Exercise can help you stay healthy and improve your mood. Be sure to drink enough water and rest if you get tired while exercising.
What to do in the event of a crisis ?
The following measures concern generalized tonicoclonic seizures (grand mal). From the outset, you must know that it is impossible to stop a crisis that is already triggered. Most of the time, the person will fall to the ground without you having the time to hold it down.
Call an ambulance in the following cases
Dogs are specially trained to accompany people with epilepsy. When a crisis occurs, the dog can go for help or protect the person. In some cases of partial crisis, he can take her to a safe place. Trials are also underway to teach dogs to “feel” the seizures before they occur, and to warn their master. In a small, uncontrolled study of 10 people with epilepsy (with tonicoclonic seizures), the presence of a guide dog eventually reduced the seizure frequency by 35% or more in 9 of them. However, the costs of training dogs are high. Get information from an association dedicated to epilepsy (see Sites of Interest).