Epilepsy: A Simple Guide for Families and Patients

Definition of epilepsy

A chronic neurological illness, epilepsy causes unprovoked seizures. These seizures are caused by aberrant brain electrical activity, which affects movement, behavior, sensation, and consciousness. Rapid brain electrical activity disrupts function. When two or more seizures occur that are not caused by fever or trauma, a diagnosis of epilepsy is made.

Sudden, uncertain epilepsy

Etiology

The etiology of epilepsy can be genetic, structural, metabolic, immune-related, or uncertain.

Stress, sleeplessness, flashing lights, and missing prescriptions might trigger it.

Epilepsy symptoms

Epilepsy symptoms vary depending on the type of seizure and the specific area of the brain affected. This simple separation helps you manage clinical and patient-facing aspects

Key seizure symptoms

• Momentary bewilderment
• Staring spells (misinterpreted as daydreaming)
• Uncontrolled arm, leg, or body jerks
• Absence of consciousness
• Surges of terror, anxiety, déjà vu
• Stiffness or limpness
• Pre-seizure aura (strange smells, tastes, or visual distortions)

Symptoms by Seizure Type

• Focal awareness seizures: Tingling, visual, emotional, maintained awareness
• Poor Focus Epilepsy: Staring, lip-smacking, repetitive motions, altered consciousness
• Generalized Grand Mal Tonic-Clonic Complete convulsions, stiffness, jerking, unconsciousness
• Absence seizures (Petit Mal) occur when children often blink, stare, or lose awareness.
• Myoclonic seizures: Sudden arm or leg jerks or twitches
• Atonic seizures (drop attacks): Loss of muscle tone leads to falls.
• Tonic seizures: Sleep-related muscle stiffening
• Clonic seizures were rhythmic jerks.

Symptoms before and after a seizure: 

• Headache, impatience, mood swings, and concentration issues
• After a seizure: Fatigue, disorientation, memory loss, pain, emotional sensitivity

Also, read https://www.rch.org.au/neurology/patient_information/about_epilepsy/.

The cause of epilepsy

1. Genetics

• Inherited ion channel or neurotransmitter mutations
• Dravet, Juvenile Myoclonic, and GEFS+ syndromes
• Some examples involve uninherited mutations.

2. Brain Structural Abnormalities

• Tumors, cortical dysplasia, vascular malformations
• Traumatic brain injury
• Scarring after stroke
• Hypoxic-ischemic encephalopathy during pregnancy

3. Infections

• In endemic areas, neurocysticercosis
• HIV-associated CNS illnesses, meningitis, encephalitis
• CNS tuberculosis

4. Autoimmune Epilepsy Antibody-mediated (e.g., anti-NMDA receptor encephalitis)

• It frequently presents with status epilepticus or psychiatric issues.

5. Metabolism and Systemic Disorders

• Hyponatremia, hypocalcemia
• Inborn metabolic abnormalities (GLUT1 deficiency, mitochondrial illnesses)
• Kidney or liver failure (uremic encephalopathy)

6. Age-Specific Causes

• Common Causes by Age Group
• Neonates: Birth trauma, hypoxia, metabolic abnormalities, congenital malformations
• Infants/Children: Genetic disorders, infections, febrile seizures
• Adults: stroke, malignancies, autoimmune diseases, head trauma
• Elderly Brain damage, Alzheimer's, late-onset epilepsy, stroke

7. Unknown Cause Idiopathic

• Up to 50% of cases lack an identifiable etiology despite careful investigation.
• Often called cryptogenic epilepsy

Types of epilepsy

Where and how seizures occur in the brain classify epilepsy. Understanding these types helps with diagnosis, treatment, and patient education. This straightforward breakdown matches your communication style.

1. Focal epilepsy

• Certain brain regions cause seizures.
• Generalized Epilepsy
• Both hemispheres are involved in seizures from the beginning.
• These seizures are typical. The condition can be either genetic or idiopathic.

3. Generalized/Focal Epilepsy

• Patients have focal and generalized seizures.
• These seizures are commonly observed in complex disorders such as Lennox-Gastaut and Dravet syndromes.

4. Unknown Epilepsy

• Current diagnostic methods cannot identify the cause of the seizure.
• Sometimes, these methods serve as a temporary measure until further evaluation is conducted.

Syndromes of epilepsy

• The age of onset, EEG findings, and prognosis are distinctive features of certain clinical patterns.
• JME: Generalized seizures and myoclonic jerks, beginning in adolescence.
• Childhood Absence Epilepsy: Frequent absence seizures, excellent prognosis
• Lennox-Gastaut Syndrome: Cognitive impairment, mixed seizures, poor prognosis
• SCN1A mutation causes severe infant myoclonic epilepsy, known as Dravet Syndrome.
• West Syndrome: Infantile spasms, EEG hypsarrhythmia, developmental delay

Can epilepsy be cured?

Chronic neurological conditions, such as epilepsy, can be treated. This systematic breakdown helps distinguish between cure and control for patient education and clinical communication.

What We Can Do

• Controlling seizures: Up to 70% of patients with epilepsy can stop experiencing seizures through medication.
• Some individuals, particularly young people with specific epilepsy syndromes, may outgrow their seizures and stop taking medication.
• Brain surgery can abolish seizures in some circumstances, such as focal epilepsy caused to a lesion.

What is not guaranteed?

• There is no universal epilepsy cure.
• Permanent resolution is not guaranteed; seizures may return even after years of being seizure-free.
• Genetic or idiopathic forms of seizures generally require lifelong care, especially when the origin is unknown or complex.

Hope Ahead

• Precision medicine: Genetic profiling customizes therapy.
• Neurostimulation: VNS and RNS devices give new alternatives.
• Researchers are studying the processes of seizures and developing new treatments.

Lifestyle and Support Matter

Even in cases of drug resistance, adhering to medication, maintaining good sleep hygiene, managing stress, and avoiding triggers can improve treatment outcomes.

Epilepsy treatment

Epilepsy Treatment: A Clinical and Patient Education Guide

Treatment for epilepsy aims to reduce seizures, improve quality of life, and minimize adverse effects. This comprehensive analysis balances technical depth with patient-friendly clarity to suit your needs:

1. Anti-Seizure Drugs

• First-line treatment for most
• Maintain neural activity and prevent aberrant electrical discharges.
• ASMs include phenytoin and carbamazepine, which block sodium channels. Effective for focal seizures
• GABA enhancers: Pregnancy warning: Valproate, Clonazepam, Broad-spectrum
• SV2A modulators: Levetiracetam, Brivaracetam: Fewer interactions; mood effects probable.
• For absence seizures, ethosuximide blocks calcium channels.

Key Points:

• ~70% of patients control seizures with medication.
• Needs personalized dose and side effect monitoring
• Abrupt withdrawal might cause seizures; therefore, adherence is key.

2. Surgery Options

Specific focal epilepsy with recognizable lesions is resistant to drug treatment.

Types:

• Corrective surgery: Removal of seizure focus (temporal lobectomy)
• Ablating laser: Minimally invasive epileptogenic tissue damage
• Corpus callosotomy: Stops the spread by separating hemispheres
• Hemispherectomy: Rare, severe pediatric case.

3. Neurostimulation Therapies 

Neurostimulation therapies are utilized either as a substitute for surgery or as an adjuvant therapy.

The device mechanism

• A VNS provides pulses to the brain via the vagus nerve.
• RNS: Real-time seizure detection and disruption
• DBS targets the thalamus or other deep regions.

4. Diet therapies

• Especially effective for pediatric refractory epilepsy
• Ketogenic diet: Excess fat, low carb; ketosis
• The modified Atkins diet: Less restrictive option
• Low-GI diet: Focuses on glucose stability

5. Lifestyle and Support

• Stress reduction, trigger avoidance, and sleep hygiene
• Psychosocial aid: Counseling, support groups
• Education: Seizure treatment, medication compliance, driving regulations

An epilepsy attack

Epilepsy Attack: Know and Respond

A seizure—a rapid brain electrical surge—is an “epilepsy attack.” These episodes vary in intensity, duration, and symptoms based on the type of epilepsy and the brain regions involved.

Common Epileptic Attack Symptoms

• Convulsions: Uncontrolled limb jerking
• Absence of consciousness
• Staring or blankness
• Sudden muscular stiffness or collapse
• Aura: Odd odors, tastes, and déjà vu before seizure
• Confusion postictal: Disorientation, weariness, or memory loss after the episode

First Aid for Epileptic Attacks

CDC and other clinical sources:

• Be calm and reassuring to others.
• Gently lower the person to prevent injury.
• Keep the airway clear by gently turning them one way.
• They cover their heads with a jacket.
• Take off your spectacles and loosen your neckwear.
• Seizures lasting more than 5 minutes require emergency treatment.
• Follow the person until they are alert and safe.
• Do not limit their movements.
• Put nothing in their mouth.
• Do not consume any food, drink, or medication during a seizure.

When to get help

• Emergency services should be called if a seizure lasts more than five minutes.
• Multiple seizures without recovery. Injured, pregnant, or diabetic
• Their first seizure
• After the seizure, they may experience problems with breathing or waking up.

Seizures: What They Are and How They Happen

Epileptic seizures are sudden, uncontrolled disturbances in the brain's electrical activity. These seizures can alter behavior, movements, emotions, and consciousness. Epilepsy is characterized by seizures; however, fever, trauma, or metabolic disorders can also lead to seizures.

During a Seizure

• During a seizure, there is an abnormal and excessive firing of neurons.
• Lightning storms in the brain impair regular brain function.
• The type of seizure and the specific brain area involved determine the symptoms experienced.

Duration/Recovery

• Seizures usually last 30–2 minutes.
• During the postictal phase, the individual may experience confusion, fatigue, or memory loss following the seizure.

Conclusion

Epilepsy affects genetics, brain anatomy, immunity, and lifestyle. Although it is not curable, it is managed, and many people enjoy seizure-free lives with therapy and care. Research and individualized therapy are promising for epilepsy management.