Epilepsy

Epilepsy, the most common of the serious neurological conditions, is marked by repeated seizures that start in the brain.^{1, 2, 3} It is diagnosed after a person has had more than one seizure. All people having a seizure for the first time should see a specialist as soon as possible for diagnosis and treatment. ^{2, 4} About 70% of epileptics become seizure-free if they have the correct diagnosis and treatment. ⁵

Epilepsy is a complex disease with multiple causes. Sometimes an exact cause cannot be found. ^{1, 6}

Three main groups: ^{1, 6}

• Symptomatic epilepsy is caused by head injury, infections (e.g. meningitis), the brain not developing properly, stroke, tumour or genetic conditions.
• Idiopathic epilepsy is genetic and can be inherited from one or both parents.
• Cryptogenic epilepsy has an unknown cause. ⁶

Worldwide about 65 million people have epilepsy, making it the most common neurological disorder after stroke. ^{1, 7} Starting at any age, it is often diagnosed in people under 20 and over 60. Causes such as birth difficulties, childhood infections or accidents are more common in young people.

A seizure is a sudden involuntary change in perception or behaviour. Epilepsy seizures are recurring and are caused by a change in the brain. ⁹

Seizures can present in a number of ways; simple or complicated, short or long lasting, they may affect consciousness, and may include other symptoms (examples below). ⁹

The form a seizure takes depends on where in the brain it starts and how far it spreads. ⁵

Brief contraction of a muscle, muscle group or several muscle groups, experienced as either a single jerk, a cluster of jerks or a continuous spasm

Jerking motion sometimes strong enough to throw a person off a chair or to the floor if standing

Result of sudden loss of the muscle tone responsible for posture If standing, person drops to the floor, or slumps if seated

Loses consciousness for a split second; in most cases can get up again straightaway

Sudden increased muscle tone causes muscles to contract
Neck extends, but does not move to either side, arms and shoulders are raised Hands are clenched in a fist shape or open with fingers extended outwards Eyes are open and eyeballs rotate upwards, legs extend outwards
Breathing muscles force air out of the lungs, causing loss of consciousness

Convulsions can last for up to 60 seconds – then get weaker and slow down Difficulty breathing
Produce more saliva, which may be seen as frothing at the mouth
A period of rest after seizure – muscles relax and become limp

Status Epilepticus is a medical emergency characterised by a single seizure or continuous seizures, which last for 30 minutes or longer. ^{1, 10}

If a convulsive seizure lasts longer than five minutes, the following steps should be taken while waiting for emergency medical personnel: ¹¹

• Check that the mouth is empty
• Position the head and body to free the airway
• Put your cheek near their mouth to feel for breath and check the chest to see if they are breathing – if not breathing, or gasping only, cardiopulmonary resuscitation (CPR) should be given
• Remove objects that could hurt the person, loosen tight clothes and ensure the environment is safe

People with epilepsy are often faced with stigmatization and discrimination leading to social isolation, emotional distress, dependence on family, poor employment opportunities, and personal injury. ⁷ There is also a link between epilepsy and learning disability. Up to 60% of patients with severe learning disabilities have epilepsy. ¹

Anti-epileptic drugs (AEDs) are the main form of treatment, but should be taken only once the diagnosis is confirmed. AEDs may stop seizures from happening, but they do not cure epilepsy. Medication should always be tailored to the type of epilepsy, lifestyle and possible side effects. ^{1, 2} With the right AEDs, up to 70% of epileptics could control seizures (have them stopped). ^{2, 7} That said, 20% of patients do not respond to medication.¹

Starting treatment with anti-epileptic drugs after the first seizure decreases the chances of a second seizure compared with no treatment or delayed treatment.⁷ In addition, people who have been seizure free for at least two years can consider stopping AED treatment. Patients withdrawing from medication should not drive during the withdrawal and for six months afterwards.¹Epilepsy is considered resolved if a person has been seizure-free for ten years, with at least five of those years without anti-epileptic medicines. ¹²

During pregnancy anti-epileptic medication can harm the unborn child, although uncontrolled seizures put both mother and child at risk. For this reason, women with epilepsy need to make informed decisions with their doctor and partner about contraception, conception, pregnancy, caring for children and breastfeeding. ^{1, 4}

A class of medication called enzyme-inducers can reduce the effectiveness of combined oral contraceptives, so additional precautions may be necessary. ¹