Epilepsy

Your brain is very complex. It is made up from millions of nerve cells called neurones that control your body's functions, senses and thoughts. The neurones communicate with each other using very small electrical signals. A fit or seizure happens when there is a brief change or break in the way cells normally send and receive these electrical signals.

Epilepsy is a condition where a person has repeated fits or seizures. A seizure happens because the normal working of the brain is interrupted. Having one seizure does not necessarily mean you have epilepsy: the definition of epilepsy is more than one seizure.

Epilepsy is common. Around 1 in 30 people in the UK develop epilepsy at some point in their life. Epilepsy can affect anyone, and it can develop at any age. However, it is usually diagnosed before the age of 20 or after the age of 60.

Epilepsy is more common in people with certain disabilities. About a third of people with a learning difficulty have some form of epilepsy. Having a learning disability does not cause epilepsy and nor does epilepsy cause a learning disability. Both epilepsy and learning disabilities are a result of the brain working in an abnormal way.

There are different types of seizure and symptoms can vary. You may lose consciousness, have muscle contractions (your arms and legs may twitch and jerk), or your body may shake or become stiff. Seizures usually last between a few seconds and several minutes. Brain activity then returns to normal.

Medication is usually very successful for treating epilepsy. In 4 out of 5 cases, treatment can reduce the number of seizures a person has. Sometimes, treatment can stop seizures happening altogether.

Repeated brain seizures are the main symptom of epilepsy. There are several different types of seizure and it is possible for the same person to have more than one type of seizure at different times.

The types of seizure are:

Partial seizure: where one part of your brain is affected. The exact symptoms depend on which part of the brain is affected, but often you won't lose consciousness; and

Generalised seizures: where all of your brain is affected.  This type of seizure will make you lose consciousness.

Partial seizures:

There are two broad types of partial seizures, simple and complex.

Simple partial seizure: Only a small part of the brain is affected and the symptoms will depend on which part of the brain it is. You may have muscle jerks or pins and needles in one arm or leg. You won't lose consciousness.

Complex partial seizure: You do not lose consciousness completely but you may not be fully aware of what is happening around you. Afterwards you may only remember a little of what happened. You might act in a confused way, mumble or seem preoccupied to other people. Partial seizures can sometimes come before a generalised seizure the partial seizure may warn that a generalised seizure is about to happen.

Generalised seizures:

These occur if the abnormal electrical activity affects all or most of the brain. The symptoms tend to affect much of the body. The main types of generalised seizures are:

Tonic-clonic: (also called convulsive seizure or grand mal). This is what many people might think of as a typical epileptic seizure. You may have some warning symptoms before a seizure (called an aura), e.g. strange movements, emotions or sensations (which are often related to smell and taste).

However, for many people, seizures happen without warning. Your muscles tighten up and you become stiff. You lose consciousness, and may injure yourself by falling over. The muscles in your jaw tighten and you may bite your tongue. Your skin (lips, ear lobes and tongue) may turn blue. Sometimes the muscles in your bladder also tighten which can cause urine or faecal leakage (you wet or soil yourself).

After this comes a shaking (clonic) phase. Your muscles tense and relax causing convulsions (shaking). This lasts between a few seconds and a few minutes. You then gradually regain consciousness. It may take some time to fully recover from the seizure, even when the main symptoms have disappeared. You might feel tired and confused and may need to rest or sleep.

Tonic: There is a brief loss of consciousness and you usually fall to the ground. Recovery is quicker than with a tonic-clonic seizure.

Atonic (meaning not-tonic): There is a brief loss of consciousness and you become limp and fall to the ground. Recovery is usually quicker than with a tonic-clonic seizure.

Myoclonic: the muscles in one part of your body (usually an arm or leg) twitch or jerk suddenly, usually without loss of consciousness or awareness of what is happening. This may happen at the same time as another type of seizure.

Absence seizure: (also known as petit mal): where you lose awareness for a short time. This occurs mainly in children. The child may seem to be staring blankly into space. There are no other obvious symptoms. The periods of absence are usually short (seconds rather than minutes).

 

A cause is now found for over two-thirds of people with epilepsy. Sometimes no clear causes is found, and this is called idiopathic epilepsy. Sometimes the tendency to have seizures runs in the family, suggesting there may be a genetic link, but in most cases there is no family history of epilepsy.

For some people with epilepsy, there is a more obvious cause. This may be referred to as symptomatic epilepsy. Causes include:

• head injury, brain surgery, or a severe blow to the head,
• chronic conditions like cerebral palsy,
• serious infections like meningitis, encephalitis and other infections when the body temperature is very high (above 39°C),
• other serious brain conditions like stroke, aneurysms and embolisms,
• growths (tumours) in the head these can be malignant or benign,
• alcohol abuse. Seizures can occur after drinking heavily or during a period of withdrawal, and
• very low blood glucose levels (hypoglaecemia), which can occur as a result of treatment for diabetes.

Certain things can trigger seizures in people who are epileptic. These include:

• Flashing lights: about 3 to 5 of every 100 people with epilepsy are photosensitive. This means that flashing lights can trigger seizures. This usually starts in the pre- teen or early teenage years. Girls are affected more often than boys.
• High body temperature: a fever may trigger a seizure, especially in young children.
• Stress and lack of sleep: some people with epilepsy have more seizures during periods of stress, or after a lot of late nights and lack of sleep.
• Alcohol: drinking too much alcohol (especially binge drinking) can cause seizures in some people.
• Illegal drugs: amphetamines, ecstasy, cocaine and heroin have all been associated with seizures.
• Hormones: when oestrogen levels are high and when progesterone levels fall, women with epilepsy are more likely to have a seizure. This may happen just before or during their period (menstruation) or at ovulation (egg release), halfway through the menstrual cycle. There are also changes in hormones during puberty and epilepsy may start around this time.
• Food and diet: Skipping meals, lack of food, tiredness and a low blood sugar level are linked to seizures. Some people with epilepsy say that certain foods can be a trigger.
• Some medicines: some anti-depressants, anti-psychotics and other less commonly used medicines may also trigger seizures.

It can be difficult for doctors to diagnose epilepsy in the early stages. Other causes of seizure need to be ruled out. Epilepsy is usually only diagnosed after more than one seizure. It is important that you, or another person who was present, describe to your GP exactly what happened during the seizure. The length and symptoms of the seizure must be considered before a diagnosis can be made.

Diagnosis should be made by a neurologist (brain specialist) or other epilepsy specialist. You should be referred to a specialist by your GP after a first seizure.

Other factors the specialist may take into account when diagnosing epilepsy include:

• family history,
• past history of seizures or loss of consciousness,
• past history of head injuries or brain diseases such as meningitis, and
• encephalitis or any other brain-related problems.

It is very important to try to find out the underlying cause of the epilepsy if possible. Your GP may do a physical examination to identify any underlying problems that might be causing epilepsy. Sometimes they may do a blood test as well. Other tests may also be used to try to identify the cause of the seizure or to rule out other conditions:

• A brain scan: CT scans (computed tomography) or MRI scans can show the structure of different parts of the brain. They are used to find out if your brain has been injured or damaged in any way, in case this is the cause of your seizures.
• EEG: an EEG is completely painless and is used to support the diagnosis, as well as finding out which type of epilepsy you might have. Sensor pads are put on your head, which follow the electrical activity of your brain cells. You will be asked to open and close your eyes, and you may have to look at flashing lights and take deep breaths. Some types of seizure produce recognisable EEG patterns. A normal recording, however, does not guarantee you do not have epilepsy.

Medication

Medicines to treat epilepsy are called anti-epileptics or anti-epileptic medicines. There are a large number of different anti-epileptics available. They are available as tablets, capsules, liquids and suppositories (medication placed in the vagina or anus).

Anti-epileptic medicines may stop seizures happening altogether, stop them occurring so often, or make them less severe. They do not cure epilepsy. They work by controlling the electrical activity of the brain that causes seizures.

Anti-epileptic medicines need to be taken daily at approximately the same time of day each day. Missing a single dose on a rare occasion is unlikely to be dangerous or result in seizures.

Finding the right medicine or combination of medicines for your particular type of seizures can take time. You might have to try several types of medicine before you find a combination that works for you. The right medicine(s) is dependent on:

• type of seizure,
• cause of seizure,
• other medicines you take (this includes any tablets, inhalers, creams, eye-drops, suppositories and herbal or homoeopathic preparations or vitamin or mineral supplements),
• side effects, and· whether you are pregnant or not.

It is important that you keep talking to your GP and pharmacist when trying out different combinations of anti-epileptic medicines.

Usually you will be started on a low dose of the medicine. If this dose does not help to control your seizures, the dose will be gradually increased to see if this works better. If the first medicine you try does not seem to be helping or has unpleasant side effects, another medicine may be added or used instead. You may need to take two or more medicines.

For some anti-epileptic medicines, particularly the older medicines, a blood test may be required to check the amount of medicine in your blood to help your GP in deciding on the best dose.

Some people may have to take medicines for life. Other people may be able to stop their medicines if they have had no seizures for two or more years. However, there is always a chance that the seizures may return. You should always talk to your GP before changing the dosage of anti-epileptics or stopping taking them all together.

Surgery

Surgery for epilepsy is only suitable for a few people. Treating epilepsy with surgery depends on the cause of the epilepsy and the effect it has on your life. Surgery is usually a last resort because it has serious risks.

There are various types of surgery. The most common is removing a small part of the brain tissue that is thought to be causing epilepsy. For many people this is not possible, because the seizures cannot be traced to a specific area of the brain. Surgery to cut the nerve fibres that carry the electrical messages can sometimes prevent generalised epilepsy.

Before making the decision on surgery you will need tests in hospital. These include an EEG, as well as MRI and PET (positron emission tomography) scans. These scans look at the way the brain works and can help to pinpoint the part of the brain that is causing epilepsy. Memory and psychological tests may also be carried out. After surgery, most people find their seizures stop, or that they have far fewer. Further medication may be needed to completely stop the seizures.

Lifestyle

Stress, excitement and anxiety can trigger seizures in many people with epilepsy. Reducing stress can help control your epilepsy, including some complementary therapies that help you to relax.

Lack of sleep or lots of late nights can trigger epilepsy. Make sure you get enough sleep (7-8 hours a night is recommended for most people), and try to go to bed at the same time each night.

Photosensitivity (sensitivity to strobe lighting and fluorescent lights, and occasionally televisions and computers) can be a trigger. Avoiding these types of light can help to control seizures.

Not skipping meals and making sure your blood sugar levels don't fall too low may reduce the number of seizures. A special diet called the Ketogenic diet can help some children and adults with certain types of epilepsy. This should only be carried out with the advice of a qualified dietician.

Drinking too much alcohol can make seizures more likely. Alcohol can also interfere with anti-epileptic medicines making them less effective. However, it is usually safe to drink a small amount; ask your GP for advice.

Some women with epilepsy do notice a link between their menstrual cycle (periods) and their tendency to have seizures. Increasing your dose of medication for the time of your period may help.

You may need to see a counsellor if you become anxious or depressed about your condition.

Sometimes, serious long-term epilepsy can affect the way the brain functions. Absence attacks (see symptoms section) can interfere with educational development. However, this usually only happens when the epilepsy is undiagnosed.

Other complications can include:

• Social stigmatism (bullying or feeling picked on), because of difficulties epilepsy sometimes causes with employment, education, and not being able to drive;
• Lack of confidence and poor self-esteem, along with anxiety and depression; 
• Physical injuries as a result of a seizure; and
• A higher risk of malformation (birth defects) in the children of woman taking anti-epileptic medicines during pregnancy.

If you are with someone who is having an epileptic fit you should:

• Move them away from anything that could cause injury, for example, a busy road or hot cooker.
• Cushion their head if they are on the ground.
• Loosen any tight clothing around their neck (such as a collar or tie) to aid breathing.
• When the convulsions stop, turn them so they are lying on their side.
• Stay with them and talk to them calmly until they have recovered.

You should not:

• put anything in their mouth, or
• try to restrain them.

In most cases, medical help is not needed. However, you should call an ambulance if the seizure lasts longer than five minutes, or if they have a series of seizures without regaining consciousness.

You should also get medical help if:

• The seizure is longer than normal for the person;
• They have a second seizure without having regained consciousness;
• It is their first seizure; or
• They have injured themselves.

Driving

It is possible to apply or reapply for a category A (motorcycle), category B (car), or category P (moped) licence as long as you have:

• been free from seizures completely for one year, or
• only experienced seizures in your sleep for a period of at least three years and
• the DVLA/DVLNI is satisfied that as a driver you are not likely to be a source of danger to the public.

This rule applies whether you are taking medication for epilepsy or not.

For a LGV/PSV licence, you can only drive if you have not had a seizure for at least 10 years while having no treatment. You cannot drive while you are coming off treatment, or for 6 months afterwards. If you have another seizure during this period, the same rules apply. For more information about driving when you have epilepsy, see the 'Selected links' section.

Prescriptions

You are entitled to free prescriptions if you are taking anti-convulsant medicines to control your epilepsy. To apply for free prescriptions, you need to fill in a FP92A form, available from doctors' surgeries, hospitals or pharmacies. Once you've filled out this form and it has been signed by your GP, it is sent to the Prescription Pricing Authority who will issue a Medical Exemption Certificate.