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Epilepsy Factsheet

What is epilepsy?

Epilepsy is a disorder of the central nervous system characterized by recurrent seizures (or 'fits'), unprovoked by an acute systemic or neurologic insult.1

How is it caused?

A seizure is caused by a sudden burst of excess electrical activity in the brain, causing a temporary disruption in the normal message passing between brain cells. This disruption results in the brain’s messages becoming halted or mixed up.2

There are a number of causal factors which contribute to epilepsy. For this reason, the disorder has been classified into three main forms:1

  • Idiopathic - where there is no apparent cause, but it is possible that there may be a genetic link1,3
  • Symptomatic - where a cause has been found such as head injury, brain damage at birth, stroke, brain infection and occasionally brain tumour1,3,4
  • Cryptogenic - where doctors believe there is likely to be a cause but they are unable to find it.1

How common is it?

Epilepsy is the most common, serious neurological disorder worldwide.5 More than half a million people in the UK have epilepsy, which equates to 1 in 100 people. Epilepsy is most commonly diagnosed in children and people aged 65 and over but can affect anyone regardless of race and social classes.6

What are the symptoms?

Doctors have described more than 30 different types of seizures which people living with epilepsy may experience.4,6 Due to the varying types of seizures which can occur, they can be classified into two main types; both of which have sub- classifications for the types of seizures people with epilepsy can experience.4

1. Focal (partial) seizures

This type of seizure starts in, and affects, just part of the brain, sometimes called the 'focus' of the seizures.2,4 Partial seizures themselves can fall into one of the below two categories given their varying nature:1

  • Simple partial seizures – people experiencing this type of seizure often remain conscious, they are alert and able to respond to questions put forward to them. Symptoms of this seizure may involve sensations such as tingling in the fingers.1
  • Complex partial seizures – people experiencing this type of seizure lose consciousness, automatic movements are common and may involve lip smacking, chewing, swallowing, grunting or repeated phrases. Dramatic movements can also occur such as screaming, running and pelvic- thrusting. These types of seizures can last anywhere from 15 seconds to 3 minutes leaving patients who experience them confused and tired after the event.1

2. Generalised seizures

Generalised seizures affect both sides of the brain at once and can happen without warning. People who experience such seizures lose consciousness even if just for a few seconds and will have no recollection of what happened during the seizure.1,2 Like partial seizures, generalised seizures are also classed into subgroups and can fall into any of the below types:

  • Absence seizures – these types often occur in children, involving staring for unusually long periods, blinking or slight twitching of the lips. Any of the above symptoms may last between 5-30 seconds which can make them difficult to detect.1
  • Myoclonic seizures – during this type of seizure a person may experience a brief shock-like jerk of the muscles which may affect the neck, shoulders arms or legs.1
  • Atonic seizures – these types of seizures often result in a fall as the person will lose all muscle tone. The duration of this seizure will last from several seconds to one minute.1
  • Tonic seizures – these types of seizures often occur whilst a person is asleep and involve the body becoming stiff as the muscles tighten. These seizures are brief lasting no more than up to 20 seconds.1
  • Tonic-clonic seizures – these types of seizures will result in a loss of consciousness associated with stiffness (the tonic phase). The seizure is then followed by the clonic phase in which a person will experience extreme jerking, foaming or drooling from the mouth, in some cases they might bite their tongue, lip or cheek and incontinence may occur. These seizures are uncontrollable and will last between 30 – 120 seconds. After the seizure, the person will return to normal but might be unable to remember anything for a while.1

How is epilepsy diagnosed?

Not one single pathway exists to diagnose epilepsy. A number of examinations are undertaken to establish whether an individual is experiencing an epileptic seizure or whether their symptoms are the result of another underlying condition. Given this, a physician will carry out a number of tests sometimes in combination, in order to detect the disorder.8 A prerequisite for diagnosis is that at least two unprovoked seizures have been experienced by the patient.1

Diagnostic tests may include the following:

  • Assessing the patient experience - the patient experiencing the seizures or a witness’s account may be questioned/examined about the events which led up to the seizure as well as what happened during and after the seizure4,8

Physical examinations may include:

  • An electroencephalogram (EEG) – to record the electrical activity in the brain following an epileptic seizure4,8
  • Magnetic Resonance Imaging (MRI) and Computerised Axial Tomography (CT or CAT) – to reveal images of the brain in the event that physical injury such as scarring has occurred4,8
  • Blood tests – to rule out the possibility of other causes of seizures which may be attributed to other conditions 4,8

Is epilepsy treatable?

Whilst there is no absolute cure for epilepsy, there are a number of treatment options to help reduce seizure frequency and/or severity, and therefore their impact on daily life. Treatment choice should be individualised, and will therefore depend on many factors: these include whether patients experience partial and/or generalised seizures, any other conditions such as mood disorders, physical factors such as size/weight, as well as lifestyle factors.1,4

Antiepileptic drugs (AEDs) are the most common types of treatment prescribed for people with epilepsy and are designed to reduce the recurrence of epileptic seizures with minimal side-effects.1,4

What are the risks of living with epilepsy?

People living with epilepsy are at risk of Sudden Unexpected Death in Epilepsy (SUDEP).4 Sudden unexpected death, can also occur in people without epilepsy but those with the disorder are at higher risk. The exact reasons why SUDEP occurs are not well understood but some causal factors have pointed to abnormal heart and respiratory functions.4 There is evidence to suggest that people with refractory epilepsy should be actively managed as this reduces the risk of SUDEP.9

There are also psychological risks associated with epilepsy which can result in depression and anxiety. Depression is often brought on as a result of the psychological stress and uncertainty of having seizures, and the social burden of stigma associated with epilepsy. The prevalence of depression amongst people with epilepsy is as high as 55%.7

Research has also revealed that death by suicide is more common in people living with epilepsy than in the population as a whole (5% compared to 1.4%).7

How does epilepsy affect daily life?

Epilepsy can affect most aspects of a person’s life. Independence and quality of life can be compromised if epilepsy is left uncontrolled. Education, employment, driving and other lifestyle factors may be difficult to engage in as a result of the uncertainty of seizures causing disruption to all of these activities.4,7,8

However certain lifestyle considerations such as limiting alcohol intake, engaging in less stressful activities, eating regularly, getting adequate sleep and engaging in aerobic exercise are known to reduce the risk of seizure recurrence well as maintaining overall health.8


References

1. Bromfield EB, Cavazos JE, Sirven JI. An Introduction to Epilepsy. US National Library of Medicine National Institutes of HealthWeb Site 2012.

2. Epilepsy Action. http://www.epilepsy.org.uk/info/seizures/about-seizures-brain(accessed August 2012)

3. Brain and Spine Foundation. Fact Sheet for patients and carers http://www.brainandspine.org.uk/information/publications/brain_and_spine_booklets/epilepsy/index.html (accessed August 2012)

4. National Institute of Neurological disorders and stroke (NINDS) http://www.ninds.nih.gov/disorders/epilepsy/detail_epilepsy.htm#197183109 (accessed June 2012)

5. World Health Organization. Neurological disorders, including epilepsy. http://www.who.int/mental_health/management/neurological/en/ (accessed October 2012)

6. Epilepsy Society. What is Epilepsy? http://www.epilepsysociety.org.uk/AboutEpilepsy/Whatisepilepsy (accessed June 2012)

7. Jackson MJ, Turkington D. Depression and anxiety in epilepsy. J Neurol Neurosurg Psychiatry 2005;76:i45-i47

8. Brodie JM, Schachter SC, Kwan P. Fast Facts: Epilepsy. Fifth Edition 2012.

9. Ryvlin et al. Risk of sudden unexpected death in epilepsy in patients given adjunctive antiepileptic treatment for refractory seizures: a meta-analysis of placebo-controlled randomised trials. Lancet Neurol 2011; 10: 961–68

Oct 2012 - UK/12VPE0061