Exploring Epilepsy: Understanding, Managing, and Living with Seizure Disorders

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26 Nov

What is Epilepsy?

An overview –

Epilepsy, a chronic neurological disorder, affects approximately 50 million individuals globally. It's marked by recurring seizures, which are spontaneous episodes of involuntary movement. These seizures can be partial, affecting only a part of the body, or generalized, involving the whole body. Often, they may lead to loss of consciousness and sometimes a loss of control over bowel or bladder functions.

These seizure episodes stem from excessive electrical activity in clusters of brain cells. The origin of these discharges can be from various regions of the brain. The nature of seizures can range widely, from minor distractions or muscle twitches to intense, extended convulsions. Their frequency also varies significantly, from less than once a year to multiple times daily.

Having a single seizure doesn't necessarily mean one has epilepsy. In fact, up to 10% of the global population may experience a seizure at some point in their lives. Epilepsy is diagnosed when an individual has two or more seizures that are not caused by some known and reversible medical condition. Epilepsy is among the oldest medical conditions known to humanity, with its existence documented as far back as 4000 BCE. Historically, it has been shrouded in fear, misunderstanding, and discrimination, leading to social stigma. This stigma persists in many parts of the world, adversely affecting the lives of those with the condition and their families. (world health organization, 2023)

Key facts

Epilepsy is a neurological disorder that causes frequent seizures.
Anyone can have a single seizure, but this does not automatically imply that they have epilepsy.
People are usually diagnosed with epilepsy only if their doctor believes they are at risk of having more seizures.
Epilepsy can strike at any age, and there are numerous types.
Some varieties are temporary, but for many others, epilepsy is a life-long disorder. (Epilepsy Action, 2019)

What Exactly Is a Seizure?

Seizures are brief bursts of aberrant and excessive electrical activity in your brain that might alter your appearance or behaviour. The location and timing of the seizure can have a significant impact. (Epilepsy Foundation, 2022)

Electrical activity occurs constantly in our brain as brain cells communicate with one another. A seizure occurs when the brain experiences a rapid burst of strong electrical activity. This causes a temporary disturbance in how the brain normally functions. As a result, an epileptic seizure occurs.

Seizures come in a variety of forms. What occurs to someone during a seizure is determined by the part of the brain affected and the extent to which the seizure activity extends.

During some forms of seizures, the person may stay conscious and aware of their surroundings while experiencing odd sensations, feelings, or movements. Other types may lose awareness and behave strangely, or they may get stiff, fall to the floor, and twitch.

After a seizure, it might take some time for the brain to fully recover, and the person may feel bewildered. (Epilepsy Action, 2019)

What causes it?

Possible causes of epilepsy include:

Brain damage, such as that caused by a stroke, a head accident, or an infection

Tumours of the brain

The process by which the brain develops in the womb

alterations in a person's DNA

However, doctors do not know what causes epilepsy in more than one-third of all cases.

Our genes instruct our bodies on how to develop and function. They are likely to influence who develops epilepsy and who does not. This could explain why some people acquire epilepsy after a catastrophic head injury while others do not.

A variety of genes have been related to specific types of epilepsy, according to researchers. Doctors believe that many types are genetic, although they don't yet know which genes are involved. (Epilepsy Action, 2019)

How is it treated?

Medicine is the primary treatment for epilepsy. These are also known as anti-seizure medications (ASMs) or anti-epileptic drugs (AEDs). The medication does not cure epilepsy, but it can help halt or reduce the amount of seizures, as well as make them less severe.

Approximately half of all persons with epilepsy find that the first medicine they take stops their seizures. However, some people need to take several medications before finding one that works well for them. Furthermore, some persons must take two or more epilepsy medications concurrently.

A third of patients with epilepsy experience seizures that do not respond to epilepsy medication. If epilepsy medication does not work well for someone, their doctor may recommend a different type of treatment. Other treatments include brain surgery, vagus nerve stimulation surgery, and a particular diet known as the ketogenic diet. (Epilepsy Action, 2019)

“Epilepsy is one of the most common serious neurological conditions in the world. It affects around 630,000 people in the UK.
This means that around 1 in 100 people in the UK have epilepsy. Around 80 people are diagnosed with epilepsy in the UK every day.”

— Epilepsy Action

Are there different types?

Epilepsy is a complex condition with many different forms. There are hundreds of epilepsy syndromes, each with seizures as a key feature. Some of these syndromes are inherited or result from new gene mutations. The causes for others remain unknown. The classification of epilepsy syndromes often depends on their symptoms or their origin in the brain.

Absence epilepsy typically manifests as brief, recurring seizures that lead to temporary loss of consciousness. These seizures usually start in childhood or adolescence and are often familial, indicating a potential genetic influence. During a seizure, individuals might display involuntary movements like arm jerking or rapid eye blinking, though some show no obvious signs aside from periods of apparent daydreaming. Post-seizure, individuals can immediately continue their activities. However, the frequency of these seizures (sometimes over 100 times a day) can significantly disrupt concentration and daily activities.

Frontal lobe epilepsy, a prevalent syndrome, is marked by short, localized seizures, often occurring in clusters. It affects the brain's movement control areas, leading to symptoms like muscle weakness or involuntary movements such as arm or leg waving, eye deviation, or facial contortions. Awareness is typically reduced during these seizures, which occur mostly during sleep but can also happen when awake.

Temporal lobe epilepsy (TLE) is the most common syndrome among individuals with focal seizures. Seizures in TLE often precede with auras, which may involve feelings of nausea, emotional experiences like déjà vu or fear, or unusual tastes or smells. The seizure itself may present as a trance-like stare, dreamy state, or repetitive unconscious movements. TLE usually starts in childhood or adolescence. Studies indicate that frequent temporal lobe seizures can lead to hippocampal damage - a brain area vital for memory and learning.

Neocortical epilepsy is characterized by seizures originating from the cerebral cortex, the brain's outer layer. These seizures can be focal or generalized, with symptoms varying widely, including unusual sensations, visual hallucinations, emotional shifts, muscle spasms, convulsions, and others, based on the seizure's brain location. (National Institute of Neurological Disorders and Stroke, n.d.).

Prevalence

Epilepsy represents a significant part of the global disease burden, impacting an estimated 50 million people worldwide. At any given time, the active epilepsy rate (meaning those who continue to experience seizures or require ongoing treatment) is estimated to be between 4 and 10 in every 1,000 individuals.

Each year, approximately 5 million people are newly diagnosed with epilepsy worldwide. In high-income nations, the annual rate of new epilepsy diagnoses is about 49 per 100,000 people. However, in low- and middle-income countries, this rate can soar to as high as 139 per 100,000. Several factors contribute to this disparity, including a greater prevalence of endemic conditions like malaria or neurocysticercosis, a higher rate of road traffic accidents, injuries related to childbirth, and differences in healthcare infrastructure, availability of preventive health programs, and access to medical care. Notably, nearly 80% of individuals with epilepsy reside in low- and middle-income countries. (world health organization, 2023).