Understanding epilepsy

Introduction

The brain is made up of millions of nerve cells called neurons. These cells generate electrical impulses and messages to produce thoughts, feelings, movement and control body functions.
A seizure happens when the normal alternating pattern of these electrical impulses are disrupted, causing them to rapidly fire all at once.

Depending on where the seizure is in the brain, this can cause changes in sensation and feeling, awareness and consciousness, behaviour or movement. Seizures vary greatly and can be very brief or last up to two or three minutes. Most seizures are over in less than two minutes. Some seizures are severe and some very subtle. Not all seizures are diagnosed as epilepsy.

What is a seizure?

Seizures and epilepsy are not the same. A seizure is an event – a disruption of the normal electrochemical activity of the brain – and epilepsy is a disease of the brain characterised by the tendency to have recurrent seizures.

There are many different types of “epilepsies” and people’s experiences differ widely. Under certain circumstances, anyone can have a seizure.

When people have an epilepsy syndrome that is age-dependent and grows past the relevant age, or if someone has been seizure-free for 10 years, with no anti-epileptic medication for 5 years, their epilepsy is considered “resolved”.

What is epilepsy?

Epilepsy is a common disease of the brain where there is a tendency to have recurrent seizures.

It is a neurological disorder — not a form of mental illness — and seizures are caused by a temporary disruption of the electrical activity in the brain.

Epilepsy can start at any age, although it is more likely to be diagnosed in childhood or senior years. Children represent approximately 40 percent of the population with epilepsy. There are many different types of epilepsies and people’s experiences differ greatly. Some types of epilepsy last for a limited time and the person eventually stops having seizures. For others, epilepsy is a life-long condition. However, more than two thirds of people with epilepsy become seizure-free with medication.

Causes of epilepsy

The cause of epilepsy can be identified in about half of people with epilepsy, but the remaining half never find out why they have epilepsy.

Some known causes of epilepsy include:

Head injury from a car accident, trauma or serious fall,

Stroke or brain haemorrhage,

Lack of oxygen to the brain for a prolonged period (such as in birth trauma, cardiac arrest, drowning, drug overdose),

Brain infections (for example meningitis, encephalitis or brain abscess),

Brain abnormalities or malformations,

Brain tumours,

Genetic factors,

Degenerative conditions affecting the brain (such as dementia).

Symptoms of seizures

Seizures can make you move, have unusual feelings, or both. Which symptoms you have depend on the type of seizure you get.

During a seizure, you might:

Stare into space,

Get confused or be unsure of where you are,

Pass out,

Jerk or twitch your arms and legs,

Rub your hands, smack your lips, or make other unusual movements,

Notice strange smells, tastes, sounds, or sights,

Feel strange in general.

These problems can last from a few seconds to a few minutes. Most people have the same symptoms each time they have a seizure.

How is epilepsy diagnosed?

If you think you have epilepsy, start with a visit to your primary care doctor. You might be referred to a specialist in brain disorders, called a neurologist.

Your doctor will ask questions about your seizures, such as:

When did you have your first one?

What were you doing before it happened?

What did the seizure feel like?

Have you had more than one? How many?

Were you tired or confused afterward?

You may get a neurological exam, a series of tests that show how well your brain and the rest of your nervous system are working.

Other tests your doctor may do to find out if you have epilepsy include a test called electroencephalogram (EEG), which checks for problems with the electrical activity in your brain. Blood tests look for signs of infections and other medical problems that can cause seizures.

Computed tomography (CT) is a powerful X-ray that makes detailed pictures of your brain. A CT scan can find other causes of seizures, like a tumor or infection. Magnetic resonance imaging (MRI) uses powerful magnets and radio waves to make pictures of your brain. An MRI can also look for problems in your brain, like tumours or infection.

Management of epilepsy

Epilepsy can get in the way of life, mostly when seizures keep happening. Sometimes, seizures make it hard to work, go to school, drive, and take part in social activities. When seizures are not controlled, it increases the risk of injury, depression, anxiety and in some cases, death.

The following tips are important in the optimal management of epilepsy:

Take your medicine as prescribed and attend all scheduled clinic visits,

Talk with your healthcare provider when you have questions,

Recognise seizure triggers (such as stress),

Keep a record of your seizures,

Get enough sleep,

Exercise safely,

Lower stress,

Keep in touch with friends and family.

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