Epilepsy

What is Epilepsy?

Epilepsy is a neurological condition that affects millions of people worldwide. It is characterised by recurring seizures caused by abnormal electrical activity in the brain. These seizures can range from brief staring episodes to severe convulsions, disrupting normal brain function and daily life.

As one of the most prevalent brain disorders, epilepsy affects individuals of all ages, genders, and ethnicities. However, it’s important to note that experiencing a single seizure doesn’t necessarily mean a person has epilepsy. A diagnosis is typically confirmed when an individual has at least two unprovoked seizures occurring 24 hours apart. Unprovoked seizures are those that occur without an identifiable or immediate cause.

At Subang Jaya Medical Centre (SJMC), we recognise the challenges faced by individuals with epilepsy. Our team of specialists is dedicated to providing accurate diagnoses and tailored treatment plans to help patients manage their condition and improve their quality of life.

Symptoms of Epilepsy

The symptoms of epilepsy depend on the type of seizure and the area of the brain affected.

Common symptoms include:

• Temporary confusion
• Staring spells
• Stiff or rigid muscles
• Uncontrollable jerking movements (convulsions)
• Loss of consciousness
• Psychological symptoms such as fear, anxiety, or déjà vu

Some individuals may also experience changes in behaviour or symptoms of psychosis. For many, the symptoms remain consistent with each seizure episode.

Warning Signs of Seizures (Aura)

Certain individuals experience warning signs, known as auras, before a seizure begins. These may include:

• A sudden uncomfortable feeling in the stomach (rising epigastric aura)
• Emotional changes such as fear or joy
• Sensory changes like unusual smells, tastes, visual disturbances, or goosebumps
• Dizziness or hallucinations

Auras serve as an early indication that a seizure may occur, allowing some individuals to prepare or seek help.

Types of Seizures

Seizures are broadly classified into focal seizures and generalised seizures, depending on how and where they originate in the brain.

Focal Seizures

Focal seizures originate in a specific area of the brain and are further divided into:

• Focal Seizures Without Loss of Consciousness: Previously called simple partial seizures, these do not affect awareness. Symptoms may include involuntary jerking of a body part, sensory changes (e.g., tingling, flashing lights), or déjà vu.
• Focal Seizures With Impaired Awareness: Previously known as complex partial seizures, these involve a loss or alteration of consciousness. Individuals may stare blankly, perform repetitive movements (e.g., chewing, rubbing hands), or appear as if they are in a dream-like state.

Specific Types of Focal Seizures

These seizures involve the entire brain and include:

• Temporal Lobe Seizures: Often associated with emotions, memory, or sensory changes such as smells or tastes.
• Frontal Lobe Seizures: May involve unusual movements like rocking, pedalling, or vocal outbursts. They may occur frequently at night, which can be mistaken with night terrors.
• Occipital Lobe Seizures: Affect vision and may cause hallucinations or temporary visual loss.

Generalised Seizures

These seizures involve the entire brain and include:

• Absence Seizures: Common in children, these cause brief staring spells or subtle movements like blinking.
• Tonic Seizures: Cause muscle stiffness, often resulting in falls.
• Atonic Seizures: Lead to a sudden loss of muscle control, causing individuals to collapse.
• Clonic Seizures: Characterised by rhythmic jerking movements, often in the neck, face, or arms.
• Myoclonic Seizures: Involve sudden, brief jerks or twitches in the upper body.
• Tonic-Clonic Seizures: Previously known as grand mal seizures, these are the most severe, involving loss of consciousness, body stiffening, and violent shaking.

When to See a Doctor

Seek immediate medical attention if any of the following occur during or after a seizure:

• The seizure lasts more than five minutes.
• Breathing or consciousness doesn’t return after the seizure stops.
• A second seizure occurs immediately after the first.
• You have a high fever.
• You are pregnant.
• You have diabetes.
• You injure yourself during the seizure.
• Seizures persist despite taking anti-seizure medication.

If you experience a seizure for the first time, consult a healthcare professional promptly for evaluation and guidance.

Causes of Epilepsy

In about half of all cases, the cause of epilepsy cannot be identified. For the other half, the condition may be linked to specific factors, including:

• Genetic Influence: Some types of epilepsy run in families, while others are linked to genetic changes that occur spontaneously.
• Head Trauma: Traumatic brain injuries, such as those from car accidents or falls, can lead to epilepsy.
• Structural Brain Disorders: Tumours, abnormal blood vessels, or strokes can cause epilepsy.
• Infections: Conditions like meningitis, HIV, and viral encephalitis can increase the risk.
• Injury Before Birth: Brain damage in unborn babies due to infections, poor nutrition, or oxygen deprivation can lead to epilepsy.
• Developmental Disorders: Autism and ADHD are associated with a higher risk of epilepsy.
• Autoimmune Encephalitis: This rare condition, where the immune system mistakenly attacks healthy brain tissue, can also lead to seizures and epilepsy.

Seizure Triggers

While seizure triggers don’t cause epilepsy, they can provoke seizures in individuals with the condition. Common triggers include:

• Excessive alcohol consumption
• Flashing lights
• Skipping doses of anti-seizure medication
• Lack of sleep
• Hormonal changes during the menstrual cycle
• Stress or emotional distress
• Dehydration or skipped meals
• Fatigue

Identifying and managing these triggers can help reduce the frequency of seizures.

Complications of Epilepsy

Epilepsy can lead to various complications, depending on the severity and frequency of seizures:

• Physical Injuries: Falls or accidents during seizures can result in head injuries or fractures.
• Drowning: Seizures while swimming or bathing increase the risk of drowning.
• Emotional Health Issues: Depression, anxiety, and suicidal thoughts are more common in individuals with epilepsy.
• Status Epilepticus: Continuous seizures lasting more than five minutes can lead to permanent brain damage or death.
• Sudden Unexpected Death in Epilepsy (SUDEP): Rare but serious, SUDEP may occur in individuals with poorly controlled seizures.

References:

1. Mayo Clinic: Epilepsy Symptoms and Causes
2. World Health Organization (WHO): Epilepsy Fact Sheet
3. National Institute of Neurological Disorders and Stroke (NINDS): Epilepsy Information
4. Cleveland Clinic: Epilepsy Overview
5. Johns Hopkins Medicine: Seizures and Epilepsy in Children
6. CURE Epilepsy: Seizures - Types, Symptoms and Causes