Epilepsy: Symptoms, Causes, Diagnosis, and Treatment Options

Prepared by,

Dr Chris Chong

Consultant Neurologist

Gleneagles Kota Kinabalu

What is Epilepsy?

Epilepsy is a chronic, non-infectious, neurologic condition that causes abnormal electrical activity in the brain, leading to seizures. Think of it like an electrical storm inside your head, where the brain's usual signals get disrupted, causing various physical and mental changes.

Seizures caused by epilepsy can vary widely. They may result in unusual behaviors, sensations, and, in some cases, a loss of awareness. Since the brain controls so many of your body’s functions, these disturbances can affect everything from your movements to your emotions, and even your thinking.

Epilepsy is considered a chronic disorder, meaning it lasts over time. It is diagnosed after a person has experienced two or more unprovoked seizures, which are not linked to an identifiable cause like a stroke, brain tumor, or traumatic brain injury. Epilepsy is a physical disorder, NOT a mental disease.

What are the Signs and Symptoms of Epilepsy, and How Long Does it Last?

Epilepsy primarily manifests through recurring seizures, which can vary in severity and type. Seizures are the hallmark symptom of this neurological disorder and can lead to a wide range of experiences for the person affected. Signs and symptoms of epilepsy include:

• Loss of Awareness or Consciousness: Some seizures may cause a temporary loss of awareness, during which the person may not respond to external stimuli or appear in a trance-like state.
• Movement Disturbances: : Seizures often cause uncontrollable movements, including shaking or stiffening of the body.
• Sensory Changes: Some people experience disturbances in their senses, such as vision problems, auditory hallucinations (hearing sounds), or unusual taste sensations.
• Mental and Emotional Disturbances: During or after a seizure, individuals may feel confused, anxious, or even depressed. In some cases, the seizure may trigger intense emotional changes.

Types of Seizures in Epilepsy

Epileptic seizures can vary significantly, affecting individuals in different ways. They are categorised into two major groups, based on how they start in the brain:

1. Focal Seizures (also known as Partial Seizures)

Focal seizures begin in one specific part of the brain and typically affect one side of the body. Symptoms can include involuntary jerking of a limb or strange sensations in a particular part of the body, such as tingling or hallucinations. These seizures may or may not affect awareness, depending on the location of the brain activity.

2. Generalised Seizures

These seizures affect both sides of the brain simultaneously and often cause widespread symptoms. Some common types of generalized seizures include:

• Tonic-Clonic Seizures: (formerly known as Grand Mal Seizures): These seizures cause loss of consciousness, stiffening of muscles, and jerking movements of the body.
• Tonic Seizures: Characterised by sudden muscle stiffness that may cause the person to fall, followed by quick recovery.
• Atonic Seizures: These cause muscles to suddenly lose strength, making the person fall, though recovery is typically quick.
• Absence Seizures: Brief periods of loss of awareness where the person may seem to "blank out" for a few seconds. These are more common in children.

3. Other Types of Seizures

• Myoclonic Seizures: These involve brief, rapid jerks of the muscles, often affecting the arms or legs.
• Focal Seizures with Impaired Awareness: These seizures can cause changes in awareness or confusion, often resulting in automatic movements such as lip-smacking or hand rubbing.

People with epilepsy may experience one type of seizure or a combination of different types. Your healthcare provider will monitor your symptoms and diagnostic tests to determine which type(s) of seizures you have, helping them tailor the most effective treatment plan.

How Long Do Seizures Last?

Most seizures related to epilepsy typically last less than five minutes. However, in some cases, they may last longer and require immediate medical attention. Prolonged seizures, also known as status epilepticus, are considered a medical emergency and require immediate treatment to prevent brain damage.

Why Do Some Patients with Epilepsy Act Abnormally?

Following a seizure, many patients experience a period of confusion known as the postictal state, during which the brain recovers from the seizure. Following a seizure, the person is said to be in the postictal state. This period of confusion and disorientation often lasts for seconds to a few minutes. During this period of confusion, people may act in ways that are out of character for them. The postictal state is often marked by symptoms such as confusion, memory loss, and altered awareness. They may be more aggressive or combative, especially if someone tries to hold or restrain them. This behavior is a direct result of the brain recovering from the seizure and should not be mistaken for intentional actions. It can be very challenging for friends or family members to know what to do. They have to be concerned about safety, as someone could wander off and get into trouble in the postictal state.

Maintaining safety in the postictal state is of paramount importance. The person may be at risk of wandering off or engaging in unsafe behaviors, so it’s important to ensure they are in a safe environment until the confusion clears. This period, while temporary, can be difficult for both the individual experiencing it and their caregivers.

How is Epilepsy Diagnosed?

Diagnosing epilepsy involves identifying the underlying cause of the condition, which is crucial for determining the most effective treatment plan. To diagnose epilepsy, doctors typically use a combination of tests and procedures, with EEG (electroencephalography) being the gold standard.

• EEG: This test measures the electrical activity in the brain and is essential for detecting abnormal brain waves, which are a key indicator of epileptic seizures. It helps doctors determine the type of seizures and the areas of the brain where they originate.
• MRI (Magnetic Resonance Imaging): MRI scans provide detailed views of the brain’s structure, allowing doctors to detect abnormalities, such as tumors, brain injuries, or malformations, that may be contributing to the seizure disorder.

Other imaging techniques, such as CT scans or functional MRI, may also be used to gain additional insights into brain function and any potential causes of seizures.

By using these diagnostic tools, doctors can accurately assess the cause of epilepsy and create a tailored treatment plan that addresses the patient's specific needs.

What are the Factors that Might Trigger Seizures?

There are a few common triggering factors for seizures, namely sleep deprivation, physical/emotional stress, alcohol withdrawal, fever, etc. Recognising these triggers and discussing them with a healthcare provider can help reduce the frequency of seizures and improve the management of epilepsy.

What are the Most Common Causes of Epilepsy?

Epilepsy occurs when the brain’s normal electrical activity is disrupted, leading to seizures. The causes can include:

1. Genetic Factors: Epilepsy can run in families, with certain genetic mutations making individuals more susceptible to seizures.
2. Brain Injury: Traumatic brain injury (TBI) from accidents can lead to epilepsy later in life.
3. Stroke: Damage to the brain from a stroke increases the risk of developing epilepsy.
4. Brain Infections: Infections like meningitis or encephalitis can cause inflammation and brain damage, triggering seizures.
5. Unknown Causes: In many cases, the cause of epilepsy remains unclear, and the condition is classified as idiopathic.

Understanding these causes can help guide diagnosis and treatment, though for many, the exact cause remains unknown.

How is Epilepsy Treated?

For about 60% of those diagnosed with epilepsy, seizures can be controlled with medications and surgical procedures. Different medications are prescribed based on the type of seizures an individual experiences. Some drugs are more effective for specific types of seizures. For some patients, special diets such as the ketogenic diet, may help to control seizures when medications are either not effective or cause serious side effects. Anti-epileptic drugs (AEDs) can be highly effective, but some are linked to pregnancy risks. Women of reproductive age should discuss their opinions with their neurologists for the best treatment options.

In some cases, epilepsy surgery or vagus nerve stimulation may be considered for individuals who do not respond to medications.

Book an Appointment for Epilepsy Treatment Today at Gleneagles Hospital Kota Kinabalu

Epilepsy may present challenges, but with the right treatment and support, it is possible to manage the condition and lead a fulfilling life. Whether it's medication, dietary changes, or surgery, there are multiple treatment options available to help control seizures and improve quality of life. Early diagnosis and ongoing care are key to finding the right approach for you.

If you or a loved one is experiencing symptoms of epilepsy, seek professional medical advice at Gleneagles Hospital Kota Kinabalu. Our team of neurologists can guide you through the process and help manage the condition with the best possible outcomes. Don’t wait, take the first step towards better managing your health today.