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Epilepsy
Epilepsy is a condition that causes recurring seizures. Seizures happen when there is too much electrical activity in your brain. This causes messages in your brain to become mixed up or stopped and can lead to changes in your movement, senses, memory, mood or level of consciousness.
About epilepsy
Symptoms of epilepsy
Complications of epilepsy
Causes of epilepsy
Diagnosis of epilepsy
Treatment of epilepsy
Living with epilepsy
About epilepsy
Epilepsy is a condition that affects your brain and the messages it sends. Your brain has millions of nerve cells continuously passing electrical messages from cell to cell. This controls the way you think, move and experience the world around you. If you have epilepsy, these electrical messages are disturbed and a sudden burst of electrical activity can cause a seizure.
The area of your brain where the electrical activity is disturbed, and how far that disturbance reaches, affects the kind of seizure you have. Seizures are sometimes called fits, attacks or convulsions.
Around 50 million people worldwide have epilepsy. It's more common in children and people over the age of 60. Epilepsy is also more common in people who have a learning disability.
Not all seizures are caused by epilepsy. They can be caused by other conditions such as diabetes (low blood sugar levels) or abnormal heart rhythms. Very young children can also have seizures if they have an infection and a fever. These are called febrile convulsions.
Symptoms of epilepsy
The symptoms of epilepsy depend on the type of seizure you have. Seizures can be different for each person with epilepsy and you can have more than one type of seizure.
Seizures are divided into two main types. Focal (partial) seizures affect only part of your brain, whereas generalised seizures affect all of your brain.
Focal seizures
During a focal seizure you may be alert and know what is happening (simple focal seizure) or you might be unaware of your seizure (complex focal seizure). Focal seizures can last a few seconds or a few minutes.
Seizures that affect the parts of your brain called the frontal lobe and the temporal lobe are common. Some of the main symptoms of seizures in these areas include:
- seeing, hearing or tasting things that aren't there
- feeling strong emotions such as fear, panic or sadness
- having memory flashbacks
- being unaware of where you are or what is happening around you
- having problems speaking
- making strange body movements
- chewing, smacking your lips or swallowing
There are other types of focal seizures that can affect your vision, cause paralysis in part of your body or affect your senses. Sometimes focal seizures can also spread further in your brain until they become generalised seizures.
- making lip-smacking or chewing movements with your mouth
- doing repetitive movements such as fiddling with your clothing
- wandering around in a confused way
- making kicking movements with your arms or legs
- talking nonsense, muttering or mumbling
Generalised seizures
Generalised seizures affect all or most of your brain and can happen without any warning. There are several different types of generalised seizure. The main ones are described below.
- Tonic-clonic seizures. These are also called grand mal seizures. During the first stage you lose consciousness and fall to the floor. Your muscles contract, your breathing may change and you may go blue. During the second stage your muscles tighten and relax, which causes your body to jerk. After a short time the seizure usually ends and you become conscious.
- Absence seizures. These are sometimes called petit-mal seizures and are most common in children. You become unconscious for a short time and may look blank and stare or lose awareness of what is going on around you.
- Tonic seizures. These are when your muscles become rigid and if you're standing up you may fall backwards.
- Atonic seizures. These are sometimes called drop attacks. The muscles in your body relax and you go floppy.
- Myoclonic seizures. These are when your muscles jerk. This can affect your whole body or just part of it.
Complications of epilepsy
Status epilepticus is a seizure or group of seizures that lasts for longer than 30 minutes, without you recovering and regaining consciousness. It can happen during any type of seizure. However, if it happens during a tonic-clonic seizure it can be very serious. If you're with someone who has a tonic-clonic seizure that carries on for longer than five minutes you should call an ambulance.
During a seizure you can have an accident or injure yourself.
Sudden unexpected death in epilepsy (SUDEP) is when someone with epilepsy dies unexpectedly and there is no reason found for the death. However, this is very rare.
Causes of epilepsy
Some people have a known cause for their epilepsy. This is called symptomatic epilepsy. However, for most people with epilepsy there is no known cause. This is called idiopathic epilepsy.
Causes of epilepsy include:
- a genetic (inherited) condition
- brain damage
- an infection in your brain (such as meningitis)
- a brain tumour, but this is rare
Diagnosis of epilepsy
A doctor will ask about your symptoms and examine you. He or she will also ask about your seizures, including what happens before, during and after.
Epilepsy can't be diagnosed after just one seizure because it's a condition that causes recurring seizures. Some people have a single epileptic seizure at some point in their life and then never have another one. Epilepsy can also be hard to diagnose because there is no single test that will diagnose it.
If your doctor thinks you may have epilepsy you will be referred to see to a neurologist (a doctor who specialises in conditions that affect the central nervous system, including the brain) for some tests. These may include:
- an electroencephalogram (EEG)
- a brain scan, such as an MRI scan or a CT scan
- blood tests
Please note that availability and use of specific tests may vary from country to country.
Treatment of epilepsy
There isn't a cure for epilepsy. The aim of treatment is to reduce the number of seizures you have or to stop them completely.
Self-help
Some people can identify things that trigger their seizures. Triggers can include:
- lack of sleep
- missing a dose of epilepsy medicine
- missing meals
- alcohol
- flashing or flickering lights – this is called photosensitive epilepsy
- stress
If you know that something triggers your seizures, you may be able to find ways of avoiding this to help control your epilepsy. Keeping a diary to record your seizures may help you to identify any triggers.
Medicines
Medicines can help to prevent seizures from happening, or reduce the number of seizures you have, by reducing the amount of electrical activity in your brain. Epilepsy medicines – or anti-epileptic drugs (AEDs) – can help prevent seizures in around eight out of 10 people. These types of medicine can't cure epilepsy and they can't stop a seizure while it's happening, however, there are some medicines that can be used to control a seizure. These include midazolam and anaesthetic medicines.
If you stop taking AEDs suddenly your seizures may come back and may happen more often and for longer than they did before.
AEDs can cause side-effects, so your neurologist will start you on a small dose and increase it gradually. The side-effects often wear off after a few days or weeks, but if they don't, speak to your neurologist. Always read the patient information leaflet that comes with your medicine and if you have any questions, speak to your doctor.
If you haven't had a seizure for two years or more, you may be able to gradually reduce the dose of your AEDs and eventually stop taking them. Ask your doctor for more advice.
Surgery
If you have severe epilepsy and your seizures haven't been controlled with AEDs then your neurologist may suggest brain surgery to remove or separate the affected part of your brain. This may help to reduce or stop your seizures.
Vagus nerve stimulation can reduce the number of seizures you have as well as decreasing the length and severity of your seizures. This involves an operation to implant a small electrical device in your chest, which regularly stimulates a nerve in your neck called the vagus nerve. You may be offered this kind of treatment if medicines have not worked to control your seizures.
Ketogenic diet
The ketogenic diet is a treatment used for children who have epilepsy. It's a high-fat, low-carbohydrate, controlled protein diet that leads to the production of a substance called ketones in the body. It's this high level of ketones that can affect your child's seizures.
This diet doesn't work for every child. It should only be used under the supervision of your child's doctor and a dietitian.
Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.
Living with epilepsy
Living with epilepsy can sometimes be difficult, particularly if your seizures aren't well controlled.
Having epilepsy may also mean making some changes to your day to day life. You may want to make changes to your home and workplace to keep yourself safe if you have a seizure.
If you have epilepsy you may not be able to drive as there is a risk that you could have a seizure while driving.
For many people with epilepsy their condition doesn't affect their work life. Your employer can't refuse you a job because you have epilepsy, unless they have a good reason for doing so.
This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email. See our answers to common questions about epilepsy and seizures, including:
What should I do if I see someone having a seizure?
Are you born with epilepsy or can you develop it later in life?
Will having epilepsy cause any complications if I get pregnant?
Is there a chance that I could pass my epilepsy on to my child?
Will epilepsy affect my child's education?
What is the ketogenic diet? Could this help control my child’s seizures?
Can I drive if I have epilepsy?
Can complementary therapies help to treat epilepsy?
What should I do if I see someone having a seizure?
Generally, you should try to stay calm and protect the person from injury. Don't restrain a person during a seizure if he or she is jerking or twitching. Stay with them until they have fully recovered.
Below is advice on what to do if you know someone is having a specific type of seizure.
Explanation
If you see a person having a seizure and they lose consciousness:
- keep calm
- don't try to move or restrain the person
- to protect the person from injury, remove any nearby harmful objects and cushion their head
- even if the person is biting their tongue, don't put anything in their mouth
- when the seizure stops, put the person in the recovery position
- after regaining consciousness, reassure the person and let him or her rest quietly in a safe place
Call for emergency help if:
- you know it's the person's first seizure or if the seizure lasts more than five minutes or longer than usual (if you know or the person can tell you how long his or her seizures usually last)
- the convulsions stop and then happen again without the person regaining consciousness
- the person injures him or herself during the seizure or has difficulty breathing
If someone has a seizure but doesn't lose consciousness:
- guide him or her away from any possible danger, such as traffic - but be careful not to put yourself at risk
- protect him or her from injury by removing any harmful objects nearby
- talk to the person and reassure him or her
- stay with the person until he or she feels well again
Are you born with epilepsy or can you develop it later in life?
Epilepsy can affect anyone and start at any age.
Explanation
Epilepsy can start in people of all ages. However, it's most often diagnosed in children or in adults over 60. This is because many of the causes of epilepsy are more common in childhood (such as difficulties at birth, childhood infections or accidents) or when you're much older (such as strokes).
Many people who develop epilepsy before they are 20 grow out of it and stop having seizures when they are older.
Will having epilepsy cause any complications if I get pregnant?
You’re at a slightly higher risk of complications, but it's important to remember that nine out of 10 women with epilepsy have healthy pregnancies and give birth to healthy babies. If possible, plan ahead and get medical advice before you become pregnant so you get the extra help you need.
Explanation
Some anti-epilepsy medicines can affect how your baby grows and develops in your womb, particularly during the first three months of your pregnancy. So the risk of your baby having a birth defect is slightly higher if you’re taking anti-epilepsy medicines.
Because of this risk, speak to your doctor before you become pregnant if possible. He or she will arrange medical advice known as pre-conception counselling, which is usually provided by a doctor who specialises in epilepsy. Your doctor will assess your epilepsy and what kind of medication you're taking. He or she will then let you know whether this could pose any risks to your unborn baby and how these risks could be reduced. Your doctor may suggest that you take a lower dose of your anti-epilepsy medicine if your seizures are well controlled or that you switch to a different anti-epilepsy medicine that poses less risk to your baby.
You should continue to take your anti-epilepsy medicines as advised by your doctor during your pregnancy. If you stop, you're more likely to have a seizure that could harm you or your unborn baby.
If you become pregnant unexpectedly, continue to take your anti-epileptic medicines and contact your doctor as soon as possible. He or she will give you advice on what to do next.
Your doctor will usually advise you to take folic acid before getting pregnant and for the first three months after you get pregnant. Folic acid is a vitamin that will help your developing baby's spine to form. Folic acid may interact with certain anti-epilepsy medicines so it’s important to speak to your doctor before you start taking supplements.
If you have epilepsy, are pregnant and are living in the UK, you can join the UK Epilepsy and Pregnancy Register. This was set up to record information about women with epilepsy throughout their pregnancy and after their baby is born. It provides useful information on which anti-epilepsy medicines are the safest to take during pregnancy and on the effects of having a seizure while you're pregnant. It's hoped that doctors will be able to use this information to give advice to other women with epilepsy in the future.
Is there a chance that I could pass my epilepsy on to my child?
Yes, there may be a higher risk of your child getting epilepsy if you, or both you and your partner, have it.
Explanation
Some types of epilepsy seem to run in families and could be passed on from parent to child. The risk varies from person to person so it's best to discuss this with your doctor or a geneticist (a doctor who specialises in genetics). He or she will be able to give you more accurate advice on the possible risk of your child inheriting epilepsy.
If your epilepsy is a result of a head injury, brain infection (such as meningitis) or brain injury caused by drug or alcohol use, there is no risk of you passing it on to your child.
Will epilepsy affect my child's education?
For some children; having epilepsy won't affect their ability to do well in school, but others may need extra support. If you feel your child's epilepsy or medicine for controlling seizures is affecting his or her performance at school, you might want to discuss your concerns with your child's teacher.
Explanation
Most children with epilepsy are just as capable of learning as other students. Around four out of five of children with epilepsy attend mainstream schools without any problems. However, epilepsy affects individuals differently and some children with epilepsy have behavioural problems or learning difficulties. For example, it's common for people with epilepsy to complain of a poor memory. Memory problems may be due to:
- frequent and/or prolonged seizures
- damage to the area of the brain responsible for memory
- side-effects from anti-epilepsy medicines, causing a slowing of the mental process and subsequent memory problems
Most children with learning difficulties can attend a mainstream school, perhaps with some specialist help. However, some children with severe learning difficulties may need to go to a special school. Your Local Education Authority (LEA) can provide you with a list of special schools in your area.
Emotional and social factors may also affect your child's behaviour at school. For example, some children with epilepsy are teased at school. This may be because other children don't understand epilepsy. Signs of bullying include nervousness, temper tantrums or sudden misbehaviour, such as playing truant. Talk to your child's teacher if you're worried and make sure your child knows he or she has your support and encouragement to stand up for him or herself.
What is the ketogenic diet? Could this help control my child’s seizures?
The ketogenic diet is a high-fat, low-carbohydrate diet that is sometimes used as an alternative treatment for children with difficult-to-control epilepsy. The ketogenic diet should only be used under the supervision of your child’s doctor and a dietitian.
Explanation
The ketogenic diet has been successfully used to decrease, and sometimes stop, seizures for children with difficult-to-control epilepsy. If your child is having frequent seizures and they aren’t well controlled with anti-epilepsy medicines, you may want to talk to your child’s doctor about the ketogenic diet. However, it’s only suitable for a small number of children.
The diet works by stimulating the body's reaction to starvation. During starvation your body first uses its store of glucose and glycogen and then burns body fat. Glucose and glycogen come from carbohydrates. If no glucose is available, body fat can't be completely burned and substances called ketones are left over. Because the ketogenic diet limits carbohydrate intake so much, ketones begin to build up in your child's body. It's this high level of ketones that can potentially suppress your child's seizures.
If your child is on the ketogenic diet, around 90 percent of his or her calorie intake comes from fat. Your child can eat about one gram per kilogram of his or her body weight as protein, and minimal carbohydrates. Calories are individually calculated for your child and depend on his or her age and activity level. Most children don't gain or lose significant amounts of weight on the diet. Your child will usually have to take vitamin and mineral supplements.
Don't change your child's diet without speaking to his or her doctor first.
Can I drive if I have epilepsy?
It depends on a number of things including when you last had a seizure and how well your epilepsy is controlled.
Explanation
If you have a seizure or suspected seizure at any time, you must stop driving and notify the Driver and Vehicle Licensing Agency (DVLA). This is a legal requirement so that you don't cause injury to yourself or others.
If you have had only one unprovoked seizure you will have to stop driving for a minimum of six months. After this time you can usually apply for your licence again if you have been assessed by a specialist and you haven’t been diagnosed with epilepsy.
If you have had more than one seizure, you will usually need to wait for 12 months without having any further seizures in this time (either with or without medication) before you can start driving again.
The restrictions cover all epileptic seizures, including those where you don't lose consciousness.
The restrictions are different if you drive a larger vehicle, such as a lorry or a bus. Ask your doctor or the Driver and Vehicle Licensing Agency (DVLA) for further advice.
Can complementary therapies help to treat epilepsy?
Although they may help you to relax, there is no scientific evidence that any complementary therapy can control seizures.
Explanation
It's important to get advice from your doctor before you use complementary therapies. Complementary therapies can’t replace your anti-epilepsy medicines. Don’t stop taking your anti-epilepsy medicines without consulting your doctor.
It's also important to ask your therapist if the treatment you're considering is suitable for people with epilepsy. St John's wort is a herbal preparation that may be helpful for depression but can interfere with anti-epilepsy medicines. If you’re considering taking St Johns wort, discuss it your doctor first.
Further information
- International League Against Epilepsy
www.ilae.org
Sources
- Epilepsy. World Health Organization. www.who.int, published October 2012
- About epilepsy. Epilepsy Society. www.epilepsysociety.org.uk, published November 2011
- Advice and information. Epilepsy Action. www.epilepsy.org.uk, published February 2011
- The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care. National Institute for Health and Clinical Excellence (NICE), January 2012. www.nice.org.uk
- Epilepsy – background information. Prodigy. www.prodigy.clarity.co.uk, published June 2009
- What is epilepsy? Epilepsy Research UK. www.epilepsyresearch.org.uk, accessed 8 February 2012
- Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press; 2010: 583
- Joint Formulary Committee. British National Formulary. 64th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2012
Produced by Rebecca Canvin, Bupa Health Information Team, October 2012.
Related topics
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This information was published by Bupa’s Health Information Team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
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