Epilepsy

About epilepsy

Epilepsy is a common condition of the brain in which a person has a tendency to have recurrent unprovoked seizures. About 3% of people are diagnosed with epilepsy at some point in their life.

The brain controls the body’s thoughts, movements, sensations and emotions through nerve cells (neurons). Neurons carry messages between the brain and the body through regular electrical impulses. A seizure happens when the usual pattern of these impulses is disrupted by sudden excessive bursts of electrical activity in the brain.

The type of seizure a person has, and how it affects the person, depends on which part of the brain is involved. Seizures can involve changes in:

• sensation and feeling
• awareness and consciousness
• emotions and behaviour
• movement.

Many seizures are not epilepsy. These seizures often have a known cause, such as an acute medical illness, trauma, fever, or drug and alcohol withdrawal. They generally do not happen again or lead to an epilepsy diagnosis.

The main treatment for epilepsy is medication. But, one in 3 people with epilepsy continue to have seizures despite taking medication. For these people, there are other treatment options available.

Seizure types

Many people think a seizure means a convulsion, where someone becomes unconscious and falls, with stiffness and jerking movements. However, this is just one type of seizure (a tonic-clonic seizure).

Seizures vary – some are subtle and some are severe. Most are over in less than 2 minutes.

Common seizure types are either generalised and focal seizures.

Generalised seizures

These seizures begin in both hemispheres of the brain at the same time. There are several types of generalised seizures, including:

• Tonic-clonic seizures – this is a convulsive seizure and the most recognised seizure type. Consciousness is lost at the onset, followed by stiffening then rhythmic jerking of the muscles of the body. The person will look pale/bluish, they may bite their tongue or lose bladder control. Afterwards, breathing is noisy (like snoring) and they are often confused and tired.
• Absence seizures – these occur mostly in children. The person will suddenly stop and stare blankly for a few seconds, and then just as quickly return to normal. These seizures can happen many times a day, but they mimic daydreaming and can go unnoticed.
• Tonic seizures – the body suddenly stiffens briefly, and the person will fall stiffly if standing, often causing injury. Recovery is usually quick. These are also called drop seizures.
• Atonic seizure – the body suddenly loses muscle tone causing the person to fall if standing, or have head nod if sitting. Injuries are common. Recovery is usually quick. These are also called drop seizures.
• Myoclonic seizures – these are brief, sudden jerks of the muscles, usually involving the arms and upper body. These can occur in isolation or clusters.

Focal seizures

These seizures start in one small area of the brain. The signs and symptoms will depend on which part of the brain the seizure involves. Symptoms can vary from person to person. Sometimes focal seizures can progress into a tonic clonic seizure.

There are 2 types of focal seizures:

• Focal seizure (aware) – the person is conscious (aware) and remembers the seizure afterwards. Sometimes they may not be able to move or talk during the seizure, but they are aware of what is happening. These seizures are typically brief and can involve sensations such as pins and needles, unusual smells or taste, hallucinations, nausea, deja vu or experience emotions such as fear. This seizure type may develop into a different seizure. They are often called an 'aura.'
• Focal seizures (impaired awareness) – the person’s conscious state is affected so they can appear confused or vague, and may do unusual or repetitive actions such as fiddling with their clothes, making chewing movements or uttering unusual sounds. They will typically not respond appropriately during the seizure. These seizures last from 30 seconds to 2 to 3 minutes. Afterwards, they may be confused and drowsy and have little or no memory of the seizure or events just before and after it.

Causes of epilepsy

Anything that injures or scars the brain can increase the risk of seizures and epilepsy. There are many possible causes but not everyone has a clear reason why they have epilepsy. In fact, up to half of people with epilepsy never find out the exact cause of their condition.

Some known causes of epilepsy can include:

• brain injury
• stroke
• brain infection
• structural abnormalities of the brain
• genetic factors.

Diagnosis of epilepsy

It’s not always easy to confirm if someone has had a seizure, especially if there are no witnesses. Seizures are often unpredictable and short-lived, and so are difficult to diagnose.

After a seizure or episode has happened, people who have been to the doctor or emergency department are usually referred for an EEG and to a neurologist. In some cases, they may also be referred to other specialists to rule out medical conditions that can mimic or cause seizures.

Although medical tests may help identify the cause of a seizure, in many cases they may not.

Treatment of epilepsy with medication

For most people, the first treatment for epilepsy is medication. Around two thirds of people with epilepsy can get seizure control with the right antiseizure medication. Although some people may need to try more than one medication before finding what works best.

Antiseizure medication

Antiseizure medications are not a cure for epilepsy, but they help control or reduce seizures.

Many people with epilepsy achieve seizure control with one medication, while others may need a combination.

Treatment can be long term, but some types of epilepsy are age-related and seizures resolve by a certain age. Others may experience long periods without seizures.

For people who have been seizure‑free for a long time, any decision to reduce or stop medication must be discussed with their specialist. Medication should continue exactly as prescribed until this discussion has occurred.

Stopping antiseizure medication can trigger seizures and may lead to a medical emergency. Any changes should be slow and only under medical supervision.

Antiseizure medication side effects and interactions

You may have unwanted side effects from your medication. These can vary, depending on which medication you are prescribed.

Possible side effects can include:

• tiredness
• dizziness
• weight changes
• mood disturbance
• blurred vision
• skin rash.

Side effects should lessen or disappear after the first few weeks of treatment. Tell your GP or prescribing doctor if they persist, are intolerable or are listed as serious.

Antiseizure medications can interact with other medications, including each other. These interactions may affect other treatments (such as the contraceptive pill), or change how antiseizure medication works, making it less effective or potentially toxic. Some common over-the-counter treatments can also interfere with antiseizure medication.

It is important to tell your doctor and pharmacist about any other medications you take, including vitamins and supplements.

Taking antiseizure medication

Some general points about taking antiseizure medication include:

• Medication is usually started on a low dose, with a gradual increase over time.
• Your doctor should guide dosage changes – don’t alter the dose yourself.
• Stick to the same brand of medication, especially if seizures are well controlled.
• Some people may need a combination of medications.
• Try not to miss a dose. Ask your doctor what to do if this happens.
• A dosette box or Webster pack can help with remembering doses.
• Doctors and pharmacists can explain possible side effects.
• Report any side effects so adjustments can be made if needed.
• Let your doctor know if seizures continue despite medication.
• Plan ahead so your medication doesn’t run out.
• Illness, diarrhoea and vomiting can affect the absorption of medication - check with your doctor about what to do in these circumstances.
• Women planning a pregnancy may need medication changes to reduce risks.
• Never stop antiseizure medication suddenly, unless advised by a doctor.

See more on medical management of epilepsy.

Other epilepsy treatments

For people who do not gain seizure control despite trying different medications, there are other treatment options available.

Surgery

A small percentage of people with epilepsy may be eligible for surgery.

Epilepsy surgery may be considered when:

• seizures are not responding to medication
• there is a focal onset of the seizures (focal epilepsy)
• seizures are of a particularly dangerous or debilitating type (such as 'drop' or prolonged seizures)
• seizures occur many times a day, making normal life impossible
• the cause of the seizures requires surgery, such as a brain tumour.

Epilepsy surgical programs are based in epilepsy centres at major public hospitals around Australia. The work-up to surgery involves a number of tests and monitoring and recording of seizures.

There is a chance that at the end of the work-up, tests may show that surgery is not possible.

Vagus nerve stimulation (VNS) therapy

VNS Therapy is mild intermittent electrical stimulation of the vagus nerve in the form of a pacemaker-like device implanted in the chest. In some people with epilepsy, this can reduce the frequency and intensity of seizures and faster recovery time.

While it is uncommon for the VNS to stop someone’s seizures completely, studies show seizure control improves over time and is maintained. Other benefits include improvement in mood, alertness and general quality of life.

Having a VNS implanted does not mean you can stop medications. It is usually used in combination with medication.

Check with your specialist about the suitability of this procedure for you.

Dietary treatment

The ketogenic diet is a recognised and proven therapy for epilepsy since the 1920s. It is standard treatment of choice for some specific epilepsy syndromes. It can be used for people with drug resistant epilepsy that are not epilepsy surgery candidates.

Even though the ketogenic diet works well, many people stop it because it is very restrictive, difficult to follow and the food choices are very limited.

Dietary options for epilepsy have expanded in recent years to include:

• the 'modified Atkins diet'
• the 'low-glycaemic index' treatment diet.

These are less-restrictive and more-palatable diets and are usually better options for adults and adolescents with epilepsy.

Avoiding triggers for epileptic seizures

There are specific circumstances that may provoke seizures in people with epilepsy. These are called seizure triggers and vary from person to person. Identifying seizure triggers can help to reduce or avoid seizures. Keeping a seizure diary or record can highlight seizure patterns and help identify possible triggers.

Some commonly reported seizure triggers include:

• lack of sleep
• missed medication or medication changes
• alcohol
• certain drugs (prescription and recreational)
• flickering lights or patterns
• stress
• hormonal changes in women
• illness (especially with diarrhoea or vomiting)
• fever or significant changes in temperature and overheating.

Complementary therapies and epilepsy

Complementary therapies are sometimes used alongside prescribed anti-seizure medication to support overall wellbeing in people with epilepsy. But, they are not a substitute for medical treatment.

Approaches such as mindfulness, relaxation techniques, yoga, and psychological therapies may help reduce stress, improve sleep, and support mental health. This can indirectly influence seizure control for some people.

It is important that any complementary therapy is discussed with your doctor to ensure it is safe and appropriate.

Where to get help

• In an emergency, call Triple Zero (000)
• Your GP (doctor)
• Neurologist
• Epilepsy Action Australia Tel. 1300 37 45 37
• Epilepsy Action Australia have animated seizure first-aid videos aimed at both adults and children
• The National Epilepsy Support Service (NESS) Tel. 1300 761 487 or email support@epilepsysmart.org.au – provides support and information across Australia
• Epilepsy Foundation Information Line Tel. 1300 761 487 or (03) 8809 0600