Epilepsy

Epilepsy

What is epilepsy?

A neurological disorder, epilepsy is a chronic condition which primarily affects the body’s central nervous system. Nerve cell activity in the brain becomes disrupted and results in occurrences of unusual behaviour and sensations, unprovoked and recurrent seizures (also known as ‘fits’ - caused by a sudden rush of electrical activity in the brain), confusion, lack of awareness and even loss of consciousness.

With epilepsy the brain’s electrical system experiences a surge of impulses which results in brief changes in behaviour, bodily movements, awareness and feeling (sensations). The result of these changes is seizures.

Symptoms of seizures vary, affecting different individuals in various ways. Some may experience repetitive twitching movements during a seizure. Others may stare blankly for short periods of time.

Seizures are classified into two main types – Generalised seizures (affecting the whole brain) and partial or focal seizures (affecting one part of the brain).

Whether mild (lasting a few seconds with no recollection) or severe (accompanied by spasms and uncontrolled muscle movements and twitches lasting up to a few minutes), all symptoms and experience variations of seizures require medical treatment in order to control them. Dangerous situations can arise if seizures are not medically controlled.

A medical doctor will likely diagnose epilepsy if it is found that a person has experienced 2 or more unprovoked seizures (without obvious triggers) within a 24-hour period.

As a disorder, epilepsy is a fairly common condition around the world, affecting millions across the globe. It is common amongst children and adults, slightly more so in males than females.

How does epilepsy affect the brain and nervous system?

Illustration of a person and epilepsy waves (the brain and central nervous system)

The brain and central nervous system

Epilepsy is typically associated with symptoms of seizure. As such, the primary area that the condition affects is the central nervous system. The brain acts as the central hub in the body. Here, all voluntary and involuntary movements are controlled. Normally, electrical activity runs through the body’s nerve cells and assists the brain is sending messages or telling the body how to behave, react or move.

Where there is a dysfunction, abnormal signals disrupt this process and cause distress. This brings on seizures:

  • Young man experiencing a staring spellGeneralised seizures: This type involves both sides of the brain and results in loss of consciousness. A person may experience absence seizures or petit mal seizures (lasting about half a minute or less) which cause blank staring (absence seizures), no recollection of the experience or twitching and rapid blinking, or atonic seizures or drop attacks where a sudden loss of muscle tone occurs and causes a sufferer to fall uncontrollably and without warning. Other seizure variations include a generalised tonic-clonic seizure or grand mal seizures (where the body and limbs contract and extend out, followed by a tremor and muscle relaxation), and myoclonic seizures (which involve jerky muscle movements and convulsions). A person can also experience a status epilepticus which is a seizure occuring for longer than 30 minutes at a time. Seizures over an extended period of time can occur as multiples, but a person will not likely regain consciousness in between.
  • Partial / focal seizures: Abnormal electrical functions occur only in one part or side of the brain. These seizures can occur with preserved consciousness or impairment of consciousness. A person experiencing this type of seizure may have a feeling of either euphoria or doom, changes in vision and hearing, as well as their sense of smell just before having a seizure (this is known as an aura). Other symptoms noted with this type of seizure depend on the area affected in the brain. Some may experience sensation changes along with nausea and sweating. A person may scream, cry or laugh. Another symptom is lip smacking. If the dysfunction occurs in the temporal lobe, memory and emotion may be affected. A person may have little to no sense of awareness about what is happening at the time of a seizure and often loses consciousness. A seizure will often result in fatigue and sleepiness following the experience.

How else does epilepsy affect the body?

  • Circulatory and respiratory system: The after effects of a seizure can impact a person’s heart rhythm and breathing function. Shortness of breath and coughing are common complaints for epilepsy suffers. Sometimes, choking can happen (although rarely). A sufferer is more prone to developing other condition complications, such as heart disease and stroke, in the long-term. The ultimate complication risk as it relates to the circulatory and respiratory systems is SUDEP (sudden unexpected death in epilepsy).
  • Muscular and digestive system: Mixed and disrupted signals from the brain during a seizure contract and relax the muscles in the body in an uncontrollable manner. This results in a breakdown of muscle tone and often causes a sufferer to fall without warning. Some sufferers may cry or scream just before a seizure. This is because the muscles surrounding the vocal cords seize up and unexpectedly force air out. The force can sound much like an intentional cry or scream. Digestive issues are common side-effects of medicinal treatment. Many experience heartburn, constipation, diarrhoea, nausea and vomiting, as well as abdominal pain. Many suffering a seizure also lose control of their bladder and bowel.
  • Reproductive system: Epilepsy, by default, can have an effect on a woman’s pregnancy. A pregnant woman is at higher risk of hypertension or delivering an underweight baby. Worse-case scenario is that she may experience a stillbirth. That said, if a woman’s epilepsy is carefully monitored and treated during pregnancy, she can have both a healthy pregnancy and give birth to healthy baby too.

Epilepsy causes, types and triggers

What causes epilepsy?

For the most part, the cause of epilepsy is unknown (this is true for up to 70% of all cases). Few instances will be determined as a result of an injury to the brain. When a cause is known, it is typically as a result of:

  • A head injury (during birth or an accident) and scarring on the brain
  • Low oxygen levels during birth
  • Tumours (or cysts) in the brain
  • A genetic condition, such as tuberous sclerosis that causes damage to the brain
  • Developmental disorders such as autism or neurofibromatosis
  • Injury as a result of stroke
  • Infections affecting the brain such as meningitis, viral encephalitis or AIDS
  • Abnormal levels of sodium or blood sugar
  • Dementia or Alzheimer’s disease
  • Brain malformation as a result of maternal drug use

Sometimes a cause can relate to a genetic influence, where the condition appears to run in families. Researchers have established that up to 500 genes, however, are linked to the condition, but not all can be definitively determined as a direct cause of epilepsy. Some genes merely make a person more sensitive to certain seizure triggers such as environmental factors.

Are there different types of epilepsy?

Types of epilepsy will typically be categorised and treated according to the condition’s causes (if known) and overall symptoms. The main classification types are known as:

  • Idiopathic (no apparent cause)
  • Cryptogenic (there is likely a cause but it is still unknown)
  • Symptomatic (an underlying cause has been identified)

From there, epilepsy may be sub-categorised as generalised or partial (focal):

  • Idiopathic generalised epilepsy: Typically diagnosed during childhood or adolescence, this type often shows little or no nervous system abnormalities, other than seizures. Tests may involve EEG (electroencephalogram which measures electrical impulses in the brain) or MRI (magnetic resonance imaging) scan. Scans will show a structurally normal brain, but a specialist may be able to determine subtle changes which may have been present since birth, such as epileptic discharges affecting one or more areas of the brain. A person with this type has normal intelligence, but will experience myoclonic seizures, absence seizures or generalised tonic-clonic seizures (grand mal seizures). Some youngsters may ‘grow out’ of this type of epilepsy and stop having seizures.
  • Idiopathic partial (focal) epilepsy (sometimes known as BFEC – Benign focal epilepsy of childhood): This mild type is often diagnosed in early childhood (between the ages of 5 and 8) and almost always is outgrown by puberty (sexual maturation). Seizures are typical during a person’s sleep state. A child will experience partial motor seizures (affecting the face) and grand mal seizures. Diagnosis is typically made with an EEG.
  • Symptomatic / Cryptogenic generalised epilepsy: With a symptomatic type, a cause has been determined and often relates to widespread brain damage. A sufferer may also have other neurological problems, such as cerebral palsy or mental retardation. Where a cause has not been determined, a diagnosis will be made as cryptogenic epilepsy. Both experience multiple types of seizures – namely, generalised tonic-clonic, tonic, myoclonic, atonic, tonic and absence). This is often difficult to control. Sub-types include Lennox-Gastaut syndrome.
  • Symptomatic partial (focal) epilepsy: Commonly diagnosed in adulthood, this type is also frequently seen in childhood. A localised abnormality in the brain (due to stroke, tumours, congenital brain abnormalities, trauma, scarring or ‘sclerosis’, infections or cysts) typically causes this type of epilepsy. Some abnormalities may be microscopic and difficult to pick up on an MRI scan, however some abnormalities can be seen and identified. In many cases, surgery may be able to correct these abnormalities without compromising the rest of the brain’s normal function.

Are there common triggers for an epileptic seizure?

Commonly noted triggers that bring on seizures among epilepsy sufferers include:

  • A fever or illness
  • Stress
  • Lack of sleep or poor sleep
  • Stimulants such as caffeine, alcohol and medications or illicit drugs
  • Bright or flashing lights
  • Overeating, skipping meals or specific foods / ingredients
  • Missing medication doses

Identifying triggers is often tricky. Sometimes a seizure incident is brought on by a trigger, other times not. For others, a combination of factors may trigger a seizure experience.

An example of triggers that lead to an epileptic seizure are flashing lights or specific visual patterns in people with photosensitive epilepsy (although this is relatively rare and only occurs in around 3% of all epilepsy cases).

Females may also note that seizures are more commonly experienced around their menstrual periods. A doctor will be able to change or prescribe other medications for a woman to take before she has her menstrual period each month.

Often a newly diagnosed epilepsy sufferer may be advised to keep a record of possible triggers (a journal). In their record-keeping, they can note details such as the day and time of the incident, what they were busy with when the seizure happened, what was happening around them at the time, if there were any particular smells, sounds, sights or unusual stressors. It may also be useful to note if the person was eating or how long it had been between the last meal and the seizure, whether the person was feeling tired or fatigued and if they had a poor night’s sleep the previous day.

Details about medications can also be included in the journal as an easy way to track whether treatment is working or not. If possible, it will be helpful to a doctor if a person can note how they felt just before and after experiencing a seizure, and whether they experience any side-effects on their medication.

A journal may also prove useful to a sufferer as many find it difficult to recall information once they have experienced a seizure or lost consciousness. If a person can train themselves to pay attention to details and take note of them as far as possible, this can be very useful for effective management of the condition.

What are the signs of epilepsy?

Signs and symptoms of epilepsy and seizures

The brain has an influence on the function of every part of the body. Seizures brought on by this condition can affect any functional process that the brain helps coordinate. Like triggers, symptoms will vary from one epileptic sufferer to another. Typically, a person will experience a similar set of triggers and symptoms (depending on their condition type classification) each time they experience a seizure.

Common symptoms among all seizure types include:

  • Confusion (temporary)
  • Loss of consciousness or awareness
  • A staring spell
  • Jerking movements or convulsions (without a fever) in the arms and legs (these are uncontrollable)

Partial / focal seizures without a loss of consciousness may cause a person to experience changes in their vision, how things smell, feel, taste or sound just before an incident. They may notice a change in emotion (suddenly become fearful, panicked or angry for no apparent reason) and experience spontaneous sensory symptoms, such as dizziness, tingling and seeing flashing lights. A seizure will bring on uncontrollable or involuntary movements and jerking of the body (often the arms or legs).

A more complex partial or focal seizure (known as focal dyscognitive seizures) causes a loss of awareness or consciousness, staring, unresponsiveness, repetitive movements (such as hand rubbing, walking in circles, chewing or swallowing).

It is not uncommon for symptoms of partial or focal seizures to be misinterpreted as another type of neurological disorder, such as mental illness, migraine or even narcolepsy. In any instance, these sorts of symptoms should always be assessed, tested and diagnosed by an appropriate medical professional.

Passerby assisting a woman experiencing a seizure

Generalised seizures cause the following types of symptoms and experiences:

  • Absence seizures: Staring into space, subtle body movements (blinking of the eyes or even lip smacking), lack of awareness.
  • Tonic seizures: Muscle stiffening, mostly in the arms, legs and back, which causes a person to collapse without warning.
  • Atonic seizures: Loss of muscle control, which can also cause a sudden collapse.
  • Clonic seizures: Repetitive or rhythmic muscle movements (jerking), commonly noted in the neck, face and arms.
  • Myoclonic seizures: Sudden, but brief twitching movements or jerks in the arms and legs.
  • Tonic-clonic seizures: An abrupt or sudden loss of consciousness, body shaking and stiffening, tongue biting and loss of bladder or bowel control.

Following a seizure, a person may feel slightly ill and extremely tired, as well as feel temporarily confused (confused memory) or dazed and struggle to communicate clearly.

If a person experiences a seizure that lasts for longer than 5 minutes, does not regain consciousness after the seizure, is not breathing during or after the seizure, has a high fever, experiences a second seizure immediately after the first one, shows signs of heat exhaustion, is diabetic or pregnant, immediate medical attention is required for emergency intervention and treatment.

Injuries sustained during a seizure may also require prompt medical treatment. Any seizure experienced should be reported to your medical professional and your condition carefully monitored.

Risk factors and potential complications

Risk factors include:

  • Family history and age: Relatives with epilepsy can play a role in increasing your risk of developing any seizure type of disorder, including this condition. Epilepsy is also more commonly diagnosed in early childhood or in seniors, 60 years of age and older. Epilepsy can, however, occur at any age.
  • Childhood seizures: Children experiencing high fevers can sometimes be as a result of seizures. Risk of epilepsy is generally only high if the seizure occurs for a long period and if there is a family history of the condition or other nervous system problems.
  • Head injuries: Accidents, such as vehicle collisions or engaging in physical activity with a risk of injury or trauma to the head, can cause epilepsy.
  • Vascular diseases and stroke: Diseases affecting the blood vessels can lead to brain damage, which in turn can cause epilepsy. Preventative measures such as limiting alcohol consumption, maintaining a healthy diet and level of fitness, as well as avoid smoking can reduce the risk significantly.
  • Brain infections: Inflammatory conditions which affect the function of the central nervous system (brain and spinal cord) can increase the risk of epilepsy.
  • Dementia: Commonly diagnosed in older people, this condition can increase risk of seizures.

Complications can be as a result of dangerous circumstances when a seizure occurs (to a sufferer or those around them). These include:

  • A fall: Injuries sustained during a fall can cause harm or trauma to the head, or result in a fracture somewhere in the body.
  • Drowning: Risk increases if an epileptic seizure occurs while swimming or taking a bath. (Water and light can sometimes be a seizure trigger)
  • A vehicle accident: If driving just before a seizure, a loss of control or consciousness can cause an accident.
  • Seizures during pregnancy: Complications can arise during pregnancy if an expectant mom experiences a seizure. Both a mother and her unborn baby can be adversely affected by a seizure. Medications can also increase the risk of birth defects. Careful monitoring by a doctor and medicinal treatment can, however, ensure a safe pregnancy and healthy baby.
  • Psychological issues and emotional health concerns: The nature of seizures can ignite intense fears in a sufferer and place them at risk of mental and emotional health problems, such as depression and anxiety. Side-effects of medications can aggravate these types of health concerns, making it even more difficult to deal with the condition on an emotional level.

Other complications (in extreme circumstances) can include:

  • A state of continuous seizure activity (status epilepticus): Seizures that last for more than 5 minutes at a time, or if one experiences recurrent or multiple seizures without regaining consciousness in between, permanent damage to the brain can occur. This can be extremely life-threatening.
  • SUDEP: A continuous state of seizure activity in some instance can result in death (sudden unexplained death in epilepsy). A cause is more than likely unknown, but can occur as a result of heart or respiratory complications.

Diagnosing epilepsy

How will a doctor diagnose epilepsy?

An initial consultation with your doctor (general practitioner or GP) will involve a medical history discussion, assessment of your symptoms and a general physical exam.

During your physical exam, the doctor may evaluate your behaviour, motor abilities, memory, speech skills and overall mental function (neurological exam or neuropsychological test) to see if they can pick up any warning signals for possible epilepsy. Any definitive clues may help your doctor to determine a possible type of epilepsy as well.

Your doctor may also recommend a blood test to check for any signs of infection, check your liver and kidney function and blood glucose levels or even identify a potentially genetic condition that may be associated with your seizure symptoms.

Medical experts studying the EEG condition of a patient

Test to check for any brain abnormalities may also likely be recommended. These can include:

  • An EEG (Electroencephalogram): Electrodes will be attached to your scalp with a paste-like substance. The electrodes will then be used to measure and record the electrical activity in your brain. Brain wave patterns typically change in a person with epilepsy even when they’re not in the middle of experiencing a seizure. Your doctor will carefully monitor you on video – you may either be awake or asleep during the test. If the test is done during a seizure, this can help a doctor to rule out other potential conditions or determine the type of seizure being experienced.
  • CT scan (Computerised tomography): X-ray images will provide your doctor with highly detailed cross-sectional visuals of the brain. Any abnormalities can easily be seen with this imagine test and as such will help your doctor make a definite diagnosis. Seizures may be caused by obvious abnormalities such as a bleed, cyst or tumour.
  • MRI (Magnetic resonance imaging) and Functional MRI (fMRI): Another imaging test that can help to provide detailed visuals is an MRI. Powerful magnets and radio waves can be used to obtain a highly-detailed view of the brain, any abnormalities and how it is functioning. As with a CT scan, obvious abnormalities can be easily seen and determined as the cause of your seizures. A functional MRI looks at the blood flow that goes through changes as specific parts of the brain function. A fMRI can help a doctor to pinpoint exact locations of the brain’s critical functions, such as movement and speech. Often this test is used just before surgery so as to avoid causing potential injury to specific locations in the brain while operating.
  • SPECT (Single-photon emission computerised tomography): If an MRI or EEG hasn’t enabled your doctor to locate or identify anything causing your seizures, he or she may recommend this test to try and pinpoint a potential cause. A small amount of low-dose radioactive material is injected into a vein, helping to create a visual (detailed 3D map) of the blood flow activity in your brain, especially during seizures. A SISCOM (Subtraction ictal SPECT) test can also be used to provide similar, detailed visuals.
  • PET (Positron emission tomography): These scans can be used to help visualise specific areas of the brain in order to try and determine any abnormalities. A doctor will inject a small amount of low-dose radioactive material into a vein in order to help create this detailed visual.

Typically, tests are looking to identify seizure causes or rule out various conditions. A doctor will usually diagnose epilepsy if you have had more than one seizure with no apparent cause or reversible reason.

Young woman having brainnwaves measured

Treatment procedures

Medications

Epilepsy requires medical intervention in order to treat the condition. Top of the list is usually prescribed medication. Medications are essential for helping to control symptoms and prevent seizures or decrease the intensity of the incidents experienced.

The purpose of prescribed medication is not typically to control or stop a seizure already in progress. Neither is medication prescribed in an attempt to ‘cure’ the condition. Currently there is no cure for epilepsy.

Medication is produced to be absorbed by the stomach, enabling it to easily travel through the bloodstream into the brain. It is then able to affect the brain’s neurotransmitters and reduce the electrical activity that causes a seizure. The medication can then pass through the digestive tract and be passed out of the body through urine.

Dosages will be controlled and your condition frequently monitored. You may be prescribed medications in tablet, liquid or injectable forms to be taken at specific or multiple times each day. There may even come a time when your doctor may feel that you can stop taking medications altogether.

Many individuals, especially children with epilepsy, who haven’t experienced symptoms for a period of time may be able to discontinue medicinal treatment and live a relatively seizure-free life. If, as an adult, you have not had a seizure for more than 2 years, you may also be able to discontinue medicinal treatment.

The type of medication and dosage may take a little trial and error to get right at first, not only to control your seizures but also taking into consideration the type of side-effects the medications will likely cause. One medication at a low dosage may be prescribed at first and gradually adjusted until it is determined that your seizures are under control. Your doctor will carefully assess your overall condition, the type and frequency of seizures you’ve experienced thus far, if you need to take other medications to treat other symptoms or conditions, and your age before prescribing any medication to you.

Mild side-effects are common and may include symptoms of fatigue, weight fluctuations (either gain or loss), dizziness, loss of bone density, impaired coordination, skin rashes, memory dysfunction and speech problems. Rare, but more severe medication side-effects can include dramatic emotional and mental changes relating to depression and suicidal thoughts and behaviours, as well as inflammation of vital organs (such as the liver) and skin rashes.

Medication is currently the best means of getting epilepsy and seizures under control. It is vitally important that you take your medication exactly as prescribed by your doctor and never try and self-treat your condition. There are generic versions of some medications. It is strongly advised that you check with your doctor before taking any generic versions available or any other prescribed or over-the-counter drugs (including herbal supplements) as well. These could interfere with your treatment and cause adverse reactions.

If you experience any unusual or dramatic changes to your mood or behaviour, or experience migraines, you must consult your doctor as soon as possible.

Surgery

Surgery is another option that may be discussed with you taking into consideration the results of some of the tests that may have been performed. The most common surgery is known as a ‘resection’. If in the testing process, your doctor was able to determine a cause of your seizures in a well-defined area of your brain that will not likely interfere with vital functions (such as language and speech, vision, hearing or motor function), surgery may be recommended to remove that area of the brain (often the temporal lobe) or obstruction.

If it is picked up that seizures originate in areas that do affect vital function, surgery can still be recommended but it may happen that you will be awake during a portion of the actual procedure so that your doctor can ask you specific questions while operating.

It can happen that the affected area of the brain is too big or vital to remove. In this instance, a doctor may recommend a surgical procedure called a ‘multiple subpial transection’ (or disconnection) which interrupts the nerve pathway in the brain. The purpose of this surgery is to help reduce the likelihood of the origin of your seizures spreading to other areas of the brain.

Following surgery, medications to prevent seizures may still be prescribed even if the procedure was successful. Dosages may be lower and less frequently taken.

As with any surgery, there are risks and complications that can occur as a direct result. Some complications can include adverse reactions to general anaesthetic, infections or bleeding. Surgery can also permanently alter your cognitive abilities (ability to think). Your doctor will discuss any risks with you before any surgery is performed, so that you are well-informed about what can happen.

Therapies for epilepsy

Your doctor may opt to recommend implanting a vagus nerve stimulator beneath the skin in your chest. This device is similar to a heart pacemaker, with wires that are connected to the vagus nerve in the neck. The device is battery powered and delivers bursts of electrical energy through the nerve, and on to the brain. It has been noted that this device can help to reduce seizures by between 20 and 40% in many epileptic individuals.

Vagus nerve stimulation will still be used in conjunction with medication treatment, but as a result, the doctor may be able to prescribe lower and less frequent doses. Side-effects from the implanted device can include coughing, shortness of breath, pain in the throat and a hoarse voice.

Potentially effective treatments for future use are in the process of being researched and tested. These involve deep brain stimulation (brain implanted electrodes connected to an implanted generator in the chest or skull which send electrical pulses to the brain), an epilepsy pacemaker (responsive stimulation or ‘closed-loop’ devices), MRI-guided laser ablation and stereotactic radiosurgery.

Living with epilepsy

Once a diagnosis is made and treatment is implemented, epilepsy will likely become a permanent fixture in your daily life. A chronic disorder, epilepsy will affect many areas of your day-to-day life (including your ability to drive and other areas of independence which may be dangerous to both yourself and others if a seizure occurs).

Where you can, try to live an independent lifestyle. You can still get around some of the limitations that may affect your daily life. Find ways to help yourself, rather than focusing too much on the restrictions. For instance, you may not be able to drive, but if you live in an area with reliable and relatively safe public transport, you can still lead a normal, active and independent life.

Lifestyle considerations and coping mechanisms can include:

  • Person keeping a record (journal) of epileptic conditionKeeping a record book or journal: Identifying triggers and detailing seizure experiences as best you can will be helpful for both you and your specialised medical team in effectively treating your condition.
  • Wear a medical alert bracelet: This can help people, both known to you and strangers, become aware of your condition should a seizure occur and you are unable to communicate what is happening. In this way, people around you will be able to quickly act to help get you the medical attention you may need following an incident.
  • Educate close relatives, colleagues and family: Making those closest to you aware of your condition and teaching them how to handle an incident (should it happen) will help to assist you in the event of a seizure and also help to arm those around you with necessary knowledge that may help keep them calm too.
  • Young woman feeling upset and emotional about her conditionSeek out support: If your mental and emotional well-being is affected by your chronic condition, it is best to seek professional help to alleviate the effects of dealing with such an unpredictable illness. Epilepsy may have an impact on some of your daily activities, school work, working environment, relationships or finances. It can be overwhelming at times, causing you to feel stressed. There may be people around you who do not understand your condition who may make fun of you or display negative behaviour. Ignore them. Educate those around you who care and can help and expose yourself to circles of people who can help keep your spirits up and your sense of humour too. It will help you to seek support at times when you feel less able to help yourself. Support groups for people with a variety of different seizure disorders can also be beneficial in helping you cope with your illness. Wherever you can seek healthy support to help you gain a positive hold over your physical, emotional or even spiritual aspects of your life.
  • Get enough rest and sleep: For many poor sleep is a trigger for seizures. It is important that you do all you can to get a good night’s rest every day.
  • Young couple performing yoga exercises together for healthy livingGet active: A healthy amount of exercise can improve your overall physical health. If your condition affects your mental health, exercise is a great way to alleviate symptoms of depression or anxiety and help you manage stress. Whatever exercise activity you choose, it’s important to rest when you get tired and stay sufficiently hydrated.
  • Make healthy choices: Refrain from smoking and indulging in aggravating substances such as alcohol that may have an adverse effect on your condition and disrupt the effectiveness of your medication treatment.

Diet and nutrition

Ketogenic diet infographicAn important part of taking care of yourself comes down to what you eat. A ketogenic diet may be recommended by your doctor and discussed with you during your treatment plan.

The ketogenic diet is low in carbohydrates and high in fats, but does require a strict balance. The diet is designed to force the body to use fat for energy, instead of glucose. This is known as ketosis. You may be referred to a nutritionist or dietician to help you put together a diet plan. Children, in particular, must be carefully monitored if placed on this diet so as to prevent malnourishment.

The diet has been noted to reduce the frequency of seizures due to the fact that it mimics the metabolic effects of fasting which has proven anti-seizure effects, but the degree of success varies between person to person. A doctor should also be involved in monitoring this diet as potential adverse effects can include dehydration, nutritional deficiencies, constipation, slowed growth (in children), and a build-up of uric acid (which can lead to kidney stones). If the diet is properly managed and medically supervised, side-effects should not occur frequently or at all.

Teens and adults may be recommended to follow a modified Atkins diet instead, which is also high in fat and a controlled carbohydrate intake. A common side-effect of a diet higher in fat and lower in fibre, unfortunately is bouts of constipation.

Behaviour

Behavioural changes in children with epilepsy can sometimes impact their learning capabilities. There isn’t always a connection to adverse effects, but it can happen that some children with epilepsy will have intellectual disabilities as well. A doctor may be able to determine a cause in this instance.

Children may experience a change in behaviour a few hours and sometimes minutes before having a seizure. They may suddenly become irritable, hyperactive, inattentive or aggressive before a seizure.

The uncertain nature of epilepsy can be a confusing and stressful thing for a child. They may worry about suddenly experiencing a seizure in front of their friends or classmates. This can cause behavioural changes in a child. He or she may act out or withdraw from specific situations on a social level.

Seeking support can help your child to find ways to cope and learn to adjust over time. Behaviours developed in childhood can become habits as an adult which can further impact relationships and social interactions. The knock-on effect may intensify emotional challenges such as anxiety and depression.

Treatment for behaviour may be influenced with medication but typically depends on the nature of the issue. Therapies for the individual child or family can do wonders to help everyone not only cope, but support one another as you deal with this chronic condition.

What to do if someone has a seizure?

It can happen that you may bear witness or be required to act when a person has a seizure, whether you know the person or not. Here are helpful steps you can take to help handle the incident with the best care possible.

At the beginning of a seizure:

  • Your first instinct may be to try and hold or restrain a person having a seizure. This will not calm them down or stop the seizure and can injure both you and the person affected. Try and remain as calm as possible and do not attempt to restrict their movement. 
  • If necessary, try to loosen any clothing around or near a person’s neck to prevent possible injury or interference with their breathing ability. Carefully place something soft beneath a person’s head.
  • If there are others around you, request that they not crowd the person and allow them room. You may need to ask others to help you remove objects which may cause injury, such as furniture or other objects in the nearby vicinity if the person is experiencing convulsions.
  • Do not try and place your fingers or anything else in a person’s mouth in an attempt to keep them from swallowing their tongue. This is actually an old wives’ tales and in reality, is physically impossible and trying to prevent this will cause unnecessary injury.
  • Call for medical assistance.
  • Stay with the person having the seizure and observe their movements and behaviours during the seizure, retaining details you can share with medical personnel when they arrive. Time the seizure if you can and note how many occurred if multiple seizures occur. Clusters of attacks can happen. Be mindful of this possibility. This will help with effectively handling the person and administering appropriate treatment which can be life-saving.

Seizure first aid - passerby assisting woman after having collapsed and lost consciousness

After the seizure

  • Gently place a person on their side to help open their airway and prevent them from inhaling any secretions that may have occurred during the seizure.
  • Be aware of any injuries that may have occurred during the seizure, especially any bleeding wounds or fractures (broken bones). Take care in handling the person so as to not cause any further injury and control any bleeding with a little applied pressure to a wound.
  • Once a person regains consciousness or gradually returns to their normal senses, they may be confused and have difficulty understanding what has just happened to them. They may not be able to answer any questions either. You can try and give them reassurance that help is on the way and that you won’t leave their side. Remain at the person’s side until medical personnel arrive to take over.
  • It is best not to try and give a person liquids to drink following a seizure.
  • If another seizure occurs, repeat the steps as necessary.

What is the outlook for someone with epilepsy?

Is epilepsy curable?

No, there is no cure for epilepsy, but medical treatment can effectively manage the condition and help a person to lead a careful, but relatively healthy lifestyle. As long as seizures are carefully controlled, a person can live a long and productive life.

Even severe cases of epilepsy treated with surgery have been seen to have a high success rate. Many can become virtually seizure-free following surgery, or have very few incidents. Research continues around the world to try and develop better treatment options, as well as a potential cure. For the moment, treatment options with careful monitoring can significantly improve a person’s quality of life.

Disclaimer - MyMed.com is for informational purposes only. It is not intended to diagnose or treat any condition or illness or act as a substitute for professional medical advice.