Epilepsy

Epilepsy is a rare condition in which people have recurrent seizures. A seizure is a sudden burst of abnormal electrical activity in the brain that can range from mild to severe. 

With epilepsy, abnormal electrical activity disrupts the networks of trillions of brain cells that control what we sense, feel and think resulting in a seizure. 

There are different types of epilepsy which people can develop at any point in their lifetime, but it normally begins in childhood. 

Some people may have a single seizure without going on to develop epilepsy, but if multiple seizures occur then their doctor needs to investigate to see if they have epilepsy.

We still don’t fully understand why people develop epilepsy but there are a few possible causes: 

• Genetic factors: a number of genes are now linked to epilepsy
• Brain damage: symptomatic epilepsy due to a stroke, trauma or from an infection to the brain such as meningitis or malaria
• Brain tumours
• Problem with the way the brain developed in the womb (cryptogenic epilepsy)

If your neurologist can’t find a definite cause, it’s known as idiopathic epilepsy. People with idiopathic epilepsy tend to respond well to medication. If you have idiopathic epilepsy, it should cause minimal disruption to your life.

What are the different types of epilepsy seizures?

There are different types of epilepsy seizures depending on the part of your brain that’s affected and how it develops. Some people can have more than one type of epileptic seizure.

During some seizures you can remain aware and alert (focal seizure or aura seizure) whereas in other types (tonic-clonic seizure) you become unconscious. 

The main types of seizure include: 

Simple focal seizures 

A seizure that begins on one side of the body and you remain conscious throughout.

Complex focal seizures 

You lose consciousness and make random body movements.

Tonic-clonic (grand mal) seizure

You lose consciousness and will fall to the floor and shake.

Absence (petit mal) seizure 

You lose consciousness very briefly but usually without falling or shaking.

Myoclonic seizures 

You have twitches normally lasting no more than a second affecting both or one sides of the body. 

Tonic seizures

You have sudden muscle stiffness lasting only a few seconds.

Atonic seizures

You may go limp and drop to the floor.

Febrile Seizures 

Triggered by high temperature and are common in children aged under six.

Anyone can have a one-off seizure but it doesn’t necessarily mean they have epilepsy. Your neurologist will give you a diagnosis for epilepsy usually after at least two seizures. 

Epilepsy can be difficult to diagnose so your neurologist will look closely at your symptoms and send you for a number of tests. These may include: 

Electroencephalogram (EEG)

Your neurophysiologist attaches electrodes to your scalp to record electrical signals from your brain showing if your brain wave patterns are normal or not.

Magnetic resonance imaging (MRI)

Your neurologist will ask you to have an MRI scan to check if there’s any damage to your brain.

Video-telemetry 

Simultaneously measures your brain waves while it videos you which may need a hospital admission.

They may ask you to keep a diary noting down your symptom patterns which can help to diagnose which type of epilepsy you have.

How is epilepsy classified?

Neurologists use five different components to classify the type of epilepsy you may have. They will look at:

• The way your brain reacts during a seizure 
• The type of seizure that’s experienced
• The syndrome, as defined by the symptoms 
• The origin of your epilepsy (idiopathic, symptomatic, cryptogenic)
• The degree of disruption the seizures and symptoms cause to everyday life

Seizure types vary greatly and can range from a tonic-clonic (grand mal) seizure where you lose consciousness, go stiff and your body may begin to jerk, to an absence seizure (petit mal) where you only lose consciousness briefly, you stay upright but your muscles become floppy.

A tonic-clonic seizure typically lasts between one to three minutes. An absence seizure lasts for a few seconds but you may have hundreds over one day. 

If your seizure starts in one part of the brain (focal seizure) you may develop an ‘aura’ which can be a sign you’re about to develop a tonic-clonic seizure. 

It may remain a focal seizure where you stay aware but may have unusual movements (simple partial seizure).

Many things can trigger an epileptic seizure including strobe lighting, stress, tiredness, dehydration, even reading.

At The London Clinic if you have a diagnosis of epilepsy your specialist will start you on anti-seizure medication (anticonvulsants). Anticonvulsants are effective for most people even at low doses. 

Some anticonvulsants may not be suitable for you if you are pregnant, breastfeeding, planning on becoming pregnant or if you have liver or kidney damage.

At The London Clinic your consultant will ensure that you are on the best medication, both to control your epilepsy and to match with your lifestyle.

About 50% of patients who take medication have no seizures during a five year period and you may be able to come off medication altogether. Around 30% of patients on medication have fewer seizures. 

However mediation doesn’t work for everyone with epilepsy and around 20% don’t find their symptoms improve with medication. 

At The London Clinic we also provide other treatments including the ketogenic diet, vagal nerve stimulation and surgery.

The ketogenic diet is a high fat, low-carbohydrate medical diet that can be useful if you can’t control your epilepsy with medication alone. Research suggests the diet can reduce the frequency of seizures by around 50%. 

NICE guidelines recommend the diet for children but it’s use is increasing for adults too. In some cases surgery can be an option to successfully treat epilepsy.