Epilepsy Explained: Causes, Symptoms, And Treatments

As described by the American Association of Neurological Surgeons (AANS), epilepsy is a disorder in which the normal electrical signaling in the brain is disrupted, causing repeated seizures. Seizures are characterized by sudden bursts of excessive electrical discharge that may change awareness, movements (e.g., jerking) or sensations. A person is considered to have epilepsy after having had two or more seizures without a known trigger such as alcohol withdrawal or extremely low blood sugar. Epilepsy is an ancient disorder that can be traced back to 4000 BCE, per the World Health Organization. Patients with epilepsy have faced discrimination and social stigma for millennia — and still do, to this day. 

There are two basic types of seizures: focal onset seizures that begin in one area on one side of the brain, and generalized onset seizures that affect both sides of the brain at once (via the Cleveland Clinic). A person with focal onset seizures may be either awake and aware (e.g., jerking of arms or legs) or unaware and confused (e.g., staring blankly). Generalized onset seizures can vary widely from brief episodes of "staring into space" or muscle jerking to convulsions. Convulsions, once called grand mal seizures, involve continuous muscle jerking up to 5 minutes and loss of consciousness and falling. In addition, drooling, tongue biting, and loss of bowel and bladder control may also occur with convulsions. 

While not contagious, epilepsy can occur in anyone (per the Epilepsy Foundation). For about half of the people with epilepsy worldwide, no cause has been identified yet. 

As reported by the Mayo Clinic, a number of different causes have been identified for the other half of people with epilepsy. For example, a strong genetic component is more likely if there is a family history of epilepsy. In some cases, a person who inherits a genetic variant gene may still be affected by environmental triggers, and perhaps even more so. Epilepsy can be caused by brain trauma from head injuries (e.g., auto accident) or brain tumors, as well as from stroke, which is the chief cause of epilepsy in people over age 35. Infections such as meningitis, HIV, viral encephalitis and parasitic infections can also trigger seizures. Other causes of epilepsy include developmental disorders (like autism) and brain damage occurring before birth. Prenatal brain injury can be caused by loss of oxygen, poor nutrition, or maternal infections. 

According to the Epilepsy Foundation, a certain type of epilepsy characterized by sudden and severe onset of seizures may have an autoimmune cause. People at greater risk of developing autoimmune epilepsy include those with a history of another autoimmune condition (e.g., rheumatoid arthritis, autoimmune thyroiditis, inflammatory bowel disease, and lupus) or a history of cancer. Having a parent, brother, sister, or child with an autoimmune disorder is also associated with an increased risk of developing autoimmune epilepsy. 

A number of risk factors are associated with a greater likelihood of developing epilepsy, per the Mayo Clinic. For example, children and older adults have an increased risk of epilepsy relative to other age groups. People with a family history of epilepsy, a long-fever-associated seizure as a child, or another nervous system disorder are also at risk of developing seizures. Head injuries, brain infections (e.g., meningitis), dementia, and blood vessel diseases such as stroke increase seizure risk as well.    

Additional risk factors for epilepsy noted by the American Association of Neurological Surgeons (AANS) include premature birth or low birth weight, trauma during birth, seizures during the first month of life, brain tumors and bleeding into the brain, abnormal structure of the brain at birth, cerebral palsy, mental disabilities, and alcohol or drug abuse. 

Apart from risk factors, a variety of factors make a person with epilepsy more prone to having a seizure (via Medical News Today). These seizure triggers include stress, sleep deprivation and fatigue. Per the Cleveland Clinic, other seizure triggers include hormonal changes, illness (e.g., fever), flashing lights or patterns, skipping meals, dehydration, overtraining, certain foods and compounds like caffeine, specific medications (e.g., the antihistamine diphenhydramine), certain times of the day or night, and missing doses of anti-seizure drugs. Tracking seizures to discover patterns and identify triggers is recommended.

While epilepsy is not curable, treatments can help control seizures, states the Epilepsy Foundation. Typically, the first-line treatment for epilepsy are anti-epileptic drugs (AEDs), which effectively control seizures in about 70% of cases. Mostly administered orally, these medications include valproic acid (Depakene), carbamazepine (Tegretol), lamotrigine (Lamictal), and levetiracetam (Keppra), per Medical News Today. 

According to the National Institute of Neurological Disorders and Stroke, surgery for epilepsy may be considered when at least two medications fail at controlling seizures, or if a brain lesion related to the seizures has been identified. Though surgery can appreciably reduce seizures in people with epilepsy, associated risks include cognitive impairment and physical disability. The most common type of surgery is a lobectomy, which involves the removal of the defined portion of the brain where seizures begin. If a lobectomy is not feasible, a series of cuts (referred to as a multiple subpial transection) are made to prevent spreading of seizures to other areas of the brain. In severe cases where damage affects only half of the brain, a hemispherectomy is performed to cut out half of the brain's cortex (outer layer). Thermal ablation is a less invasive type of surgery that delivers a set amount of energy to a targeted section of the brain, thus destroying brain cells causing the seizures. 

For people with epilepsy who do not respond to medications or are unable to undergo surgery, electrical stimulation of the brain (e.g., vagus nerve stimulation, deep brain stimulation) is a treatment option. 

As noted by the American Association of Neurological Surgeons (AANS), treatment with medications or surgery successfully manages seizures in most people with epilepsy, allowing them to lead ordinary, active lives.

Getting sufficient sleep and coping with stress by practicing yoga, meditation, biofeedback, and deep breathing exercises are lifestyle measures that can also help manage seizures (via the Cleveland Clinic). Other important lifestyle improvements can contribute to epilepsy management as well, including regular exercise (around 150 minutes per week), a nutritious diet, and moderation in alcohol use. Additionally, people with epilepsy should recognize and avoid seizure triggers and keep their doctor updated about any new medications that have been prescribed by other physicians, particularly antidepressants, antihistamines, and stimulants — all of which can interact with anti-epilepsy drugs or cause adverse reactions. Information about over-the-counter medications, vitamins and supplements, and any herbal products should also be revealed to the managing doctor. 

While the likelihood of a woman with epilepsy to give birth to a normal, healthy baby is 90% or better (via the AANS), women with epilepsy who wish to get pregnant should first consult with their physician. The managing physician may reduce anti-seizure medications, since they can cause birth defects. However, severe birth defects are rare when the mother's seizures are carefully managed. 

According to the World Health Organization, one in four cases of epilepsy are preventable. Safeguarding against head injury (e.g., wearing a helmet when bike riding) is first and foremost when it comes to preventing post-traumatic seizures. Pregnant women should seek perinatal care to reduce the risk of epilepsy from birth injuries. In cases of childhood epilepsy, the possibility of febrile seizures can be minimized by reducing the body temperature of a feverish child. Managing risk factors for cardiovascular disease is the recommended strategy to prevent stroke-induced epilepsy. These cardio risk factors include high blood pressure, diabetes, obesity, smoking, and excessive alcohol use. In low- to middle-income tropical areas of the world, the risk of parasitic infections such as neurocysticercosis that cause epilepsy can be reduced with good hygiene practices. 

People with epilepsy, like the general population, should be encouraged to exercise, concludes a 2015 review of studies published in the journal Seizure. Exercise rarely triggers seizures. On the contrary, in people with epilepsy, exercise improves physical/mental health and social integration, while also reducing stress indicators and the number of seizures. Interestingly, beginning exercise at an early age builds up reserves in the nervous system that may reduce the susceptibility to seizures later in life.