What is epilepsy?
Epilepsy is a disorder that is best described as disturbed electrical
activity in the brain. This activity usually appears as a seizure. Seizures can
also be caused by other conditions or by seizure-inducing activities. To be
considered to have epilepsy a person has to have 2 or more seizures that are
not caused by illness or any other provoking event. Seizures from epilepsy can
vary in their appearance, severity, and cause. Although seizures are the main
symptom of the disease, patients’ lives can be affected in many other ways by
epilepsy.
How many people are affected
by epilepsy?
There are 120 per 100,000 people in the United States that go to the
emergency room or doctor because of a seizure, and approximately 125,000 new
cases of epilepsy occur every year. It estimated that about 2 million people in
the United States have epilepsy, and 50 million people throughout the world
have epilepsy as estimated by the World Health Organization (WHO). Epilepsy
occurs more frequently in younger children less than 2 years old and adults
older than 65 years old. Epilepsy has an estimated annual cost of $15.5 billion
in medical costs and lost or reduced earnings and productivity.
What are the types of
epilepsy?
Epilepsy can be classified into 2 different groups by seizure type or as
an epileptic syndrome. The seizures type is generally determined by an electrical
study of the brain (an electroencephalogram or EEG) and the behavior of a person
during and after a seizure. There are 2 major types of seizures, generalized
seizures and partial seizures (see Table below).
Table. Types of seizures
associated with epilepsy.
|
Seizure
types
|
Description
|
|
|
Generalized seizures
|
Tonic, clonic, tonic-clonic, atonic,
myoclonic, absence
|
Involve a large, widespread part of the
brain
|
|
Partial seizures
|
Simple (no loss of consciousness) or
complex (loss of consciousness)
|
Affect a smaller area of the brain and are
more localized
|
Epileptic syndromes differ from epilepsy in that they are associated with
more signs and symptoms than just seizures, including slow mental development.
Epileptic syndromes are defined by a cluster of factors including seizure
types, age when seizures begin, EEG findings, brain structure, family history of
epilepsy, genetic disorder, and prognosis or future outlook. The epilepsy
syndromes can be classified into 4 categories. These include familial,
symptomatic, idiopathic, and reflex. Some syndromes and seizure types may not
fall under any of the categories and be classified as unknown.
What are the signs and
symptoms of epilepsy?
The symptoms a person experiences will depend largely on the type of
seizure they have. They can present very noticeably such as a generalized
tonic-clonic seizure where the patient will fall to the ground with muscle
jerking or can be hardly noticeable with an absence seizure where a person just
seems to be staring off into space for a moment. Between seizures there are
usually no outright signs of epilepsy. Patients are unable to predict when
another seizure will occur.
What can cause epilepsy?
Epilepsy may develop early in life or at any point when an event occurs
that alters the connection between the nerve cells of the brain. Conditions or
events that can cause this include:
- oxygen deprivation (eg, during childbirth)
- brain infections (meningitis, encephalitis)
- traumatic head or brain injuries
- stroke
- brain tumors
- other neurological diseases (eg, Huntington's disease, Alzheimer's disease)
In some cases epilepsy can be inherited as part of certain syndromes, but
in most cases of epilepsy the cause is unknown.
Can epilepsy be prevented?
Depending on the cause of epilepsy there are some actions that can be
taken to prevent it. Some of these include:
- prenatal care to avoid complications associated with pregnancy
- immunizations to lessen the likelihood of certain infections that can be linked with epilepsy
- reduce your risk of falls and motor vehicle accidents that are often causes of epilepsy
- reduce your risk for stroke by treating obesity, physical inactivity, diabetes, high blood pressure, and high cholesterol, and quit smoking
How is epilepsy diagnosed?
Epilepsy should be diagnosed by a specialist with training and expertise
in epilepsy. A person would be evaluated for epilepsy when they have had more
than one seizure of an unknown cause. The official diagnosis of epilepsy is a
combination of 2 more seizures not caused by illness. There are 3 major areas
of testing that will be done to help diagnosis epilepsy.
- Laboratory or blood tests: none specifically diagnosis epilepsy but will be used to help rule out other conditions that may cause a seizure
- An EEG can be used to show abnormal brain activity
- Magnetic resonance imaging (MRI): will be used to look for any abnormalities in the brain to help determine a cause of seizures or epilepsy
Finally other conditions and precipitating factors need to be ruled out
to diagnose epilepsy. These include seizures from alcohol or drugs,
chemically-induced seizures, migraines, panic attacks, transient ischemic
attacks, and several others.
After a patient is diagnosed with epilepsy doctors will want to determine
the seizure type to help guide treatment decisions. There are multiple factors
that go into diagnosing the seizure type. These include the EEG findings,
duration of seizure, patient’s behavior during and after the seizure, and
whether the patient loses consciousness during the seizure.
How is epilepsy treated?
Once a person’s diagnosis of epilepsy has been confirmed and their seizure
type determined their treatment will be begin. Epilepsy treatment can include a
variety of options.
- Antiseizure medications are the backbone of treatment for epilepsy. There are several available and choosing which one will be used is based on a variety of factors. These include seizure type, other health condition and medications, patient age, and side effects of the medication. Usually 50% to 70% of patients will be controlled with one antiseizure medication. For 30% to 35% of patients, medication will not be able to control their seizures and they will have to seek other treatment options.2
- Surgery is an option for epilepsy that cannot be controlled with medication alone. This is especially true when the abnormal electrical activity that causes the seizure mostly starts from the same portion of the brain. In some cases, surgeons can remove this area, stopping seizure activity.
- Vagus nerve stimulators are sometimes used if surgery cannot be done. This is an electrical device that is implanted into the head and intermittently releases an electrical shock. This is reported to reduce seizure frequency in epilepsy.
- A ketogenic diet is reported to be associated with seizure reduction. This diet is high in fat and low in carbohydrate. The diet typically has a 3:1 ratio of fats to carbohydrates. It is said to be most effective in generalized and partial epilepsy.
Finding the right treatment for epilepsy takes careful review of a
patient’s symptoms and side effects of therapy, working closely with their
doctor.
How can I prevent
complications if I already have epilepsy?
People with epilepsy should avoid factors or activities that may
precipitate or cause a seizure, such as sleep deprivation, fever, alcohol
intake, and certain light stimulation. Families, caregivers, and patients
should also be educated about road and driving safety, first aid, and
prevention of injury at home, work, and school.
Where can I find more
information at?
There are several resources online where you can find more information
about epilepsy. You can also talk to your doctor or pharmacist for more
information.
·
Epilepsy
Foundation
·
Centers
for Disease Prevention and Control
·
Managing
Epilepsy Well Network
Written by: Katy
Skowronski
Doctor
of Pharmacy Candidate
College
of Pharmacy, University of Illinois at Chicago
UIC
Pharmacy
August
2013
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