Epilepsy Clinic

Who Does Epilepsy Affect?

Epilepsy is one of the most common severe neurological (brain) conditions.

Around 10-12% of people will have a seizure during their lifetime, and 3-4% will be diagnosed with epilepsy at some point.

The causes of epilepsy are often different through age.

What Causes Epilepsy?

There are different causes of epilepsy, but a structural problem within the brain almost always causes adult-onset seizures.

In children, epilepsy can be due to

• abnormal brain development,
• genetic reasons,
• head injuries,
• fever,
• infection of the brain or its surrounding membranes (meningitis) and
• hydrocephalus (excess fluid within the brain).

Types of Epilepsy

There are different types of epilepsy, but generally, there are two key types of epileptic seizures.

• Partial or Focal Seizure - activity is restricted to a local area in the brain but can evolve into a generalised epileptic seizure.
• Generalised Seizure - activity affects a larger area and both sides of the brain.
• Focal Seizures can either be Simple or Complex Focal Seizures.
• Simple Seizures are ones where there is no loss of consciousness, and
• Complex Seizures may involve a loss of awareness.
• Generalised Seizures can be categorised as:
• Absence Seizures - causes you to blank out or stare into space for a few seconds
• Tonic Seizures - involve a brief stiffening of the body, arms or legs, causing loss of balance.
• Myoclonic Seizures - sudden single jerks of a muscle or a group of muscles that may last no more than a second or two
• Atonic Seizures - brief seizures that cause a sudden loss of muscle tone, and the person often falls to the ground or will have a sudden head nod if sitting.
• Tonic-clonic Seizures - the body stiffens (the tonic phase), and then the limbs begin to jerk rhythmically (the clonic phase)

Progression of Epilepsy

People who have epilepsy have seizures intermittently and may be asymptomatic for months to years between seizures.

Epilepsy Symptoms

Seizures can affect any process your brain coordinates. Seizure signs and symptoms may include:

• Confusion or a staring spell,
• Muscles rigidity,
• Unexplained falling,
• Uncontrollable jerking movements of the arms and legs
• Loss of consciousness or awareness
• Heightened fear, anxiety or deja vu
• Children with epilepsy may experience
• Strange sensations and emotions,
• Abnormal behaviour, and
• Convulsions, muscle spasms, and even loss of consciousness.

Risk Factors for Epilepsy

Conditions that increase the likelihood of developing epilepsy include:

• Stroke or other cerebrovascular diseases
• Cerebral tumours
• Alcohol abuse or withdrawal
• Severe head trauma
• Family history of epilepsy: 30% of people with epilepsy will have a first-degree relative with a history of seizures
• Previous brain surgery
• Infections of the brain or central nervous system
• Abnormalities of nervous system development.
• Precipitating factors that may cause a seizure to occur include:
• Psychological or physical stress
• Sleep deprivation
• Hormonal changes associated with the menstrual cycle
• Lights or a flickering television may provoke an attack in susceptible patients
• Exposure to toxic substances, such as alcohol
• Certain medications can provoke epileptic fits in people with a natural tendency to have seizures.

How is Epilepsy diagnosed?

Diagnosis of Paediatric Epilepsy involves

• Physical Examination, and
• Diagnostic Testing.

Pathology Tests for Epilepsy

Blood tests may be performed to look for potential causes of seizures. These may include a full blood count, liver function tests, and toxin screens.

Not all patients on anticonvulsant medications need to have their blood anticonvulsant levels checked. Sometimes it can be helpful for efficacy, sometimes to see if the patient is taking the medication.

EEG Testing for Epilepsy

An EEG test looks at the electrical activity of the brain. It will be abnormal during a seizure and so may help diagnose epilepsy; however, it is usually normal between seizures in people with epilepsy.

Children with epilepsy can have irregular electrical activity in the brain. This can be tested using an Electroencephalogram (EEG) test.

Imaging Tests for Epilepsy

CT/MRI of the head – to exclude the possibility of an underlying cause such as a brain tumour.

Other investigations may be available in specialist epilepsy centres. These may be particularly useful if surgery is considered a treatment option.

How is Epilepsy Treated?

Management of epilepsy will involve

• the treatment of underlying conditions that could be causing epileptic seizures, avoidance of triggering factors,
• use of antiepileptic medications,
• surgical treatment options, and
• addressing the emotional issues that face a patient with epilepsy.

Anti-epileptic prescription drugs

Anti-epileptic medications are the mainstay of treatment. Most doctors recommend antiepileptic medications after a patient has had two or more seizures.

The choice of anti-epileptic medication depends on seizure type and patient factors. Similarly, for children, determining the best medication depends on the type of epilepsy.

Other Treatments for Epilepsy

Many antiepileptic medications have unwanted side effects. In patients who do not respond to medical management, surgical treatment for certain types of epilepsy may be an option.

Your doctor may suggest surgery or implanting a device such as a vagus nerve stimulator (VNS) The VNS is placed underneath the skin of the chest, like a heart pacemaker, to control the number of seizures experienced.

Some patients with epilepsy may benefit from brain surgery where the abnormal brain cells causing the seizures are removed to control the seizures.

Some children with epilepsy are recommended to follow a special diet called a ketogenic diet to help prevent seizures.

General Epilepsy Advice

Patients should be informed of restricted driving conditions – most can drive a car for private use after 1-year seizure-free, either off or on prescription drugs, according to Australian guidelines.

• Avoid swimming alone.
• Avoid dangerous sports such as rock climbing.
• Take showers rather than baths. Be supervised or leave the door unlocked when taking a bath.

Epilepsy and Pregnancy

Epileptic women have some reduction in fertility, possibly caused by several factors. Furthermore, the risks of birth defects amongst women taking anticonvulsants are higher than in the general population. Therefore counselling before becoming pregnant is crucial.

If drug therapy is continued during pregnancy, use of the lowest possible dose of a single, first-line drug is recommended. Folic acid supplements are also recommended.

Please seek your doctor’s advice if you are pregnant or planning to become pregnant.

Prognosis and Risks with Epilepsy & Treatments

Despite drug treatment, seizures may persist in 20 – 35% of cases of epilepsy. These patients may benefit from a review of medications, attention to treatment compliance, and consideration of surgical options.

With anticonvulsant medications, about 70% of people with epilepsy can have their epilepsy well controlled. Up to 60% of people can have good control without experiencing significant medication side effects.

Patients with epilepsy have an increased risk of developing depression, anxiety, and psychosis. Approximately 20% of epilepsy patients develop depression, and a higher suicide rate than the general population has also been noted in patients with epilepsy.

There is a 2-3 fold increase in the risk of death in a patient with epilepsy when compared to the general population. Some of this increased risk is probably due to the underlying causes of epilepsy, such as cerebral tumours or strokes. However, a very small percentage of patients die from a syndrome known as a sudden unexpected death in epileptic patients (SUDEP). The cause of SUDEP is unknown.