Epilepsy is a chronic brain disease that can affect people of all ages.1 Read on to learn about the main types of epileptic seizures, how they affect people, and how epilepsy is diagnosed and treated.
Epilepsy is a condition that affects the brain, people with epilepsy have a tendency to experience frequent seizures. Seizures are caused by a disturbance in the brain’s electrical activity, which temporarily affect how it works. This causes a huge range of symptoms, from becoming stiff or staring blankly into space, to uncontrollable shaking or jerking.2
Epilepsy is considered a ‘spectrum disorder’ because it has numerous causes and several different seizure types and its severity and impact can vary from person to person, with a range of co-existing conditions.3
There are many types of epilepsy, including focal epilepsy, generalised epilepsy, and combined generalised and focal epilepsies. Doctors will investigate the types of seizures that are experienced and what has caused them to help them to classify the type of epilepsy.4
There are over 30 different types of epileptic seizures.3 In some seizures people remain alert, while others can cause loss of awareness. They may cause shaking and jerking or give people unusual sensations.5 The main seizure types and their symptoms are covered in detail in the symptoms section below.
Epilepsy is one of the most common neurological (meaning it affects the nervous system) conditions in the world. Around 50 million people worldwide have the condition, however it is estimated that up to 70% of people with epilepsy could live seizure-free with the correct diagnosis and treatment.1
The main symptom of epilepsy is epileptic seizures. These are caused by sudden bursts of electrical activity in the brain which disrupt the function of the brain and mix up its usual messaging. Depending on which part of the brain is involved, seizures can affect people in different ways.2
The main symptom of epilepsy is recurrent seizures5 – these are often unpredictable and episodic, which means that they come and go.6 However, many people find it helpful to keep track of what happens before each seizure to help them build up a better understanding of any warning signs that are typical for them.6
Most people with epilepsy have seizures that last for a short time (less than five minutes) and stop by themselves. But sometimes, a seizure can last longer than five minutes, or multiple seizures can happen with no recovery time in between. This is known as ‘status epilepticus’ and emergency assistance and/or medication may be required to end the seizure as quickly as possible. Make sure you call an ambulance if someone has a seizure that lasts longer than 5 minutes.5
Seizures are categorised into focal, which start in one part of the brain, and generalised, which involve all parts of the brain.
Focal seizures are generally brief, lasting less than two minutes.
Epilepsy does not have defined stages; it can come on quite suddenly and can start at any age. Anyone can have a single epileptic seizure, and this does not necessarily mean you have epilepsy.2
Often, epilepsy is a life-long condition, although some types of epilepsy last for a limited time and the seizures will eventually stop.3
The causes of epilepsy are complex and not always easy to identify, in up to 50% of people the cause is unknown. It could be a result of a person’s genetics, a structural change in the brain or other comorbidities such as brain tumours and infectious diseases, such as meningitis and viral encephalitis. Certain events can also make epileptic seizures more likely, such as lack of oxygen the brain, or brain injury from an accident or a stroke.1
In adults with epilepsy, the risk of dying is up to three times higher than in the general population1. However, a recent review found that in adults diagnosed with symptomatic epilepsy (epilepsy caused by brain injury) in the 2000s, life expectancy was increased following diagnosis.11 In most epilepsy subgroups they found no significant difference between life expectancy of adult epilepsy patients compared to the general population.11
Around one in three people with epilepsy also has a family member with the condition, which suggests the cause can be hereditary. Therefore, many people who have parents with epilepsy may not experience seizures or develop epilepsy themselves.2 It is also sometimes a result of a non-inherited genetic tendency, caused by a change in a person’s genes12, which can happen as we get older.
Epilepsy can develop in anyone at any time in their life, but it’s most commonly diagnosed in people under 20 and in people over the age of 65. This is because people are more likely to experience events which cause brain injuries at these ages. For instance, a lack of oxygen at birth as a child or a stroke in older people.13
Once you have developed epilepsy it is often a lifelong condition2, although there are many treatment options to help reduce seizures or even stop them altogether.14
With proper treatment, 6 out of 10 people with epilepsy can become seizure free within a few years.15 Some of these people may experience a sudden seizure after years without one, this is known as a ‘breakthrough seizure’. In this case, it is important to seek medical advice as treatment may need to be adjusted.16
Many people remain on treatment for their whole life2, but some people’s seizures disappear over time, which means they can stop taking medication. When epilepsy goes away like this it is called spontaneous remission.13
People who are diagnosed with epilepsy tend to experience repeated seizures. Having a single seizure doesn’t mean you have epilepsy, however, if you have experienced a seizure ensure that you talk to your GP or primary care giver straight away so that they can begin exploring the cause.2
First, doctors will look to determine whether the seizures you are experiencing are starting in the brain or not. Other types of seizures, such as those caused by low blood sugar or heart problems, are not associated with epilepsy.17
If they believe it may be epilepsy, you will usually be referred to a neurologist, which is a doctor who specialises in conditions affecting the brain and nerves.18
There is no single test to diagnose epilepsy, so it can be a lengthy process while doctors look at a range of information to find out what’s causing the seizures. Often, the symptoms can appear similar to other conditions like panic attacks, migraines or fainting, so any specific information you can provide about your seizures will be helpful. This might include:
Once your doctor has a clearer picture of the seizures you’re experiencing, they may suggest some tests. These will help them to gather more information for a diagnosis and to rule out other causes, but the tests can’t confirm or dismiss epilepsy on their own.19
The tests for epilepsy include:
If you have been diagnosed with epilepsy there are a range of treatments available including medication, surgery and stimulation treatments. While epilepsy cannot generally be cured, with the right treatment many people are able to keep seizures under control or even stop them altogether.20
In cases where AEDs have not helped to control seizures, surgery may be considered. First, tests will be carried out to see if the seizures are caused by a small part of the brain where surgery is possible.20
There are two different types of surgery available24:
Having brain surgery is a big decision and it’s important to be sure before you go ahead. Your doctor will explain the procedure and talk through your concerns about your recovery and any potential side effects. Gather as much information as possible before making a decision.
Other procedures used to treat epilepsy include vagus nerve stimulation (VNS) and deep brain stimulation (DBS).
In VNS therapy, a small electrical device (like a pacemaker) is implanted under the skin of your chest. Electrical impulses are sent to your brain through the vagus nerve in your neck.20
It’s unlikely that VNS will stop seizures completely, but it can help to reduce their severity and frequency by changing the electrical signals in the brain. It is often used alongside AEDs.20
DBS works in a similar way. Electrodes are implanted in the chest and connected to wires that go directly to the brain. This is a relatively new procedure that is currently only used on adults and more research needs to be done to understand how effective it is.20
The ketogenic diet (also known as ketogenic therapy) is a specialist medical diet that is high in fats and low in carbohydrates and protein. It is sometimes used to treat epilepsy when seizures can’t be controlled by AEDs. For this reason, it’s more commonly used to treat children, and it has been shown to reduce the number of seizures in some children.20
It’s important that children only follow the ketogenic diet under strict supervision of a paediatrician or a paediatric dietitian who can make sure that the diet is carefully balanced.20
For people whose epilepsy can be triggered by stress, exercise can be useful alongside other treatments. Many people find stress-relieving and relaxation therapies helpful, such as yoga and meditation.20
The causes of epilepsy are wide ranging, so there’s no single preventative method, but there are some simple things you can do to help lower your chances of developing it.
For people who have epilepsy, keeping a seizure diary can be an effective method of preventing epileptic seizures as it can help to pinpoint factors that are more likely to trigger a seizure, and allow you to avoid these situations in future.26
There are some devices which are able to notify others if a seizure occurs by detecting motion. These can be mattress, watch, camera or motion devices. Most of the devices available have not been proven to work in the ‘real world’ (outside of a laboratory setting) so make sure you speak to your doctor if you think you would benefit from one of these devices.27
While many people with epilepsy respond well to treatment, 30-40% of people have uncontrolled seizures that do not respond to medication.3 For this reason, there is still a lot of research being done to explore new treatments for people with epilepsy.
For example, scientists are exploring why genetics are different in people with epilepsy28 and researching new molecules that could potentially be developed into new epilepsy drugs.29 These findings could be crucial to help discover new medication for people whose seizures do not respond to current treatments.