Epilepsy (Seizures) - Medtick
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Epilepsy (Seizures)

What is it?

A surge of chemical activity in the brain causing the body to do things not normal to one self causing one or a variety of epileptic seizures.

Practical definition of epilepsy based on the International League Against Epilepsy task force

Epilepsy is a disease of the brain defined by any of the following conditions:

  • At least two unprovoked (or reflex [i.e. induced by a specific trigger]) seizures occurring >24 hours apart;
  • One unprovoked (or reflex) seizure and a probability of further seizures, similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next ten years, based on neurologist experience;
  • Diagnosis of an epilepsy syndrome.

Fisher R, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia 2014;55:475–82. doi:10.1111/epi.12550

The Pharmaceutical Journal, PJ, April 2022, Vol 308, No 7960;308(7960):
DOI:10.1211/PJ.2022.1.139730

Epilepsy is defined as resolved in individuals with an age-dependent epilepsy syndrome, who are now past the age criteria for certain syndromes, or those who are seizure-free for more than ten years, with no antiseizure medicines (ASMs) and have not needed antiseizure medicines for the past five years.

  • Epileptics can have a mix of seizures depending on which part of brain affected.
  • Epilepsy normally occurs in some sort of pattern known as epilepsy syndrome.

Some persons have auras and have a ‘feeling’ an epileptic seizure is on the way ,if so get into a safe place and safe body position.

Auras can differ from person to person i.e.

  • Strange taste or strange smell
  • Deja vu feeling
  • Sense of fear or anxiety
  • Body feels strange
  • Outside world have become unreal or dream like

There are four main types of seizures:

Focal seizures (partial seizures)– where seizures can last from just seconds up to a couple of minutes, consciousness is retained and they will be able to talk during their seizure, respond to instructions and will remember the seizure afterwards. the abnormal electrical activity begins in a localised area and pending where one has activity in the brain determines their symptoms.

For example:

  • If the activity/focus is in the temporal lobes, then the person may experience an intense unpleasant sensation, such as smelling a strong smell or feeling an overwhelming sense of déjà -vu.
Scheffer I, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: Position paper of the ILAE Commission for Classification and Terminology. Epilepsia 2017;58:512–21. doi:10.1111/epi.13709
  • If the focus is in the frontal cortex, then the seizure is often movement related, so the person may display peddling or kicking movements, their head may turn to one side or they may adopt a strange bodily position, perhaps with one arm straight and one bent.

Generalised seizure– If the seizure activity move/propagates to both cerebral hemispheres, in what is called a focal impaired awareness seizure then one is either unaware or ones awareness is impaired (will usually be unresponsive or only partially responsive during the seizure, and will not remember the event afterwards).

Generalised and focal epilepsy– If your seizures consist of both generalised and focal, your epilepsy is classified as generalised and focal epilepsy. Many syndromes are classed in these types of seizures (see some syndromes in causes).

Unknown epilepsy: If it’s unclear whether your seizures are focal or generalised.

When most likely to occur (general):

  • Incidence peak in infancy, often caused by brain damage during birth
  • High association between epilepsy and intellectual disabilities and developmental disorders

Robertson J, Hatton C, Emerson E, et al. Prevalence of epilepsy among people with intellectual disabilities: A systematic review. Seizure 2015;29:46–62. doi:10.1016/j.seizure.2015.03.016

  • Second peak in older age owing to cerebrovascular disease, with seizures common after stroke.

Hauser W, Annegers J, Kurland L. Incidence of epilepsy and unprovoked seizures in Rochester, Minnesota: 1935-1984. Epilepsia 1993;34:453–68. doi:10.1111/j.1528-1157.1993.tb02586.x

  • The incidence steadily increases after age 50 years, with the greatest increase seen in those aged over 80 years.

If one has a seizure:

  1. Stay calm.
  2. Look around – is the person in a dangerous place?  If not, don’t move them. Move objects like furniture away from them.
  3. Note the time the seizure starts.
  4. Stay with them. If they don’t collapse but seem blank or confused, gently guide them away from any danger. Speak quietly and calmly.
  5. Cushion their head with something soft if they have collapsed to the ground.
  6. Don’t hold them down.
  7. Don’t put anything in their mouth.
  8. Check the time again. If a convulsive (shaking) seizure doesn’t stop after 5 minutes, call for an ambulance .
  9. After the seizure has stopped, put them into the recovery position and check that their breathing is returning to normal.  Gently check their mouth to see that nothing is blocking their airway such as food or false teeth. If their breathing sounds difficult after the seizure has stopped, call for an ambulance.
  10. Stay with them until they are fully recovered.

If they are injured, or they have another seizure without recovering fully from the first seizure, call for an ambulance.

Cause

  • Unknown

Syndromes

Triggers may include:

  • Alcohol consumption
  • Sleep deprivation, whether it’s disrupted or missed
  • Being sick, with or without a fever
  • Feeling stressed
  • Low blood sugar
  • Menstrual cycles and/or hormonal changes such as puberty and menopause
  • Flashing lights or specific visual patterns, such as in video games (photo convulsive epilepsy)
  • Certain foods, activities, or noises

Medication

  • Any medications, whether over-the-counter, prescription, or nutritional supplements, that may interfere with the effectiveness of your seizure medication
  • Missing or skipping epileptic medication and/or diabetic medication

Illicit drugs

Vitamins, herbals and minerals

Symptoms

Focal seizures

  • Involve just one area of your brain and are the most common

This type of seizure is split in two:

Focal seizures

Where one is aware and awake and normally last from just seconds up to a couple of minutes

(Symptoms can vary-Aura):

  • Changes in the way things look, smell, feel, taste, or sound?
  • Deja vu feelings?
  • Sudden tense motion e.g. fear or joy?
  • Muscle, arms, legs and face, become stiff?
  • Twitching on one side of body?

Focal impaired seizures (complex seizures)

Where one is not aware and lasts one to two minutes

(Symptoms can vary and be repeated):

  • Smacking your lips?
  • Rubbing your hands?
  • Randomised noises?
  • Chewing/swallowing?
  • Moving arms around?
  • Tapping?
  • Rapid blinking?
  • repeating words or phrases?
  • Grunting?
  • Repetitive hand movements
  • Picking or fumbling at clothes or objects?
  • Mumbling?
  • Complex acts like shuffling cards; dramatic acts like laughing, crying, screaming, or removing clothes?
  • Then one may have ‘Focal seizure’ symptoms (see above)?
  • Generally experience the same seizure pattern and symptoms each time they have a focal seizure, but the intensity may vary?

Generalised seizures

  • Sudden onset of abnormal electrical activity involving both sides of the brain

Generalised seizures can be split to six main types.

Absence (petit mal-mainly children , rare in adults)

  • Less awareness ‘space out’ of their surroundings from 5-30 seconds?
  • Stare vacantly in space?
  • Flutter their eyes and/or smack their lips?
  • Above symptoms occur several times each day (duration can be a few seconds but one can have 10 to 100 episodes per day)?

Atonic seizure

  • All muscles lose tone and relax and one becomes limp?
  • Could fall to ground?
  • Duration can be approximately 15 seconds?

Myoclonic jerks

  • Brief loss of consciousness causing upper body to arms, legs which cause muscles to jerk or switch?
  • Last fraction of second but can have clusters of them occurring?

Clonic seizure

  • Like myoclonic but last up to few minutes and there can be loss of conscious?
  • Jerks and twitches to muscles which are repetitive (again and again)?

Tonic seizure

  • All muscles become stiff?
  • One loses balance and fall over?
  • Can occur during sleep?
  • Duration is approximately one minute?

Tonic-clonic seizures or known as  ‘epileptic fit’ (grand-mal-common)

  • Mixture of tonic and clonic seizure- Muscles become stiff, may fall to ground then jerks and twitches to muscles which are repetitive (again and again)?
  • Cry out and/or bite their tongue?
  • Breathing difficulties/skin turn blue around the mouth?
  • Some may ‘wet’ themselves?
  • Some may ‘soil’ themselves?
  • Duration approximately 1-3 minutes?

Complications /Information to beware of/General tips:

Do not wait, phone for ambulance if have or develop:

  • Experience recurrent episodes where they breathe very fast (hyperventilation), often followed by episodes where they struggle to breath or momentarily stop breathing (aponea crises)
  • Blue skin around lips, fingers, toes and nails
  • Status epilepticus – when one has a seizure that lasts for more than five minutes or one repeatedly have seizures without completely waking up in between.
  • You know it is the person’s first seizure
  • They are injured during the seizure
  • You believe they need urgent medical attention

If one has a seizure:

  1. Stay calm.
  2. Look around – is the person in a dangerous place?  If not, don’t move them. Move objects like furniture away from them.
  3. Note the time the seizure starts.
  4. Stay with them. If they don’t collapse but seem blank or confused, gently guide them away from any danger. Speak quietly and calmly.
  5. Cushion their head with something soft if they have collapsed to the ground.
  6. Don’t hold them down.
  7. Don’t put anything in their mouth.
  8. Check the time again. If a convulsive (shaking) seizure doesn’t stop after 5 minutes, call for an ambulance .
  9. After the seizure has stopped, put them into the recovery position and check that their breathing is returning to normal.  Gently check their mouth to see that nothing is blocking their airway such as food or false teeth. If their breathing sounds difficult after the seizure has stopped, call for an ambulance.
  10. Stay with them until they are fully recovered.

If they are injured, or they have another seizure without recovering fully from the first seizure, call for an ambulance.

  • Suicidal thoughts

www.epilepsysociety.org.uk

Epileptic have a high incidence of drowning:

Always Take showers rather than baths where possible, sit in the shower rather than standing and have someone nearby when bathing, with the door unlocked.

Females:

  • High Oestrogen levels seem to increase ‘epileptic seizures while progesterone has the opposite effect’

Velísková J, De jesus G, Kaur R, Velísek L. Females, their estrogens, and seizures. Epilepsia. 2010;51 Suppl 3:141-4. doi:10.1111/j.1528-1167.2010.02629.x

  • Seizures during pregnancy are dangerous for your baby and can lead to miscarriage, preterm labor, and premature birth
  • If one is planning to be pregnant and/or is pregnant
  • if one is planning to breast-feed
  • Plan to take Contraceptive use , HRT and/or oestrogen supplements- (some oestrogen medicines can increase epilepsy symptoms  , while other epilepsy medicines decrease oestrogen activity)
  • Experience seizures around their  menstruation cycle (catamenial epilepsy)

Discuss with your medical doctor the best possible treatment and advice

This condition can be associated with:

Systemic (other parts of the body) conditions:

Driving Authority

This condition can show similar symptoms to:

Benbadis S. The differential diagnosis of epilepsy: a critical review. Epilepsy Behav 2009;15:15–21. doi:10.1016/j.yebeh.2009.02.024
    • PNES commonly arise in response to thoughts and feelings linked to present and past traumatic experiences, including a history of abuse.
    • Video-EEG telemetry can distinguish between PNES and epileptic seizures if seizures are captured during recording.
    • EEG indicators of PNES include:
      • The length of the seizure — PNES tend to be longer than epileptic seizures;
      • Unresponsiveness while the EEG shows the person is not asleep;
      • Eye closure in a seizure that is not a generalised tonic-clonic seizure;

Brunnhuber F. Psychogenic non epileptic seizures: diagnostic approach. In: Alarcon G, Valentin A, eds. Introduction to Epilepsy. Cambridge: : Cambridge University Press 2012. 313–317.

    • PNES requires specialist input and patients are usually referred to a neuropsychiatrist for psychotherapy and counselling. It is possible for people to experience both epilepsy and PNES.
  • Fainting (Syncope)) – i.e. a temporary loss of consciousness, usually related to insufficient blood flow to the brain
    • Cardiovascular or cerebrovascular causes, such as heart valve disease, cardiomyopathy or cardiac arrhythmia should considered before considering if it is epilepsy
  • Stroke (as it can before an epilepsy episode)
  • Tourettes and/or tics

Please talk to your healthcare professional (i.e. Medical Doctor/Pharmacist) for further advice

Detailed Information

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  • DR Axe

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Diet, Exercise and Body Manipulations

Diet

  • Ask your specialist on whether a ketogenic diet and/or ‘Atkins’ diet may help to reduce epileptic seizures.

Medscape

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