UNDERSTANDING EPILEPSY

About epilepsy2018-07-07T15:21:04+00:00
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EPILEPSY

A neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain.

EPILEPSY IN LATER LIFE

Epilepsy can begin at any age, but more likely when you are young or in later life. Around one in every four people who are nearly diagnosed with epilepsy is over the age of 65. Many of the issues will be the same but some may be more relevant: safety, bone health, driving and memory. Epilepsy in later may be associated with other health issues e.g. stroke.

HOW COMMON IS EPILEPSY?

Epilepsy is the most common, serious neurological disorder worldwide. More than half a million people in the UK have epilepsy, which equates to 1 in 100 people. Epilepsy can affect anyone, of any age, race, or sex, at anytime from any walk of life.

WHY DOES IT MATTER?

Epilepsy is the 4th most common neurological condition.

40 Types of Epilepsy.

Around the world an estimated 65 million people have epilepsy at any given time.

There are 600,000 people suffering from epilepsy in the UK.

In the West Midlands 53,000 suffer from epilepsy.

1 in 10 will have a seizure in their lifetime.

Approximately 1 in 26 people will develop epilepsy at some point in their lifetime.

WHAT CAUSES EPILEPSY?

In over half all epilepsy cases, the cause is unknown. A short list of instances, which may cause a seizure or lead a person to epilepsy includes;

  • Head injury

  • Brain infection

  • Brain tumours

  • Stroke

  • Alzheimer’s

  • Arteriosclerosis

  • Alcohol Abuse

  • Drug Abuse

  • Trauma during birth

  • High fever mainly in children

  • Certain medications

WARNING SIGNS

Simple partial seizures are where you remain fully conscious throughout. These seizures are sometimes known as “warnings” or “ auras”, because they can be a sign that another type of seizure is on its way. This may give you time to warn people around you and make sure you are in a safe place.

Symptoms of a simple partial can include:

  • A general strange feeling that is hard to describe.

  • “Rising” feeling in your tummy – sometimes likened to the sensation in your stomach when on a fairground ride.

  • An intense feeling that events have happened before (déjà’ vu).

  • Experiencing an unusual smell or taste.

  • A tingling sensation, or “pins and needles”, in your arms and legs.

  • A sudden intense feeling of fear of joy.

  • Stiffness or twitching in part of the body, such as an arm or hand.

TRIGGERS?

Not everyone has an identifiable seizure trigger. In many cases, though, seizures can be triggered by a number of factors. However you can monitor the types of trigger factors by keeping a seizure diary for a period of time.

Types of triggers include:

  • Forgotten or incorrect medication

  • Fever/infections

  • Lack of Sleep

  • Stress of excitement

  • Boredom

  • Alcohol

  • Drugs (prescription and recreational)

  • Flickering lights

  • Startle response

  • Menstruation

  • Ovulation

  • Constipation

SIDE EFFECTS OF EPILEPSY

The most common side effects include:

  • Dizziness

  • Nausea

  • Headache

  • Vomiting

  • Fatigue

  • Vertigo

  • Weight gain

  • Blurred vision

  • Poor co-ordination

  • Ataxia

  • Double vision

  • Stress

  • Weight gain

  • Depression

  • Anxiety

  • Confusion

  • Irritability

  • Tremor

TYPES OF SEIZURES

  • Absence Seizure (“Petit Mal”)

    Absence seizures account for 2-4 percent of epilepsy. They are characterized by brief episodes of staring, usually lasting only 2-10 seconds and may happen repeatedly during the day. There is no warning before a seizure and the person is completely alert afterwards, with no memory of it. Because they are so mild, you might not even realize you had one and it’s easily not noticed by those around you.

  • Clonic Seizures

    During a clonic seizure, you may lose control of bodily functions and begin jerking rhythmically in various parts of your body. Consciousness may be temporarily lost and followed by confusion. Clonic seizures begin in early childhood. With time, clonic seizures may eventually progress to generalized tonic-clonic seizures.

  • Eclampsia

    Eclampsia is a severe complication of preeclampsia. It’s a rare but serious condition where high blood pressure results in seizures during pregnancy. Seizures are periods of disturbed brain activity that can cause episodes of staring, decreased alertness, and convulsions (violent shaking).

  • Atonic Seizures (Drop Attacks)

    Without warning, a person will abruptly loses consciousness, collapse and fall to the floor. Your head may drop suddenly, your eyelids may droop, your head may nod, and you may drop things.  Recovery occurs after a few seconds. You regain consciousness, and can again stand and walk.

  • Tonic Seizures

    Tonic seizures are characterised by facial and muscle spasms of your trunk, flexing or reaching of your upper and lower extremities, and impaired consciousness. Several types of tonic seizures exist. The more prolonged seizures usually are convulsive and may manifest dilation of your pupils, tachycardia, apnoea, a bluish tinge to your skin, salivation, and the loss of bladder or bowel control. Tonic seizures are often followed by postictal confusion.

  • Pattern — Sensitive Epilepsies

    In this reflex condition, seizures are produced by particular visual patterns. These triggers may consist of circles, stripes, or other patterns, usually of high contrast. Moving patterns are most likely to incite a seizure.

  • Nocturnal Seizures

    These are usually tonic-clonic. They might occur just after a person has fallen asleep, just before waking, during daytime sleep, or while in a state of drowsiness. People who experience nocturnal seizures may find it difficult to wake up or to stay awake. Although unaware of having had a seizure while asleep, they may arise with a headache; have temper tantrums, or other destructive behaviour throughout the day.

  • Partial (Focal) Seizure

    Partial (focal) seizures occur when this electrical activity remains in a limited area of the brain. The seizures can sometimes turn into generalized seizures, which affect the whole brain. This is called secondary generalization.

    Partial seizures can be divided into:
    • Simple, not affecting awareness or memory
    • Complex, affecting awareness or memory of events before, during, and immediately after the seizure, and affecting behaviour.

READ MORE TYPE OF SEIZURES

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HOW IS EPILEPSY DIAGNOSED?

EEG ELECTROENCE – PHALOGRAM

An EEG can be used to help diagnose and monitor a number of conditions affecting the brain.

MRI MAGNETIC RESONANCE IMAGING

Magnetic resonance imaging (MRI) is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body.

PET POSITION EMISSION TOMOGRAPHY

Positron emission tomography (PET) scans are used to produce detailed three- dimensional images of the inside of the body.

SPECT SINGLE PHOTO EMISSION COMPUTED TOMOGRAPHY

A Single Photon Emission Computed Tomography (SPECT) scan is a type of nuclear imaging test that shows how blood flows to tissues and organs.

HOW IS EPILEPSY TREATED?

MEDICATION FOR EPILEPSY

Epilepsy cannot be cured with medication. However, with the right type and strength of medication, the majority of people with epilepsy do not have seizures. The medicines work by stabilising the electrical activity of the brain. You need to take medication every day to prevent seizures.

Deciding on which medicine to prescribe depends on such things as:

  • Your type of epilepsy

  • Your age

  • Other medicines that you may take for other conditions

  • Possible side effects

  • Whether you are pregnant or planning a pregnancy

A low dose is usually started. The aim is to control seizures at the lowest dose possible. If you have further seizures, the dose is usually increased. There is a maximum dose allowed for each medicine.

FIRST AID FOR SEIZURES
DO
  • Remove harmful objects nearby

  • Cushion their head

  • Aid breathing by gently placing in recovery position

DON’T
  • Restrain the person’s movement

  • Put anything in the person’s mouth

  • Give them anything to eat and drink, until they are fully recovered

SURGERY

Surgery is only possible for a minority of people with epilepsy and it may be considered when medication fails to prevent seizures, especially focal seizures (used to be called partial seizures). Only a small number of people with epilepsy are suitable for surgery and, even for those are, there are no guarantees of success. Also, there are risks from operations. However, surgical techniques continue to improve and surgery may become an option for more and more people in the future. Vagal nerve stimulation is a treatment for epilepsy where a small generator is implanted under the skin below the left collarbone. The vagus nerve is stimulated to reduce the frequency and intensity of seizures. This can be suitable for some people with seizures that are difficult to control with medication. The ketogenic diet is a diet very high in fat, low in protein and almost carbohydrate-free. This can be effective in the treatment of difficult-to-control seizures in some children.

Resective Surgery

Temporal Lobotomy

  • Removal of a portion of the temporal lobe of the brain.
  • It is the most common type of epilepsy surgery.
  • After surgery, 60% to 70% of patients are seizure free.

Frontal Lobotomy

  • Removed of a portion of a frontal lobe.
  • It is the second most common type of epilepsy surgery, after temporal lobotomy 30% to 50% of patients are free of seizures that impair consciousness or cause abnormal movements.
Subpial Transections

Multiple subpial transection (MST) is a surgical technique in which the connections of the epileptic focus are partially cut without resecting it. Palliative surgery for seizure reduction, generally patients does not become seizure free.

Corpus- Colostomy

This is an operation that severs (cuts) the corpus callosum, interrupting the spread of seizures from hemisphere to hemisphere. Seizures generally do not completely stop after this procedure. Seizures usually become less severe, as they cannot spread to the opposite side of the brain.

Hemispherectomy

The surgeon removes all or portions of the affected hemisphere. The surgeon also gently separates the hemispheres to access and out the corpus-callostum.

Vagus Nerve Stimulation (VNS)

The goal of VNS Therapy is to prevent seizures before they start, and stop them if they do. Benefits of VNS may include:

  • Fewer seizures
  • Shorter seizures
  • Faster recovery
  • Decreased seizure severity
  • Fever medications
  • Improved alertness, mood and memory
  • Improved quality of life

How it works: VNS Therapy is delivered through a device (generator and lead) that sends mild pulses through the vagus nerve to areas of the brain known to be associated with seizures. VNS Therapy delivers these periodic pulses all day, in an effort to control your seizures.

The procedure: A small device (generator and lead) is implanted during a short, outpatient procedure.

  • Usually takes about an hour.
  • Most people go home the same day.
  • Involves a small incision in the neck and in the upper check area.
  • Under general anesthetic.

Possible side effects of VNS Therapy:

  • Hoarseness/changes in voice tone.
  • Coughing.
  • A tickling sensation in the throat or on the neck.
  • A feeling of Shortness of breath.
  • Side effects usually decrease over time and mainly occur during stimulation.

HELP AND SUPPORT

Epilepsy Action, 0808 800 5050: Confidential advice and information from trained staff, on diagnosis, medication, driving, pregnancy and other issues related to living with epilepsy.

Epilepsy Society, 01494 601400: For people with epilepsy, their families, friends, carers, employers, GPs, nurses, healthcare professionals, schools, students…

Epilepsy Research UK, 020 8747 5024: Funds independent research into the causes, treatment, prevention and impact of epilepsy throughout the UK.

Young Epilepsy, 01342 832 243: To create better futures for young lives with epilepsy and associated conditions.

Matthew Friends, 01342 836 571: To publicise Ketogenic Dietary Therapies and make them more available to all those who should need them, be it child or adult.

Sudep Action, 01235 772 850: SUDEP Action is dedicated to raising awareness of epilepsy risks and tackling epilepsy deaths including Sudden Unexpected Death in Epilepsy. We are the only UK charity specialised in supporting and involving people bereaved by epilepsy.

Brain and Spine Foundation, 0808 808 1000: A service run by neuroscience nurses and other health professionals, covering all brain and spine conditions, from fairly common to the very rare.

Epilepsy Scotland, 0808 800 2200: A confidential freephone number for anyone looking for advice or information about epilepsy.

Dravet Syndrome Foundation, 07874 866 937:

Dravet Syndrome UK is an independent UK charity dedicated to improving the lives of those affected by Dravet syndrome through support, education and medical research.

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