Epilepsy: Causes, symptoms and treatments

What is epilepsy?

Epilepsy is a neurological disorder characterised by abnormal electrical activity in the brain. This electrical activity can lead to seizures, or epileptic seizures, which can vary in intensity and duration from person to person. Epilepsy can affect people of all ages worldwide and represents a global cost of 20 billion euros per year.

Definition of epilepsy

Epilepsy is a chronic disease characterised by recurrent seizures or epileptic seizures. To be considered to have epilepsy, a person must have had at least two seizures not caused by an external cause such as a head injury or a high fever. Or a single seizure, if a persistent and causative brain lesion is detected. 

Causes of epilepsy

There are several factors that can cause epilepsy, some of them are:

• Congenital brain abnormalities.
• Brain injuries due to trauma or brain diseases such as a brain tumour.
• Infectious diseases such as meningitis or encephalitis.
• Disorders of brain development that are present from birth such as Down's syndrome.
• Genetic defects that are passed on from parents to children.
• Substance abuse such as alcohol and drugs.

How is epilepsy diagnosed?

To diagnose epilepsy, the doctor performs a series of tests including:

• Patient history and physical examination.
• Electroencephalogram (EEG) to measure the electrical activity of the brain.
• Blood tests for metabolic disorders or infections.
• Computed tomography (CT) or magnetic resonance imaging (MRI) to detect brain abnormalities.

Types of epilepsy

There are several types of epilepsy, among them are:

Generalised epilepsy

Generalised epilepsy is characterised by the involvement of both cerebral hemispheres and can present different types of epileptic seizures such as generalised tonic-clonic seizures.

Focal epilepsy

Focal epilepsy is characterised by abnormal activity in a specific area of the brain and can present with various types of seizures such as simple partial seizures and complex partial seizures.

Idiopathic or genetic epilepsy

Idiopathic or genetic epilepsy is epilepsy where the exact cause is unknown but is known to be genetically conditioned.

Cryptogenic or symptomatic epilepsy

Cryptogenic or symptomatic epilepsy occurs when epilepsy is related to an underlying cause such as a brain injury or developmental disorder.

Reflex epilepsy

Reflex epilepsy occurs in response to certain stimuli such as the flashing light of electronic games or sudden changes in temperature.

Symptoms of epilepsy

Epilepsy manifests itself in different ways in different people, although there are some common symptoms that are important to know. Symptoms vary depending on the type of epilepsy a person has and the part of the brain that is affected.

Symptoms of generalised epilepsy

Generalised epilepsy is characterised by the involvement of the whole brain. The most common symptoms are:

• Tonic-clonic seizures, also known as tonic-clonic seizures, also known as convulsions
• Loss of consciousness and fall to the ground
• Whole body tremors
• Muscle contractions
• Drooling or biting of the tongue
• Loss of sphincter control

Symptoms of focal epilepsy

Focal epilepsy, also known as partial epilepsy, affects one part of the brain. Symptoms will vary depending on the area of the brain affected but may include:

• Disorderly movements in one part of the body
• Difficulty in speaking or understanding the language
• Strange sensations such as tingling or warmth in a part of the body
• Visual, auditory or olfactory perceptual disturbances
• Dizziness or disorientation

Types of epileptic seizures

There are several types of seizures that can occur, each with its own characteristics and symptoms. Some of the most common types of seizures are described below:

Generalised tonic-clonic seizures

This is the most common form of epileptic seizure and is often the most commonly associated with epilepsy. It is characterised by loss of consciousness and rigidity of the body (tonic phase) followed by involuntary and uncontrollable movements (clonic phase). These seizures may last for several minutes and may require immediate medical treatment.

Simple partial seizures

In these seizures, the patient maintains consciousness, but experiences sensory or motor disturbances. For example, there may be a strange sensation in a limb or involuntary movements on one side of the body.

Complex partial crises

In these seizures, the patient experiences a temporary loss of consciousness and may exhibit automatic behaviours (such as repetitive movements or excessive chewing). These seizures usually last for several minutes.

Focal seizures

Focal seizures occur when abnormal electrical activity originates in a specific area of the brain. They may affect a single part of the body or a specific function, such as speech or vision.

Generalised seizures

Generalised seizures originate in both cerebral hemispheres at the same time. They may take the form of a sudden spasm (myoclonus) or a temporary loss of consciousness (absence).

Epileptic aura

An epileptic aura is a strange sensation that a person may feel before having a seizure. It can also be a warning sign for a partial seizure. Auras are different for each person and can include unpleasant sensations such as a strong smell, a feeling of déjà vu or a feeling of fear for no apparent reason.

Epilepsy and psychological disorders

People with epilepsy are at increased risk of psychological disorders such as depression, anxiety and sleep difficulties. These disorders may be related to the emotional burden of living with a chronic illness and the side effects of medication.

Epilepsy and neurological disorders

People with epilepsy may also develop other neurological disorders such as migraine, Tourette's syndrome and Rett syndrome. Regular monitoring is important to detect any possible symptoms and treat them appropriately.

Epilepsy and physical health problems

People with epilepsy may experience other physical health problems related to the disease or its treatment. These may include injuries during a seizure, hormonal problems, weight gain due to medication, and osteoporosis due to decreased physical activity from the drugs themselves. It is important to take these symptoms into account and report them to a specialist for proper diagnosis and treatment to improve quality of life.

How is epilepsy treated?

Epilepsy is a disease that can be treated with different methods, depending on the type of epilepsy the patient has and the severity of the symptoms they experience. In this section, we will discuss the most common methods used to treat epilepsy.

Anti-epileptic drugs

Antiepileptic drugs are the most common treatment for epilepsy. These drugs help control seizures and abnormal electrical activity in the brain. It is important to note that each patient requires a specific type of medication, so it is necessary for a neurological specialist to prescribe the appropriate treatment for each case.

Types of anti-epileptic drugs

There are several types of antiepileptic drugs, which are divided according to their mechanism of action. Some of the classics are: - Valproic acid - Carbamazepine - Phenytoin - Lamotrigine - Levetiracetam - Topiramate - Oxcarbazepine. Although effective, they have significant adverse effects and very effective and better tolerated alternatives have appeared in recent years. 

Side effects of anti-epileptic medicines

Antiepileptic medicines can have side effects, such as: - Drowsiness - Dizziness - Nausea - Irritability - Mood swings It is important that the patient informs their doctor if they experience any side effects during treatment.

Epilepsy surgery

In some cases, surgery may be necessary to treat epilepsy. This procedure involves removing a small part of the brain that is causing the seizures. Surgery is only performed in patients whose epilepsy cannot be controlled with medication and is always performed after a thorough examination of the patient.

Types of epilepsy surgery

There are different types of epilepsy surgery, including: - Temporal lobectomy: in which part of the temporal lobe of the brain is removed. - Hemispherectomy: in which a complete part of one of the cerebral hemispheres is removed. - Epileptogenic area resection: in which a small part of the brain where the epilepsy originates is removed.

Vagus nerve stimulation

Vagus nerve stimulation is a treatment that involves implanting a device in the neck that stimulates the vagus nerve. This helps to reduce the frequency and intensity of seizures in some people with epilepsy.

Ketogenic diet

The ketogenic diet is a treatment that involves following a high-fat, low-carbohydrate diet. This type of diet may reduce the frequency and intensity of seizures in some patients with epilepsy.

Epilepsy prevention

It is not possible to prevent all cases of epilepsy, but there are some steps that can be taken to reduce the risk of developing epilepsy, such as: - Avoiding head injuries - Controlling blood pressure - Getting enough sleep and avoiding stress - Maintaining a healthy diet and getting regular exercise It is important to follow the recommendations of neurological specialists to prevent epilepsy or control it if it does occur.

Risk of death in epilepsy

While epilepsy itself is usually not life-threatening, seizures can be life-threatening. In very rare cases, seizures can lead to sudden unexpected death in epilepsy (SUDEP). To reduce the risk of SUDEP and other complications, it is important to follow medical advice and take appropriate measures to control seizures.

Safety measures to prevent injuries

During a seizure, the patient may lose control of their body and fall to the ground. To prevent injury, it is important to take safety measures, especially if the person is in a place with dangerous objects or sharp edges. Some safety measures that can be taken include:

• Keep a safe distance from dangerous objects
• Place a cushion or pillow under the patient's head to avoid bumping.
• Ensure that the patient's clothing is not too tight or has objects that could cause injury
• Avoid restraining or immobilising the patient during the seizure.s website

What to do during and after a seizure

During the seizure, it is important to remain calm and ensure that the patient is safe and not at risk of injury. It is important not to try to put anything in the patient's mouth during the seizure. After the seizure, it is important:

• Place the patient in the lateral recovery position (face down to prevent choking in case of vomiting).
• Monitor the patient's breathing and consciousness
• Note the time and duration of the seizure.
• Check the patient for injuries or signs of trauma

How does epilepsy affect everyday life?

Epilepsy is a disorder that affects not only the physical health of people who suffer from it, but also their quality of life. It can lead to certain limitations and affect daily habits and activities. The following are some of the most relevant aspects to take into account.

Epilepsy and work

For people with epilepsy, finding and keeping a job can be a challenge. Although epilepsy should not prevent access to employment, seizures or poor medication management can lead to problems in job performance. It is important that people with epilepsy communicate their condition to their employer. and colleagues, so that they can take action in the event of a seizure. In many cases, people with epilepsy can lead a normal working life. 

However, there are professions or jobs that can be dangerous if you suffer from seizures, such as flying aeroplanes or driving vehicles that require constant attention. In these cases, it is advisable to consult a specialist to assess whether you are fit for such tasks.

Epilepsy and sex life

Epilepsy should not be an impediment to a person's sex life. However, there may be certain limitations or situations to be aware of. In some cases, anti-epileptic drugs may affect libido, erection or the ability to reach orgasm. 

It is important to talk to the neurologist or specialist about these problems, so that treatment can be adapted or alternatives sought. Seizures during sex are rare, but can occur. It is important that both the person with epilepsy and their partner are aware of the symptoms of a seizure and know what to do if one occurs. In addition, it is recommended that protective measures be taken during sexual intercourse to avoid injury in the event of a seizure.

Epilepsy and pregnancy

Epilepsy does not prevent pregnancy or vice versa, but there may be certain risks that are worth knowing about. Some anti-epileptic drugs may affect the foetus or increase the risk of malformations or complications during pregnancy. 

For this reason, it is important that women with epilepsy consult with their neurologist before becoming pregnant, so that treatment can be adjusted if necessary. During pregnancy, women with epilepsy should receive specialised care to prevent seizures that may affect the foetus and the mother. In addition, childbirth should be scheduled and monitored by a specialist to avoid complications.

Epilepsy and sport

People with epilepsy can safely engage in sports and physical exercise. However, there are certain risks and limitations to be considered. Seizures can occur during physical activity, so it is recommended to take precautions and consult a specialist to avoid risky situations. 

In some cases, it is advisable to avoid sports or activities that may pose a risk to the individual or others, such as solitary swimming or extreme risk sports. In any case, it is important to consult a specialist before starting any kind of physical activity, in order to assess the risk and prevent dangerous situations.

Medical care in epilepsy

Epilepsy may require specialised medical care, so it is important to know what role doctors play in the treatment and follow-up of epilepsy. In this respect, two specialists are essential: the primary care physician and the neurologist.

The role of the primary care physician

The primary care physician is the first health professional that many people see.ersons with symptoms of epilepsy. Their role is fundamental in the assessment of the patient and in the referral to other specialists if necessary.

In many cases, the primary care physician will be responsible for making an initial assessment of the patient's symptoms and ordering the necessary diagnostic tests to establish a diagnosis of epilepsy. If the diagnosis is positive, he or she may be responsible for starting treatment with antiepileptic drugs and for initial follow-up of the patient.

In any case, the primary care physician will work closely with other specialists, such as the neurologist, to ensure an accurate diagnosis and appropriate treatment.

The role of the neurologist

The neurologist is the specialist who diagnoses and treats epilepsy. His experience in the management of this disease and his training in the field of neurology make him the ideal professional to treat patients with epilepsy.

The neurologist's role in the treatment of epilepsy is key. Firstly, he or she will be responsible for confirming the diagnosis and carrying out complementary tests to discover the cause of the epilepsy, determine the type of seizure and establish an appropriate treatment.

The neurologist is also responsible for deciding which anti-epileptic drugs should be used in each case. This is based on clinical experience and international recommendations.

In short, ehe neurologist is the most knowledgeable specialist in the diagnosis and treatment of epilepsy. and their role is key to the proper management of this disease.

Epilepsy and health care in other countries

Epilepsy care varies according to the country and the health and financial resources available in that country. In some developing countries, it may be difficult to access a neurologist or specialised treatment for epilepsy.

For this reason, international organisations such as the WHO and the ILAE are working to improve epilepsy care worldwide, promoting the creation of diagnostic and treatment centres and the training of health professionals in the approach and treatment of this disease.

In any case, it is important to emphasise that epilepsy is a disease that can be treated successfully and that is why it is essential to turn to specialists in the management of this pathology to ensure the best possible quality of life for patients with epilepsy.

Frequently asked questions about epilepsy

Epilepsy can be a complicated and difficult condition to understand, and it is common to have questions about the disease and its symptoms. Here are some of the most frequently asked questions about epilepsy and their answers:

Is there a cure for epilepsy?

There is no known cure for epilepsy, but proper treatment can help control the symptoms of epilepsy and improve the quality of life of people with epilepsy.

Are seizures always epilepsy?

Not all seizures are epilepsy. Seizures can be a symptom of other conditions, such as brain infections, strokes or brain tumours, so it is important that a doctor makes a proper diagnosis.

What are the most common causes of epilepsy?

The causes of epilepsy can be varied, and may include brain damage from injury or disease, congenital brain disorders, genetic disorders, stroke and brain tumours.

Is epilepsy a mental illness?

Epilepsy is a neurological condition, not a mental illness. However, epilepsy can be associated with certain psychiatric disorders, such as depression and anxiety, and can affect a person's mental health.

How can I help someone during a seizure?

The best thing you can do is to protect the person from injury during the seizure. Keep people around them away, and gently place something soft under their head. Do not try to put anything in the person's mouth or try to restrain their movements.

Can epilepsy affect cognitive development?

In some cases, epilepsy can affect cognitive development, especially if the disease begins in childhood. However, many people with epilepsy do not experience any cognitive or developmental problems.

Is it possible to have epilepsy without seizures?

Yes, it is possible to have epilepsy without seizures. Some forms of epilepsy can cause other symptoms, such as dizziness, fainting, or absences, in addition to seizures.