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Epilepsy is a condition in which a person has repeated seizures over time. A seizure is a sudden burst of abnormal electrical and chemical activity in the brain. Seizures can cause a change in attention, behaviour, or the ability to remain awake and alert (altered mental status).

• Depression
• Poor memory.
• Sudden unexplained death in epilepsy (SUDEP). This complication is rare, and its cause is not known.

Most people with epilepsy lead normal lives.

What are the causes of epilepsy?

This condition may be caused by:

• A head injury.
• An injury that happens at birth.
• A high fever during childhood.
• A stroke.
• Bleeding that goes into or around the brain.
• Certain medicines and drugs.
• Having too little oxygen for a long period of time.
• Abnormal brain development.
• Certain infections, such as meningitis and encephalitis.
• Brain tumours.
• Conditions that are passed from parent to child (are hereditary).

What are the signs or symptoms of epilepsy?

Symptoms of a seizure vary greatly from person to person. They may include:

• Convulsions
• Stiffening of the body.
• Involuntary movements of the arms or legs.
• Loss of consciousness.
• Breathing problems.
• Falling suddenly.
• Confusion
• Head nodding.
• Eye blinking or fluttering.
• Lip smacking.
• Drooling
• Rapid eye movements.
• Grunting
• Loss of bladder control and bowel control.
• Staring
• Unresponsiveness

Some people have symptoms right before a seizure happens (aura) and right after a seizure happens. Symptoms of an aura include:

• Fear or anxiety.
• Nausea
• Feeling like the room is spinning (vertigo).
• A feeling of having seen or heard something before (déjà vu).
• Odd tastes or smells.
• Changes in vision, such as seeing flashing lights or spots.

Symptoms that follow a seizure include:

• Confusion
• Sleepiness
• Headache

How is epilepsy diagnosed?

This condition is diagnosed based on:

• Your symptoms.
• Your medical history.
• A physical exam.
• A neurological exam. A neurological exam is similar to a physical exam. It involves checking your strength, reflexes, coordination, and sensations.
• Tests, such as:
  • A painless test that creates a diagram of your brain waves (electroencephalogram, or EEG).
  • An MRI.
  • A CT scan.
  • A lumbar puncture, also called a spinal tap.
  • Blood tests to check for signs of infection or abnormal blood chemistry.

How is epilepsy treated?

Treatment can control seizures. Some types of epilepsy will need lifelong treatment, and some types go away in time. Treatment for this condition may involve:

• Taking medicines to control seizures.
• Having a device called a vagus nerve stimulator implanted in the chest. The device sends electrical impulses to the vagus nerve and to the brain to prevent seizures. This treatment may be recommended if medicines do not help.
• Brain surgery. There are several kinds of surgeries that may be done to stop seizures from happening or to reduce how often seizures happen.
• Having regular blood tests. You may need to have blood tests regularly to check that you are getting the right amount of medicine.

Once this condition has been diagnosed, it is important to begin treatment as soon as possible. For some people, epilepsy eventually goes away.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as instructed by your healthcare provider.
• Avoid any substances that may prevent your medicine from working properly, such as alcohol.

Activity

• Get enough rest. Lack of sleep can make seizures more likely to occur.
• Follow instructions from your healthcare provider about driving, swimming, and doing any other activities that would be dangerous if you had a seizure.

Educating others

Teach friends and family what to do if you have a seizure. They should:

• Lay you on the ground to prevent a fall.
• Cushion your head and body.
• Loosen any tight clothing around your neck.
• Turn you on your side. If vomiting occurs, this helps keep your airway clear.
• Stay with you until you recover.
• Not hold you down. Holding you down will not stop the seizure.
• Not put anything in your mouth.
• Know whether or not you need emergency care.

General instructions

• Avoid anything that has ever triggered a seizure for you.
• Keep a seizure diary. Record what you remember about each seizure, especially anything that might have triggered the seizure.
• Keep all follow-up visits as told by your healthcare provider. This is important.

Contact a healthcare provider if:

• Your seizure pattern changes.
• You have symptoms of infection or another illness. This might increase your risk of having a seizure.

Get help right away if:

• You have:
  • A seizure that does not stop after five minutes.
  • Several seizures in a row without a complete recovery between seizures.
  • A seizure that makes it harder to breathe.
  • A seizure that is different from previous seizures.
  • A seizure that leaves you unable to speak or use a part of your body.
• You did not wake up immediately after a seizure.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (995 in Singapore). Do not drive yourself to the hospital.

Summary

• Epilepsy is a condition in which a person has repeated seizures over time. Some types of epilepsy will need lifelong treatment, and some types go away in time.
• Seizures can cause many symptoms, from brief staring spells or involuntary movements of the arms or legs to convulsions with loss of consciousness.
• Treatment is effective at controlling seizures. Take over-the-counter and prescription medicines only as told by your health care provider.
• Follow instructions from your health care provider about driving, swimming, and doing any other activities that would be dangerous if you had a seizure.
• Teach friends and family what to do if you have a seizure.

This information is not intended to replace advice given to you by your healthcare provider. Make sure you discuss any questions you have with your healthcare provider.

References:

Chen Z, Brodie MJ, Liew D, Kwan P: Treatment outcomes in patients with newly diagnosed epilepsy treated with established and new antiepileptic dDrugs: a 30-year longitudinal cohort study. JAMA Neurol 2018; 75: pp. 279-286.

Fiest KM, Sauro KM, Wiebe S, et. al.: Prevalence and incidence of epilepsy. Neurology 2017; 88: pp. 296-303.

Saxena S, Li S: Defeating epilepsy: A global public health commitment. Epilepsia Open 2017; 2: pp. 153-155.

Singh A, Trevick S: The epidemiology of global epilepsy. Neurol Clin 2016; 34: pp. 837-847.

Sveinsson O, Andersson T, Carlsson S, Tomson T: The incidence of SUDEP: a nationwide population-based cohort study. Neurology 2017; 89: pp. 170-177.

Thijs RD, Surges R, O'Brien TJ, Sander JW: Epilepsy in adults. Lancet 2019; 393: pp. 689-701.

For more information on epilepsy, visit:

HealthHub – Epilepsy and Seizures

Singapore Epilepsy Foundation

Updated on 9 February 2021 by CaregiverAsia.

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