Epilepsy is a brain disorder with seizures. These seizures are caused by a sudden, temporary disruption in the transfer of electrical impulses in the brain. The seizures vary by person. One person loses consciousness, falls and shocks with arms and legs. The other is suddenly not responsive for a moment, stares ahead or drops something from the hands.
Cause
An epileptic seizure results from a sudden, temporary disruption of the electric equilibrium in the brain. It’s like a kind of ‘short circuit’ in the brain. In half of epileptic patients, there is no apparent cause. In the others, epilepsy is caused by other brain disorders, such as brain injury in an accident, brain tumor, infection in the brain, stroke or oxygen shortage.
It’s usually not clear why a person with epilepsy has a seizure at some time. The seizure comes, as it were, out of nowhere. In some cases the reason is clear. For example, some people get a seizure in the following situations:
- Drinking too much alcohol.
- Before or after severe stress.
- Due to little sleep, for example after weekend action.
- Around menstruation, due to hormonal changes.
- Due to strong light stimuli, for example computer games or disco light.
- Due to strong fluctuation in body temperature, such as fever.
Symptoms
The symptoms of an epileptic seizure may include involuntary body movements and a decrease or loss of consciousness. Urinary losses and, for example, biting the tongue can also belong to the seizure. The patient may first have strange sensations through the senses, such as seeing flashes or smelling scents; this is called an aura. An epileptic seizure doesn’t always attract attention, sometimes a person is just ‘gone’ for a while (this is called an absence). Roughly a third of patients have less than one seizure per year, one third has one seizure per month and one third has more than one seizure per month.
Diagnosis
The general practitioner will refer the patient to a neurologist for examination and treatment of epilepsy. The diagnosis of epilepsy requires several examinations. The story of the patient is difficult here, because the patient was unconscious during the seizure. Therefore, use is made of the description of the seizure by others (heteroanamnesis). Apart from the story of bystanders, video footage taken with a mobile phone provides a doctor with a lot of information about what kind of seizure it was. Other examinations are:
- An electroencephalogram (EEG). In this examination, the electrical activity of the brain is recorded.
- A CT scan can be made to find out whether there are damages or defects in the brain.
- An MRI scan is made when the other examinations don’t yet lead to a clear diagnosis.
Treatment
The following treatment methods can be applied:
- Medicines. The cause of epilepsy can almost never be taken away. However, most people with epilepsy can be free of seizures with medication. These drugs are called anti-epileptic drugs (AED). Which anti-epileptic drug is chosen, depends on the type of epilepsy and the types of seizures that the patient has. Sometimes there must be sought for the right combination of different drugs. It can take months for the medications to work. It’s also very important that the patient always takes the medication.
- Surgery. When medicines don’t help and the patient continues to have many seizures, then in exceptional cases can be chosen for epilepsy surgery. Here, the place where the insult occurs is disabled.
- Vagus nerve stimulation. The vagus nerve is an important nerve in the body. By stimulating this nerve with a kind of pacemaker, attempts are made to reduce seizures and make them less severe. However, it doesn’t make the patient free of seizures and he or she receives this treatment in combination with medications.
- Ketone diet. A ketone diet contains a lot of fats and is low in carbohydrates and proteins. Ketones are caused by the breakdown of fats in the body. Ketones may decrease the number of seizures. The exact effect of the diet is not known. Especially children who cannot be treated with medication or surgery, may benefit from the diet. It’s an alternative method that is still being investigated.
Prognosis
Epilepsy can usually not be cured. But in general, the quicker the seizures are brought under control, the better the prospects are. About half of the patients with epilepsy have had, twenty years after the diagnosis was made, no seizure for at least five years and don’t have to use anti-epileptic drugs.
Considerations
- Ensure sufficient and regular sleep. Sleep deprivation is a known trigger for seizures, even in people who otherwise have the seizures under control.
- Avoid alcohol. Alcohol can interfere with medication and research shows that large amounts of alcohol increase the risk of seizures and can even cause them.
- Learn relaxation techniques. Stress can be a trigger for seizures, so the development of a daily meditative practice or participation in yoga might help.
- Be careful with playing electronic games. In some people, prolonged exposure to flashing lights can trigger seizures.
- Stay active. Participation in daily exercise can help a person to feel good, while maintaining a healthy weight and building self-confidence. Avoid swimming, hiking, mountain climbing and most contact sports in order to prevent dangerous situations.
