Epilepsy: Types, Symptoms, and Treatment

Seizures are not a disease in themselves. Instead, they are symptoms of many different disorders that can affect the brain. Some seizures may hardly be noticed, while others are disabling. They occur due to abnormal electrical activity in the brain. If a person has two or more unprovoked seizures, they are said to have epilepsy.

The manifestations of seizures vary, because of different parts of the brain control movements, sensations, behaviours and experiences. A person may or may not lose consciousness when having seizures.

Seizure types

Seizures are categorized as generalized and focal seizures.

Generalized seizures

Generalized seizures affect both sides of the brain. They can be further categorized as:

  • Absence seizures: Also known as petit mal seizures. They cause frequent blinking or staring into space for a few seconds. They are more common in children. 

  • Tonic seizures: They are characterized by muscle stiffness and may cause sudden fall

  • Atonic seizures: They cause loss of muscle control and sudden collapse

  • Clonic seizures: They cause repeated jerking muscle movements affecting the face, neck and arms.

  • Myoclonic seizures: They cause sudden brief jerky movements affecting a part of the body or the whole body

  • Tonic-clonic seizures: Also known as grand mal seizures where a person can lose consciousness, have muscle spasms, bite their tongue, and experience loss of bladder control. A person may feel tired for several hours after experiencing tonic-clonic seizures.

Focal seizures 

Focal seizures, earlier also known as partial seizures, arise from one small area of the brain.  Focal seizures can be further classified into 3 types:

  • Simple focal seizures: Affect a small area of the brain and do not cause loss of consciousness. It can lead to a change in sensation and emotions. It can also cause involuntary jerky movements. 

  • Complex focal seizures: In this type of epilepsy, a person can be left confused and unable to reply to any questions for a few minutes. 

  • Secondarily generalized seizures: It arises in one area of the brain and then spreads to both sides of the brain. In this type of situation, a person will have a focal seizure first which is then followed by a generalized seizure.

Symptoms

The symptoms vary according to the type of seizure.

Simple focal seizures

  • Twitching of part of the body

  • Numbness in a limb

Complex focal seizures

  • Vacant Stare

  • Smacking of  lips

  • Involuntary chewing or swallowing

  • Fiddling with objects

Tonic-clonic seizures

There are two stages in this type of seizure.

  • Tonic stage: loss consciousness, stiffening of the body, and fall to the ground

  • Clonic stage: Jerking of  limbs, tongue bite, loss of bladder or bowel control, breathing difficulty

Clonic seizure

  • Jerky movements of  the body

Tonic seizure

  • Muscles become stiff

Absence seizure

  • Momentary loss of contact with the environment

  • Fluttering of eyelids

Myoclonic seizure

  • Sudden twitching of some part of the body or the whole body

Atonic seizure

  • Muscles suddenly relax and the person abruptly falls 

Status epilepticus

  • An emergency condition in which a person experiences seizure for more than 5 minutes or multiple episodes within 5 minutes without regaining consciousness between them. It can lead to death or permanent brain damage if not treated promptly. 

Epilepsy Causes

The causes vary according to the age group.

  • Newborns

Lack of oxygen during birth, brain abnormalities, maternal drug use, bleeding in the brain, low blood sugar level, and inborn errors of metabolism

  • Infants and Children

Seizures during episodes of fever, infections, and brain tumors

  • Children and Adults

Inherited, head trauma, and congenital conditions

  • Elderly people

Head Injury, stroke, liver and kidney failure, low sodium, dementia

Risk factors

There are various risk factors of epilepsy such as:

  • Family history

  • Trauma or lack of oxygen supply to the brain during birth

  • Premature birth or low birth weight

  • Brain defects, injuries, tumors and infections

  • Alcohol or drug abuse, alcohol withdrawal

  • Lack of sleep

Complications 

  • Learning disability

  • Injury from falls during a seizure

  • Permanent brain damage

  • Aspiration pneumonia due to swallowing of food and saliva into the lungs

When to see a doctor

It is important to reach out for medical help immediately if a person is having a seizure for the first time or if a person is having repeated seizures.

Your doctor will carry out tests and prescribe medications to keep prevent recurrence of seizures.

FAQs

  1. How to prevent Seizures?

You must wear helmets to decrease the risk of getting a head injury. Keep away from illegal drugs and alcohol. Have adequate sleep and maintain a regular sleep pattern. Taking medicines as prescribed and reporting regularly for review is crucial.

  1. What is the prognosis?

The prognosis varies from person to person. Some people are at life-long risk of having recurrent seizures and will need to keep taking medications. Some people with epilepsy may be advised to decrease the dose gradually and stop taking drugs if they do not experience any seizures for a length of time.

  1. How is epilepsy diagnosed?

After obtaining your medical history and performing a physical examination, your doctor will recommend some tests. An electroencephalogram (EEG) is done to look for abnormal electrical activity in the brain. Other tests may include blood tests and lumbar puncture. A CT scan of the head or MRI may be recommended.

  1. What is the treatment of epilepsy?

The treatment includes lifestyle changes, anticonvulsant medications, and in some selected cases, surgery. Surgery is needed if the epilepsy is due to tumour, bleeding in the brain, abnormal blood vessels and for some kinds of congenital abnormalities of the brain

  1. Does having an episode of seizure means I have epilepsy?

No, if you had one episode of seizure, it does not mean you have epilepsy. Seizures can happen for other reasons as well. Some reasons include low blood sugar, high fever, and withdrawal from alcohol or drug.

  1. Can a person die from epilepsy?

 Most people with epilepsy do not die from it. But the risk is higher in some cases such as brain tumour or stroke, falls or injuries, and seizures that last more than 5 minutes (status epilepticus). Very rarely, there are cases of sudden unexpected death in epilepsy (SUDEP). 

 

Dr (Lt gen) C S Narayanan VSM

HOD And Consultant - Department Of Neurology

Manipal Hospitals, Dwarka, Delhi

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