A blank stare, a fall with loss of consciousness or repetitive movements can be signs of an epileptic seizure. Epilepsy is one of the most common neurological conditions: about 50 million people are affected worldwide. With good treatment, most people can lead a normal life. This article covers the types of seizures, causes, daily life, first aid and treatment.
What is epilepsy?
Epilepsy is a chronic brain disorder. It is characterised by recurrent seizures caused by excessive electrical discharges in a group of brain cells. A single seizure is not enough to diagnose epilepsy: the diagnosis relies on repeated seizures and on a neurological assessment.
In the general population, the condition affects between 4 and 10 people per 1,000. It accounts for more than 0.5% of the global burden of disease. Epilepsy is not contagious, and the cause remains unknown in about half of cases.
What types of seizure are there?
According to the World Health Organization (WHO), seizures can involve part of the body (partial seizures) or the whole body (generalised seizures). They range from a brief lapse of attention or muscle jerks to long convulsions, and their frequency varies from less than one a year to several a day. The NHS describes several forms:
- tonic-clonic seizure: loss of consciousness, possible fall, stiffening and then jerking of the body;
- absence seizure: a brief loss of awareness of the surroundings;
- focal seizure: unusual sensations, impressions or movements;
- myoclonic (brief jerks), tonic (sudden stiffening) and atonic (sudden loss of muscle tone) seizures, the last two with quick recovery.
Symptoms also depend on the area of the brain involved and on how the discharge spreads: confusion, movement problems, visual, auditory or taste sensations, and mood changes. This is why a brief, repeated episode of “unusual behaviour” should prompt a medical consultation.
What are the causes?
- brain damage around the time of birth;
- congenital or genetic abnormalities;
- a serious head injury;
- a stroke;
- a brain infection, such as meningitis or encephalitis;
- a brain tumour.
According to the NHS, symptoms often begin in young children and in people over 50. The WHO estimates that around 25% of cases could be prevented.
Triggers and daily life
In some people, certain factors make seizures more likely. The NHS lists tiredness, stress, periods, flashing lights, certain foods or drinks and excess alcohol. Keeping a diary helps identify your own triggers. To reduce risks, here are some points from the NHS guide:
- Driving: you must not drive after a seizure; when you can resume depends on the type of seizure, the date of the last one and the rules of your country.
- Work and leisure: the risk of a seizure may limit some activities; take care with cooking, tools, swimming or sport.
- At home: choose showers over baths, tell those close to you what to do, and carry a medical card or bracelet.
- Treatment: never miss a dose and do not change anything without medical advice.
According to the WHO, stigma is often harder to overcome than the seizures themselves: talking openly about the condition helps family and employers react better.
Pregnancy and children
Pregnancy is possible with epilepsy. According to the NHS, seizures can become more frequent during pregnancy, and some medicines are not safe: if you are planning a pregnancy or find out you are pregnant, keep taking your treatment and contact your specialist team quickly, without stopping it on your own.
In a child, a seizure that occurs with a high fever is a febrile convulsion, which is different from an epileptic seizure. For a child having a first seizure, the NHS recommends calling emergency services; for a child under 5, it advises seeking medical advice. It helps to come to the appointment with someone who saw the seizure: their account helps the diagnosis.
What to do during a seizure
Most people with known epilepsy do not always need to go to hospital, and a care plan can guide those around them. In the meantime, according to the Epilepsy Foundation:
- stay calm, note the time the seizure starts and stay with the person until they are fully awake;
- move dangerous objects away, slip something soft under their head and do not hold them down;
- do not put anything in their mouth;
- if they are not awake, place them on their side and loosen anything tight around the neck.
Call emergency services if it is a first seizure, if it lasts more than five minutes, if the person does not recover as usual or if another seizure follows without a return to consciousness, in case of injury, breathing difficulty, a seizure in water or pregnancy. The NHS adds three or more seizures in 24 hours.
How is epilepsy treated and when should you see a doctor?
Treatment relies on daily antiepileptic medicines. If they are not effective, surgery or other treatments are possible. According to the WHO, up to 70% of people with epilepsy could live seizure-free if they had access to medicines.
Care also includes screening for associated problems, particularly learning difficulties and depression, as well as psychological and social support. Assessment often involves an electroencephalogram (EEG) and brain imaging.
See a doctor without delay after any first seizure or unusual episode, and talk to your doctor before changing any treatment.
Further reading at La Rose Clinic
Frequently asked questions
Is a single seizure epilepsy?
Not necessarily. Diagnosis relies on repeated seizures and a neurological assessment. Any first seizure should still be checked by a doctor.
When should I call emergency services?
For a first seizure, a seizure lasting more than five minutes, no usual recovery, or seizures following one another without a return to consciousness.
Can you drive with epilepsy?
You must not drive after a seizure. When you can resume depends on the type of seizure, the date of the last one and national rules: ask your doctor.
Can a woman with epilepsy have a baby?
Yes, pregnancy is possible. Discuss it beforehand with your specialist team, as some medicines may need adjusting, and never stop treatment on your own.
Can epilepsy be cured?
Treatment allows many patients to become seizure-free. According to the WHO, up to 70% could live without seizures with suitable treatment.
References
- OMS, Épilepsie, principaux repères (www.who.int)
- PsychoMédia, Qu’est-ce que l’épilepsie : causes, symptômes (d’après l’aide-mémoire de l’OMS) (www.psychomedia.qc.ca)
- OMS, Le traitement de l’épilepsie est très rarement disponible dans les pays à revenu faible (2019) (www.who.int)
- Assurance Maladie (ameli.fr), Traitement de l’épilepsie (www.ameli.fr)
- NHS, Epilepsy : living with epilepsy (www.nhs.uk)
- NHS, Epilepsy : symptoms (www.nhs.uk)
- Epilepsy Foundation, Seizure first aid (earlychildhood.marylandpublicschools.org)
This article is for information only. It does not replace a medical consultation: if in doubt, talk to your doctor.
