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Epilesy

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. 

Around 2 per cent of the population suffers from epilepsy. Most people with epilepsy have had it since childhood. Epilepsy usually starts between the ages of three months and the teens. Around 60 per cent of children with epilepsy grow out of it. Most other people can control their seizures with medication and there is relatively little disruption to their lives. 

Epilepsy is characterised by seizures, sometimes called fits or convulsions. These occur when some of the nerve cells in the brain become overactive, and fire off uncontrolled random signals.

Some people have one seizure and then never have another ever again. People who experience repeated seizures - whether once a year, or several times a day - have epilepsy.

The cause of epilepsy is not known, but its generally thought to be the result of a chemical imbalance in the brain. People can be more at risk if they have had a stroke, head injury, meningitis or if they have a history of drug or alcohol abuse.

Epilepsy sometimes runs families, and can be the result of a brain injury at birth or rarely due to a brain tumour. In most cases, though, it is not known why some people get epilepsy and others do not.

The main symptom of epilepsy is repeated seizures. Most people have no other symptoms, and live perfectly normal lives.

Seizures normally come on without warning, although they can be triggered by flashing lights, or preceded by an aura - people with epilepsy sometimes report a strange smell, taste or feeling.

There are different kinds of seizures. Some people experience just a fleeting loss of awareness. Others lose consciousness and suffer stiffening or jerking movements in their body and even incontinence.

Seizures can last just a few seconds, or may go on for some minutes, and can be barely noticeable or quite traumatic.

There are several different types of epilepsy, each with different symptoms.

Primary generalised epilepsy
In this kind of epilepsy, also known as grand-mal epilepsy, nerve cells in both sides of the brain become overactive at the same time. Seizures usually last for about five minutes, and can be frightening.

In a grand mal, people are likely to experience some or all of the following:

  • falling to the ground
  • losing consciousness
  • experiencing stiffened muscles or jerking movements, known as involuntary movements
  • stopping breathing for a few seconds
  • the jaw going rigid, frothing at the mouth and biting the tongue
  • wetting or soiling themselves
  • feeling confused and drowsy when they come round


Absence seizures

Absence seizure, also called petit-mal epilepsy, is not as alarming as grand mal. There may be a loss of consciousness, or more often just a loss of awareness, but this kind of seizure does not involve falling down or experiencing involuntary movements. In fact, people may just look as if they are daydreaming.

This kind of seizure is most common in children aged between five and nine. Most grow out of them by the time they are 13.

Juvenile myoclonic epilepsy

During a juvenile myoclonic epileptic seizure, the hands, arms or whole body will start jerking, but the person does not lose consciousness or awareness. This type of epilepsy usually develops in late childhood, and it always runs in families.

Temporal lobe epilepsy

Temporal lobe epilepsy has quite different symptoms. They include:

  • making strange faces and noises
  • chewing, swallowing and smacking the lips
  • plucking at the clothes
  • People may seem to be awake, but they wont respond to what is going on around them

To diagnose epilepsy, the doctor will need a detailed description of the seizures – family members or friends can often help with this.

The doctor may then arrange for some tests. These can include:

  • an EEG (electroencephalogram )
  • a brain scan - either CT (computerised tomography) or MRI (magnetic resonance imaging)
  • blood and urine tests

There is no cure for epilepsy, but drug treatment can control the seizures in around 70 per cent of people. These drugs sometimes have side effects, though, such as drowsiness or a rash.

If someone who has had epilepsy does not have a seizure for two years, their doctor may suggest they come off the medication (or reduce the dose).

Very occasionally, in very specific cases, brain surgery may be appropriate.

People with epilepsy may need to avoid certain activities or jobs where it could be dangerous to have a seizure - most obviously, things like flying a plane, but also, for example, operating certain machinery, riding a bicycle in busy traffic, or swimming alone. People who are diagnosed with epilepsy cannot drive until their doctor confirms that their seizures are under control.

If a child has epilepsy, it is important to ensure he or she does not get too tired. Older children and adults may benefit from relaxation and anti-stress exercises.

Its also a good idea for someone with epilepsy to carry a card, necklace or bracelet which says that they have epilepsy. Family, friends, teachers and colleagues should be told what to do in the event of a seizure.

If someone has a seizure

If someone has an epileptic seizure while you are present - if they lose consciousness or suffer convulsions - protect them from injury by doing the following:

  • asking onlookers to keep back
  • loosening clothing around their neck
  • cushioning their head
  • When the convulsions stop, put them in the recovery position. After they regain consciousness, let them rest quietly in a safe place.
  • Do not try to move or restrain the person, or put anything in their mouth. Do not give them anything to drink until they are fully conscious again.

You should call an ambulance only if any of the following happen:

  • the seizure lasts more than five minutes
  • the convulsions happen again without the person regaining consciousness
  • the person injures themselves during the seizure

If someone has a seizure that does not involve loss of consciousness, do the following.

  • help them to sit down in a quiet safe place
  • talk to them calmly and reassuringly
  • stay with them until they feel well again

1. What should I do if I see someone having a seizure?

Generally, you should try to stay calm and protect the person from injury. Don't restrain a person during a seizure if he or she is jerking or twitching. Stay with them until they have fully recovered. Below is advice on what to do if you know someone is having a specific type of seizure.

If you see a person having a seizure and they lose consciousness:

  • keep calm
  • don't try to move or restrain the person
  • to protect the person from injury, remove any nearby harmful objects and cushion their head
  • even if the person is biting their tongue, don't put anything in their mouth ·
  • when the seizure stops, put the person in the recovery position
  • after regaining consciousness, reassure the person and let him or her rest quietly in a safe place

 

Call for emergency help if:

  • you know it's the person's first seizure or if the seizure lasts more than five minutes or longer than usual (if you know or the person can tell you how long his or her seizures usually last)
  • the convulsions stop and then happen again without the person regaining consciousness
  •  the person injures him or herself during the seizure or has difficulty breathing

 

If someone has a seizure but doesn't lose consciousness:

  • guide him or her away from any possible danger, such as traffic - but be careful not to put yourself at risk
  • protect him or her from injury by removing any harmful objects nearby
  • talk to the person and reassure him or her
  • stay with the person until he or she feels well again

 

2. Are you born with epilepsy or can you develop it later in life?

Epilepsy can affect anyone and start at any age.

Epilepsy can start in people of all ages. However, it's most often diagnosed in children or in adults over 60. This is because many of the causes of epilepsy are more common in childhood (such as difficulties at birth, childhood infections or accidents) or when you're much older (such as strokes).

Many people who develop epilepsy before they are 20 grow out of it and stop having seizures when they are older.

3. Will having epilepsy cause any complications if I get pregnant?

You're at a slightly higher risk of complications, but it's important to remember that nine out of 10 women with epilepsy have healthy pregnancies and give birth to healthy babies. If possible, plan ahead and get medical advice before you become pregnant so you get the extra help you need.

Some anti-epilepsy medicines can affect how your baby grows and develops in your womb, particularly during the first three months of your pregnancy. So the risk of your baby having a birth defect is slightly higher if you're taking anti-epilepsy medicines.

Because of this risk, speak to your doctor before you become pregnant if possible. He or she will arrange medical advice known as pre-conception counselling, which is usually provided by a doctor who specialises in epilepsy. Your doctor will assess your epilepsy and what kind of medication you're taking. He or she will then let you know whether this could pose any risks to your unborn baby and how these risks could be reduced. Your doctor may suggest that you take a lower dose of your anti-epilepsy medicine if your seizures are well controlled or that you switch to a different anti-epilepsy medicine that poses less risk to your baby.

You should continue to take your anti-epilepsy medicines as advised by your doctor during your pregnancy. If you stop, you're more likely to have a seizure that could harm you or your unborn baby.

If you become pregnant unexpectedly, continue to take your anti-epileptic medicines and contact your doctor as soon as possible. He or she will give you advice on what to do next.

Your doctor will usually advise you to take folic acid before getting pregnant and for the first three months after you get pregnant. Folic acid is a vitamin that will help your developing baby's spine to form. Folic acid may interact with certain anti-epilepsy medicines so it's important to speak to your doctor before you start taking supplements.

If you have epilepsy, are pregnant and are living in the UK, you can join the UK Epilepsy and Pregnancy Register. This was set up to record information about women with epilepsy throughout their pregnancy and after their baby is born. It provides useful information on which anti-epilepsy medicines are the safest to take during pregnancy and on the effects of having a seizure while you're pregnant. It's hoped that doctors will be able to use this information to give advice to other women with epilepsy in the future.

4. Is there a chance that I could pass my epilepsy on to my child?

Yes, there may be a higher risk of your child getting epilepsy if you, or both you and your partner, have it.

Some types of epilepsy seem to run in families and could be passed on from parent to child. The risk varies from person to person so it's best to discuss this with your doctor or a geneticist (a doctor who specialises in genetics). He or she will be able to give you more accurate advice on the possible risk of your child inheriting epilepsy.

If your epilepsy is a result of a head injury, brain infection (such as meningitis) or brain injury caused by drug or alcohol use, there is no risk of you passing it on to your child.

5. Will epilepsy affect my child's education?

For some children; having epilepsy won't affect their ability to do well in school, but others may need extra support. If you feel your child's epilepsy or medicine for controlling seizures is affecting his or her performance at school, you might want to discuss your concerns with your child's teacher.

Most children with epilepsy are just as capable of learning as other students. Around four out of five of children with epilepsy attend mainstream schools without any problems. However, epilepsy affects individuals differently and some children with epilepsy have behavioural problems or learning difficulties. For example, it's common for people with epilepsy to complain of a poor memory. Memory problems may be due to:

  • frequent and/or prolonged seizures
  • damage to the area of the brain responsible for memory
  • side-effects from anti-epilepsy medicines, causing a slowing of the mental process and subsequent memory problems

 

6. What is the ketogenic diet? Could this help control my child's seizures?

The ketogenic diet is a high-fat, low-carbohydrate diet that is sometimes used as an alternative treatment for children with difficult-to-control epilepsy. The ketogenic diet should only be used under the supervision of your child's doctor and a dietitian.

The ketogenic diet has been successfully used to decrease, and sometimes stop, seizures for children with difficult-to-control epilepsy. If your child is having frequent seizures and they aren't well controlled with anti-epilepsy medicines, you may want to talk to your child's doctor about the ketogenic diet. However, it's only suitable for a small number of children.

The diet works by stimulating the body's reaction to starvation. During starvation your body first uses its store of glucose and glycogen and then burns body fat. Glucose and glycogen come from carbohydrates. If no glucose is available, body fat can't be completely burned and substances called ketones are left over. Because the ketogenic diet limits carbohydrate intake so much, ketones begin to build up in your child's body. It's this high level of ketones that can potentially suppress your child's seizures.

If your child is on the ketogenic diet, around 90 percent of his or her calorie intake comes from fat. Your child can eat about one gram per kilogram of his or her body weight as protein, and minimal carbohydrates. Calories are individually calculated for your child and depend on his or her age and activity level. Most children don't gain or lose significant amounts of weight on the diet. Your child will usually have to take vitamin and mineral supplements.

Don't change your child's diet without speaking to his or her doctor first.

7. Can complementary therapies help to treat epilepsy?

Although they may help you to relax, there is no scientific evidence that any complementary therapy can control seizures.

It's important to get advice from your doctor before you use complementary therapies.

Complementary therapies can't replace your anti-epilepsy medicines. Don't stop taking your anti-epilepsy medicines without consulting your doctor.

It's also important to ask your therapist if the treatment you're considering is suitable for people with epilepsy. St John's wort is a herbal preparation that may be helpful for depression but can interfere with anti-epilepsy medicines. If you're considering taking St Johns wort, discuss it your doctor first.      

Further information

 

Sources

  • What is epilepsy? Epilepsy Action. www.epilepsy.org.uk, accessed 7 January 2010
  • Epilepsy. Clinical Knowledge Summaries. www.cks.nhs.uk, accessed 11 January 2009
  • About epilepsy. The National Society for Epilepsy. www.epilepsysociety.org.uk, accessed 7 January 2010
  • Clinical guidelines and evidence review for the epilepsies: diagnosis and management in adults and children in primary and secondary care. Royal College of General Practitioners, 2004. www.nice.org.uk
  • Epilepsy - a parents guide. Epilepsy Action. www.epilepsy.org.uk, accessed 11 January 2009
  • Seizures.The National Society for Epilepsy. www.epilepsysociety.org.uk, accessed 7 January 2010
  • Febrile convulsions. Epilepsy Action. www.epilepsy.org.uk, accessed 11 January 2009
  • Simon C, Everitt H, and Kendrick T, Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010: 582, 826, 895
  • Possible seizure triggers. Epilepsy Action. www.epilepsy.org.uk, accessed 11 January 2009
  • Treatment with anti-epileptic medication. Epilepsy Action. www.epilepsy.org.uk, accessed 11 January 2009
  • Epilepsy surgery. Epilepsy Action. www.epilepsy.org.uk, accessed 11 January 2009
  • Vagus nerve stimulation therapy. Epilepsy Action. www.epilepsy.org.uk, accessed 11 January 2009
  • Febrile convulsions - prevention. GP Notebook. www.gpnotebook.co.uk, accessed 11 January 2009
  • Epilepsy facts, figures and terminology. Epilepsy Action. www.epilepsy.org.uk, accessed 11 January 2009
  • Risks of taking anti-epileptic drugs in pregnancy. Epilepsy Action. www.epilepsy.org.uk, accessed 13 January 2010
  • Folic acid. Epilepsy Action. www.epilepsy.org.uk, accessed 13 January 2010
  • Inheritance. Epilepsy Action. www.epilepsy.org.uk, accessed 13 January 2010
  • Learning, behaviour and epilepsy. Epilepsy Action. www.epilepsy.org.uk, accessed 11 January 2009
  • Epilepsy and memory. The National Society for Epilepsy. www.epilepsysociety.org.uk, accessed 11 January 2009
  • Ketogenic diet. Epilepsy Action. www.epilepsy.org.uk, accessed 11 January 2009
  • At a glance guide to the current medical standards of fitness to drive. Driving and Vehicle Licensing Agency, September 2009, www.dft.gov.uk
  • Complementary treatment. Epilepsy Action. www.epilepsy.org.uk, accessed 11 January 2009
  • St John's Wort. Epilepsy Action. www.epilepsy.org.uk, accessed 11 January 2009 

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