21 of the most common questions about Epilepsy

The term Epilepsy isn’t new. It’s been present in the air for centuries now, however, only a few are aware that it is one of the most common neurological diseases in the world. It affects around 50 million people worldwide. However, public awareness regarding Epilepsy is quite less and it can result in the rise of false notions and stigma. Some of the most asked questions around Epilepsy are as follows:

1. What is epilepsy?

Epilepsy is a disorder of the central nervous system (neurological). It causes of unusual or abnormal brain activity characterized by seizures or periods of unusual behavior, sensations, and sometimes loss of awareness. 

Epilepsy can develop in any person and at any age. However, it is more common in young children and older people. It was also observed that men are more at risk to develop epilepsy than women. About 1 in 100 people will have an unprovoked seizure in their lifetime.

2. What causes Epilepsy?

The causes of Epilepsy vary from person to person. Different conditions that affect the normal functioning of the brain can lead to Epilepsy. However, in most cases, the reason behind Epilepsy remains unclear. This type of epilepsy is called cryptogenic or idiopathic. Some known causes include:

• Stroke.
• Brain tumor.
• Severe Head Injury.
• Lack/ loss of oxygen to the brain (especially during birth).
• Brain infection from parasites (malaria, neurocysticercosis), viruses (influenza, dengue, Zika), and bacteria.
• Drug or alcohol abuse.
• Some genetic disorders (such as Down syndrome).
• Other neurologic diseases (such as Alzheimer’s disease).

3. What are the seizures?

A seizure is a sudden, uncontrolled, abnormal electrical disturbance or activity in the brain. It might or might not go unnoticed, however, in serious cases, it results in unconsciousness and convulsions accompanied by sudden uncontrollable jerks in the body.

Seizures can lead to changes in behavior, feelings, body movements and consciousness. Episodes of two or more seizures confirm Epilepsy. 

What are the different types of Seizures? 

Seizures are broadly classified into two groups. 

Generalized seizures that affect all areas of the brain. It is further bifurcated into: 

• Absence seizures, also sometimes referred to as petit mal seizures, can cause rapid blinking or a few seconds of staring into space. It can also involve lip-smacking and cause a brief loss of awareness. 
• Tonic-clonic seizures, also called grand mal seizures, can make a person cry out, lose consciousness, lose balance, experience muscle jerks or spasms and get tired. It causes stiffness in arms and legs. 
• Atonic seizures also known as drop seizures, may lead to sudden collapsing or falling down of the body due to loss in muscle movements. 
• Clonic seizures are associated with repeated or rhythmic, jerking movements of the muscles usually of the neck, face and arms. 
• Febrile seizures are convulsions faced by a child from a high fever caused by an infection. They only last a few minutes but are often harmless.

Focal seizures are the seizures that are a result of abnormalities in just one area of the brain. These seizures are also called partial seizures. 

• Simple focal seizures affect a small part of the brain. These seizures can cause twitching or a change in sensation, such as a strange taste or smell. 
• Complex focal seizures make a person with epilepsy confused, dazed or lose consciousness. The person will be unable to respond to questions or direction for up to a few minutes.

5. How common are seizures?

According to the WHO, up to 10% of the total global population will experience one seizure during their lifetime. Seizures can happen anytime and so suddenly that it even gets undetected or unnoticed. Less than 1 in 10 people who have a seizure get epilepsy.

6. Why do people get epilepsy?

Factors such as health conditions, age, and race may act as triggers in developing epilepsy and seizures. Brain tumour or strokes can cause seizures. Stroke is a leading cause of epilepsy in adults older than age 35. It has been also observed that infectious diseases such as meningitis, AIDS and viral encephalitis can also cause seizures.

7. Can Seizures kill you? 

Seizures can be fatal. Among people with uncontrolled epilepsy, sudden expected death in epilepsy (SUDEP) is responsible for the death of 1 in 1,000 people. 

8. In what ways can a seizure kill you?

During a seizure, a person can face issues with breathing that can become fatal. An obstructed airway due to convulsion seizure can lead to suffocation. Abnormal heart rhythm during a seizure can also become fatal. However, the exact cause still remains in the dark and further research is underway. 

9. How do seizures cause brain damage?

Epileptic seizures can cause severe damages to brain cells. There exists indirect evidence of uncontrolled epilepsies causing progressive brain injury. (Tasch E., et al). A study led by Thompson and Duncan demonstrated a particularly strong relationship between cognitive decline and the frequency of generalized tonic-clonic seizure. It also noted that frequent complex partial seizures were also associated with worsening scores in tests of verbal learning, delayed recall, and semantic fluency, suggesting site-specific cerebral effects of seizures or of epileptogenic pathology.

10. Why do people froth in seizures?

Usually, during a seizure, the mouth is shut closed. This leads to stimulation of salivary glands thus producing spit in excess. When the mouth opens, it comes out in the form of drool or forty salivate. 

11. Can Epilepsy cause personality changes?

Epilepsy can be associated with changes in cognition, personality, and other behavioral aspects. Changes in emotional state can also be observed. The most important aspect of behavioral changes in epilepsy that needs attention is dysfunctional behavior. Depression is also a common problem that goes unrecognized and untreated. Other treatable problems include impotence, anxiety, panic attacks, and psychosis. (O Devinsky, B Vazquez – Behavioral changes associated with epilepsy) 

12. Can you drive if you have epilepsy?

Seizures can prove to be dangerously fatal if they occur while driving. Thus. If a person experiences seizures, regardless of being epileptic or not, in an immediate effect it is advised to stop driving. Different countries have different guidelines for the same. For instance,  in England, Scotland and Wales you need to tell the Driver and Vehicle Licensing Agency (DVLA). In Northern Ireland you need to tell the Driver and Vehicle Agency (DVA). 

13. What should I do if I have a seizure and I’m home alone?

There is nothing much you can do. You should try knowing your triggers to keep a track on it and have a proper response plan made with the help of your doctors. For extra caution, you should get rid of any objects that might hurt you in any way. If it is your first time experiencing a seizure, you can call 911 and your family to inform them about your seizure episode. If you have experienced it before, then you can call your doctor to inform him about it. Some people experience an aura before the seizure, in that case, you can call to inform your family about it, you can lie down to a place away from any objects. 

14. How accurate are EEG reading seizures?

EEG (electroencephalogram) is used to diagnose the cause of symptoms, such as seizures or memory loss. An EEG evaluates brain function by looking at the electrical activity within the brain, that appear as waves. The basic brain waves are alpha, beta, theta, and delta waves. Doctors examine each facet of the wave and determine unusual activities. 

However, EEG only shows brain activity during that particular time. Therefore, a person experiencing seizures can have a normal EEG. Stats demonstrated that approximately one-half of all EEGs done for patients with seizures give normal results. 

15. How can Epilepsy be cured?

Drugs and medications can control Epilepsy. These medications do not cure epilepsy, but can often control seizures very well. More than 20 different types of medications are available. About 80% of people with epilepsy today have their seizures controlled by medication at least some of the time. The first step towards managing a seizure is to prescribe Anti-epileptic drugs (AEDs), which help in reducing the number of seizures. 

16. How can surgery treat epilepsy?

If in some patients AEDs fail to bring the desired results, they undergo different types of neurosurgery depending on the type of seizure. Surgery can remove the specific area of the brain thought to be causing seizures, or it also can involve separating the part of the brain that is causing seizures from the rest of the brain.

However, with surgery comes risks as well that varies from person to person and can range from memory, a partial loss of sight, depression to other mood problems.

17. What is the best treatment or medicine for epilepsy?

Treatment for epilepsy includes antiepileptic medications (AEDs), diet therapy, and surgery. Anticonvulsant therapy in adults comes into consideration usually after two unprovoked epileptic seizures. The various classes of AEDs include sodium channel inhibitors, calcium channel inhibitors, GABA A receptor agonists, synaptic vesicle protein SV2A modulator, Na/Ca channel modulators and AMPA receptor blockade.

Epidiolex is the first prescription, plant-derived cannabis oral formulation developed by the GW

Pharmaceuticals. Xcorpi (cenobamate) is an FDA-approved AED for the treatment of partial-onset seizures in adults. Nayzilam is an investigational midazolam formulation developed for the rescue treatment of seizures in patients who require control of intermittent bouts of increased seizure activity. Fintepla, is an oral medication that is a low-dose solution of fenfluramine hydrochloride. 

18. What is the difference between epilepsy and hysteria?

While Epilepsy is a commonly occurring neurological disorder characterized by recurring and unprovoked seizures, Hysteria, on the other hand, is usually a fear related to a certain part of the body or an imaginative state of mind. 

19. What is the difference between epilepsy and eclampsia?

Preeclampsia is a complication that arises during pregnancy leading to high blood pressure and damage to another organ system, most often the liver and kidneys. Severe Preeclampsia can also lead to seizures known as Eclampsia. Less than 1% of women who have preeclampsia experience seizures. (Habli M, Sibai BM (2008))

20. What is the average lifespan of an epileptic?

Most people with epilepsy live a full life. However, this does not rule out the the risk of early death.  

Not many have read or heard about Epilepsy. The public awareness and attitudes towards epilepsy vary from negative, neutral to positive as well, depending upon the understanding of the disease among common people. To tackle the situation, several organizations are running campaigns, and awareness programmes to help those living with Epilepsy and add to their quality of lives.