About epilepsy

Epilepsy is a neurogical disorder that is affecting all ages. It is taking place in the central nervous system, more specifically in the brain, and is charactarized with spontenous and recurrent epileptic seizures. Epilepsy is one of the most common neurological disorders. In fact, Canada counts 300 000 people living with epilepsy and there’s approximately 50 million in the entire world.

To know…

Epilepsy is not an illness (it can’t be transmitted) and is not a psychological disorder. Futhermore, having only one seizure doesn’t mean you have epilepsy : at least one person in ten will have a seizure during their lifetime.

Contrary to what we may think, there’s a lot of types of seizures. We can regroup them in three categories : focal seizures, generalized seizures and unknown origin seizures.

 

Focal seizures

Focal seizure starts in a precise area of the brain. They can be localized (staying in the same area during the seizure) or they can spread to another area.

Depending of the seizure, the person’s state of consciousness might alter (the person is not aware of their situation or their surrounding) or not. Futhermore, we can characterize the seizure of motor (changes in muscular activity) or non-motor (changes in emotions, behaviours, senses…).

Focal seizures regroup three types of epilepsy : focal seizures with retained awareness, focal seizures with a loss of awareness and tonic-clonic focal to bilateral seizure.

 

Generalized seizures

Generalized seizures happen all over the brain. In this category, the person has loss of awareness. The type of seizure is established by the presence or the absence of motor symptoms.

Generalized seizures regroup two types of epilepsy : tonic-clonic seizure and absence seizure.

 

Unknown origin seizures

Like the name says,  unknown origin seizures occur in an unknown area of the brain. We can’t establish where the seizure comes from. The tonic-clonic seizure might be a type of unknown origin seizure.

 

Grouping the three categories

A couple of types can be listed as focal, generalized or unknown origin. This is the reason why we don’t associate them to a category. This is the case of atonic seizures, tonic seizures, clonic seizures and myoclonic seizures.

 


 

Types of epilepsy’s description

 

Focal seizures with retained awareness
    • On average, it lasts less than a minute ; 
    • The person is aware of their situation and their surrounding during the seizures. The person stays alert ;
    • Focal seizures with retained awareness are also called aura because they can be a warning of worse type of seizures (for example, the focal seizure with retained awareness can change into a tonic-clonic seizure) ;
    • The person might have a sensation of ”déjà-vu” ;
    • The person might have intense emotions (like unexplained anger or sadness)
    • The person might have sensory experiences (hearing voices, burnt smell…) ;
    • Muscular contractions or uncontrollable movements may occur.

 

Focal seizures with a loss of awareness
    • On average, it lasts between a  few seconds and two minutes ; 
    • Consciousness state is altered (the person doesn’t understand their situation or is not aware of their surrounding. The person will also have post-seizure amnesia (the person doesn’t remember what happened)
    • The person will not be able to speak ;
    • The person has no reaction, has a blank stare and might mumble.
    • The person will do repetitive movements called automatisms (touching their clothes, licking their lips, walking without an objective…) ;
    • After the seizure, the person might be confused or tired.

 

Tonic-clonic focal to bilateral seizure
    • On average, it lasts less than two or three minutes ;
    • At first, the seizure occurs in a precise area of the brain then spreads throughout the brain. It is at this moment that the person loses their awareness.
    • There’s three phases, like the tonic-clonic seizure (see below) ;
    • The person keeps a few or no memories from before the seizure ;
    • After the seizure, the person might feel tired, confused, agitated or sad ;
    • A few minutes or a few hours after the seizure, the person might feel the need to rest.
  •  
Generalized or unknown origine tonic-clonic seizure
    • On average, it lasts bewteen two or five minutes ;
    • The person loses their awareness ;
    • There’s threes phases :
      1. Tonic phase :  During this phase, the person will scream or moan. After that, the person will fall and their muscles will tense. Respiration might be difficult and the skin might take a blue or grey coloration. 
      2. Clonic phase : convulsions and contractions of the whole body. The person might salivate a lot,  can bite their tongue or lose control of their blader and/or its intestine.
      3. Recovery phase  : convulsions stop and the respiration is back to normal. The person stays unconscious during a few minutes. The person might feel tired, confused and might have headaches a couple minutes or a couple hours after the seizure.

 

Absence seizure
    • On average, it lasts around nine seconds ;
    • It begins and stop suddenly. The person continue the activity they were doing right before the seizure, like nothing happened. 
    • The person loses their awareness ;
    • The person has a blank stare. Because of that, we have the impression that the person is being inattentive or looks in the moon ; 
    • It might happens that the eyelids twitch and that the eyes roll up.

 

Atonic seizure
    • Lasts a few seconds ;
    • It’s characterized by a sudden fall ; 
    • The person loses their muscular control, which is why the person falls ; 
    • The person drops objets unintentionally ;
    • The person tilts their head unintentionally ;
    • Since there’s no warning signs, the person has more chances to hurt themself.

 

Tonic seizure
    • Lasts between a few seconds and a minute ;
    • The person’s muscles tense ;
    • The person might fall because of the muscles contractions (especially if the person is standing up).

 

Clonic seizure
    • The person convulses like in the tonic-clonic seizure, but this is the only characteristic that they have in common ;
    • Usually occurs with a muscle stiffness.

 

Myclonic seizure
    • Lasts a few seconds ;
    • One of the person’s body parts will make a sudden and unintentional movements (their arm or their leg, for example) ;
    • A few movements are subtle. It might be hard to be seen by someone else ; 
    • The person might fall.

Epileptic seizures are induced by a modification in the electrical activity in the brain. Brain cells can unload an abnormal amount of nerve impulses or they might not unload nerve impulses when the should be. Epileptic seizures are the physical manifestations of those sudden, brief and spontaneous unloads. Epileptic seizures can alter someone’s behaviour, consciousness state, movements, perceptions and sensations.

 

The factors that can  trigger a seizure
  • Tiredness ;
  • Stress ;
  • Alcohol and/or drugs abuse ;
  • Hormonal changes ;
  • Photosensitivity
  • The adjustment or the change of a medication
  • Et cetera.

There’s multiple causes to epilepsy. The causes depends from one person to another : they can vary depending the age of when the seizures started and they can be genetic or acquired.

 

What are the causes of epilepsy ?

  • Genetic ;
  • Birth trauma ;
  • Head trauma ;
  • Brain tumor ;
  • Alcohol and/or drugs abuse ;
  • Infection (meningitis, HIV, encephalitis,) ;
  • Stroke ;
  • Cerebral hemorrhage or lesions ;
  • Unknown.

Medication

Medication (anticonvulsants)  helps approximately 65% of people with epilepsy to control their seizures, which mean to decrease the number of their seizures or to stop them completely. In 50% of the cases, epilepsy seizures stop completely. Even though, medication doesn’t heal epilepsy.  

Anticonvulsants may have side effects, like drowsiness, weight gain or loss, dizziness, headaches, et cetera. It is important to discuss about the possible side effects with your doctor. Futhermore, there’s multiple types of anticonvulsants and each of them are different. One kind of anticonvulsant can work on someone and not work on another.

If a person with epilepsy decides to stop its medication, it needs to be approved by its doctor and to be under its doctor’s supervision.

 

Surgery

When medication doesn’t work and when the life conditions are affected by the seizures (10% to 20% of epilepsy cases), surgery may be recommend. Before doing the surgery, the person with epilepsy will need to do a couple of tests and neurogical evaluation.

 

Vagus Nerve Stimulation

If medication doesn’t work and if the brain surgery is not an option, then the VNS (Vagus Nerve Stimulation) might be considered. This little device is located inside the thorax and send electric signals to the brain through the left vagus nerve, a nerve located in the neck. Those electric impulses are sent by fixed intervals (five minutes) and can help to stop or decrease the frequency of seizures. This treatment work for 50% of epilepsy’s cases.

 

Ketogenic Diet

This type of treatment is usually use with children. It was sometime use by teenagers and adults. This treatment consists to change the child’s alimentation : he will eat a lot of food high in fats, but low in carbohydrates and proteins. However, this treatment need to be supervised carefully by a doctor because the children doesn’t receive all nutrients that they need : a few child will need to take supplements. Normally, the diet lasts two to three years.

With this diet, seizures have stopped for approximately the third of the children, and the frequency of the seizures has decrease for another third

 

Other treatments

There is other treatments for epilepsy. Even though they’re not scientifically approved, a few epileptic people said these other treatments were effective for them. Among this treatments, there’s yoga, therapeutic massage, acupuncture, relaxation, meditation…

However, those treatments don’t replace the recognized treatments (medication, surgery, VNS and Ketogenic diet). Others treatments need to be complementary and need to be discussed with a doctor.

What to do when a seizure with convulsions occurs ?

  • Stay calm ;
  • Note the time of the seizure ;
  • Make the surrounding safe to avoid injury ;
  • Release what squeezes the neck ;
  • Don’t immobilize the person ;
  • Don’t put anything on the person’s mouth. It can’t swallow its tongue.
  • Turn carefully the person on the side during the seizure ;
  • After the seizure, reassure the person.

 

What do to when a seizure with no convulsions occurs ?

  • Normaly, there’s no first aids required if the person stay conscious ;
  • Stay with the person ;
  • Put the dangerous object out of the way ;
  • Don’t immobilize the person ;
  • Prevent the person to approach a potential danger and block the access to stairs ;
  • If there’s a fall, check if there’s any wounds ;
  • After the seizure, reassure the person.

 

When should you call for an ambulance ?

If the person is known to have epilepsy, the seizure has no complication or the seizure is predictable, you probably don’t need to call the ambulance. However, it is important to call it in the following situations

  • The seizure lasts longer than five minutes ;
  • The person does not regain consciousness ;
  • There’s cyanosis (the skin has a grey or blue coloration)
  • The person has difficulty to breath during the seizure and after ;
  • A second seizure occur without a return to normal after the first one ;
  • Confusion after the seizure lasting longer than an hour ;
  • The seizure happens in the water (swallowing water might induce cardiac or respiratory problems) ;
  • The person never had a seizure before ;
  • The person is hurt, pregnant or has diabetes.
Can I work even though I have epilepsy ?

Yes. However, there’s a few jobs that epileptic person can’t do for security reasons (like pilot). If your seizures are difficult to control and prevents you to keep a stable job, you can launch your own company or volunteer, for example. 

 

Can I have a driver’s license if I have epilepsy ?

Yes, but your seizures need to be controlled. The person with epilepsy need to wait 6 to 12 months after a seizure before driving again and need to wait for their doctor’s recommendation. Also, if you’re planning to go on a trip outside the province, you need to take information about the different regulations because they’re not the same as in Quebec. 

 

Can I play sport if I have epilepsy ?

Yes, epilepsy cause no problem with sports. Sport helps to decrease your stress, which is decreasing the chances to trigger a seizure. However, you need to be more careful with a few sports like scuba diving, swiming alone, parachute jump or escalation. They can be dangerous in a case that a seizure occurs at the same time.

 

Can I be pregnant even though I have epilepsy ?

Yes. However, a few anticonvulsants can be harmful for the foetus. It is important to get information from a healthcare professional so they can change your medication if needed. Moreover, the baby has more chances than another one to have epilepsy (6% comparatively to 1-2%)

References

Alliance canadienne de l’épilepsie. (s.d.). “À propos de l’épilepsie'” (site web).

Edmonton Epilepsy Association. (2020). “Living with epilepsy”. Epilepsy Education Series.

Épilepsie Section Québec. (2021). “Journal de crises : 0-17 en trois temps (6-11 ans)”.

Épilepsie Section Québec. (2022). “Qu’est-ce que l’épilepsie ?'”(site web).