Brief overview
- Symptoms: Epileptic seizures of varying severity from mere “mental absence” (absence) to convulsions and subsequent twitching with unconsciousness (“grand mal”); localized (focal) seizures also possible
- Treatment: Usually with medication (antiepileptic drugs); if these do not have sufficient effect, surgery or electrical stimulation of the nervous system (such as vagus nerve stimulation), if necessary.
- Diagnostics: Medical history (anamnesis), ideally supported by relatives/companions; electroencephalography (EEG) and imaging procedures (MRI, CT), cerebrospinal fluid (CSF) puncture and laboratory tests if necessary.
- Course of the disease and prognosis: Varies depending on the type of epilepsy and the underlying disease; in about half of those affected, it remains a single epileptic seizure.
What is epilepsy?
Epileptic seizures vary in severity. The effects are correspondingly variable. For example, some sufferers only feel a slight twitching or tingling of individual muscles. Others are briefly “out of it” (absent). In the worst case, there is an uncontrolled seizure of the entire body and brief unconsciousness.
- At least two epileptic seizures occur more than 24 hours apart. Usually these seizures come “out of nowhere” (non-provoked seizures). In rarer forms of epilepsy, there are very specific triggers, such as light stimuli, sounds, or warm water (reflex seizures).
- A so-called epilepsy syndrome is present, for example Lennox-Gastaut syndrome (LGS). Epilepsy syndromes are diagnosed based on certain findings, such as seizure type, electrical brain activity (EEG), imaging results, and age of onset.
In addition, occasional cramps sometimes occur in severe circulatory disorders, poisoning (with drugs, heavy metals), inflammation (such as meningitis), concussion or metabolic disorders.
Frequency
In general, the risk of developing epilepsy in the course of one’s life is currently three to four percent; and the trend is rising because the proportion of older people in the population is increasing.
Forms of epilepsy
There are different forms and manifestations of epilepsy. However, the classifications in the literature vary. A commonly used (rough) classification is as follows:
- Focal epilepsies and epilepsy syndromes: Here, the seizures are confined to a limited area of the brain. The symptoms of the seizure depend on its function. For example, twitching of the arm (motor seizure) or visual changes (visual seizure) are possible. In addition, some seizures begin focally, but then spread to the entire brain. Thus, they develop into a generalized seizure.
Epilepsy: What are the symptoms?
The exact symptoms of epilepsy depend on the form of the disease and the severity of the epileptic seizures. For example, the mildest variant of a generalized seizure consists of a brief mental absence (absence): The affected person is briefly “out of it”.
Another severe form of epilepsy is the so-called “status epilepticus”: this is an epileptic seizure that lasts longer than five minutes. Sometimes there is also a series of several seizures in quick succession without the patient regaining full consciousness in between.
Such situations are emergencies that require medical treatment as soon as possible!
What medications are used for epilepsy?
Therapy not always necessary
If someone has only had one epileptic seizure, it is usually possible to wait with treatment for the time being. In some cases, it is sufficient for those affected to avoid known triggers (such as loud music, flickering lights, computer games) and adopt a healthy lifestyle. This includes, among other things, a regular lifestyle, regular and sufficient sleep, and abstaining from alcohol.
In the case of structural or metabolic epilepsy, the doctor first treats the underlying disease (meningitis, diabetes, liver disease, etc.). Here, too, it is advisable to avoid all factors that promote an epileptic seizure.
In general, medical professionals advise epilepsy treatment after the second seizure at the latest.
In doing so, he also takes into account the patient’s willingness to adhere to the doctor’s recommendations (adherence to therapy). There is little point in prescribing medication if the patient does not take it (regularly).
Drug treatment
Various active substances are used as antiepileptic drugs, for example levetiracetam or valproic acid. The doctor weighs up for each patient which active ingredient is likely to work best in the specific case. The type of seizure or the form of epilepsy plays an important role. In addition, the doctor considers possible side effects when choosing the antiepileptic drug and its dosage.
As a rule, the doctor prescribes only one antiepileptic drug (monotherapy) for epilepsy. If this medication does not have the desired effect or causes severe side effects, it is usually worth trying to switch to another preparation with medical consultation. Sometimes the best individual antiepileptic drug is found only after the third or fourth attempt.
Epilepsy medications are often taken as tablets, capsules or juice. Some can also be administered as an injection, infusion or suppository.
Antiepileptic drugs only help reliably if they are used regularly. It is therefore very important to follow the doctor’s instructions carefully!
How long do you have to use antiepileptic drugs?
In some patients, the epileptic seizures then return (sometimes only after months or years). Then there is no way around taking the epilepsy medication again. Other patients remain permanently seizure-free after stopping the antiepileptic drugs. For example, if the cause of the seizures (such as meningitis) has healed in the meantime.
Never discontinue your epilepsy medication on your own – this may have life-threatening consequences!
Surgery (epilepsy surgery)
In some patients, epilepsy cannot be adequately treated with medication. If the seizures always originate from a limited region of the brain (focal seizures), it is sometimes possible to surgically remove this part of the brain (resection, resective surgery). In many cases, this prevents future epileptic seizures.
Resective brain surgery is used primarily when the epileptic seizures originate in the temporal lobe of the brain.
During a callosotomy, the surgeon cuts through all or part of the so-called bar (corpus callosum) in the brain. This is the connecting piece between the right and left hemispheres of the brain. This procedure may significantly reduce the number of falls. However, there is a risk of cognitive impairment as a side effect. For this reason, doctors and patients carefully weigh the benefits and risks of callosotomy in advance.
Stimulation procedure
Various procedures are used to treat epilepsy. The most common is vagus nerve stimulation (VNS), in which the surgeon implants a small, battery-powered device under the skin of the patient’s left collarbone. This is a kind of pacemaker that is connected to the left vagus nerve in the neck via a cable that also runs under the skin.
During the current impulses, some patients experience feelings of hoarseness, coughing, or sensations of discomfort (“buzzing in the body”). In some cases, vagus nerve stimulation also has a positive effect on concurrent depression.
Deep brain stimulation is only performed in specialized centers. So far, it has not been widely used as a method of epilepsy treatment. The procedure is used much more frequently in Parkinson’s patients.
Treatment for status epilepticus
If someone suffers a status epilepticus, it is important to call the emergency doctor immediately – there is a danger to life!
The emergency physician who arrives also administers the sedative as an injection into a vein if necessary. He then quickly takes the patient to a hospital. There, the treatment is continued.
If the status epilepticus still does not end after 30 to 60 minutes, many patients receive anesthesia and are artificially ventilated.
Epileptic seizure
An epileptic seizure is very often followed by an after-phase: although the brain cells no longer discharge abnormally, abnormalities may still be present for up to several hours. These include, for example, a disturbance of attention, speech disorders, memory disorders or aggressive states.
Sometimes, however, people are fully recovered after an epileptic seizure after only a few minutes.
First aid
An epileptic seizure often appears disturbing to outsiders. In most cases, however, it is not dangerous and ends on its own within a few minutes. If you witness an epileptic seizure, it is helpful to follow these rules to help the patient:
- Stay calm.
- Do not leave the affected person alone, calm him down!
- Protect the patient from injury!
- Do not hold the patient!
Epilepsy in children
Epilepsy very often occurs in childhood or adolescence. In this age group, it is one of the most common diseases of the central nervous system. In industrialized countries such as Germany, Austria and Switzerland, around 50 out of every 100,000 children contract epilepsy every year.
Overall, epilepsy in children is easily treatable in many cases. The concern of many parents that epilepsy will impair their child’s development is usually unfounded.
You can read all the important information on the subject in the article Epilepsy in children.
Epilepsy: Cause and risk factors
Sometimes there is no explanation at all for why a patient has epileptic seizures. There are no indications of the cause, such as pathological changes in the brain or metabolic disorders. This is what doctors call idiopathic epilepsy.
Nevertheless, it is usually not hereditary. Parents usually only pass on the susceptibility to seizures to their children. The disease only develops when external factors (such as sleep deprivation or hormonal changes) are added.
These include, for example, epileptic seizures resulting from congenital malformations of the brain or brain damage acquired at birth. Other possible causes of epilepsy include craniocerebral trauma, brain tumors, stroke, inflammation of the brain (encephalitis) or meninges (meningitis), and metabolic disorders (diabetes, thyroid disorders, etc.).
Examinations and diagnosis
When you first experience an epileptic seizure, it is advisable to consult a doctor. He or she will then examine whether it is actually epilepsy or whether the seizure has other causes. The first point of contact is usually the family doctor. If necessary, he will refer the patient to a specialist in nervous disorders (neurologist).
Initial consultation
Sometimes there are photos or video recordings of the epileptic seizure. They are often very helpful for the physician, especially if they focus on the patient’s face. This is because the appearance of the eyes provides important clues to seizure symptoms and helps to distinguish an epileptic seizure from other seizures.
Examinations
The interview is followed by a physical examination. The doctor also checks the condition of the nervous system using various tests and examinations (neurological examination). This includes a measurement of brain waves (electroencephalography, EEG): sometimes epilepsy can be detected by typical curve changes in the EEG. However, the EEG is sometimes also inconspicuous in epilepsy.
Complementary to the MRI, a computer tomogram of the skull (CCT) is sometimes obtained. Especially in the acute phase (shortly after the seizure), computed tomography is helpful, for example, to detect brain hemorrhages as the trigger of the seizure.
In addition, the doctor may take a sample of cerebrospinal fluid (CSF or lumbar puncture) from the spinal canal using a fine hollow needle. The analysis in the laboratory helps, for example, to detect or exclude inflammation of the brain or meninges (encephalitis, meningitis) or a brain tumor.
In individual cases, further examinations are necessary, for example, to exclude other types of seizures or to clarify the suspicion of certain underlying diseases.
People whose epilepsy is caused by an underlying condition such as a brain disease are particularly at risk: The risk of further seizures is about twice as high in them as in sufferers whose epilepsy is based on a genetic predisposition or has no known cause.
Avoid seizures
Sometimes epileptic seizures are provoked by certain triggers. It is then advisable to avoid them. However, this is only possible if the triggers are known. A seizure calendar helps: the patient notes down the day, time and type of each seizure together with the current medication.
Living with epilepsy
If the epilepsy is well under control with treatment, a largely normal life is usually possible for those affected. However, they should take some precautions to avoid dangerous situations:
- Do not use electric knives or cutting machines.
- Refrain from bathing and take showers instead. Never go swimming without an escort. Death by drowning is about 20 times more common among epileptics than in the rest of the population!
- Choose a low bed (risk of falling).
- Secure sharp edges in the home.
- Keep a safe distance from roads and bodies of water.
- Do not lock yourself in. Use an “occupied” sign on the toilet instead.
- Don’t smoke in bed!
Epilepsy patients who get behind the wheel even though they are unfit to drive endanger themselves and others! They also risk their insurance coverage.
Most professions and sports are generally also possible for epileptics – especially if epileptic seizures no longer occur thanks to therapy. In individual cases, your doctor will advise you whether it is better to avoid a particular activity or sport. He may also recommend special precautions.
Some epilepsy drugs weaken the effect of the contraceptive pill. Conversely, the pill may impair the effectiveness of some antiepileptic drugs. It is advisable for girls and women with epilepsy to discuss such interactions with their doctor. He or she may recommend a different contraceptive.
Antiepileptic drugs in higher doses have the potential to disrupt the development of the child or cause malformations (up to the twelfth week of pregnancy). Moreover, this risk is higher with combination therapy (several antiepileptic drugs) than with monotherapy (treatment with a single antiepileptic drug).
