Epilepsy

Published by Bupa's Health Information Team, April 2010.

This factsheet is for people who have epilepsy, or who would like information about it.

Epilepsy is a common condition that causes seizures. Seizures are the result of electrical disturbances in the brain.

About epilepsy

Epilepsy is a brain disorder that causes you to have recurring seizures. Seizures happen when the electrical activity in your brain is suddenly disrupted. This disruption can cause changes in your body movements, awareness, behaviour, emotions or senses. Seizures are also referred to as fits, attacks or convulsions.

Epilepsy affects at least 456,000 people in the UK. It often begins in childhood, although around one in three children will grow out of it by the time they become an adult.

Not all seizures are caused by epilepsy. Seizures can also be caused by other conditions such as meningitis, diabetes or an overactive thyroid gland. Febrile convulsions are seizures caused by a fever (high temperature) brought on by another illness, such as tonsillitis.

Symptoms of epilepsy

There are many different types of epileptic seizure, each with their own set of symptoms. Some of the common types are listed below.

Seizures are mainly categorised as partial or generalised, depending on the degree to which your brain is affected.

Partial seizures

Partial seizures affect only part of your brain. Symptoms of partial seizures depend on which part of your brain is affected.

Simple partial seizures
During a simple partial seizure, you will be fully conscious. If you have this type of seizure you may have one or more of the following symptoms:

• a sense of 'déjà vu' (the feeling of having done something before)
• a feeling of fear or joy
• a funny taste or smell
• numbness, tingling or 'pins and needles' in part of your body
• involuntary, jerky movements or twitching in part of your body
• seeing flashing or coloured lights
• hallucinations

Complex partial seizures
Complex partial seizures affect a larger part of your brain and often last longer than other types of epileptic seizure. You may be only partly conscious and probably won't remember the seizure. Symptoms include:

• making lip-smacking or chewing movements with your mouth
• doing repetitive movements such as fiddling with your clothing
• wandering around in a confused way
• making kicking movements with your arms or legs
• talking nonsense, muttering or mumbling

Generalised seizures

Generalised seizures affect all or most of your brain. You will lose consciousness and won't remember what happened. There are several different types of generalised seizure including those described below.

Tonic-clonic seizures
Also called 'grand-mal' seizures, tonic-clonic seizures are the most common type of generalised seizure. There are two stages - the 'tonic' phase followed by the 'clonic' phase. You can also have either the tonic or the clonic phase alone.

During the tonic phase, you may:

• lose consciousness
• have stiff muscles, which can make you lose your balance and fall to the ground
• cry out
• bite your tongue or cheek

During the clonic phase you may:

• have jerking muscles
• lose control of your bladder or bowel
• become very pale

You may be confused and drowsy, have a headache or want to go to sleep after coming round.

Atonic seizures
During an atonic seizure (also called a drop attack) the muscles in your body relax and you go floppy. You may fall forwards to the ground, which can sometimes cause you to injure yourself.

Myoclonic seizures
Your legs, arms, head or whole body will jerk in this type of seizure. This often happens just after you have woken up.

Absence seizures
Absence seizures are also known as 'petit-mal' attacks and happen mainly in childhood. This kind of seizure doesn't involve falling down or having involuntary jerking movements. You will probably lose awareness, look blank and your eyelids might flutter. You may just look as if you're daydreaming.

Nocturnal seizures

These seizures occur when you're asleep - during the day or night.

Secondary generalised seizures

Secondary generalised seizures start as a partial seizure (either simple or complex) and develop into a generalised seizure.

Complications of epilepsy

Status epilepticus

If you have a seizure or group of seizures that lasts longer than 30 minutes, without you recovering and regaining consciousness, this is called status epilepticus. If status epilepticus happens during a tonic-clonic seizure, it's a medical emergency.

Sudden unexpected death in epilepsy

Sudden unexpected death in epilepsy (SUDEP) is very rare and occurs in about one in 1000 people who have the condition, usually those who have severe epilepsy.

Causes of epilepsy

Epilepsy with a known cause is called symptomatic epilepsy. Causes of epilepsy include:

• a genetic (inherited) condition - one in five people with epilepsy have inherited it
• brain damage caused by problems during birth, a head injury, stroke, brain surgery or as a result of alcohol, drugs or other toxic substances
• an infection in your brain (such as meningitis)
• rarely, a brain tumour

Around six in ten people have epilepsy with no known cause - this is called idiopathic epilepsy.

Diagnosis of epilepsy

Your GP will ask about your symptoms and examine you. He or she will also ask about your seizures, including what happens before, during and after. Family members or friends may be able to help you describe what happens.

Your GP may refer you to a neurologist (a doctor who specialises in conditions that affect the central nervous system, including the brain) for some tests. These may include:

• an electroencephalogram (EEG) to record your brain wave patterns from the electrical signals in your brain
• a brain scan, such as an MRI scan or a CT scan
• blood tests

Anyone can have a single epileptic seizure at some point in their life and then never have another one. So a diagnosis of epilepsy is usually only given if you have more than one seizure.

Treatment of epilepsy

There isn't a cure for epilepsy. The aim of treatment is to prevent seizures.

Self-help

Some people can identify things that trigger their seizures. Triggers can include:

• lack of sleep
• missing a dose of epilepsy medicine
• missing meals
• alcohol or illegal drugs
• flashing or flickering lights - this is called photosensitive epilepsy
• stress
• hormonal changes, for example, at certain times of the menstrual cycle in women - this is called catamenial epilepsy
• a high temperature - for example, if you're ill with flu
• certain medicines

If you know that something triggers your seizures, you may be able to find ways of avoiding this to help control your epilepsy. Keeping a diary to record your seizures may help you to identify any triggers. It can also help you to notice if there are any changes in the length or frequency of your seizures.

Medicines

Epilepsy medicines - or anti-epileptic drugs (AEDs) - can control seizures in around eight out of 10 people. AEDs prevent seizures from happening - they aren't used to stop seizures while they are happening.

You will usually be prescribed one medicine. If it's not controlling your seizures well, you may be offered an alternative or a combination of medicines.

AEDs can interact with other medicines, such as the contraceptive pill, so it's important to tell your doctor if you're taking anything else.

If you haven't had a seizure for two or three years, you may be able to gradually reduce the dose of your AEDs and eventually stop taking them. Ask your doctor for more advice.

Common side-effects of AEDs include drowsiness and dizziness, but these often disappear when your body adjusts to the medicine.

Surgery

Vagus nerve stimulation can reduce the frequency and intensity of seizures for some people. This involves an operation to implant an electrical device in your chest, which stimulates a nerve in your neck called the vagus nerve.

For some people with severe epilepsy, brain surgery (neurosurgery) may be an option. You will only be able to have surgery if epilepsy is associated with a specific area of your brain. Ask your doctor for more information.

Living with epilepsy

If you have epilepsy, it may mean you can't drive as there is a risk that you could have a seizure while driving. You can get more information about this from the Driver and Vehicle Licensing Agency (DVLA).

You may not be able to do certain activities or jobs where it could be dangerous for you to have a seizure. This may include flying a plane, working at heights, riding a bicycle in busy traffic or swimming alone. Ask your doctor for more advice.

You may be tempted not to discuss your seizures with your doctor because of the potential impact on your lifestyle. However it's important to understand that these restrictions help to protect not only your safety but that of others including your own relatives and friends.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.