About 1 in 30 people develop epilepsy at some stage in their life. It most commonly starts in childhood and in people aged over 60. However, epilepsy can begin at any age. In general, seizures are well controlled by treatment in about 4 in 5 cases
A seizure is a short episode of symptoms caused by a burst of abnormal electrical activity in the brain. Typically, a seizure lasts from a few seconds to a few minutes.
The brain contains millions of nerve cells (neurons). Normally, the nerve cells are constantly sending tiny electrical messages down nerves to all parts of the body. Different parts of the brain control different parts and functions of the body. Therefore, the symptoms that occur during a seizure depend on where the abnormal burst of electrical activity occurs. Symptoms that may occur during a seizure can affect your muscles, sensations, behaviour, emotions, consciousness, or a combination of these.
If you have epilepsy, it means that you have had repeated seizures. If you have a single seizure, it does not necessarily mean that you have epilepsy. About 1 person in 20 has a seizure at some time in their life. It may be the only one that occurs. The definition of epilepsy is more than one seizure. The frequency of seizures in people with epilepsy varies. In some cases there may be years between seizures. At the other extreme, in some cases the seizures occur every day. For others, the frequency of seizures is somewhere in between these extremes..
Epileptic seizures arise from within the brain. A seizure can also be caused by external factors which may affect the brain. For example, a high fever may cause a febrile convulsion. Other causes of seizures include: lack of oxygen, a low blood sugar level, certain drugs, poisons, and a lot of alcohol. Seizures caused by these external factors are not classed as epilepsy.
Unknown cause (idiopathic epilepsy)
In many cases, no cause for the seizures can be found. The abnormal bursts of electrical activity in the brain occur for no known reason. It is unclear why they start, or continue to occur. Genetic (hereditary) factors may play a part in some cases. People with idiopathic epilepsy usually have no other neurological (brain) condition. Medication to control seizures usually works very well.
In some cases, an underlying brain condition or brain damage causes epilepsy. Some conditions are present at birth. Some conditions develop later in life. There are many such conditions. For example: a patch of scar tissue in a part of the brain, a head injury, stroke, cerebral palsy, some genetic syndromes, growths or tumours of the brain, and previous infections of the brain such as meningitis, encephalitis. The condition may irritate the surrounding brain cells and trigger seizures.
Some underlying conditions may cause no other problems apart from seizures. In other cases, the underlying condition may cause other problems or disabilities in addition to the seizures.
There is often no apparent reason why a seizure occurs at one time and not at another. However, some people with epilepsy find that certain triggers make a seizure more likely. These are not the cause of epilepsy, but may trigger a seizure on some occasions.
You should see a doctor if you have had a possible seizure or similar event. Sometimes it is difficult for a doctor to confirm that you have had a seizure. The most important part of confirming the diagnosis is the description of what happened. Other conditions can look like seizures - for example, faints, panic attacks, collapses due to heart problems, breath-holding attacks in children.
Therefore, it is important that a doctor should have a clear description of what happened during the event. It may be that a person who witnessed your seizure may be able to give a more accurate description of what happened during your seizure.
There is no one test to confirm a diagnosis of epilepsy. However, tests such as brain scans, electroencephalogram (EEG - brainwave recordings) and blood tests may help to make a diagnosis.
Although helpful, tests are not foolproof. It is possible to have epilepsy with normal test results. Also, if an abnormality is found on a brain scan, it does not prove that it causes seizures.
However, tests may help to decide if the event was a seizure, or caused by something else. It is unusual for a diagnosis of epilepsy to be made after one seizure, as the definition of epilepsy is recurrent seizures. For this reason a doctor may suggest to wait and see if it happens again before making a firm diagnosis of epilepsy.
Epilepsy cannot be cured with medication. However, with the right type and strength of medication, the majority of people with epilepsy do not have seizures. The medicines work by stabilising the electrical activity of the brain. You need to take medication every day to prevent seizures. Deciding on which medicine to prescribe depends on such things as: your type of epilepsy, your age, other medicines that you may take for other conditions, possible side-effects.
One medicine can prevent seizures in most cases. A low dose is usually started at first. The dose may be increased if this fails to prevent seizures. In some cases two medicines are needed to prevent seizures.
It is unusual to start treatment after a first seizure. A common option is to wait and see after a first seizure. If you have a second seizure within a few months, more are likely.
Medication is commonly started after a second seizure that occurs within 12 months of the first. However, there are no definite rules and the decision to start medication should be made after a full discussion with your doctor.
The type of treatment you will be given often depends on the type of seizures you have and also if you are taking any other medication.
The success in preventing seizures by medication varies depending on your type of epilepsy. For example, if no underlying cause can be found for your seizures (idiopathic epilepsy), you have a very good chance that medication can fully control your seizures. Seizures caused by some underlying brain problems may be more difficult to control.
A trial without medication may be an option if you have not had any seizures over 2-3 years. If a decision to stop treatment is made, a gradual reduction of the dose of medication is usually advised over several months. You should never stop taking medication without discussing it with a doctor.
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