Epilepsy is a neurological disorder that leads to recurrent seizures, caused by abnormal electrical activity in the brain. The symptoms can vary widely, ranging from brief lapses in awareness to severe convulsions, and may include confusion, unusual sensations, or loss of consciousness. Diagnosing epilepsy typically involves a thorough medical history, neurological exams, and diagnostic tests like EEGs or MRIs. Treatment options focus on managing symptoms and may include medications, lifestyle changes, and in some cases, surgery. While many individuals can achieve good seizure control with appropriate treatment, ongoing support and education are essential for living well with epilepsy. Epilepsy: learn about Epilepsy causes symptoms treatment other issues!
What is epilepsy?
Epilepsy is a condition associated with significant psychosocial consequences, primarily due to its stigmatizing nature.
To define epilepsy, it’s essential to understand the term “epileptic seizure” (EC). This clinical term refers to an excessive, abnormal, and synchronous discharge of neurons primarily in the cerebral cortex. Typically, this activity is intermittent and can last from a few seconds to several minutes.
Prolonged or recurrent seizures characterize “status epilepticus” (PE).
Epilepsy involves the recurrence of two or more unprovoked epileptic seizures. “Unprovoked” indicates that the seizure does not stem from factors such as traumatic brain injury, fever, concomitant disease, or hydro electrolytic alteration.
It is worth noting that there is an effort worldwide to raise awareness about epilepsy, through initiatives such as the Purple March campaign , which focuses on the importance of the issue and early diagnosis.
According to a survey carried out by the World Health Organization (WHO), the disease affects approximately 2% of the population of Brazil.³ Worldwide, around 50 million people live with epilepsy.
How does epilepsy arise?
Epilepsy is a neurological condition in which seizures occur when a part of the brain, for a few seconds or minutes, emits incorrect and excessive electrical signals. The manifestations of an EC involve convulsions, characterized by muscle twitching, and/or other symptoms, such as absences (shutdowns).
During the characteristic episodes of the condition, a network of brain cells begin to behave in a hypoexcitable manner. This is when the clinical manifestation of epilepsy appears.
What are the types of epilepsy?
Although it is a chronic neurological condition, epilepsy can be prevented and treated . However, when the patient does not receive due care, there is a greater risk of sudden death and physical, social and psychological comorbidities.
Another very important aspect that a significant portion of people are unaware of is that there are several types of epilepsy . Did you know that? Considering the relevance of this knowledge, let’s list the most common classification of epileptic seizures. Check it out!
Clinic seizure
Clinic seizures are characterized by repeated, rhythmic contractions involving the same muscle groups. In focal seizures, they involve muscle groups restricted to a segment of one half of the body. 5 In generalized seizures, on the other hand, they involve all muscle groups. Tonic crisis
Tonic seizures arise due to a sustained increase in muscle contraction that lasts from seconds to minutes. In focal seizures, they may occur in muscle groups restricted to one side of the body or, when they involve muscle groups on both sides of the body, they occur asymmetrically. 5 In generalized seizures, they involve bilateral muscle groups in a symmetrical manner.
Myoclonic seizure
Myoclonic seizures are characterized by sudden and brief contractions , which may be isolated or affect multiple muscles or muscle groups. 5 They may even involve the axial, proximal or distal muscles of the limbs.
Furthermore, in focal seizures, myoclonic seizures occur in muscle groups restricted to one side of the body. In generalized seizures, they involve bilateral muscle groups, with a predominance in the upper limbs and are not associated with altered consciousness.
Myoclonus-atonic seizure
It is characterized by generalized seizures composed of myoclonic jerks followed by a fall due to muscle atonia . In addition, myoclonic-atonic seizures usually occur in a type of epileptic syndrome called Dose epilepsy .
Epileptic spasms
Epileptic spasms can be defined as a sudden flexion or extension — or even a mixture of flexion and extension — of predominantly proximal and trunk muscles, of a more sustained duration than that of myoclonic seizures.
Manifestations of this class usually occur in a limited way, characterized by grimacing (changes in facial expressions), head rocking or subtle eye movements.
Myoclonic-tonic-clonic seizure
These are generalized seizures characterized by single or multiple bilateral limb jerks , of a clinic or myoclonic nature, followed by tonic-clinic seizures.
The manifestations are common in Juvenile Myoclonic Epilepsy.
Automation
This is a repetitive motor activity, more or less coordinated , usually associated with a cognitive alteration and which the patient does not remember. 5 The manifestations may consist of the continuation of motor activities that were being carried out before the crisis.
In such cases, the condition is called perseverative automatism. In general, the condition affects the individual as motor manifestations of focal seizures, but it can affect them, causing some generalized seizures.
Jacksonian March
This is the name given to the propagation of clinic movements along neighboring parts of the body unilaterally. Manifestations of this class may occur in some focal motor clinic seizures.
Hypsometer crisis
In the case of hypsometer seizures, focal seizures are characterized by cessation or decrease in motor activity .
Hypermeter crisis
Focal seizures in this type of epilepsy are characterized by bipedal motor activities , with pedaling and/or kicking movements of the lower limbs, or bimanual , with rubbing or clapping. They sometimes occur in association with sexual automatisms and autonomic alterations, with or without alteration of consciousness.
Versie crisis
In versine seizures, focal seizures are characterized by forced and sustained rotation of the trunk, head and/or eyes . Atonic crisis
It is characterized by the sudden loss or decrease of muscle tone without a preceding tonic or myoclonic event, lasting between one and two seconds and involving the head, trunk, jaw or limbs. in focal seizures, muscle groups restricted to a body segment are affected. In generalized seizures, the entire body musculature is affected, causing falls.
Typical absences
Typical absences are characterized by the interruption of activities , so that the patient presents a vacant look, a brief deviation of the eyes upwards and the complete loss of consciousness. The manifestation lasts between 10 and 30 seconds. In addition, there is an abrupt onset and end.
Atypical absences
Atypical absences are characterized by partial loss of consciousness, a vacant stare, and then loss of muscle tone. In addition, the onset and end are gradual. 5 Manifestations usually occur in Lennox-Gestate Epileptic Syndrome .
Myoclonic absences
These are crises characterized by absences associated with myoclonic jerks of the limbs associated with a greater or lesser degree of tonic contraction of the muscles of the shoulders and upper and lower limbs.
Myoclonic jerks of the upper limbs are accompanied by a progressive elevation. 5 The events have an abrupt onset and end and last between 10 and 60 seconds, occurring in Epilepsy Syndrome with myoclonic absences .
Myoclonic eyelid jerks
They consist of rapid and rhythmic contractions of the eyelids, with a frequency of at least three contractions per second. 5 The manifestation is associated with retropulsion of the eyeball and precipitated by eye closure.
The condition may occur in association with brief absences lasting between 3 and 6 seconds. Patients generally present with photosensitivity. These generalized seizures occur in a type of epilepsy called Jevons Syndrome .
What causes epilepsy?
The cause of epilepsy can be a brain injury caused by a strong blow to the head, an infection (such as meningitis), the abuse of alcohol and other drugs, etc. However , in many cases, it is not possible to identify what caused the condition.
The fact is that epilepsy affects all age groups and both sexes, but with a higher prevalence in the elderly and children . In this sense, it is also worth mentioning the study considered the most comprehensive in the world on the disease, in which more than 29 thousand patients were evaluated and 26 areas of the genome related to the disorder were detected.
The work published in Nature Genetics indicates that there are very specific changes in DNA that signal a higher risk of developing the brain condition. From this, the tendency is for the complexity of diagnosis to decrease and for there to be advances in the treatment of epilepsy.
What are the symptoms of epilepsy?
As we have seen, there are different types of epileptic seizures , and each one has different characteristics.
One of the most common is the tonic-clinic seizure, which many people know as a “seizure.” The condition can be easily identified, as the patient exhibits generalized muscle twitching , excessive salivation and, in many cases, bites the tongue and loses control over urine and feces.
However, other crises can be difficult for patients, family members and even doctors to recognize based on their symptoms . This is because the manifestations are quite subtle, such as staring, slight changes in behavior and automatic movements.
In children, for example, absence seizures are common, in which there is a brief interruption of the activity being carried out at the time. In addition, sometimes the condition is associated with “blinking” and/or automatic hand movements.
This type of crisis can occur many times a day and, in some cases, is not immediately recognized. 8In these circumstances , the problem only becomes noticeable when the child’s school performance begins to be compromised, which is usually identified by the teacher at school. 8 Then, the possibility is considered.
How to deal with epilepsy seizures?
Prevention through available treatments is always the best alternative . In fact, it is possible to prevent some causes of epilepsy, such as cerebrovascular diseases and neonatal anoxia. Thus, adequate prenatal care and good care during childbirth help to reduce the number of related cases.
Similarly, appropriate control of risk factors for cerebrovascular disease, such as high blood pressure and diabetes, leads to a reduction in the number of strokes. Therefore, cases of epilepsy resulting from strokes also decrease.
How is epilepsy treated?
Epilepsy is treated with medications that prevent abnormal electrical discharges in the brain, which are responsible for epileptic seizures.
It is estimated that at least 25% of epileptic patients in Brazil are in more advanced stages of the condition , requiring continuous medication throughout their lives.6 Although they represent the smallest proportion of patients with epilepsy, as the seizures are often refractory to treatment, they become candidates for surgical procedures. It is worth noting that the country has centers for surgical treatment of epilepsy authorized by the Ministry of Health.
Once the condition has been diagnosed, treatment begins, with results that are usually satisfactory in up to 70% of cases. 8 The other 30% are called refractory. These can only be treated through surgery, a ketogenic diet (with low carbohydrate intake) and neuromodulation (with electromagnetic waves).
Drug treatment
Drug treatment aims to modulate the occurrence of abnormal electrical discharges in the brain, which are responsible for epileptic seizures, as we have pointed out. Therefore, treating epilepsy is an extensive process that requires great persistence from the patient to maintain therapy over time and achieve control of the condition.
Depending on the medication prescribed, the patient may need to take it every 6, 8, 12 or 24 hours. Taking the medication at the dose and time indicated by the doctor is one of the most important actions. 8 In fact, adhering to the medication treatment is one of the main pillars of care in epilepsy .
In practice, there is usually a combination of medications. The fact is that most of them reduce neuron activity in a generalized way.
For some time now, researchers have been proposing some medications that are normally applied to other conditions, but which act on the risk genes for epilepsy highlighted in the aforementioned study.
Adverse effects
The goal of epilepsy treatment is complete control of seizures, without undesirable adverse effects , to allow patients to reach their full potential. Up to 60% of individuals with epilepsy will have seizure control with the first or second anti-seizure drug (AED), a level of control that can be achieved in primary health care.
The ideal treatment is monotherapy, a treatment with only one antiepileptic.5 Up to 50% of patients may experience adverse effects at the beginning, but they are usually mild and transient. In approximately 20% of cases, the FAC needs to be replaced due to persistent and undesirable side effects.
It is essential that the patient and their family members be informed about the most common adverse effects of FAC in use at the beginning of treatment. They should also be informed that these side effects are usually temporary and that there is no need to suspend the medication .
The prescribing physician may make adjustments, such as first trying to reduce the daily dose and/or increasing the number of administrations. 5 If adverse effects persist and are not tolerated, switch to another FAC — preferably one with a different adverse effect profile.
Adherence to drug treatment is essential and should be encouraged on an ongoing basis. 5 Non-adherence is often caused by unreported adverse effects, lack of acceptance/understanding of the situation of the person with epilepsy, cognitive deficit or a difficult-to-follow medication regimen, and occurs in up to 50% of patients.
Furthermore, it is worth noting that up to 30% of patients may experience sporadic seizures in the first six months of treatment, before the ideal dose of antiepileptic is reached.
Drug refractoriness
If seizures are not controlled with up to two appropriately chosen antiepileptics used at the maximum appropriate dose, there is less than a 10% chance of controlling them with another antiepileptic. 5 This is characterized by drug refractoriness .
When refractoriness is established, the patient should be referred to secondary or tertiary care for reevaluation, repeat electroencephalogram (EEG) and neuroimaging, and possible surgical treatment. However, seizure control with FAC, when possible, is still the best treatment for epilepsy.
When it comes to surgical treatment of epilepsy, it can control seizures in 50% to 80% of patients with refractory epilepsy, but only 50% of them will be able to do without FAC.
Duration and care
In order for us to consider that the patient has epileptic seizures under control, he or she must remain seizure-free for at least one year or for a period greater than three times the average interval between seizures, whichever is longer.
The minimum duration of treatment is two years. Patients who have been in remission for at least two years will have a 60% chance of remaining seizure-free after the FAC is removed.
After the end of medication administration, there is a reduction in the risk of recurrence of attacks during the first year. Approximately 40% of attacks will occur during withdrawal; 60% in the first six months and 90% in the first year.
How to start treatment?
The chosen FAC should consider the type of epilepsy under suspicion, as well as the individual’s experience and the adverse effect profile of the drug. Individualization of treatment for each patient is essential .
If seizures continue even with the target dose reached, it is recommended to review the diagnosis of epilepsy and adherence to treatment. If there is no doubt, it is recommended to establish a new target dose and gradually increase the daily dose until it is reached.
Again, if the seizures persist and the patient experiences intolerable adverse effects, it can be said that the individual is proven not to be responsive to this FAC. Therefore, the antiepileptic regimen in use must be changed.
Recognizing the common symptoms of epilepsy, seeking an early diagnosis and initiating appropriate treatment are fundamental steps to improving the quality of life of people affected by this condition .
In conclusion: Epilepsy causes symptoms treatment
epilepsy is a complex neurological disorder characterized by recurrent seizures that can significantly affect an individual’s quality of life. Understanding its causes and symptoms is crucial for effective diagnosis and treatment. With a range of treatment options available, including medication and lifestyle adjustments, many people with epilepsy can manage their condition successfully. Ongoing research and awareness are essential to improve outcomes and reduce the stigma associated with epilepsy, ensuring that individuals receive the support and resources they need to lead fulfilling lives.
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