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In this Health Hub article, we explore the signs & symptoms, causes, diagnosis, and treatments of epilepsy.

Epilepsy


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Epilepsy

Epilepsy

In this Health Hub article, we explore the signs & symptoms, causes, diagnosis, and treatments of epilepsy.

Introduction

The term “epilepsy” is a tendency of an individual to experience repeated seizures. A seizure (often called a fit, an attack, a turn or a blackout) occurs when there is a disruption of electrical activity in the brain. Seizures can take many forms since the brain is responsible for many functions. Hence functions such as intelligence, personality, mood, memory, movement, and consciousness can be temporarily disturbed during the course of an epileptic seizure.

Any person has the capacity to produce a seizure and many people have a single seizure at some time in their lives, but this does not constitute epilepsy. Anyone can develop epilepsy; it occurs in all ages, races and social classes.


Causes of Epilepsy

A seizure can be caused by a disturbance arising within the brain or, more rarely, by an external factor such as a temporary lack of oxygen or glucose. In at least 50%, f cases no cause is identified. A predisposition to seizure can be seen in some families. Individuals vary as to their threshold or resistance to seizures and it is probably linked to genetic characteristics.

Some stimuli may reduce the existing seizure threshold such as flickering light, some drugs, injuries or emotional upset. Severe brain injuries, caused by infections, birth trauma, stroke or tumour, or road traffic accidents may result in epilepsy developing as a consequence.

Heavy drinking can cause seizures, as well as interact with anti-epileptic drugs (AEDs), making them less effective. AEDs can heighten the effects of alcohol, while alcohol can make the side effects of AEDs worse. Heavy drinking is also associated with disrupted sleep patterns, and this can increase the risk of having a seizure


Facts & Figures

  • About 1 in every 20 people will have a single seizure at some time during their lives.
  • It is estimated that there are over 37,000 people with epilepsy in Ireland.
  • There are 130 epilepsy-related deaths in Ireland every year

Signs & Symptoms

Seizures can affect people in different ways, depending on which part of the brain is involved. Possible symptoms include:

  • uncontrollable jerking and shaking – called a "fit"
  • losing awareness and staring blankly into space
  • becoming stiff
  • strange sensations – such as a "rising" feeling in the tummy, unusual smells or tastes, and a tingling feeling in your arms or legs
  • collapsing

When to Call for Help

Call 999 for an ambulance if someone:

  • is having a seizure for the first time
  • has a seizure that lasts more than five minutes
  • has lots of seizures in a row
  • has breathing problems or has seriously injured themselves


Diagnosis

If you have a seizure, your GP may refer you to a specialist, usually a neurologist to find out what caused it. It’ll help the specialist if you can describe what you remember about your seizure in as much detail as possible - write notes, bring someone along who witnessed your seizure or bring a video recording of the seizure.

Your specialist may suggest a test to assess your brain activity called an electroencephalogram (EEG) or a brain scan to look for any problem in your brain. An EEG test involves placing small sensors onto your scalp to pick up electrical signals. For a brain scan, usually, a magnetic resonance imaging (MRI) would be the scan of choice. An MRI is a large tube that you lie inside which uses radio waves to create a 3D image of your brain.


Treatments

Treatment can help most people with epilepsy have fewer seizures or stop having seizures completely.

Treatments include:

  • medicines called anti-epileptic drugs – these are the main treatment
  • surgery to remove a small part of the brain that's causing the seizures
  • a procedure to put a small electrical device inside the body that can help control seizures
  • a special diet (ketogenic diet) that can help control seizures

Some people need treatment for life. But you might be able to stop treatment if your seizures disappear over time.


Medications

The objective of treatment is to prevent the occurrence of seizures by maintaining an effective dose of one or more antiepileptic drugs. Anti-epileptic drugs are selected based on the presenting epilepsy syndrome, concomitant medication, other conditions, and sex.

Common antiepileptic medications include:


TABLE


Side Effects of Medications

Side effects are common when starting treatment with antiepileptic medications. Some may appear soon after starting treatment and pass in a few days or weeks, while others may not appear for a few weeks.

For information about the side effects of your medicine, check the information leaflet that comes with it. General common side effects include:

  • drowsiness
  • a lack of energy
  • agitation
  • headaches
  • tremor
  • hair loss or unwanted hair growth
  • swollen gums
  • rashes – contact your GP or specialist if you get a rash, as it might mean you're having a serious reaction to your medicine

Contact your GP or specialist if you experience symptoms similar to being drunk, such as unsteadiness, poor concentration and vomiting. This could mean your dose is too high.

Always discuss with your doctor if you are thinking of having a baby. Some of these medicines can harm your unborn baby, particularly sodium valproate. Your doctor may suggest switching to another medication if there’s risk to your baby.


Free Medicines

In Ireland, if you have been diagnosed with Epilepsy you are entitled to get the medications used to treat this condition, free of charge. The scheme under which these medications are dispensed is the Long-Term Illness scheme (LTI) and you must apply and have an LTI number to be allowed get medicines free. The application needs to be filled out by your GP and your pharmacy before being returned to your local community health organisation.


Advice From The Pharmacist

  • Call 999 for an ambulance if you suspect someone is experiencing a fit for the first time, or if it lasts for more than 5 minutes, or is having serious breathing issues.
  • If you are diagnosed with epilepsy you are entitled to free anti-epileptic medications through the Long-term illness scheme.
  • If you experience a seizure or are diagnosed as epileptic, it is your responsibility to tell the National Driver License Service (NDLS) and your insurance provider of any long-term or permanent injury or illness that may affect your ability to drive safely.
  • If you are female taking antiepileptic medications and are thinking of becoming pregnant discuss with your pharmacist or doctor.


Supports Available In Ireland


References