Epilepsy – Symptoms and Causes

Overview

Epilepsy is a common brain condition that causes recurring seizures. These seizures happen due to abnormal electrical activity in the brain—similar to an electrical storm.

About 3 million people in the United States have epilepsy, making it the fourth most common neurological disease after migraine, stroke, and Alzheimer’s disease.

Seizures can affect any process controlled by the brain. When someone has a seizure, they may experience unusual behaviors, feelings, and sometimes loss of awareness.

There are two main types of seizures:

• Focal Seizures: Start in a specific part of the brain.
• Generalized Seizures: Initially involves all areas of the brain.

Common Myths About Epilepsy

Several misconceptions exist about epilepsy that should be addressed:

• You cannot swallow your tongue during a seizure
• Never put anything in someone’s mouth during a seizure
• Don’t restrain someone having a seizure
• Epilepsy is not contagious

Who Develops Epilepsy?

While epilepsy can affect anyone at any age, certain groups face higher risks:

• Children
• Older adults
• People who have had a stroke
• People with brain tumors
• Those with genetic abnormalities
• Individuals with prior brain infections
• People with prenatal injuries
• Those with developmental disorders

In about half of epilepsy cases, doctors cannot identify a specific cause.

Seizure symptoms vary widely based on the type of seizure. Most people with epilepsy tend to have the same type of seizure each time, but some experience multiple types.

Common signs of a seizure include:

1. Temporary confusion
2. Staring spells
3. Uncontrollable jerking movements
4. Loss of consciousness
5. Feelings of fear or anxiety
6. Experiencing déjà vu

Diagnosis Process

Even after experiencing a seizure, an epilepsy diagnosis isn’t always immediate. If you have what seems like a seizure, it’s important to see a doctor.

The diagnostic process may include:

• Neurological examination
• Blood tests
• Electroencephalogram (EEG)
• CT scan
• Brain imaging (MRI)
• Neuropsychological tests

A team of specialists often works together on diagnosis and treatment, including neurologists, epileptologists, neurosurgeons, and other healthcare professionals.

Treatment Options

Accurate diagnosis forms the foundation of effective treatment.

Medications represent the first line of defense against epilepsy:

• Over 50% of people become seizure-free with their first medication
• When medications don’t work, other options include:
  • Surgery
  • Brain stimulation
  • Specialized care at comprehensive epilepsy centers

Patients undergoing treatment should keep a detailed seizure journal recording:

• Time of seizure
• Type of seizure
• Duration
• Potential triggers (missed medication, lack of sleep, stress, menstruation)

Living With Epilepsy

For many people with epilepsy, treatment can effectively control seizures. Some important aspects of managing the condition include:

1. Taking medications consistently as prescribed by your doctor.
2. Identifying and avoiding triggers that may cause seizures.
3. Regular follow-up appointments with healthcare providers.
4. Keeping a seizure journal to track patterns and effectiveness of treatment.

Some people require lifelong treatment, while others may see their seizures decrease or disappear over time. Some children with epilepsy outgrow the condition as they age.

Research and Progress

Though scientists don’t always know why people develop epilepsy, ongoing research continues to build knowledge and improve treatment options.

Warning Signs Before Seizures

Some people experience warning signals before a seizure begins. These warnings, called auras, can happen minutes before a seizure starts.

Common auras include stomach feelings, emotions like fear, a sense of familiarity (déjà vu), unusual tastes or smells, and visual changes like flashing lights or colors. Some people feel dizzy or lose balance.

Others might see things that aren’t really there. These warning signs give some people time to find a safe place before the seizure starts.

Seizures are grouped into two main types based on brain activity: focal seizures (affecting one brain area) and generalized seizures (affecting both sides of the brain).

Focal Seizures

• Focal seizures without awareness changes: These don’t cause blackouts but may change emotions or alter sensory perception. You might feel things look, smell, taste, or sound different. Some people experience jerking in a body part or sensations like tingling.

• Focal seizures with impaired awareness: These involve confusion or loss of consciousness. You might stare blankly or seem dreamlike. Some people make repetitive movements like rubbing hands, chewing, or walking in circles.

Different brain regions cause different focal seizure symptoms:

• Temporal lobe seizures often start with fear, joy, strange tastes/smells, or déjà vu. During these seizures, people may stare blankly, smack their lips, or make small hand movements.

• Frontal lobe seizures can cause head and eye turning, screaming, laughing, or repetitive movements like rocking.

• Occipital lobe seizures often affect vision, causing hallucinations or temporary blindness.

Generalized Seizures

Generalized seizures involve both sides of the brain and include several types:

Absence Seizures

• Often occur in children
• Brief episodes of staring into space
• May include subtle movements like eye blinking
• Last only 5-10 seconds
• Can happen up to 100 times daily
• Cause brief loss of awareness

Tonic Seizures

• Cause sudden muscle stiffening
• Mostly affect back, arms, and legs
• May cause falls
• Can affect consciousness

Atonic Seizures

• Also called “drop seizures”
• Cause sudden loss of muscle control
• Often result in falls
• Typically affect the legs

Clonic Seizures

• Create rhythmic jerking movements
• Usually affect the face, neck, and arms
• Involve repeated muscle contractions

Myoclonic Seizures

• Appear as sudden, brief jerks or twitches
• Usually affect upper body parts
• Often happen in clusters

Tonic-Clonic Seizures

• Most intense type of epileptic seizure
• Cause sudden loss of consciousness
• Begin with body stiffening (tonic phase)
• Progress to shaking and twitching (clonic phase)
• May cause tongue biting or loss of bladder control

Common seizure symptoms across different types may include:

• Temporary confusion
• Staring spells
• Muscle stiffness
• Uncontrolled jerking of arms and legs
• Loss of consciousness
• Psychological symptoms like fear or anxiety

People with epilepsy usually have consistent seizure types and similar symptoms each time.

When Medical Help Is Needed

Seek immediate medical attention if:

• A seizure lasts longer than five minutes
• The person doesn’t regain normal breathing or consciousness after the seizure
• Another seizure happens right after the first one
• The person has a high fever
• The person is pregnant
• The person has diabetes
• There’s an injury during the seizure
• Seizures continue despite taking anti-seizure medication

What Causes Epilepsy?

In about half of epilepsy cases, doctors can’t find a specific cause. For the other half, several factors may play a role in causing this brain condition.

Genes can influence epilepsy development. Some types run in families due to specific genes. However, genetic changes can also happen in a child without being inherited.

Most often, genes make someone more sensitive to things that trigger seizures rather than directly causing epilepsy.

Brain injuries from accidents can lead to epilepsy. This includes serious head trauma from car crashes or other injuries.

Several brain conditions increase epilepsy risk. These include brain tumors and blood vessel problems like arteriovenous malformations. For adults over 35, stroke is one of the main causes of epilepsy.

Infections affecting the brain or nervous system can result in epilepsy. These include meningitis, viral encephalitis, HIV, and certain parasitic infections.

Brain damage before birth sometimes leads to epilepsy. A baby’s brain may be harmed by the mother’s infection, poor nutrition, or oxygen shortage during pregnancy.

Developmental conditions often occur alongside epilepsy. People with autism have higher epilepsy rates. Those with epilepsy are more likely to have ADHD and other developmental issues. These connections may have genetic links.

Things That Trigger Seizures

Certain factors don’t cause epilepsy but can trigger seizures in people who already have the condition.

Most people with epilepsy can’t pinpoint specific triggers for their seizures, but they can usually identify factors that increase the likelihood of having one.

• Medication issues: Missing doses of anti-seizure medicine or taking too much
• Lifestyle factors:
  • Not getting enough sleep
  • High stress levels
  • Skipping meals
  • Dehydration
• Substance use: Alcohol and recreational drugs
• Environmental factors: Flashing lights or patterns
• Physical changes:
  • Hormonal changes during menstrual cycles
  • Illness or fever

Risk Factors

Several factors can raise a person’s chance of developing epilepsy:

• Age-related risks: Epilepsy often begins in childhood or older adulthood, though it can start at any age.
• Genetic factors: People with family members who have epilepsy face a higher risk themselves.
• Brain trauma: Head injuries account for many epilepsy cases. Protective measures like wearing seat belts in cars and helmets during sports can lower this risk.
• Blood vessel problems: Strokes and other vascular diseases damage brain tissue, potentially triggering seizures. Healthy lifestyle choices—limiting alcohol, avoiding tobacco, eating nutritiously, and exercising regularly—can reduce these risks.
• Cognitive decline: Older adults with dementia have an increased risk of developing epilepsy.
• Brain infections: Conditions like meningitis that cause brain or spinal cord inflammation can raise epilepsy risk.
• Childhood seizure history: While febrile seizures (those caused by high fevers) typically don’t lead to epilepsy, the risk increases when:
  • The fever-related seizure lasts a long time
  • The child has another nervous system condition
  • There’s a family history of epilepsy

Health Challenges

Living with seizure disorders can affect a person’s mental health. Even those whose seizures are well-controlled may face higher risks of emotional difficulties. These challenges may come from dealing with the condition itself or from medication side effects.

Common mental health issues include:

• Depression – feelings of sadness, hopelessness, or loss of interest that last for weeks.
• Anxiety – persistent worry, fear, or nervousness that interferes with daily activities.
• Suicidal thoughts – considering or planning to end one’s life.

Seizures can create dangers in everyday situations:

Safety Risks During Seizures

Situation	Risk	Prevention Tips
Falls	Head injuries, broken bones	Pad sharp corners at home, wear helmets during risky activities
Swimming	13-19 times higher drowning risk	Never swim alone, inform lifeguards
Driving	Car accidents	Follow driving restrictions, take medication regularly

Sleep problems are also common. Many people have trouble falling or staying asleep, which can trigger more seizures and create a difficult cycle.

Memory issues affect some people, making it harder to remember information or follow conversations.

While rare, life-threatening complications can occur:

1. Status epilepticus is a continuous seizure activity lasting over five minutes or multiple seizures without regaining consciousness. This can lead to brain damage if not treated promptly.

2. Sudden unexpected death affects about 1% of people with seizure disorders. The risk is higher for those with frequent or poorly controlled seizures, particularly tonic-clonic types.

Regular medical care, medication management, and safety precautions can help reduce these risks.