Epilepsy
Published by Bupa's health information team, November 2007.
This factsheet is for people who have epilepsy, or who would like information about it.
Epilepsy is a common condition which causes seizures, sometimes called fits, attacks or convulsions. These occur when some of the nerve cells in the brain become overactive and fire off uncontrolled random signals. About one to two in every 200 people have epilepsy.
- About epilepsy
- Symptoms of epilepsy
- Complications of epilepsy
- Causes of epilepsy
- Diagnosis of epilepsy
- Treatment of epilepsy
- If someone has a seizure
- Living with epilepsy
- Further information
- Questions and answers
- Related topics
- Sources
About epilepsy
Epilepsy is a neurological condition. This means it affects the brain and nervous system. Seizures can affect all or part of the brain. Areas of the brain called the temporal, occipital or frontal lobe are commonly affected. Each area of the brain performs different functions causing a different type of seizure - if the temporal lobe is affected, for example, this is called temporal lobe epilepsy.
Symptoms of epilepsy
There are over 40 types of epilepsy and seizure. Some of the common epilepsy types are listed below.
Partial seizures
Simple partial seizures
This is when one small part of the brain is affected. If you have this type of seizure you may experience one or more symptoms including:
- a sense of "déjá vu" (the feeling of having done something before) or a "jamais vu" sensation (feeling like something familiar is new)
- flashbacks
- an intense feeling of fear or joy
- a funny taste or smell
- numbness or tingling
- strange movements
- seeing flashing lights or coloured shapes
Complex partial seizures
This type of seizure affects a larger part of the brain and often lasts longer than other types of epileptic seizure. If you have a complex partial seizure you may be only partly conscious, and you may not recall what happened. Symptoms may include:
- lip smacking or chewing movements
- rubbing, stroking or fiddling with your hands
- looking from one side to another in a confused manner
- juddering movements
Generalised seizures
This is the type of seizure people most associate with epilepsy and is sometimes called grand mal epilepsy. This affects all or most of the brain at once. If you have this type of seizure you may lose consciousness and not recall what has happened.
Tonic-clonic seizures
If you have a tonic-clonic seizure, you may:
- lose control and fall to the ground
- lose consciousness
- have stiff muscles or jerking (involuntary) movements
- stop breathing for a few seconds
- have a rigid jaw and may bite your mouth or tongue
- lose control of your bladder or bowel
- be confused and drowsy when coming round
Clonic seizures
You will twitch repeatedly but won't fall to the ground and won't go stiff in this type of seizure.
Tonic seizures
If you have a tonic seizure, you may go completely stiff and fall to the ground.
Atonic seizures
During an atonic seizure, the muscles in your body go floppy. If you have this type of seizure, you may fall forwards to the ground.
Myoclonic seizures
Your leg, arm, head or body will jerk in this type of seizure. This usually only happens in the morning.
Absence seizures
You may lose consciousness, or more often just awareness, but this kind of seizure doesn't involve falling down or experiencing involuntary jerking movements. In fact, you may just look as if you are daydreaming. This is also called petit mal epilepsy and isn't as obvious as a tonic-clonic seizure. This kind of seizure is most common in children and can continue into adulthood.
Secondary generalised seizures
Secondary generalised seizures start as a partial seizure (either simple or complex) and develop into a generalised seizure such as a tonic-clonic seizure.
Nocturnal seizures
These seizures occur when you are asleep and can happen during the day or at night.
Complications of epilepsy
Status epilepticus
Any seizure or group of seizures that lasts longer than 30 minutes, without recovery in between is called status epilepticus. If this occurs during a tonic-clonic seizure, it's a medical emergency.
SUDEP
Sudden unexpected death in epilepsy (SUDEP) is rare and can occur in a small number of individuals. Your doctor can explain this risk.
Causes of epilepsy
The most common causes of epilepsy are:
- tumours and diseases in the brain
- genetic or inherited conditions
- alcohol, drugs or other potentially toxic substances
- head injuries
- infections which affect the brain such as meningitis
Images of the nervous system, including the brain (see Diagnosis), can highlight the cause of epilepsy in two out of three people.
Epilepsy with a known cause is called symptomatic epilepsy, if there is a likely cause it's called cryptogenic, and if there is no known cause it's called idiopathic.
Diagnosis of epilepsy
If you experience repeated seizures - whether once a year, or several times a day - you may have epilepsy. To diagnose epilepsy, your GP will ask you about your seizures such as what happens before, during and after. Family members or friends can often help describe what happens to you during a seizure.
Your GP may then refer you to a specialist for some tests. These can include an EEG (electroencephalogram), a brain scan which can be either a CT (computerised tomography) or an MRI (magnetic resonance imaging) scan and blood and urine tests. For information, please see Related topics.
Some people have one seizure and then never have another again. This can occur in one in 20 people. Small children can have a febrile convulsion if there is a sudden rise in their body temperature at the same time as a fit - this is not usually epilepsy. For information, please see Related topics.
Treatment of epilepsy
Self-help
Some people can identify the triggers of their seizures. Triggers can include:
- lack of sleep
- missing meals
- alcohol or recreational drugs
- flashing or flickering lights such as strobe lighting - this is photosensitive epilepsy and affects less than one in 20 people with epilepsy
- stress
- hormonal changes, for example at certain times of the menstrual cycle in women - this is called catamenial epilepsy
If you know what triggers a seizure, you may be able to find ways of avoiding the trigger to help to control your seizures. For example, if stress is a trigger you may benefit from relaxation and anti-stress exercises such as yoga. Keeping a diary to record your seizures can help to identify triggers.
Medicines
There is no cure for epilepsy, but epilepsy medicines can control seizures in around seven out of 10 people. These medicines may have side-effects such as drowsiness or a rash. Ask your doctor for more advice.
If you haven't had a seizure for two years, your specialist may suggest you gradually reduce the dose and stop taking your epilepsy medicines. This depends on the type of epilepsy you have and this may not be suitable for some people.
Complementary therapies
Aromatherapy, acupuncture and reflexology may help to reduce stress and anxiety, which can trigger epilepsy in some people.
Ask the therapist if the treatment you are considering is suitable for people with epilepsy. If you are taking any epilepsy medicines, check with your GP and pharmacist before taking or using any herbal remedy.
Some herbal remedies such as St John's wort may be helpful for depression but can interfere with epilepsy medicines. Evening primrose oil and star oil can trigger epilepsy in some people.
Diet
Some children with particular forms of epilepsy are recommended a ketogenic diet, which is high in fat and low in carbohydrates. This is individually calculated for each child by a dietician, so a certain amount of ketone bodies (produced when fat is burned) build up in the body. These appear to suppress seizures.
Vagus nerve stimulation
Vagus nerve stimulation (VNS) can reduce seizures in some people. This is when an electrical device, implanted in the chest, regularly stimulates a nerve in your neck called the vagus nerve. The vagus nerve then sends signals to areas of the brain. This treatment is only available if other medicines haven't helped and neurosurgery (brain surgery) isn't possible.
Surgery
You may be offered neurosurgery if your epilepsy is severe and is not controlled after trying several different epilepsy medicines. This can only take place if the epilepsy is associated with a specific area of your brain. Your specialist will be able to explain your options to you.
If someone has a seizure
It would be helpful for friends and family to know what to do if you have a seizure.
If someone has a tonic-clonic seizure where they lose consciousness and have fits, remember to keep calm and check the time to monitor how long the seizure lasts. Protect them from injury by doing the following:
- ask onlookers to keep back
- loosen clothing or jewellery around their neck
- cushion their head
- move away anything that could cause injury
- don't put anything in their mouth
When the seizure stops, put the person on their side in the recovery position. After they re-gain consciousness, re-assure them and let them rest quietly in a safe place.
Don't try to move or restrain the person and don't give them anything to drink until they are fully conscious again. You should call an ambulance only if:
- it's the person's first seizure, the seizure lasts more than five minutes or longer than usual, (if you know how long the person's seizure usually lasts)
- the convulsions happen again without the person re-gaining consciousness
- the person injures themselves during the seizure
- they have trouble breathing afterwards
If someone has a seizure that doesn't involve the loss of consciousness:
- guide them away from any possible danger such as traffic if they are in the road
- talk to them calmly and re-assure them
- stay with them until they feel well again
Living with epilepsy
People with uncontrolled epilepsy may need to avoid certain activities or jobs where it could be dangerous to have a seizure - such as flying a plane, working at heights, riding a bicycle in busy traffic or swimming alone.
Can I drive if I have epilepsy?
Whether or not you have a confirmed diagnosis of epilepsy, if you have a seizure or suspected seizure at any time you must stop driving. Ask your doctor and the DVLA for further advice.
If you stop taking epilepsy medicine, you can't drive while the medicine is being withdrawn or for six months afterwards.
Identity card or jewellery
It's a good idea for you to carry a card or wear a bracelet which says that you have epilepsy. If your epilepsy isn't controlled, you may decide to tell your family, friends, teachers and colleagues about the help you need if you have a seizure, or ask them to seek advice.
Further information
- Epilepsy Action
0808 800 5050
www.epilepsy.org.uk - The National Society for Epilepsy
01494 601300
www.epilepsynse.org.uk
Related topics
Sources
- British National Formulary (BNF). September 2006. BMJ Publishing Group, 2007. 52
- Epilepsy. The National Society for Epilepsy. www.epilepsynse.org.uk, accessed 4 January 2007
- Epilepsy. Epilepsy Action. www.epilepsy.org.uk, accessed 16 April 2007
- Epilepsy. NHS Library for Health. Clinical Knowledge Summaries. http://cks.library.nhs.uk, accessed 18 December 2006
- Status epilepticus: an evidence based guide. BMJ 2005:331:673-677
- The Epilepsies. The diagnosis and management of the epilepsies in adults and children in primary and secondary care. Clinical Guideline 20. October 2004 National Institute of Health and Clinical Excellence (NICE). www.nice.org.uk
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Adrian Winbow MB, FRCPysch, DPM, Consultant Psychiatrist, Cygnet Hospital; and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Date published: November 2007
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