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Epilepsy

Published by Bupa's health information team, November 2009.

This factsheet is for people who have epilepsy, or who would like information about it.

Epilepsy is a common condition that 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 epilepsy
• Symptoms of epilepsy
• Complications of epilepsy
• Causes of epilepsy
• Diagnosis of epilepsy
• Treatment of epilepsy
• Living with epilepsy
• Questions and answers
• Related topics
• Further information
• Sources

About epilepsy

Epilepsy is a condition that affects your brain. Seizures can affect all or part of your brain. Commonly affected areas of the brain are the temporal, occipital or frontal lobes. Each area of the brain performs different functions so can lead to different types of seizure - for example, if the temporal lobe is affected, this is called temporal lobe epilepsy.

One in every 130 people in the UK has epilepsy. Five people in 100 will have a one-off seizure at some point in their life. It's important to note that febrile convulsions (seizures) in children aren't epilepsy.

Symptoms of epilepsy

There are over 40 types of epilepsy and seizure. Some of the common types are listed below.

Partial seizures

Simple partial seizures

This is when only a part of your brain is affected. If you have this type of seizure you may have one or more symptoms including:

• a sense of 'déjà vu' (the feeling of having done something before)
• an intense feeling of fear or joy
• a funny taste or smell
• numbness or tingling
• involuntary, jerky movements of your face or arms and legs
• seeing flashing or coloured lights

Complex partial seizures

This type of partial seizure affects a larger part of your brain and often lasts longer than other types of epileptic seizure. You may be only partly conscious and not recall what happened. Symptoms may include:

• making lip-smacking or chewing movements with your mouth
• doing repetitive movements such as fiddling with your clothing
• wandering around in a confused way
• making kicking movements with your arms or legs

Generalised seizures

This type of seizure affects all or most of your brain at once. You will lose consciousness and not recall what happened. There are different types of generalised seizure including those described below.

Tonic-clonic seizures

This is the type of seizure people most associate with epilepsy. There are two stages - the 'tonic' phase followed by the 'clonic' phase. You can also have either the tonic or the clonic phase alone.

During the tonic phase, you may:

• have stiff muscles, which can make you lose your balance and fall to the ground
• cry out

During the clonic phase you may:

• have jerking muscles
• have a rigid jaw and bite your mouth or tongue
• lose control of your bladder or bowel
• be confused and drowsy when coming round

Atonic seizures

During an atonic seizure, the muscles in your body go floppy. You may fall forwards to the ground.

Myoclonic seizures

Your leg, arm, head or body will jerk in this type of seizure. This often happens just after you have woken up. Many people have sudden jerks as they are falling asleep - although these are similar to myoclonic seizures, they aren't epilepsy.

Absence seizures

You will probably lose consciousness or awareness, but this kind of seizure doesn't involve falling down or having involuntary jerking movements. In fact, you may just look as if you're daydreaming - you may look blank and stare or your eyelids might flutter. Absence seizures are 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.

Nocturnal seizures

These seizures occur when you're asleep - during the day or at night.

Complications of epilepsy

Status epilepticus

If you have any seizure or group of seizures that lasts longer than 30 minutes, without recovering and regaining consciousness in between, this is called status epilepticus.

If status epilepticus happens during a tonic-clonic seizure, it's a medical emergency. If you're having this type of seizure and there is somebody with you, he or she must call for emergency help immediately.

SUDEP

Sudden unexpected death in epilepsy (SUDEP) is very rare and occurs in about one in 1000 people who have the condition, usually those who have severe epilepsy. Ask your doctor to explain this risk.

Causes of epilepsy

The most common causes of epilepsy are:

• a genetic or inherited condition
• problems during birth
• brain damage from a head injury
• brain damage as a result of alcohol, drugs or other potentially toxic substances
• brain damage from a stroke
• an infection in the brain (such as meningitis) or rarely, a tumour

Epilepsy with a known cause is called symptomatic epilepsy; if there is a likely cause, it's called cryptogenic epilepsy; if there is no known cause, it's called idiopathic epilepsy.

Diagnosis of epilepsy

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP will ask you about your seizures, such as what happens before, during and after. Family members or friends may be able to help you describe what happens.

Your GP may refer you to a specialist for some tests. These can include:

• an electroencephalogram (EEG) to record your brain wave patterns from the electrical signals in your brain
• a brain scan, such as an MRI scan or a CT scan - images of the nervous system, including the brain, can highlight the cause of epilepsy in two-thirds of people
• blood tests

Anyone can have a single epileptic seizure at some point in their life and then never have another one. This is why a diagnosis of epilepsy is usually only given if you have more than one seizure.

Treatment of epilepsy

There isn't a cure for epilepsy yet. The aim of treatment is to prevent seizures.

Self-help

Some people can identify the triggers of their seizures. Triggers can include:

• lack of sleep
• missing a dose of epilepsy medicine
• missing meals
• alcohol or illegal drugs
• flashing or flickering lights such as strobe lighting - this is called photosensitive epilepsy and affects fewer 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
• a high temperature - for example, if you're ill with flu
• certain medicines (other than those to treat epilepsy) - ask your GP or pharmacist for more advice

If you know what triggers your seizures, you may be able to find ways of avoiding them to help control your epilepsy. Keeping a diary to record your seizures may help you to identify any triggers.

Medicines

Epilepsy medicines - or anti-epileptic drugs (AEDs) - can control seizures in around seven out of 10 people who have the condition. AEDs prevent seizures from happening - they aren't used to stop seizures while they are happening.

Often you will be prescribed a single medicine. However, if it's not controlling your seizures well, you may be offered an alternative or a combination of medicines. AEDs can interact with other medicines, such as the contraceptive pill, so it's important to tell your doctor if you're taking anything else.

If you haven't had a seizure for two years, your doctor may suggest you gradually reduce the dose of your epilepsy medicines and stop taking them. This depends on the type of epilepsy you have and your individual circumstances - ask your doctor for more advice.

If you're having a seizure, there are other medicines that you may be given to try to stop it.

Surgery

If your epilepsy is severe and isn't controlled after trying several different epilepsy medicines, brain surgery (neurosurgery) may be an option. You will only be able to have this if the epilepsy is associated with a specific area of your brain. Your doctor can explain your options to you.

Vagus nerve stimulation

Vagus nerve stimulation (VNS) can reduce seizures in some people. An electrical device, implanted in your chest, regularly stimulates a nerve in your neck called the vagus nerve. The vagus nerve starts in your brain and runs through other parts of your body. It sends and receives messages between your brain and your body.

VNS is only available if other medicines haven't helped and brain surgery isn't possible.

Complementary therapies

It's important to get advice from your doctor before you use complementary therapies. Although they may help you to relax, there is no scientific evidence that any complementary therapy can control seizures.

It's important to ask your therapist if the treatment you're considering is suitable for people with epilepsy. Some essential oils used in aromatherapy can trigger a seizure. St John's wort may be helpful for depression but can interfere with epilepsy medicines.

Living with epilepsy

If you have uncontrolled epilepsy, it may mean you can't drive if there is a risk that you could have a seizure while driving. You can get more information about this from the Driver and Vehicle Licensing Agency (DVLA).

You may not be able to do certain activities or jobs where it could be dangerous to have a seizure. This could include flying a plane, working at heights, riding a bicycle in busy traffic or swimming alone. Ask your doctor for more advice.

Related topics

• Childhood seizures
• CT scan
• Emergency life support for adults
• MRI scan

Further information

Epilepsy Action
0808 800 5050
www.epilepsy.org.uk

The National Society for Epilepsy
01494 601 400
www.epilepsynse.org.uk

Sources

• Practice guidance: epilepsy. Royal Pharmaceutical Society of Great Britain, May 2008. www.rpsgb.org
• What is epilepsy? Epilepsy Action. www.epilepsy.org.uk, accessed 8 June 2009
• Epilepsy facts, figures and terminology. Epilepsy Action. www.epilepsy.org.uk, accessed 8 June 2009
• Describing seizure types. Epilepsy Action. www.epilepsy.org.uk, accessed 8 June 2009
• Epilepsy. GP Notebook. www.gpnotebook.co.uk, accessed 8 June 2009
• Epilepsy. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 8 June 2009
• Seizures. The National Society for Epilepsy. www.epilepsysociety.org.uk, accessed 8 June 2009
• Myoclonic seizures or jerks. Epilepsy Action. www.epilepsy.org.uk, accessed 13 October 2009
• Seizures. Epilepsy Action. www.epilepsy.org.uk, accessed 8 June 2009
• Status epilepticus. GP Notebook. www.gpnotebook.co.uk, accessed 8 June 2009
• Epilepsy. BMJ Clinical Evidence. www.clinicalevidence.com, accessed 8 June 2009
• The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care. National Institute for Health and Clinical Excellence (NICE), October 2004. www.nice.org.uk
• Possible seizure triggers. Epilepsy Action. www.epilepsy.org.uk, accessed 8 June 2009 www.epilepsy.org.uk, accessed 8 June 2009
• Pharmacists - the scientists in the high street. Aromatherapy and essential oils. Royal Pharmaceutical Society of Great Britain, September 2006. www.rpsgb.org
• Safety measures. Aromatherapy Trade Council.www.a-t-c.org.uk, accessed 8 June 2009
• Complementary treatment. Epilepsy Action. www.epilepsy.org.uk, accessed 8 June 2009
• St John's wort. Epilepsy Action. www.epilepsy.org.uk, accessed 8 June 2009
• Personal communication, Dr Jeff Kimber, consultant neurologist, Surrey and Sussex Healthcare NHS Trust
• Joint Formulary Committee, British National Formulary. 57th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2009
• At a glance guide to the current medical standards of fitness to drive. Driver and Vehicle Licensing Agency, September 2009. www.dft.gov.uk/dvla

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 Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: November 2009