Epilepsy

Epilepsy Clinics

Epilepsy

Epilepsy is a brain disease characterised by an enduring predisposition to generate epileptic seizures and the associated cognitive, psychological, and social consequences. [1,2] An epileptic seizure is a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain. [3] This means that a seizure is a symptom and epilepsy is the disease where there is as tendency to have recurrent seizures. The word Epilepsy (Greek: Επιληψία [Epilepsia]) derives from the ancient Greek word Επιλαμβάνειν meaning “to take hold of” or “seize upon” and refers to the seizure of a person undergoing an epileptic attack.

DEFINITION OF EPILEPSY:

Seizures have variable presentations: they can last from few seconds to a few minutes and can be associated with objective signs or subjective symptoms such as, loss of awareness, stiffening, jerking, a sensation that rises from the abdomen to the chest, a smell of burnt rubber or feeling of déjà vu. [2] Almost one in ten people will experience at least one seizure during their lifetime. [4] However, only one in 26 will develop epilepsy in their lifetime. [5] This is because the diagnosis of epilepsy requires the occurrence of spontaneous seizures in the absence of an acute brain disturbance; these are known as unprovoked seizures. [1] Seizures that occur in the presence of an acute brain insult or illness (such as in the context of high fever in children, acute stroke, alcohol withdrawal or concussion) are called acute symptomatic or provoked seizures and are not epilepsy; this is because they are not expected to happen in the absence of the acute problem. [1, 6] At any given time, 0.6-0.7% of the population suffers from epilepsy. [2] Although epilepsy can develop at any age regardless of gender or ethnic group, more often it starts in early childhood or after the age of 65 years. [2] There are many different types of seizures and epilepsy. Based on where in the brain they start, seizures are divided in two major groups: focal-onset and generalised-onset. [7] The International League Against Epilepsy has recently published a framework for the classification of seizures and epilepsies and revised the previous terminology from the 1980s. [7-8]

Click here for a detailed definition

SEIZURE TYPES & PRESENTATION

Link to Seizure Types and Presentation

EPILEPSY SYNDROMES

Link to Epilepsy Syndromes

OPERATIONAL CLASSIFICATION OF SEIZURE TYPES BY THE ILAE

Link to Operational Classification

ILAE CLASSIFICATION OF THE EPILEPSIES

Link to ILAE Classification

Epilepsy can be caused by many different brain insults including distinct, physical causes that alter the structure of the brain (such as head injury and brain tumour), infections (such as neurocysticercosis or herpes simplex encephalitis), disruptions in brain metabolism (such as mitochondrial disorders), immune conditions (such as limbic encephalitis) and genetic diseases (such as Dravet Syndrome). [2] The causes of epilepsy vary according to age. Current research shows that genetic conditions account for a significant proportion of epilepsy in very young children. On the other hand, strokes and dementia account for most new cases of epilepsy in the elderly. [2] In about 50% of cases however, the cause of epilepsy is unknown. [2] It is now accepted that certain people are simply more prone to developing seizures than others. A person’s genetic make-up may lead to lowering of the so-called “seizure threshold” in the brain and predispose them to having seizures. Indeed, a history of seizures in the family makes it more likely that a person will develop epilepsy.[2]

The diagnosis of epilepsy is primarily clinical and relies on a detailed medical history. [2] It requires the occurrence of at least one unprovoked (or reflex) seizure and evidence of high likelihood of further seizure(s) in the next 10 years. [1] The likelihood is high in the presence of specific abnormalities on brain imaging and/or the electroencephalogram (EEG), and in the case of two unprovoked seizures that are >24 hours apart. [1] Other conditions, such as sleep phenomena, blackouts, migraine aura or transient ischemic attacks may be confused with epilepsy and need to be excluded by the neurologist. [2] People with epilepsy are often burdened by other conditions such as depression, memory or sleep problems, headaches, learning or behavioural problems. [2] Such co-occurring (or comorbid) conditions are important to recognise and treat as they affect the management of epilepsy and a person’s quality of life. [8,9]

The care of people with epilepsy aims to eliminate or reduce seizures, minimize the adverse effects of treatment, manage medical and psychiatric comorbidities and ultimately improve quality of life. [2] Antiepileptic (or antiseizure) drugs are the mainstay of treatment in epilepsy. [2] Different drugs work better with different types of epilepsy, making the diagnosis of the specific type of epilepsy important. Unfortunately, medications fail to fully control the condition in about one third of patients and often cause intolerable side effects. [2] People who do not respond to two or more appropriately chosen antiepileptic drugs and/or have intolerable side effects are said to have drug-resistant epilepsy. [2] In these cases, brain surgery, neuro-stimulation or ketogenic diet may be considered. While many people require lifelong treatment, a substantial number of people improve to the point that medication is no longer needed or -in the case of children- they “grow out” of their epilepsy. The epilepsy is then considered resolved. [1]

Epilepsy is a multifaceted condition that is much more than the seizures that define it.

  • Seizures are not only associated with unexpected, transient disruption of activity but, importantly, may compromise safety, cause injury and even death. [2]
  • The risk of premature death is elevated in people with epilepsy compared to the general population. [10] An important -and potentially avoidable- cause of death is Sudden Unexpected Death in Epilepsy (usually referred to by its acronym SUDEP). This is diagnosed when a person with epilepsy dies suddenly and prematurely and no cause of death is found. [2]
  • Seizures carry work and driving restrictions in adults and can affect a child’s education and development.
  • Epilepsy is associated with many other medical and mental health conditions that not only affect the management of epilepsy, but are also affected by the treatment of epilepsy. [9]
  • The treatment of epilepsy is often associated with side effects, and may interfere with the management of co-existing conditions. [9] Perhaps the most relevant example of such difficulties is the management of epilepsy in pregnancy: the occurrence of seizures poses a risk to the mother and baby and; many antiepileptic drugs may cause birth defects and/or developmental problems (such as learning difficulties, ADHD or Autism) to the babies of mothers exposed to these drugs in pregnancy. [2]

All these factors have serious implications for the personal, family and social life of a person with epilepsy. Perron Institute has two Epilepsy Clinics and a dedicated Epilepsy & Pregnancy Clinic.

People with epilepsy and their families can obtain information, training and support from the two major epilepsy organisations in Australia:

Epilepsy Action Australia

Epilepsy WA

SUDEP

WOMEN ISSUES & PREGNANCY 1

WOMEN ISSUES & PREGNANCY 2

EPILEPSY: THE FACTS

Fact 1

Fact 2

  1. Fisher RS et al. Epilepsia 2014; 55(4): 475–482 [doi:10.1111/epi.12550]
  2. Devinsky O et al. Nat Rev Dis Primers 2018; 4: 18024 [doi:1038/nrdp.2018.24]
  3. Fisher RS et al. Epilepsia 2005; 46(4): 470–472
  4. Hauser WA & Beghi E. Epilepsia 2008; 49(Suppl. 1): 8–12. [doi: 10.1111/j.1528-1167.2008.01443.x]
  5. Hesdorffer DC et al. Neurology 2011; 76: 23–27. [doi.org/10.1212/wnl.0b013e318204a36a]
  6. Beghi E et al. Epilepsia 2010; 51(4): 671–675. [doi: 10.1111/j.1528-1167.2009.02285.x]
  7. Fisher RS et al. Epilepsia 2017; 58(4): 522–530. [doi: 10.1111/epi.13670]
  8. Scheffer IE et al. Epilepsia 2017; 58 (4): 512–521. [doi: 10.1111/epi.13709.]
  9. Gaitatzis A. Epilepsia 2012; 53(8): 1282-1293. [doi: 10.1111/j.1528-1167.2012.03528.x]
  10. Gaitatzis A et al. Brain 2004; 127: 2427–2432.

Epilepsy Clinics

For more information on Epilepsy clinics. Click Here

For more information on Epilepsy and Pregnancy clinics. Click Here