Epilepsy is a neurological condition characterized by seizures caused by disturbances in the electrical activity of the brain.1 A person may be diagnosed with epilepsy if he or she has:
1. At least two unprovoked (or reflex) seizures occurring more than 24 hours apart, or
2. One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60 percent) after two unprovoked seizures, occurring over the next 10 years, or
3. Diagnosis of an epilepsy syndrome.2
Seizures affect a variety of mental and physical functions, such as consciousness, movements, and awareness or thought changes.3
Epilepsy can be caused by thousands of medical conditions, from genetic mutations to traumatic brain injury.4 More often than not, no cause can be identified.1
A person may be diagnosed with epilepsy if he or she has had a seizure and has a significant risk of having additional seizures, or has been diagnosed with an epilepsy syndrome.2 There are many types of seizures, varying from brief disruptions of the senses, to short periods of unconsciousness, to convulsions.4 It is important to note that all people with epilepsy will have seizures, but not all people with seizures will necessarily be diagnosed with epilepsy.5
Classifying Epilepsies and Seizures
More than one-third of all patients with epilepsy have a seizure type called Complex Partial Seizures (CPS).6,7 Some people will experience an aura, often described as a strange sensation, immediately before the seizure. The first indication of this type of seizure may be a blank stare or arrest of motion. During a seizure, people with CPS may make repetitive and purposeless movements called “automatisms,” which include chewing, lip-smacking and picking at the air, for example. Impaired consciousness can occur during the seizure, resulting in an inability to respond to commands or interact with one’s surroundings. The average duration of the seizure is between 30 seconds to two minutes and after the seizure, people may be confused or fatigued.7
Epilepsy is also grouped into epileptic syndromes according to a set of common characteristics, like patient age, seizure type(s), and cause (etiology).8
Approximately one-third of people with all types of epilepsy are refractory, meaning their seizures are not completely controlled by multiple therapies.9 About half of patients with CPS do not achieve seizure control and are considered to have refractory CPS.10
There are many different types of epilepsy syndromes. Among particularly severe forms of epilepsy are Lennox-Gastaut syndrome (LGS) and Infantile Spasms (IS).
LGS is a rare and severe form of epilepsy that is typically diagnosed in childhood and often persists into adulthood.11 LGS is associated with multiple types of seizures with periods of frequent seizures, and daily seizures are common.12 Some of these seizures may cause falls, or “drop attacks,” which may result in injury.11,12 More than 90% of children with LGS become mentally handicapped.13
IS is a difficult-to-manage syndrome that usually starts in the first year of life, and onset is typically between four and eight months. Children with IS can experience hundreds of spasms per day. Many infants have neurological impairment prior to the onset of spasms. While spasms usually cease by age five, more than half of children with IS develop other types of seizures, and approximately one-fifth of children with IS develop LGS.14,15
The estimated proportion of the worldwide general population with active epilepsy at a given time is between 5 to 10 per 1000 people.16 Worldwide, around 70 million people have epilepsy.17
Epilepsy can occur in people of all ages and races. In industrialized countries, the onset of epilepsy is consistently high in the youngest age groups, with the highest incidence occurring during the first few months of life. The onset of epilepsy is the lowest during the adult years, but increases after age 70. In developing countries, the age patterns differ.18
Seeking diagnosis and care
Epilepsy can be diagnosed and managed by many types of doctors, including neurologists, pediatricians, internists, and family physicians. If possible, patients and their caregivers should seek out a neurologist with a special expertise in epilepsy – these epilepsy specialists are often referred to as “epileptologists.”19
Diagnosis is a multi-step process that includes a review of the medical history, a physical examination, and tests to analyze blood and other bodily fluids.20,21 Several additional diagnostic tools can be used, including an electroencephalogram (EEG), and brain imaging techniques. The precise tests and diagnostic tools that are used will vary.20
Following the diagnosis of epilepsy, the next step is to develop an appropriate management plan. There are multiple options, and sometimes a combination of these may be required to help manage the specific epilepsy type. Options include surgery, a special diet, medicines, complementary therapy, or stimulation of the vagus nerve. 22-25 Surgery can prevent seizures that are caused by an underlying correctable brain condition.22 Recent studies in both developed and developing countries have shown that up to 70% of newly diagnosed children and adults can manage their epilepsy with antiepileptic drugs (AEDs).17
It is essential that people with epilepsy seek comprehensive care from healthcare professionals.
- Epilepsy Foundation. About Epilepsy: The Basics. http://www.epilepsy.com/learn/about-epilepsy-basics. Accessed 4/4/16.
- Fisher, Robert; et al. A practical clinical definition of epilepsy. ILAE Official Report. Epilepsia; 2014; 55(4): 475-482.
- Epilepsy Foundation. What Happens During a Seizure? http://www.epilepsy.com/learn/epilepsy-101/what-happens-during-seizure. Accessed 4/4/16.
- Rogers SJ, Cavazos JE. Epilepsy. In: DiPiro JT, Talbert RL, Yee GC, et al., eds. Pharmacotherapy: A Pathophysiologic Approach. 7th edition. New York, NY: McGraw-Hill; 2008: 927.
- Lowenstein DH. Seizures and epilepsy. In: Fauci AS, Braunwald E, Kasper DL, et al., eds. Harrison’s Principles of Internal Medicine. 17th edition. Philadelphia, PA: McGraw-Hill; 2010: p1.
- Owolabi LF, et al. ClinicoElectroencephalography Pattern and Determinant of 2 year Seizure Control in Patients with Complex Partial Seizure Disorder in Kano,Northwestern Nigeria. Annals of Medical & Health Sciences Research. 2014; 4(2): 186–191.
- Carroll E. Medscape. Complex Partial Seizures. http://emedicine.medscape.com/article/1183962-overview. Accessed 4/4/16.
- Berg AT., et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia. 2010; 51(4), 676–685.
- Wheless J. Intractable Epilepsy: A Survey of Patients and Caregivers. Epilepsy & Behavior. 2006; 8:756-764.
- Treiman DM. Management of refractory complex partial seizures: current state of the art In: Neuropsychiatric Disease and Treatment. Phoenix, AZ; 2010; 6(1):297-308.
- Arzimanoglou A et al. Lennox-Gastaut syndrome: a consensus approach on diagnosis, assessment, management, and trial methodology. Lancet. 2009; 8(1):82-93.
- Conry JA et al. Clobazam in the treatment of Lennox-Gastaut syndrome. Epilepsia. 2009; 50(5):1158-1166.
- van Rijckevorsal, Kenou. Treatment of Lennox-Gastaut syndrome: overview and recent findings. Neuropsychiatric Disease and Treatment. 2008; Dec; 4(6): 1001–1019.
- National Institute of Neurological Disorders and Stroke. NINDS Infantile Spasms Information Page. http://www.ninds.nih.gov/disorders/infantilespasms/infantilespasms.htm. Accessed 4/4/16.
- Epilepsy Foundation. Infantile Spasms/West’s Syndrome. http://www.epilepsy.com/learn/types-epilepsy-syndromes/infantile-spasms-wests-syndrome. Accessed 4/4/16.
- Sander, WJ. The epidemiology of epilepsy revisited. Current Opinion in Neurology. 2003; 16: 165-170.
- Brodie, M.J., et al. Patterns of treatment response in newly diagnosed epilepsy. Neurology. 2012; 78: 1548–1554.
- Banerjee P and Hauser W. Chapter 5: Incidence and Prevalence. International League Against Epilepsy.http://www.ilae.org/booksales/data/pages/Comprehensive%20Textbook%20chapter1.pdf. Accessed 4/4/16.
- Epilepsy Foundation. What Kind of Doctor is Best? http://www.epilepsy.com/learn/diagnosis/diagnosis-101/what-kind-doctor-best. Accessed 4/4/16.
- Epilepsy Foundation. Diagnosis 101: The Basics. http://www.epilepsy.com/learn/diagnosis/diagnosis-101-basics. Accessed 4/4/16.
- Mayo Clinic. Epilepsy: Diagnosis. http://www.mayoclinic.org/diseases-conditions/epilepsy/diagnosis-treatment/diagnosis/dxc-20117234. Accessed 7/21/16.
- Epilepsy Foundation. Surgery. http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/surgery. Accessed 4/4/16.
- Epilepsy Foundation. Dietary Therapies. http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies. Accessed 4/4/16.
- Epilepsy Foundation. Seizures and Epilepsy Medications. http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/seizure-and-epilepsy-medicines. Accessed 4/4/16.
- Epilepsy Foundation. Devices. http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/devices. Accessed 4/4/16.
- Epilepsy Foundation. Epilepsy Statistics. http://www.epilepsy.com/learn/epilepsy-statistics. Accessed 4/4/16.