What is epilepsy?
Epilepsy is the commonest serious neurological disorder in adults, and affects almost 500,000 people in the UK. About 75 people are diagnosed with epilepsy every day in the UK and approximately one in 20 people will experience a seizure at some point in their lifetime.
What causes epilepsy?
Epileptic seizures are caused by abnormal electrical activity in the brain. This can be due to a number of different causes, for example, serious head injuries, meningitis, strokes or brain tumours. In a large proportion of people, it is not possible to establish the cause of their epilepsy. Some forms of epilepsy are passed down through families and there is a large amount of research underway trying to understand which genes may be responsible.
Epileptic seizures may take a number of forms. One of the commonest types which tends to be depicted in television programmes or films is generalised tonic-clonic seizures. These are characterised by sudden loss of consciousness, collapse and limb jerking which typically last 1 to 2 minutes. During the seizures, people may bite their tongue or lose bladder function and they will be drowsy and confused for up to 30 minutes subsequently. Less obvious types of epileptic seizures include brief blank spells where people may sit motionless, staring blankly, unaware of their surroundings. Often during the seizures, people will develop unusual movements of their hands or face, such as picking or plucking at their clothes or chewing and repetitive swallowing.
How is epilepsy diagnosed?
It is important for people who are suspected of having epileptic seizures to be seen by a neurologist so that investigations can be performed and if necessary, treatment started. The investigations will usually include an MRI brain scan and EEG recording. The MRI brain scan will provide a detailed picture of the brain structure and this will help to establish the underlying cause of the seizures, such as a stroke or area of scarring. An EEG recording involves having 20 to 30 electrodes placed on the scalp and the brainwaves monitored for a period of time. Initially, this may be for 30 to 45 minutes. Longer periods of recording can also be performed and if necessary, people can be admitted to hospital to be monitored continuously for up to 2 weeks. The EEG recording will help the neurologist to understand more about the epilepsy and this may influence which form of treatment is advised.
How is it treated?
The mainstay of treatment is medication. There are over 20 antiepileptic drugs licensed for use in the UK and the neurologist will choose which of these is the most suitable, according to the type of epilepsy and seizures. Other factors, such as the age and gender of the patient are also important to take into account when choosing medication. Most patients who commence medication become seizure free. However, approximately 25% of people with epilepsy continue to experience seizures despite taking medication. For these, epilepsy surgery may be an option. This involves the surgical removal of the area of the brain that is causing the seizures. A large number of investigations are required before surgery can take place to make sure that the area of the brain from which the seizures arise is accurately located and that removal of that area of the brain will not cause additional problems, such as weakness down one side of the body or memory or language difficulties. This is undertaken in only a handful of specialist centres.
In addition to arranging investigations and recommending medication, managing a person's epilepsy involves discussing the impact of seizures and medication on a number of important lifestyle issues including safety, driving, contraception, pregnancy and work.
Further information is available from the Chalfont Centre for Epilepsy website
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London Epilepsy Clinics