Epilepsy
Also known as: seizure disorder, fits
A tendency to recurrent, unprovoked seizures: bursts of abnormal synchronised electrical activity in the brain.
Overview
Seizures take many forms depending on where they start: a focal seizure may cause twitching of one hand, an odd smell or a period of unresponsive staring; a generalised tonic-clonic seizure involves loss of consciousness, stiffening and jerking of the whole body. Most people with epilepsy become seizure-free on medication.
Causes
- Often unknown or genetic
- Scarring from stroke, head injury, infection or birth injury
- Brain tumours and malformations
- Hippocampal sclerosis
- Dementia in older people
Risk factors
- Family history
- Previous brain injury or infection
- Febrile seizures in childhood
- Stroke
Symptoms
What a clinician may find
- Usually normal between seizures
- Post-seizure confusion, bitten tongue, incontinence
Complications
- Injury during seizures
- Status epilepticus (a seizure over five minutes: an emergency)
- Sudden unexpected death in epilepsy (SUDEP)
- Driving and employment restrictions
- Depression
Diagnosis
A witness account or video is the most useful evidence. An EEG may show epileptic discharges; MRI looks for a structural cause; blood tests exclude metabolic causes and an ECG excludes a cardiac cause of collapse.
Treatment
Anti-seizure medication chosen by seizure type (levetiracetam, lamotrigine, valproate and others), taken consistently. Surgery, laser ablation or nerve stimulation for drug-resistant focal epilepsy. Seizure first aid education for family.
Prevention
Take medication regularly, sleep well, limit alcohol, avoid known triggers; helmets and safe driving reduce head injuries that cause acquired epilepsy.
When to seek care
Call emergency services for a seizure lasting more than five minutes, repeated seizures without recovery, a first seizure, injury, or difficulty breathing afterwards.