Epilepsy is a neurological condition that can be serious and life-threatening if not properly treated. It affects around 600,000 people in the UK – that’s approximately one in 100 people – with an average of 87 people getting an epilepsy diagnosis every single day (Epilepsy Action). The earlier the condition is diagnosed, the sooner treatment can begin and the better the outcome for the patient will be. But, despite the condition’s prevalence, many people don’t know the common signs of epilepsy or what treatment can look like.
In this article, we’re going to look at early epilepsy in more detail, exploring how a diagnosis is made, the importance of an early diagnosis, and what treatment options are available for people with the condition.
How are Seizures and Epilepsy Diagnosed?
One of the main symptoms of epilepsy is seizures, but having a seizure doesn’t necessarily mean you have epilepsy. Seizures occur when there is a burst of electrical activity in the brain that alters how the brain works for a period of time. Depending on the type and length of the seizure, the effects can range from mild to severe, so it’s important to determine what caused the seizure as soon as possible.
There are lots of other conditions that affect the brain and nervous system that can cause you to have a seizure, such as an infection like meningitis, cerebral edema (fluid around your brain), a head injury, or excessively high salt or sugar levels in your blood. With this in mind, epilepsy can take time to diagnose as other conditions need to be ruled out first. This will be done through a series of tests, but first, a neurologist or an epilepsy specialist will seek to identify what type of seizure you’ve had.
Types of seizures
There are nine main types of seizures, all of which affect people differently. Not all seizures cause a person to shake or fit; some cause other symptoms like loss of awareness. Seizures can happen whilst you’re awake or asleep, and sometimes they can be triggered by certain things, like flashing lights or feeling tired. Most seizures last a few minutes, but some go on for longer.
These are the most well-known type of seizure and are often depicted in films or TV shows. They are what most people think of when it comes to an epileptic seizure. They involve a loss of consciousness, followed by stiffening of the body (tonic phase) and then jerking movements (clonic phase) of the limbs. You may also lose control of your bladder or bowels, and you might bite your tongue or lips.
Myoclonic seizures involve sudden, brief, shock-like movements of a muscle or group of muscles, a bit like an electric shock. They can occur in isolation or as part of another seizure type, such as tonic-clonic seizures, and generally happen just after you wake up.
Tonic seizures involve a sudden onset of muscle stiffness or rigidity, usually in the back, arms or legs. You might fall over if you are standing up when the seizure occurs, and your breathing may be temporarily impaired.
Clonic seizures involve repeated, rhythmic jerking movements of a muscle or group of muscles. They can occur in isolation or as part of another seizure type, such as tonic-clonic seizures, and they generally last for a couple of minutes and cause you to fall unconscious. The difference between a clonic seizure and a tonic-clonic seizure is that with a clonic seizure, you won’t go stiff at the start of the seizure.
Simple partial (focal) seizures / auras
Simple partial seizures occur when you are awake and aware. They are sometimes referred to as ‘warnings’ or ‘auras’ because they can indicate that another type of seizure is going to follow. Common symptoms of simple partial seizures include stiffness or twitching of a part of the body, numbness or tingling, visual or auditory hallucinations, and feelings of intense joy, fear or déjà vu.
Complex partial (focal) seizures
Complex partial seizures occur when you are awake, but you lose awareness, will be unresponsive during the seizure, and won’t be able to remember it afterwards. Symptoms of complex partial seizures can include confusion, altered consciousness, repetitive movements, picking at or fiddling with things/clothes, making random and uncontrolled noises, and chewing or swallowing excessively.
Also known as drop attacks, atonic seizures involve a sudden loss of muscle tone or strength, causing you to collapse or fall to the ground. They are brief and you will usually be able to get back up immediately.
This is a medical emergency and involves a prolonged seizure or a series of seizures without recovery in between. It can occur with any seizure type and requires immediate medical attention to prevent brain damage or other complications.
Diagnosing seizures into a specific type can be useful in making a diagnosis and informing an effective treatment plan. To do this, you may be asked to keep a seizure diary to keep track of the frequency and symptoms, as well as potential seizure triggers.
Tests Used in the Diagnosis of Epilepsy
In addition to looking at the type of seizures you’ve experienced, the diagnosis of epilepsy involves several other tests that a neurologist will undertake in order to determine the underlying cause of your symptoms and recommend appropriate treatment. Generally speaking, you will:
Undergo a neurological exam
The first step in diagnosing epilepsy is to undergo a comprehensive neurological exam. During this exam, your doctor will evaluate your muscle strength, reflexes and coordination, as well as your vision, hearing and speech. They will also assess your cognitive abilities, like memory, attention and language skills, to determine if any other neurological conditions may be present. Lastly, they will look at your medical history and ask you questions about your lifestyle to rule out anything else that could be causing seizures.
Have an Electroencephalogram (EEG)
An EEG is a non-invasive test that records the electrical activity of your brain. An EEG is the most common test used to diagnose epilepsy because it can detect abnormal brain waves that may be associated with seizures. During the test, you will lie down while small electrodes are placed on your scalp, which record the electrical signals of your brain.
Undergo brain imaging
Brain scans, like magnetic resonance imaging (MRI) and computed tomography (CT) scans, are often used when diagnosing epilepsy because they can effectively detect any structural abnormalities in your brain that may be causing your seizures. These tests can also rule out other conditions that might be causing your symptoms, such as tumours or stroke.
What if it’s Not Epilepsy?
As mentioned, there are lots of different medical conditions that can cause seizures and epilepsy-like symptoms. If epilepsy is ruled out, your neurologist may conduct further tests to determine what else could be responsible for your symptoms, and they will work with you to determine a bespoke treatment plan that aims to enhance your quality of life.
Treatment for Epilepsy After a Diagnosis
An epilepsy diagnosis is life-changing, but fortunately, there are a wide range of treatments available for people with epilepsy which can help them manage their symptoms and improve their quality of life.
The treatment for epilepsy in the UK typically begins with medication. There are several anti-epileptic drugs (AEDs) available, which work by stabilising the electrical activity in the brain and reducing the frequency and severity of seizures. These medications are usually taken orally and on a daily basis. Common types of AEDs include:
- Sodium valproate
Generally, you will start on a low dosage and work your way up to a higher dosage that stops your seizures. It’s not uncommon for the first type of medication you try to not be effective; a lot of people with epilepsy try many different types of AEDs at varying doses before they find the right one for them. Generally speaking, AEDs are one of the most effective ways to treat seizures in most people.
Like all medications, AEDs can have side effects. Most side effects wane after a few days or weeks, but some AEDs have side effects that don’t appear for a few weeks. Common side effects include:
- Hair loss or growth
If you have a rash or persistent side effects that don’t go away after a few weeks, speak to your doctor as it’s possible that you’re having an adverse reaction to the medication.
If you have epilepsy and you’re thinking about having a baby, make sure you speak to your doctor first, as some times of AEDs can be harmful to unborn babies.
In addition to medication, there are other treatment options available for people with epilepsy, including epilepsy surgery. This involves removing the part of the brain responsible for seizures without causing any other damage. In terms of treating epilepsy, surgery is highly effective and can stop seizures entirely – but it is typically only available to those whose epilepsy can’t be managed through AEDs.
Other non-medication treatment options include vagus nerve stimulation (VNS) therapy and deep brain stimulation (DBS), both of which use small devices to stimulate the nerves in the brain and reduce the frequency and severity of seizures.
Due to the prevalence and severity of epilepsy, research into the condition and treatments is ongoing. Some patients with epilepsy may be suitable candidates for clinical trials, depending on the research that is being undertaken and the patient’s condition. It can be difficult to be put forward for a clinical trial on the NHS due to the complexity of suitability, but at Dementech Neurosciences, we can provide suitable candidates with a faster route to clinical trials.
Lifestyle and home remedies
In addition to the above, there are also lifestyle changes that can help people with epilepsy manage their symptoms. For example, getting enough sleep, avoiding triggers such as stress and flashing lights, and following a healthy diet and exercise plan can all help reduce the frequency and severity of seizures in some people.
Epilepsy Diagnosis and Treatment at Dementech Neurosciences
At Dementech Neurosciences, we have a team of epilepsy specialists and expert neurologists who can work with you to determine the cause of your symptoms, make an appropriate and timely diagnosis, and develop a personalised treatment plan for you. To find out more about how we can help you, please contact us today.