EPILEPSY: Demystifying Epilepsy in Simple Terms

Epilepsy is more than just having seizures. It is the tendency to have unprovoked seizures. A single episode of seizure does not necessarily mean that a person has epilepsy.

In fact, the International League Against Epilepsy defines epilepsy as:

1. At least two unprovoked seizures more than 24 hours apart, or
2. One unprovoked seizure with a high risk (greater than 60%) of having more within the next ten years (Note that the average person has a 5% risk of having a seizure in their lifetime), or
3. The diagnosis of an epilepsy syndrome.

Causes of Epilepsy

According to research carried out in 2020, the most common reasons Nigerians attribute epilepsy to include:

• Brain injury or infection
• Witchcraft
• God’s will
• Contact with someone who has epilepsy

However, according to a different study, most cases (about one-third) of epilepsy in Nigeria – like the rest of the world – have no identifiable cause. Other common causes of epilepsy in Nigeria include:

• Head trauma
• Fever (most common in children)
• Stroke
• Brain tumours
• Neonatal jaundice
• Birth asphyxia
• Brain infections

Pathophysiology of Epilepsy

What exactly happens during epilepsy?

To function normally, the brain is constantly balancing between excitation and inhibition. This means that not every part of the brain is working all the time, which is good. It is a good thing because, this way, the brain remains responsive to the environment without overworking itself or firing inappropriately.

When there is a disruption in this balance, seizures occur. The increased likelihood for a disruption to occur or to keep occurring is known as Epilepsy.

Types of Epilepsy

Epilepsy is classified into various groups based on the different types of seizures. Therefore, types of epilepsy include:

• Generalized Epilepsy
• Focal Epilepsy
• Combined Generalized and Focal Epilepsy
• Epilepsy of Unknown Nature

Generalized Epilepsy

People with generalized epilepsy have features of generalized seizures. The seizure begins somewhere in the brain and quickly spreads to both sides of the brain.

Generalized epilepsy may be genetic or of unknown causes (also known as ‘idiopathic’).

Genetic generalized epilepsy refers to epilepsy caused by a genetic factor. This doesn’t always mean that it is hereditary. Sometimes, it could be due to a new or sudden genetic change. Most cases of generalized epilepsy are genetic and often start before the age of 35 years.

Idiopathic generalized epilepsy usually involves multiple genetic alterations and sometimes environmental factors. Seizures can be Absence seizures (brief loss of awareness), Myoclonic seizures (sudden muscle jerks), or generalized Tonic-Clonic seizures (stiffening and shaking).

Focal Epilepsy

In focal epilepsy, seizures don’t involve both sides of the brain at the same time. Focal epilepsy can affect one spot (unifocal), multiple spots (multifocal), or an entire side of the brain (hemispheric) but not both hemispheres simultaneously. Epilepsy that starts after the age of 35 years is often focal.

Combined Generalized and Focal Epilepsy

Some people have features of both generalized and focal epilepsy.

Epilepsy of Unknown Nature

The term ‘unknown’ is used when it is clear that a patient has epilepsy, but it is difficult to tell (even on an EEG) if the seizures are focal, generalized, or a mix of both.

How To Administer First Aid for Seizures

• Clear the area and remove anything that can injure the person, such as fire, sharp objects, heavy machines, etc.
• Do not put anything in their mouth during a seizure. Trying to force a finger, spoon, or any other thing into a person’s mouth during a seizure can cause more harm than good.
• Do not leave the person alone until they fully recover.
• When the convulsion stops, turn the person on their side with their chest towards the floor and their chin upwards. Then, bend the elbow and knee on the side facing upward so that they are at right angles. This is what the person should look like:

• If a seizure lasts for more than five minutes without recovery, it is known as status epilepticus and requires urgent medical attention.

Lifestyle Advice for People with Epilepsy

• People with epilepsy should avoid triggers as much as possible.
• Activities like swimming and fishing should be avoided or done in the company of others to prevent drowning if a seizure occurs.
•  Certain career options like airplane pilot should be avoided.
• Ensure medication compliance and routine clinic visits.

Is Epilepsy Contagious?

No, epilepsy is not contagious. With the right combination of genetic changes and environmental factors, anybody can develop epilepsy. Therefore, there is no need to fear, punish, or stigmatize a person with epilepsy.

How Can Epilepsy Be Prevented?

While genetic or idiopathic epilepsy may not be prevented, common, known causes of epilepsy can be prevented in small ways. For instance:

• Always use helmets when riding bikes and motorcycles to protect your head in the case of an accident.
• Always wear protective gear when engaging in high-impact activities such as boxing, rock climbing, construction work, and so on.
• Fever and febrile diseases should be treated promptly, especially in children.
• Pregnant women should register for and attend routine ante-natal visits.
• Women in labour should seek the medical assistance of a licensed professional obstetrician and/or midwife.
• Control of blood pressure and cholesterol can help to prevent a stroke.
• Get vaccinated against meningitis.

Does Epilepsy Kill?

Seizures that occur in the water or around water can lead to drowning.

If a seizure occurs at a dangerous time, such as while driving or operating hazardous machinery, it can result in a fatal accident.

In rare cases, epilepsy can cause something known as Sudden Unexpected Death in Epilepsy (SUDEP), where individuals with epilepsy die suddenly from no identifiable cause. Most cases of SUDEP happen in sleep.

Can Epilepsy Be Cured?

There is currently no definitive cure for epilepsy. However, there are a number of treatment options that help to reduce how often the seizures occur. Some of these treatments include:

• Medications
• Epilepsy Surgery
• Diet

Conclusion

Epilepsy is a condition with repeated, unprovoked seizures. It can be caused by head injuries, infections, or genetic factors. Anybody can have epilepsy, so stigmatization should not be condoned.

When someone has a seizure, clear the area, don’t put anything in the person’s mouth, and put them in a recovery position after the seizure.

While there’s no cure, treatments like medication can manage seizures. It’s not contagious, and precautions can reduce risks.