Epilepsy

*The information on this website is not intended to diagnose, treat, cure or prevent any disease.

What is Epilepsy?

Epilepsy is a general term used to describe seizures in which there is no identified underlying cause. The seizures typically occur over and over again in epilepsy, although they may vary in length and frequency with which they occur. Seizures which are related to other known health issues (such as brain tumors) are not considered epilepsy. A caveat to this would be health conditions which have occurred but otherwise resolved or were treated, yet seizures persist. This could include conditions like a stroke or infections (such as meningitis). This is known as epileptogenesis.

Epilepsy is a relatively common condition, affecting around 40 million people worldwide. The vast majority of the cases occur in developing countries. Mortality rates are very low; however, death can occur from this disease. Epilepsy can arise at any age. The Western world, there is a bi-modal development; i.e., it begins more often in either babies or the elderly. Up to 10% of people may experience a seizure before the age of 80. In this group of people, there is approximately a 50% chance that at least one more seizure will occur.

Seizures can be divided into convulsive and non-convulsive categories depending on how they appear. The classic type of seizure most people are familiar with is convulsive seizures. These seizures may result in shaking and alternating tensing and relaxing of the muscles, and uncontrolled movements. The second category are non-convulsive seizures. When these occur, the suffered may simply experience a loss of reduced sense of consciousness.

Often following a seizure, there is a “post-ictal” period which can result in clouded thinking, tiredness, headaches, unusual behavior, psychosis, and difficulty speaking. The post-ictal period may last from minutes to hours.

Common Symptoms

Depending on the types of seizures, the symptoms can vary quite substantially. Common manifestations include:

Temporary loss of consciousness
Uncontrolled jerking/shaking/muscle tension and relaxation
Appearing “absent” in which no shaking occurs, but a loss or altered state of consciousness occurs
Confusion
In the post-ictal period:
- Headaches
- Tiredness
- Confusion
- Brain fog
- Inability to use certain parts of the body for minutes to hours (“Todd’s Paralysis)

Diagnosis

A thorough neurologic examination is typically required, in addition to other tests to rule out conditions which can cause seizures. These tests may include:

Blood tests: These are important for ruling out certain causes of seizures like low blood sugar, anemia, and low calcium.
Cerebrospinal Fluid Analysis: This is a helpful test in ruling out infectious diseases or inflammatory causes as a source of seizures.
Electroencephalogram (EEG): This is an electrical recording of the activity in your brain. Seizures alter the normal electrical signals in your brain. This can help identify causes of seizures or aid in further classifying your epilepsy. In some instances, they may try to induce seizures in order to record the activity in your brain. This is performed in a tightly controlled setting.
Magnetic Resonance Imaging (MRI): This test is important for ruling out structural issues within the brain, such as tumors, congenital malformations, or evidence of certain infectious processes.
Functional MRI (fMRI): A functional MRI is able to track blood flow in the brain. These are often used prior to undergoing brain surgery to avoid cutting important areas.
Positron Emission Tomography (PET): This is another imaging which allows doctors to see different functional areas of the brain. A radioactive material is given intravenously which will then reveal changing patterns of blood flow.
Single-photon Emission Computerized Tomography (SPECT): This may be used as a follow-up test if the other tests were unable to identify the origin of your seizures within the brain.
Magnetoencephalography (MEG): This is a type of test which measures the magnetic field fluctuations in the brain during a seizure.
Infectious Disease Testing: Diseases like toxoplasmosis, Lyme disease, or fungal diseases may be tested for to rule them out as potential causes of seizures.
Heavy Metal Testing: This is another rule-out for seizures. Past toxicities such as lead or mercury may cause epileptogenesis, leading to a lifetime of seizures.

Treatment Options

The following treatments may be recommended:

Pharmaceuticals and Medical Procedures:

Anti-seizure Medications/Anti-convulsants: There are many different drugs which may be prescribed to control seizures. They are divided into narrow and broad-spectrum anti-epileptic drugs. Many people find that a combination of drug works best. Many of these medications can have a host of other side effects, such as sedation, memory issues, feeling tired, weight gain, or suicidal thoughts.
- Narrow Spectrum Drugs: These are for specific types of seizures.
  - Carbamazepine:
  - Diazepam
  - Divalproex
  - Eslicarbazepine
  - Ethosuximide
  - Gabapentin
  - Methsuximide
  - Oxycarbazepine
  - Perampanel
  - Phenobarbital
  - Phenytoin
  - Pregabalin
  - Rufinamide
  - Tiagabine
  - Vigabatrin
- Broad Spectrum Drugs: These work on many different types of seizures. They are often prescribed for people who have more than one type of seizure.
  - Clonazepam
  - Clorazepate
  - Ezogabine
  - Felbamate
  - Lamotrigine
  - Levetiracetam
  - Lorazepam
  - Primidone
  - Topiramate
  - Valproic Acid
  - Zonisamide
Antimicrobials: If your epilepsy is thought to be related to infectious causes such as Lyme disease, these drugs may be beneficial in treatment.
Medical Marijuana: This is not available in all localities, but is becoming increasingly more common. Some people find that this provides control when other medications fail.
Brain surgery: Some cases of epilepsy are refractory to medications. The goal of surgery is to remove the diseased portion of the brain which is generating the seizures. This requires careful planning and will certainly require some of the more advanced techniques in brain imaging described above. There is potential for permanent damage to the brain with these procedures, although it is uncommon. Good candidates for surgery have seizures which appear to be originating in small areas of the brain not associated with speaking, vision, or hearing. You may still need medication following surgery.
Vagus Nerve Stimulation: This is a device that is surgically implanted under the skin and connected to the vagus nerve. Stimulation of this nerve appears to reduce the frequency of seizures by up to 40%. It can greatly improve quality of life, but usually does not eliminate the need for medication.
Deep Brain Stimulation: Electrodes are implanted into specific areas of the brain and connected to a generator.

Non-pharmaceutical options:

There are many non-pharmaceutical options (many of which have significant evidence supporting their use and may be prescribed by your doctor).

Ketogenic Diet: This approach is particularly effective in some children. By shifting the body’s metabolism toward utilization of fat rather than carbohydrates as a fuel source, seizures can be suppressed. A proper ketogenic diet can be difficult to adhere to, and may be particularly challenging in growing children. This diet should not be implemented in children without consultation of a nutritionist due to the ease with which normal growth and development can be impaired. Delayed growth, constipation, and kidney stones are possible consequences of this diet. More recent studies have shown that long-term ketogenic diets can also be detrimental to the heart, as well. In some children, a few years of this diet can effectively manage and potentially eliminate seizures.
Biofeedback: Biofeedback teaches you to modify your own physiologic responses. You may be able to begin to recognize the early signs of seizures and take measures to prevent them, particularly if they are triggered by events such as stress or lack of sleep.
Acupuncture: Although clinical evidence has not shown acupuncture to be effective at preventing seizures, it may be helpful in managing the stress of life as well as for reducing the pain of headaches and muscle aches which may occur after a seizure.
Chiropractic Care: Spinal manipulations may be helpful in controlling seizures, or addressing the pain and discomfort which can follow a seizure.
Music Therapy: In children, listening to a specific Mozart sonata called K448 resulted in reduced seizures. Other types of music are not effective, and may even be more likely to trigger seizures (such as jazz).
Cannabidiol (CBD) Oil: This oil derived from cannabis plants seems to be very effective in some children for management of epilepsy. Availability may depend on your state, but because it lacks THC, it is frequently legal.
Mind-Body Techniques
- Meditation
- Hypnosis
- Exercise
- Yoga
Aromatherapy: Either traditional aroma-therapy or simply sniffing a strong odor when a seizure feels imminent may be helpful in preventing the onset.
Chelation Therapy: Heavy metal toxicosis can potentially lead to seizures. Using drugs like EDTA or Succimer can help draw these toxins out of the body
Mold Binders: Toxic molds may also contribute to epilepsy. Using mold binders to cholestyramine or apple pectin can help draw toxins out of the body.
Probiotics: Maintaining good GI health through probiotics is important for maintaining systemic health. Probiotic supplementation seems to help some people better manage their seizures, possible through influence on the vagus nerve.
Other Supplements:
- Magnesium: This is an essential mineral many people are deficient in, which may lower the seizure threshold.
- Vitamin E: Deficiency of this essential vitamin has been found in some people with epilepsy. This vitamin is important for neurologic health and has strong anti-oxidant quality.
- Vitamin D: Deficiency due to anti-seizure medications is common in epileptics. Supplementation may be helpful in controlling seizures and preventing other health conditions.
- Melatonin: Melatonin levels are often low in people who suffer from seizures, but spike during the seizure itself. There is conflicting evidence on the usefulness of melatonin – in some people it may be helpful, but in the vast majority of people it showed no great benefit, or even made seizure control worse.
- Herbal remedies: There are many herbal remedies which purportedly help control seizures in some people. These are commonly used by sufferers of epilepsy:
  - Burning Bush
  - Groundsel
  - Hydrocotyle
  - Lily of the Valley
  - Mugwort
  - Mistletoe
  - Tree of Heaven
  - Valerian
  - Peony

Prevention

Preventing epilepsy from starting is usually not possible for most people. As the cause of epilepsy is usually unknown, there are rarely specific steps people can take in order to avoid the onset. Generally, however, living a healthy lifestyle with plenty of exercise and a healthy diet makes you less likely to suffer conditions like strokes which can eventually lead to epilepsy.

For people with epilepsy, taking measures to avoid triggering seizures is as important as taking the prescribed medications. For many people, seizures become more likely when they are tired or stressed. Getting a full night’s sleep and practicing relaxation techniques can be the most effective therapies. Alcohol is well-known to lower the seizure threshold, and should be avoided in people with epilepsy. Other drugs like nicotine, caffeine, and other stimulants may also make seizures more likely to occur and should be avoided.

Stress and anxiety are also major triggers of seizures for many people. Incorporating exercise, meditation, and relaxation techniques are important reducing your risk of having seizures. Avoid stressful situations when at all possible. Uncontrolled emotional issues may also serve as a trigger. Seeing a therapist regularly to help manage underlying issues can be helpful.

Sometimes, overstimulation of the senses can also trigger seizures. People who are sensitive to overstimulation should avoid bright, flashing lights which may be present in movies, at parties, on television, or in video games.

Causes

The causes of most cases of epilepsy is never identified. There are known genetic mutations associated with an increased risk of epileptic seizures, however. There may be mutations of a single gene or multiple genes which result in epilepsy. There have been over 20 genes identified to be associated with epilepsies. For other people, there may have been an inciting event which eventually leads to seizures, even after the inciting event has apparently passed.

In older people, a variety of conditions are associated with the onset of epilepsy. Strokes, or cerebrovascular accidents, are one of the most common triggers of epilepsy in older people. Depriving parts of the brain of blood flow and oxygen may result in permanent damage and an alteration in the seizure threshold of the affected area of the brain. Head trauma is another major factor in the development of seizures in older people, even if the brain does not appear to be overtly injured on MRI or other tests. Alzheimer’s, which is typically thought of as primarily affecting memory, is also linked to the development of epileptic seizures.

In younger children and babies, genetic causes are often associated. Epileptic seizures are often associated with other conditions, such as autism. Up to 1/3 of autistic children may also have concurrent epilepsy. Children with Down’s Syndrome are also at higher risk. Children may also be affected by complications during birth, particularly if they were deprived of oxygen for a short period, or if the mother abused drugs and/or alcohol during pregnancy.

Children are also at higher risk of infections such as meningitis or encephalitis which may lead to lasting damage and contribute to the development of seizures. These may be viral, bacterial, or fungal in origin. Adults are also at some risk of these conditions, although they are considerably less common. Sometimes, parasites like toxoplasmosis or aberrantly migrating worms like the beef tapeworm can end up in the brain, causing seizures.

Other major causes linked to seizures include infectious causes such as Lyme disease, which can manifest in many different ways in people and can be difficult to diagnose. It should be considered if you live in a Lyme-endemic region, such as the northeastern United States. Toxic mold is also a possible factor if you developed seizures later in life. Chronic mold exposure is associated with a variety of health conditions which develop later in life. Heavy metal toxicity is also something to be considered. This may occur in children, especially those who grow up in houses with lead-based pain that often peels and is eaten, or if the water sources are contaminated with lead or industrial wastes.

Cancer should also be considered in older people who suddenly develop seizures. Brain tumors can begin as microscopic abnormalities and they may not be evident for weeks to months on tests like MRIs. Even if a brain tumor is identified and treated/removed, there may be lasting damage which leads to continued seizures.

Finally, traumatic brain injuries are another major cause of epilepsy. These can range from obvious head injuries which might occur in a car wreck to less obvious, chronic injuries sustained over a period of years, as might occur due to participation in sports.