Epilepsy

Epilepsy is a condition where the entire brain or individual areas thereof are overactive. Too many signals are sent, which can trigger what are known as epileptic seizures. In some cases, this just causes individual muscles to twitch but it is also possible for the whole body to convulse and loss of consciousness to ensue.

Epilepsy can occur at any age. Some people have their first seizure as a child, others only once they are older. No physical disorders are generally noticeable between seizures but the risk of a further seizure places mental strain on many of those affected.

An epileptic seizure can occur in several ways. A single arm or leg can convulse, but also the whole body. This can be over in a matter of seconds or even go unnoticed. During a seizure, some people can remain fully conscious or only have a brief loss of awareness. Others lose consciousness though.

Epileptic seizures usually pass relatively quickly. If a seizure lasts for more than five minutes, “status epilepticus” is said to occur. This is an emergency that needs to be treated quickly with medication. An emergency also exists if multiple seizures occur in quick succession.

Most people have no noticeable physical disorders between seizures.

Certain areas of the brain control movement, others control speech, feelings and individual perceptions. Billions of nerve cells are involved in these processes. They interact with each other through the use of electrical and chemical signals. When an epileptic seizure occurs, the interaction between the nerve cells is temporarily disrupted.

This leads to certain areas of the brain or the entire brain becoming overactive and the nerve cells sending too many signals. This explains why epileptic seizures are sometimes described as a “brainstorm” that can trigger a seizure in the rest of the body.

It is often impossible to clearly determine the cause of epilepsy.

However, there are several possible triggers, such as injuries, inflammation of the meninges or the brain, strokes or tumors. Such cases are referred to as “symptomatic epilepsy”.

Evidence also exists of a hereditary disposition, as epilepsy is found in some families over several generations.

A condition is only regarded as epilepsy if multiple epileptic seizures have occurred without apparent triggers. According to statistics, this occurs in almost one in 100 people. If you add occasional seizures to this, about 10 in 100 people have experienced an epileptic seizure at some point in their lives.

A person’s first epileptic seizure can occur at any age. Many people are still children when epilepsy begins. In rarer cases, the first seizure can occur between the ages of 40 and 59. Only after that age the number of people with their first seizure increases.

Many people only ever have a single seizure or only suffer from epilepsy for a few months or years. Others have the condition permanently. About 50 percent of people who have had a first seizure also have a second. The risk then becomes greater – in the couple of years after their second seizure, about 7 in 10 people have a third.

However, these are averages. The risk of someone having a further seizure strongly depends on the cause: in the case of a known cause such as a brain disorder, the risk of a further seizure is about twice as high as with an unknown cause or genetic predisposition.

Some people can remain free from seizures for years by taking medication – and remain so even after stopping their medication. Others can only prevent seizures if they keep taking medication. About 3 in 10 people affected suffer from regular epileptic seizures despite various treatments.

Epilepsy is usually diagnosed when

• at least two seizures have occurred
• at least 24 hours have passed between seizures
• there are no indications of an occasional seizure

It can also be diagnosed if there is a significantly heightened risk of a second seizure. Rarer, special forms of epilepsy can also be diagnosed that are classed as epilepsy syndromes.

Further to the physical and neurological examinations, blood samples are also taken.

In addition, the electrical activity in the brain is usually measured using an electroencephalogram (EEG). Certain patterns in this regard can indicate an increased risk of seizure. However, an EEG alone does not suffice to diagnose epilepsy. Magnetic resonance imaging (MRI) is usually also performed. This helps to determine whether changes in the brain have occurred that could trigger the seizures.

If appropriate, the cerebrospinal fluid (liquor) from the lumbar spine area is taken with a syringe and examined (lumbar puncture). This examination is usually performed if inflammation of the brain or meninges is suspected.

The treatment depends on the type of epilepsy and the progression of the condition. Most patients are treated with medication known as anti-epileptic drugs. There are various different forms of medication from different groups of active substances. If a low dose does not have sufficient effect, this can first be increased. If there is still no success, several active substances are combined or a drug from a different group of active substances is tried.

As many people only ever have a single seizure, treatment is not instantly required. It usually only commences once a patient has had a second seizure. If there is an increased risk of further seizures, for instance in the event of a brain disorder, treatment may be appropriate even after the first seizure. It is important for patients to fully discuss their personal situation with their doctor.

If epilepsy is treated with medication, this is normally taken for several years.

Usually, the examination and treatment partly take place in a hospital. Some outpatient facilities and clinics specialize in treating people with epilepsy.

If further seizures occur despite medication, medical intervention is an alternative. The options include:

• Surgery: if it is determined that a certain part of the brain is triggering focal seizures, this can sometimes be removed. However, this is not always possible.
• Vagus nerve stimulation: this aims to inhibit the overactivity of the nerve cells. A pacemaker is fitted under the skin in the chest area and emits electrical impulses. This occurs through contacts in the neck area that are connected to the “vagus nerve”.

Complementary psychotherapy can also be useful. This can help patients deal with the condition and improve their quality of life. No scientific evidence yet exists as to whether psychotherapy can also help reduce the number of seizures.

More detailed information about epilepsy, e.g. on treatment options for adults, can be found at gesundheitsinformation.de.

In the event of an epileptic seizure, the most important things that those providing help can do are to protect the person having the seizure from injury and to remain calm. If the seizure lasts for more than five minutes or if several seizures occur in quick succession, the emergency services should be contacted by calling 112. A severe seizure can result in hospitalization.