Epilepsy is a long-term brain condition typically diagnosed when a person has repeated seizures. It is estimated to affect about 3 in every 100 Australians. *

About half the number of people who have a seizure, will only have the one, and it is important to know – that one seizure is not considered to be epilepsy. Under certain circumstances, anyone can have a seizure, especially when certain co-existing health conditions are present such as diabetes, certain heart conditions, fever and alcohol withdrawal capable – all of which can cause a seizure.

Epilepsy is not one single condition; rather it is a range of different conditions that can cause repeated seizures.*

Epilepsy is diagnosed when someone has recurrent seizures. It is a neurological disorder with the seizures caused by a temporary disruption of the electrical activity in the brain. While epilepsy can start at any age, it is more likely to be diagnosed in childhood or senior years.

There are many different types of epilepsies, and it is important to know that people’s experiences differ greatly. Some types of epilepsy are age-limited and the person eventually stops having seizures. For other types of epilepsy, it can be a life-long condition.

In Australia, around 250,000 people are currently diagnosed with epilepsy – that’s over 1 per cent of the population so chances are most people know someone with the condition.**

What is the Difference Between a Seizure and Epilepsy?

A seizure happens when the regular electrical impulses in the brain are disrupted, causing them to rapidly fire all at once. Seizures can vary, they can be very brief or last up to two or three minutes. Most seizures are generally over in less than two minutes. Some seizures go for longer and some are severe and some very subtle.

Under certain circumstances, anyone can have a seizure and it is important to know that not all seizures are diagnosed as epilepsy. Depending on where the seizure happens in the brain, they can cause changes in:

• Consciousness and awareness
• Sensation and feeling
• Emotions and behaviour, both short and long-term
• Movement

What are the Different Types of Epilepsy?

The International League Against Epilepsy revised its classification of seizures in 2017 to make diagnosing and classifying seizures more accurate and simpler. The classification of seizures names the different types of epileptic seizures and categorises them into groups. Words such as ‘tonic-clonic’ are still used while other classifications such as ‘partial’ and ‘grand mal’ are no longer used.**

Doctors consider the following three things when classifying a seizure:

1. Where in the brain the seizure starts (e.g., the onset of the seizure)
2. If the person is conscious / aware during the seizure
3. Whether the seizure involves bodily movement

Seizures can be divided into three major groups:

1. Focal Onset Seizures

Focal onset (formerly known as partial seizures) means the seizure starts in just one small region of the brain, though it may progress to a bilateral ‘tonic-clonic’ seizure that starts in one area of the brain and then spreads to both sides causing muscle stiffening and jerking.

These seizures can often be subtle or unusual and may go unnoticed or be mistaken for anything from being intoxicated to daydreaming. About 60% of people with epilepsy have focal onset seizures that are referred to as focal seizures.

Focal seizures can be divided into two groups relating to a person’s awareness during a seizure:

• Focal aware: the person is fully aware of what’s happening around them but may not be able to talk or respond (formerly known as simple partial seizures). These seizures are typically brief and are often called a warning or ‘aura’ seizure.
  
  
• Focal impaired awareness: formerly known as a complex partial seizure, awareness is affected in this type of seizure, with the person appearing confused, vague or disorientated.

2. Generalised Onset Seizures

Generalised onset means the seizure affects both hemispheres (sides) of the brain from the onset. Because of this, a person almost always affects awareness, so the terms ‘aware’ or ‘impaired awareness’ aren’t used. However, they can be classified further by movement:

• Generalised motor seizure: may involve stiffening (tonic) and jerking (clonic), known as tonic-clonic (previously known as grand mal) or other movements such as sudden jerks of a muscle or a group of muscles that may last no more than a second or two (Myoclonic).
• Generalised non-motor seizure: These seizures involve brief changes in awareness, staring, and some may have automatic or repeated movements like lip-smacking.
  
  

3.  Unknown Onset Seizures

In rare cases doctors might be sure that someone has had an epileptic seizure but are unable to determine what type of seizure it is. This could be because they don’t have enough information about the seizure, or the symptoms of the seizure are unusual.

Most people will only have one or two seizure types, which may vary in severity. A person with severe or complex epilepsy or develops significant damage to the brain may experience several different seizure types.**

When Should I See a Doctor?

You should always see a doctor if the following occur:

• You are unsure if you have had a seizure, even if it is your first
• You have been experiencing repeated seizures
• You are experiencing more seizures than normal

You should also see your doctor after a seizure if you are injured or if you are pregnant or have diabetes.

What Causes Epilepsy?

The cause of epilepsy is unknown in half of cases. We know that family history (genetics) can play an important role. Seizures or epilepsy can also be caused by anything that causes damage to the brain; however, seizures may not develop for years after the damage to the brain occurs often making it difficult to connect the cause.

Causes of epilepsy can include the following:

• A head injury or trauma
• A stroke or brain haemorrhage
• Brain infection or inflammation, such as in meningitis, encephalitis or a brain abscess
• Brain malformations or tumours
• Brain diseases, such as Alzheimer’s disease
• Chronic alcohol or drug use
• Genetic factors
• High or low blood sugar and other biochemical imbalances

How is Epilepsy Diagnosed?

An epilepsy diagnosis is based on your history of seizures with your doctor typically asking what symptoms you may have experienced and what you can remember before the seizure happened. For some people they may recall feeling strange before the onset of the seizure.

It can be useful to talk to anyone who witnessed the seizure and ask them exactly what they saw, especially if you cannot remember the seizure, and how long the seizure event went for. If possible, it can be helpful if a witness can film the seizure on a phone video.

Your doctor may order tests including blood tests, an EEG (electroencephalogram) and scans of the brain, such as a CT scan or an MRI.  While an EEG or brain scans can be helpful, some people who are diagnosed with epilepsy can have “normal” brain scans.

How Is Epilepsy Treated?

Fortunately, most people diagnosed with epilepsy can control the majority, if not all their seizures with antiepileptic medicines, and for some, by avoiding their specific triggers. The type of antiepileptic medicines and therapy will depend on specific factors such as how old you are and what types of seizures you are experiencing. Most antiepileptic medication will require regular blood tests to determine the level of medication in your blood is not too high or low or causing other medical problems.

Approximately 33 per cent of people with epilepsy become seizure-free with medication.**

You also may need different treatment for the underlying cause of the epilepsy, depending on what it is. Several new antiepileptic treatments are currently being researched, including:

• Stimulation of the Vagus nerves in the neck by a device placed under the skin
• Surgery on the area of the brain causing the seizures
• Strict medically supervised diet for some children with epilepsy, called a ketogenic diet
• Medical cannabis that has has been shown in some studies to help people control their seizures.

Keeping a diary that tracks the number and intensity of seizures can help monitor how well your epilepsy is being managed as well as help you identify what your triggers are. Your doctor may also help you develop an epilepsy management plan which can be useful for schools, employers and health professionals.

By working with your doctor, you will be able to determine if it is safe for you to drive or participate in high-risk activities like operating heavy machinery. Depending on the type of epilepsy you have, most people can return to driving after being seizure-free for six months.

What are the Triggers for Epilepsy?

You can help prevent seizures by taking your medication and avoiding the triggers. *

Typical triggers for epilepsy can include:

• Lack of sleep
• Missed or too much antiepileptic medication
• Physical and emotional stress
• Alcohol or drug use
• Flashing lights
• Caffeine
• Missing meals
• Being ill, fever or having an infection
• Vomiting, diarrhea or constipation
• Hormonal fluctuations, including menstruation
• Allergies
• Severe changes in temperature

Complications of epilepsy

Epilepsy can affect your life and you will need to pay more attention to your health. Some people may feel quite anxious or depressed when they are first diagnosed. Children with epilepsy may find it harder to learn or to concentrate. If you are pregnant or planning on pregnancy, you should talk to your doctor about the levels of your medication.

Having epilepsy can also put you at greater risk of injury, you might fall, knock yourself, or breathe in food or saliva when having a seizure. If you have epilepsy, you should typically avoid jobs using heavy machinery, working at heights or under water. You may also be prohibited from driving unless your seizures are controlled. Precautions may be required around water, including when swimming.

First Aid – What do I do If Someone is Having a Seizure?

Seizures usually last 1 to 3 minutes. If someone has a seizure that lasts for more than 5 minutes, or they are unresponsive, call an ambulance on 000.**

Steps to follow if someone is having a seizure include:

• Staying with the person
• Do not make loud noises or if there is bright lighting, turn down if possible
• Time the seizure if possible
• Keeping the person safe and protecting from injury (especially head injuries)
• Roll the person into a recovery once the seizure has stopped (or immediately if food/fluid/vomit is in mouth)
• Observe and monitor breathing
• Gently reassure until recovered
• Call 000 if the seizure lasts 5 minutes or more, or the person is unresponsive
  
  

Resources and Support

Support

To read more about staying healthy and avoiding complications, visit the Epilepsy Action Australia website at:

Epilepsy Action Australia
https://www.epilepsy.org.au/about-epilepsy/living-with-epilepsy/

Epilepsy Australia
https://epilepsyaustralia.net/

Sources

*https://www.healthdirect.gov.au/epilepsy

**https://www.epilepsy.org.au/about-epilepsy/

***https://www.healthline.com/health/epilepsy

By Tracey Hordern

Reviewed by the First Light Healthcare team