Epilepsy and Seizure

Dr. SHIU Ka Lock

Honorary Consultant in Neurology

Specialist in Neurology

Epilepsy is a common chronic neurological disorder. More than 50 million people are affected worldwide. The estimated lifetime prevalence of seizure in Hong Kong is around one in twenty, while the estimated prevalence of epilepsy is around one is every seventy thousand. Having seizure and epilepsy has significant implication on one's safety, daily lives, work, interpersonal relationships, driving and so much more.

Our cerebral cortex has billions of cells. Under normal circumstances, these cells receive and convey messages via electric waves across the brain. In people with epilepsy, bursts of electrical activity in the brain temporarily affect how it works and result in epileptic seizure.

Seizures can affect people in different ways, depending on which part of the brain is involved. Some seizures cause the body to jerk and shake, while others cause problems, such as loss of awareness or unusual sensations. Seizure can occur when one’s awake or asleep and typically passes in few seconds to minutes.

Types of Seizures

There are two main types of seizure, i.e. focal seizure and generalized seizure.

Focal seizure occurs where the abnormal discharges start from an area of the brain.  A person can present with repetitive twitching of body parts or strange sensations etc. with or without change in alertness.

Generalized seizure has to do with the abnormal discharges that affect both sides of the brain. For instance, in tonic-clonic seizure, a person presents with stiffening of limbs followed by generalized jerking. During limb jerking, the person may stare up, bite his/her tongue, or lose control of bladder or bowel. Following the attack, one may have headache or difficulty recalling what happened and feel tired or confused. Another example is absence seizures, during which one may look blank with eye fluttering. 

Some people may have a variety of funny sensations (auras) before a seizure attack. They may see shapes, hear sounds, feel stomach discomfort, or have “Déjà vu” before the attack.

What is Epilepsy?

Seizure is a symptom that can be provoked, meaning that the attack is caused by some known and reversible medical conditions such as alcohol withdrawal, extremely low blood sugar, other metabolic disturbances or infections. Some conditions such as syncope, muscle problem or psychological condition might present seizure-like symptoms that are not caused by abnormal brain activities. These are called non-epileptic seizures.

Epilepsy is a disorder with which patients has a tendency to have repeated seizures that start in the brain.  A person is diagnosed with epilepsy in case of two or more unprovoked seizures 24 hours apart, a single seizure with a high likelihood of recurrence or an epilepsy syndrome.

Epilepsy can be caused by any sorts of brain injury, such as stroke, tumour, infection or trauma. While epilepsy is due to genetic causes in some people, the cause remains uncertain in almost half of the cases despite extensive investigations.

Diagnosis

Your doctor will obtain as much information as possible about the seizure, and a bystander history is of utmost importance as the person with seizure might not be aware of or recall the attack. Apart from medical history, information on any trigger or warning, the initial symptoms, circumstances of seizure including activity engaged, abnormal limb movement, associated features, time to regain awareness, etc. are all important to help your doctor make the right diagnosis. A thorough physical examination will be performed to look for any clues on the cause of seizure and bodily injury. Investigations including blood tests, electroencephalography (EEG), brain imaging studies and lumbar puncture will be ordered depending on clinical needs.

What to Do if You See a Person with Seizure?

If you witness a tonic-clonic seizure and the person is unconscious, lay him/her down on the side in a safe place. Do not forcibly open his/her mouth and put object inside, or try to feed oral medication. Loosen the clothing around the neck and see if his/her breathing is alright. Accompany him/her until he/she is fully awake.

Most of the attacks will be aborted spontaneously and the person will recover slowly. If he/she does not recover within 15 minutes, has sustained an injury during seizure or has difficulty in breathing, he/she should be sent to hospital for immediate treatment.

Seizure Treatment

If you are diagnosed with epilepsy, your doctor will prescribe seizure-preventing medications (anti-convulsants) to reduce the chance of further attack. The choice will depend on your seizure type, sex, age, and other medical conditions. In general, around half of the patients have no further seizure while taking single anti-convulsant. Sometimes combinations may be needed to provide the best protection from seizure. Up to 80% of people with epilepsy can become seizure-free with medications.

As most anti-convulsants can cause dizziness, somnolence or difficulty in concentration, a “start low - go slow” approach may help ease these symptoms. However, if you develop skin rash, feel depressed or have thoughts of harming yourself or others, you are strongly advised to seek medical attention immediately.

Life with Epilepsy

Epilepsy is usually a lifelong condition, but most people with it are able to have normal lives if their seizures are well-controlled. Like many other chronic conditions, taking your medication regularly is of paramount importance for epilepsy. A regular daily routine, avoidance of alcohol, sleep deprivation, emotional stress and abstinence from high-risk activities are advised. You are also advised to keep a seizure diary and tell your doctor about your seizures control and any side effects with drugs.

Remember to check with your doctor before starting any new medications, and consult your doctor on questions related to reproduction, sports, driving, etc. In short, working closely with your doctor and adhering to prescribed medications are essential to helping control seizures and leading a full, balanced life.

Note:

1. Fong GC, Kwan P, Hui AC, Lui CH, Fong JK, Wong V. An epidemiological study of epilepsy in Hong Kong SAR, China. Seizure. 2008 Jul;17(5):457-64. doi: 10.1016/j.seizure.2007.12.005. Epub 2008 Feb 7. PMID: 18261935.