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What is Epilepsy?

Epilepsy is a disease of the brain where there are recurrent unprovoked seizures [1].

About 46 million people live with epilepsy worldwide [2], of which 150,000 live in Australia [3].

Potential consequences of epilepsy include discrimination, need for medications, and mood disorders [3].

A seizure is a short-lasting expression of excessive, uncontrolled electrical impulses of neurons in the brain [1,4].

In a focal seizure, electrical activity begins in a localised area of the brain. In a generalised seizure, the electrical activity involves both sides of the brain at the same time.

If localised electrical activity spreads to the other hemisphere; this is called a secondary generalised seizure.

Following the seizure is the postictal state which may last five to 30 minutes. During this time the person can feel confused or sleepy, and almost a third do not recall a seizure [6].


Core motor symptoms

Focal onset – aware
  • Visual disturbance
  • Jerking of face/limb
  • Speech problems
Focal onset – impaired awareness
  • Possibly an aura e.g. déjà vu or fear +/- seizure
  • Purposeless, stereotyped repetitive motions (automatisms) e.g. lip smacking, hand movements, groaning
Generalised onset – non-motor
  • Absence seizure (previously known as petit mal) – staring +/- muscle jerking/shaking
  • Typically a few daily, each lasting about 10 seconds [7]
Generalised onset – motor
  • Tonic-clonic seizure (previously known as grand mal) – limbs stiffen and jerk, may be blueness of lips, tongue-biting and loss of bladder/bowel control.
  • Commonly provoked by sleep deprivation, fatigue and lower threshold to alcohol [8]

Examples of specific causes are [5]:

  • Idiopathic and generalised epilepsy
  • Neurofibromatosis
  • Down syndrome
  • Cerebral palsy
  • Head injury
  • Brain tumour
  • Meningitis
  • Stroke
  • Drugs

An epilepsy specialist is needed to confirm the diagnosis, using history, eyewitness accounts and examination.

Potential tests include:

  • Blood tests
  • Electroencephalography (EEG) which tests brain electrical activity via scalp electrodes.
  • Brain imaging such as magnetic resonance imaging (MRI) or computerised tomography (CT) scan
  • Positron Emission Tomography (PET) scan which provides brain activity mapping

Anti epileptic drugs

Anti-epileptic drugs (AEDs) are usually started only after a second seizure.

Treatment includes:

  • Education and counselling of patient, family/carers
  • Tailored AEDs for seizure control depending on epilepsy type and whether:
    • Child, adult, man or woman, or pregnant
    • Other medical issues and medications are present

Other treatments

About 30% of people have medically refractory epilepsy, meaning their seizures have not responded to two AEDs. Out of these people, two-thirds are thought to be suitable for surgery [10], which has about an 80% success rate [11].


Surgery involves physically removing the part of the brain that is causing seizures or using 3-D imaging and focused radiation.


If surgery is unsuitable, neurostimulation is an option, vagal nerve stimulation (VNS) being most established type [12]. Leads are surgically implanted on the left vagus nerve in the neck, and a pulse generator device implanted under the skin of the chest. Electrical pulses are programmed remotely which can be intermittent or on demand [13].

Another option is deep brain stimulation (DBS), where a surgically placed implant in the brain’s thalamus produces electrical impulses [14].

Ketogenic diet

The ketogenic diet has been around for decades, including the Atkins diet. It is an option for some children with medically refractory epilepsy or certain epilepsy syndromes [15].

Epilepsy device developed by Bionics Institute researchers

Researchers at the Bionics Institute worked closely with University of Melbourne’s Professor Mark Cook to develop the Epiminder device. Minder is a device that continually monitors brain activity outside the clinic, aiming to improve the diagnosis and clinical management for people living with epilepsy. Small, thin flexible electrodes are implanted under the scalp and electrical activity in the brain is recorded by a wearable microprocessor that sits behind the ear. This data is then transmitted to the cloud and analysed by expert technicians.

Currently, clinicians depend on patients to keep a diary of seizures in order to assess effectiveness of medication. However, many seizures occur without the patient’s knowledge. A clinical trial of the device in a small group of people showed that it is possible to obtain an accurate and long-term record of seizures, which can be used to adjust medication. In 2017, Epi-Minder Pty Ltd was established to commercialise the device so that people around the world can benefit from the technology.

The next steps will be to test the next generation of the device in a larger group of people and develop technology to enable seizure prediction using AI. For more information, go to our epilepsy research page

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Medical disclaimer

This article contains general information relating to a medical condition. Such information is provided for informational purposes only and does not replace medical advice given by your healthcare professional.


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