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].
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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, groanin
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
Surgery involves physically removing the part of the brain that is causing seizures or using 3-D imaging and focused radiation.
Neurostimulation
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].
1. Huff JS, Murr N. Seizure. (CC BY 4.0) [Internet]. StatPearls. StatPearls Publishing; 2022 [cited 2022 Mar 13]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430765/
2. Beghi E, Giussani G, Abd-Allah F, Abdela J, Abdelalim A, Abraha HN, et al. Global, regional, and national burden of epilepsy, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. (CC BY 4.0). Lancet Neurol [Internet]. 2019 Apr 1 [cited 2022 Feb 15];18:357–75. Available from: http://www.thelancet.com/article/S147444221830454X/fulltext
3. Hackett ML, Glozier NS, Martiniuk AL, Jan S, Anderson CS. Sydney epilepsy incidence study to measure illness consequences: The SESIMIC observational epilepsy study protocol. (CC BY 2.0). BMC Neurol [Internet]. 2011 Jan 9 [cited 2022 Feb 16];11(3):1–11. Available from: https://bmcneurol.biomedcentral.com/articles/10.1186/1471-2377-11-3
4. Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE Official Report: A practical clinical definition of epilepsy. (CC BY-SA 4.0). Epilepsia [Internet]. 2014 Apr 1 [cited 2022 Feb 15];55(4):475–82. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/epi.12550
5. Shorvon SD. The etiologic classification of epilepsy. (CC BY-SA 4.0). Epilepsia [Internet]. 2011 Jun 1 [cited 2022 Feb 16];52(6):1052–7. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1528-1167.2011.03041.x
6. Abood W, Bandyopadhyay S. Postictal Seizure State. (CC BY 4.0) [Internet]. StatPearls [Internet] [Internet]. StatPearls Publishing; 2021 [cited 2022 Feb 17]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526004/
7. International League Against Epilepsy. Childhood absence epilepsy. (CC BY-SA 4.0) [Internet]. 2020 [cited 2022 Feb 19]. Available from: https://www.epilepsydiagnosis.org/syndrome/cae-overview.html
8. International League Against Epilepsy. Epilepsy with generalized tonic-clonic seizures alone. (CC BY-SA 4.0) [Internet]. 2020 [cited 2022 Feb 19]. Available from: https://www.epilepsydiagnosis.org/syndrome/egtcsa-overview.html
9. Tan M. Epilepsy in adults. AFP [Internet]. 2014 [cited 2022 Feb 18];43(3). Available from: https://www.racgp.org.au/afp/2014/march/epilepsy
10. Epilepsy Implementation Task Force. Provincial guidelines for epilepsy surgery referrals in Ontario | Version 1.0 | Critical Care Services Ontario [Internet]. 2016 [cited 2022 Feb 18]. Available from: https://criticalcareontario.ca/wp-content/uploads/2020/10/Provincial-Guidelines-for-Epilepsy-Surgery-Referrals-Final-2016.pdf
11. Epilepsy Implementation Task Force. Provincial guidelines for the managementr of epilepsy in adults and children | Version 1.0 | Critical Care Services Ontario [Internet]. 2015 [cited 2022 Feb 18]. Available from: https://criticalcareontario.ca/wp-content/uploads/2020/10/Provincial-Guidelines-for-Management-of-Epilepsy-in-Adults-and-Children_January-2015.pdf
12. Swaminathan A. The Role of Neurostimulation in the Treatment of Epilepsy-A Commentary on the State of Its Use and Its Potential World wide. (CC BY). Int J Neurol Neurother [Internet]. 2020 [cited 2022 Feb 18];7(1):1–3. Available from: https://clinmedjournals.org/articles/ijnn/international-journal-of-neurology-and-neurotherapy-ijnn-7-097.pdf
13. Epilepsy Implementation Task Force. Provincial guidelines for the management of medically-refractory epilepsy in adults and children who are not candidates for epilepsy surgery | Critical Care Services Ontario | [Internet]. 2016 [cited 2022 Feb 18]. Available from: https://criticalcareontario.ca/wp-content/uploads/2020/10/Prov-Guidelines-for-Management-of-MRE-in-Adults-Children-not-candidates-for-Surgery_EN.pdf
14. Fisher R, Bakay R, Henderson J, French J, Baltuch G, Rosenfeld Y, et al. Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy. (CC BY-SA 4.0).
15. Kossoff EH, Zupec-Kania BA, Auvin S, Ballaban-Gil KR, Christina Bergqvist AG, Blackford R, et al. Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group. (CC BY-SA 4.0). Epilepsia Open. 2018 Jun 1;3(2):175–92.
16. Thurman DJ, Begley CE, Carpio A, Helmers S, Hesdorffer DC, Mu J, et al. The primary prevention of epilepsy: A report of the Prevention Task Force of the International League Against Epilepsy. (CC BY-SA 4.0). Epilepsia [Internet]. 2018 May 1 [cited 2022 Feb 19];59(5):905–14. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/epi.14068
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.
Epilepsy device developed by Bionics Institute researchers
In 2022, Bionics Institute researchers started investigating the effectiveness of stimulating the vagus nerve at abdominal level to treat epilepsy.
Our researchers have developed a small electrical device to deliver higher-intensity stimulation to the vagus nerve, which aims to improving seizure control without side effects.
The next phase of our research involves evaluating the effectiveness of abdominal vagus nerve stimulation to treat epilepsy and moving towards clinical trials.
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