Epilepsy and epileptic seizures: causes, differences and treatment

Dr. Antonio Yusta Izquierdo is a Cum Laude doctor and specialist in Neurology. He is an expert in the treatment of Multiple Sclerosis, Headaches and Epilepsy. He applies all treatments with Botulinum Toxin. He currently combines teaching with his position as Head of the Neurology Service at the University Hospital of Guadalajara.

Definition of epilepsy

Epileptic seizures are episodes of sudden onset of abnormal activity in a group of neurons in the brain. This group of neurons, with this abnormal activity, is called epileptic focus. The clinical symptoms of the seizure will depend on where in the brain the focus is located. If the abnormal activity spreads to the rest of the brain, then loss of consciousness and loss of postural tone with falling to the floor will occur. It is necessary to differentiate between epilepsy and epileptic seizures. Epilepsy is a disease that, in addition to epileptic seizures, will have other symptoms. The latter can be very varied, such as mental retardation, paralysis of the limbs, etc… Epileptic seizures can be triggered not only by lesions in the brain, but also by alterations in metabolism, drug use or drugs that alter the functioning of the brain.

These epileptic seizures are very frequent and about 5% of the population will suffer a seizure during their lifetime. However, epileptics are only 5 out of every 1,000 people. The causes of epilepsy and epileptic seizures can be very varied, depending on the age of the subject.

What happens during an epileptic seizure?

Epileptic seizures are caused by the existence of a focus of abnormal activity of a group of neurons and depending on where it is located, so will be the clinical expressivity. If the focus is located in the area of movement control, jerks will appear in the upper or lower limb, if it is in the area of speech the patient will not be able to emit any sound, if it is located in the area that receives the sensitivity will appear “tingling” or “numbness” in body areas, if it is in the occipital region will appear halos of colors; etc.. The duration of an epileptic seizure varies from less than one minute to no more than 5 minutes. Most commonly, they last less than two minutes.

Causes of an epileptic seizure

The causes of epilepsy and epileptic seizures vary widely, depending on the age of the subject. Epilepsy can be divided into primary epilepsy and secondary epilepsy. In primary epilepsy the cause is not clearly known (it is suspected to be genetic). In the secondary epilepsy the cause is known, which can be very varied as malformations in the brain, tumors, cerebral infarcts, lesions in the brain by traumatism, etc… This causes will also depend on the age, in children the most frequent etiology are genetic alterations and malformations of the structure of the brain, which are often accompanied by mental retardation. In adults, tumors and cerebral infarcts are the main causes.

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Prevention of epileptic seizures

The first prevention is to avoid the causes of seizures (excessive alcohol intake, illicit drugs, certain drugs, etc.). It is essential for epileptics, who are under antiepileptic treatment, not to forget to take any medication, as doing so may trigger seizures. It is also important to have an adequate night’s rest of at least 7 hours. It is also advisable that this nocturnal rest should always be at the same time of the night. As a general rule, video games should not be avoided, except in some rare cases of reflex epilepsy (seizures are triggered by a certain visual stimulus). It is also very advisable to have a rhythm of life with little change (rest the same hours and at the same time of the day, eat at the same times, etc.).

What to do in the event of an epileptic seizure?

If the patient loses consciousness and falls to the floor, the first thing to do is to prevent damage during seizures. To do this, remove heavy objects or furniture with which it can be hit. Nothing should be put in the mouth once the patient has lost consciousness. Once the seizure has passed, the patient should be placed lying on one side to prevent the tongue from blocking the airway. Once the patient has regained consciousness, he/she should be reassured and if it is the first time it happens, he/she should go to a Hospital Emergency Department. If the patient is a known epileptic, he/she should visit his/her neurologist.

Advances in the treatment of epilepsy

To treat epileptic seizures and epilepsy, we must first diagnose the cause and treat it if possible. At present, we have antiepileptic drugs that can be taken once or twice a day and which, with a single drug, control seizures in about 60% of epileptics. Up to 30% are controlled with two antiepileptic drugs; adding a third will only control seizures by 5% more. The newer antiepileptic drugs are also much better tolerated, with similar potency to the older ones.

There are 10% of patients who will not be controlled with the various combinations of these antiepileptic drugs. These patients are called refractory and undergo a protocol for epilepsy surgery. This type of surgery will depend on the type of seizure, the number of foci and where they are located. However, the real breakthrough will come when these patients are no longer socially stigmatized and are no longer rejected by society.