Epilepsy is described according to the ILAE (International League Against Epilepsy) as a “disorder of the brain characterized by a permanent predisposition to generate epileptic seizures and by the neurobiological, cognitive, psychological and social consequences of this condition”. The term Epilepsy derives from the Greek concept epilambanei, which means “to take by surprise” and thus describes the main symptom of this type of disorder, epileptic seizures or epileptic attacks.
In Spain more than 20,000 new cases of epilepsy are diagnosed every year. About 400,000 people suffer from this disease, and although it can appear at any age, most cases appear in childhood or after the age of 60. Worldwide, it is estimated that approximately 50 million people live with this disease.
What is an epileptic seizure?
An epileptic seizure is caused by excessive activity of a group of neurons located in the cerebral cortex. This hyperexcitability may affect functions such as movement, behavior or level of consciousness. The duration of the seizure usually consists of seconds or minutes; once it is over, brain activity returns to normal. Seizures can appear at any stage of life, from the first day of life to a very advanced age; there are patients who have their first epileptic seizure at the age of 90.
It is estimated that between 2-5% of the population will experience an episode of epilepsy during their lifetime, however, this does not imply that it is an epilepsy disorder. According to the ILAE, in order to establish a diagnosis of the disease, more than one seizure must have been experienced.
Types of epileptic seizures
Broadly speaking, we can distinguish between two types of seizures: generalized seizures, which affect the entire surface of the brain and cause loss of consciousness, and partial or focal seizures, in which the discharge originates in a specific area and may spread to the rest of the cerebral cortex. In some cases, the patient experiences a sensation similar to an indication that a seizure is about to occur, this sensation is known as aura and it is really a partial epileptic seizure that is going to spread.
Within these two groups we can distinguish different types of seizures, the most frequent are:
Origin of Epilepsy according to age
Epilepsy, as we mentioned in the previous section, can appear at different stages of life and the cause is different in young children, adolescents, young adults and the elderly. The following table shows the most frequent causes of epilepsy classified according to the age of onset of seizures:
Treatment for epilepsy
Worldwide, 8 people out of every 1,000 have active epilepsy and therefore need treatment. Fortunately, 75% of patients can benefit from drug treatment and can control seizures and the vast majority can lead a normal life. Twenty-five percent cannot control seizures with drugs; however, some may benefit from other treatments: surgery, ketogenic diet, stimulators and/or more specific treatments.
Depending on the patient’s response to treatment, four groups of epilepsies with different prognoses can be considered:
- Spontaneously benign epilepsies: these are those with a low number of epileptic seizures, often not requiring the use of drugs, or low doses of drugs for some time. They do not show alterations in the physical examination, in imaging studies or in intelligence. The most common prototype of this group is epilepsy with infantile origin and central-temporal paroxysms. 20-30% of patients are in this category.
- Epilepsies sensitive to antiepileptic drugs: in general they have a good prognosis. The use of drugs is maintained for some time and can be withdrawn later without recurrence of seizures. This group includes childhood absence epilepsies and some adult focal epilepsies. It includes 30-40% of patients.
- Drug-dependent epilepsies: they have a less favorable prognosis, although in most cases adequate seizure control is achieved, the drug cannot be withdrawn due to the high probability of recurrence when treatment is discontinued. It includes several of the idiopathic generalized epilepsies, constituting 10 to 20% of patients.
- Treatment-refractory or drug-resistant epilepsies: these account for 20-25% of epilepsies and are characterized by refusal of treatment, often from the onset of the disease. Complementary studies are clearly abnormal. They are often associated with psychomotor retardation or psychiatric disorders such as anxiety and depression. In some of these cases the prognosis clearly improves with epilepsy surgery or other types of treatment.
What to do in the event of an epileptic seizure
Although the types of epileptic seizures can develop in different ways, the course of action follows a very similar sequence. Therefore, to conclude, we would like to remind you how to act in the event of an epileptic seizure. The FEDE (Spanish Epilepsy Federation) recommends the following action protocol:
- What to do in the event of an epileptic seizure:
- Remain calm, because once the seizure has started, it cannot be stopped.
- Keep observers away and remove dangerous objects from the area.
- Protect the person from harm by putting something soft under the head, loosening tight clothing that may make breathing difficult, and removing glasses or any objects that may hurt the person during the seizure.
- Carefully turn the person on his or her side, so that any fluid in the mouth can flow out safely.
- Watch the duration of the seizure with a watch. If it lasts more than five minutes, call 112
- When the seizure is over, accompany the person until he/she is recovered and allow him/her to rest if desired.
- Things NOT to do
- Do not force the person’s mouth open or put anything in the person’s mouth.
- Do not move the person to another location.
- Do not try to stop the person from moving or shaking, do not try to stop the seizures.
- Do not try to wake the person, shout, or shake the person.
- Do not give water, food or medication by mouth for the duration of the seizure.
- When to seek medical help
- If the seizure lasts more than five minutes
- If the seizure is repeated in a short period of time.
- If the person does not recover completely after resting for a while after the seizure.
- If there has been a major trauma during the seizure.
- If the person who has had the seizure is a pregnant woman.
- If the person who has had the seizure does not have epilepsy and may need treatment for another acute illness.