Epilepsy

The symptoms of epilepsy are diverse, depending on the type of seizure and the area of the brain affected. There are two main types of seizure: focal and generalized.

Focal seizures

These seizures begin in a specific region of the brain, and their symptoms vary according to the location of the abnormal activity.

Focal seizures without altered consciousness: These are characterized by symptoms such as sensory alterations (e.g. unusual smells or tastes), involuntary movements, or sensations of déjà vu. The patient remains conscious and alert, but may experience intense fear or strange sensations.
Focal seizures with altered consciousness: These seizures manifest as a loss or alteration of consciousness. The patient may stare, perform repetitive movements such as hand rubbing or chewing, and fail to respond to external stimuli.

Generalized seizures

These seizures immediately involve both cerebral hemispheres, and may cause loss of consciousness, convulsions and other physical manifestations.

Absence seizures: Most frequent in children, these result in a brief loss of consciousness, often interpreted as a simple blank stare or “disconnection” from the outside world.
Tonic-clonic seizures: Also known as “grand mal”, these seizures begin with a tonic phase (muscle stiffness), followed by clonic movements (rhythmic muscle jerks). They generally last several minutes, and can lead to a loss of control over bodily functions such as urination or saliva.
Myoclonic seizures: These cause sudden muscle jerks, often in the arms and legs, and can occur singly or in series.
Atonic seizures: Known as “falling seizures”, these involve a sudden loss of muscle tone, which can lead to sudden falls.

Symptoms vary not only according to the type of seizure, but also according to the individual. Some people may experience “auras” before a seizure, premonitory signs such as headaches, strange abdominal sensations, or changes in sensory perception.

Epilepsy can be caused by a variety of factors, but in around 50% of cases, the cause remains unknown. Identified causes include :

Genetic causes: Some epilepsies are hereditary and result from specific genetic mutations. Advances in genetics have identified several genes associated with an increased risk of developing epilepsy. However, the presence of a defective gene does not necessarily mean that an individual will develop the disease; environmental factors may also play a role.
Brain damage: head trauma can result in brain damage that increases the risk of seizures. Similarly, the after-effects of a stroke, which interrupts the supply of oxygen to the brain, are a frequent cause of epilepsy in the elderly.
Infections: Serious infections such as meningitis, encephalitis or HIV can cause neurological damage and lead to epileptic seizures. In some parts of the world, particularly low- and middle-income countries, these infections are major causes of epilepsy.
Congenital cerebral malformations: Some children are born with cerebral malformations that increase the risk of epilepsy. These malformations may be due to genetic disorders or complications during pregnancy.
Metabolic disorders: Metabolic abnormalities, such as impaired glucose or urea metabolism, can also be responsible for epileptic seizures.
Brain tumors: Tumors, whether benign or malignant, can compress or destroy brain tissue, leading to seizures.

Several factors can increase the risks of developing epilepsy:

• Family history: a major risk factor, especially in genetic forms of the disease.
• Age: Although epilepsy can occur at any age, it is more common in young children and people over 60. In children, seizures are often linked to congenital or developmental causes, while in the elderly, they are more often due to stroke or neurodegenerative disease.
• Previous brain infections or neurodegenerative disorders: People who have suffered from meningitis, encephalitis or other serious brain infections are more likely to develop epilepsy. People suffering from neurodegenerative disorders such as Alzheimer's disease are also at greater risk.
• Head injuries: Head injuries, particularly those causing loss of consciousness, increase the risk of developing epileptic seizures.

The diagnosis of epilepsy is often complex, and relies on a combination of clinical and paraclinical methods:

Medical history: The doctor usually begins with a thorough interview to gather the patient's medical history, including family history of epilepsy and details of seizures (frequency, duration, associated symptoms). Keeping a seizure calendar is an important tool in the treatment of epilepsy.
Electroencephalogram (EEG): The EEG is the reference test for diagnosing epilepsy. It records the brain's electrical activity and detects specific abnormalities, such as epileptiform discharges, which indicate a predisposition to seizures.
Neuropsychological tests: These evaluations measure the impact of seizures on the patient's cognitive functions, such as memory, language and ability to concentrate.
Genetic testing: In certain cases, genetic testing can be performed to identify specific mutations responsible for hereditary forms of epilepsy.

Brain imaging :

Magnetic Resonance Imaging (MRI): This examination is essential for identifying structural abnormalities of the brain, such as tumors, scars or malformations, which may cause seizures.
Computed tomography (CT-scan): used to detect acute lesions, such as cerebral hemorrhages, often associated with seizures.
PET CT, especially for scientific research.
 

The main aim of epilepsy treatment is to prevent seizures while minimizing the side effects of treatment. The main treatment options include :
Anti-epileptic drugs: Despite their widespread use as “anti-epileptics”, these drugs do not cure epilepsy, but they can control and reduce the frequency of seizures by stabilizing the brain's electrical activity. These drugs are the mainstay of epilepsy treatment, and their effectiveness is notable: around 70% of people with epilepsy live seizure-free. 

Surgery: When medication fails to control seizures, surgery may be considered. Epilepsy surgery involves removing or isolating the area of the brain where seizures begin. Although this procedure can raise concerns, it should be noted that in chronic seizures, the brain region involved is often already severely damaged or non-functional. Successful intervention allows healthy areas of the brain to regain harmonious function.

Specific diets: The ketogenic diet, rich in fats and very low in carbohydrates, is used in some children whose epilepsy is difficult to control with medication. This diet modifies the brain's energy metabolism, which can reduce the frequency of seizures. Other diets, such as the modified Atkins diet or the low-glycemic index diet, are also being explored.

Nerve stimulation devices: The vagus nerve stimulator (VNS) is an implanted device that sends regular electrical impulses to the vagus nerve, one of the body's major nerves, to help prevent seizures. Reactive neurostimulation (RNS) is another option, which detects and interrupts abnormal electrical activity before it turns into a seizure.

Emerging treatments: Research is underway to develop new therapies, such as gene therapies, drugs targeting specific brain receptors, or deep brain stimulation devices.

A key element of the epilepsy treatment protocol is the seizure calendar. This document tracks the frequency and typology of seizures, in addition to the medication history.

Download the seizure calendar 

If you witness an epileptic seizure, it's essential to remain calm and follow these steps:

1. Protect the person: keep away from dangerous objects that could cause injury.
2. Don't restrict movement: don't try to restrain the person or block their movements. Let the seizure run its course.
3. Note the duration of the seizure.
4. Call for help: if the seizure lasts several minutes, if the person does not regain consciousness or if he/she suffers several consecutive seizures. 
5. After the seizure, place the person in the lateral safety position, especially if they have lost consciousness. This facilitates breathing and avoids the risk of suffocation.

Epilepsy can have various repercussions on patients' lives, depending on seizure frequency, intensity and response to treatment:
Physical complications: Falls and other seizure-related accidents can lead to serious injuries, including fractures and head trauma.

Cognitive and psychological disorders: Epilepsy patients are more likely to develop cognitive disorders, including memory problems, as well as mood disorders such as depression and anxiety. These disorders may be exacerbated by the side effects of medication or by the stigma associated with the disease.

Status epilepticus: This is a medical emergency characterized by a prolonged epileptic seizure (10 to 15 minutes on average) or by repeated seizures with no recovery of consciousness between them. Status epilepticus requires immediate medical intervention to prevent permanent brain damage or death.

SUDEP (Sudden Unexplained Death in Epilepsy): SUDEP is a rare but serious complication, where a person with epilepsy dies suddenly without apparent cause. The risk of SUDEP is higher in people with frequent seizures, particularly generalized tonic-clonic seizures. When epilepsy is controlled, the risk of SUDEP is very low.

Although some forms of epilepsy cannot be prevented, several measures can reduce the risk of developing the disease, or prevent seizures in those already diagnosed:

Preventing head trauma: to avoid brain damage that can lead to post-traumatic epilepsy.
Managing cardiovascular risk factors: Adopting a healthy lifestyle, including a balanced diet, regular exercise and stopping smoking, can reduce the risk of stroke and, consequently, epilepsy.
Vaccination and hygiene: Protecting yourself against central nervous system infections, such as meningitis, through vaccination and rigorous hygiene practices, is essential, especially in regions where these diseases are endemic.
Regular medical follow-up: People at risk or with a history of seizures need regular medical follow-up to adjust treatments and prevent complications.

It is essential to consult a physician in the following situations:
First seizure: Anyone experiencing a first seizure should consult a physician for a thorough diagnosis and evaluation.
Frequent or prolonged attacks: If attacks become more frequent, last longer, or change in nature, it is imperative to review the treatment plan with a specialist.
Drug side effects: If significant side effects occur with epilepsy medications, a dosage adjustment or change of treatment may be necessary.

Hôpital de La Tour offers comprehensive care for patients with epilepsy, thanks to a multidisciplinary team. Patients benefit from a personalized approach, including precise diagnosis using cutting-edge technologies such as functional MRI.

What is an epileptic seizure?
An epileptic seizure is an excessive, abnormal electrical discharge in the brain, manifesting itself through a variety of symptoms such as convulsions, sensory alterations or loss of consciousness.

Is epilepsy always hereditary?
No, although some forms of epilepsy are hereditary, the majority of cases are sporadic, with no direct family link.

How is epilepsy diagnosed?
Diagnosis is based on clinical examinations, imaging tests (such as MRI) and recordings of brain activity (EEG).

What are the most common treatments for epilepsy?
Treatments include anti-epileptic drugs, surgery, specific diets and nerve stimulation.

How can I prevent epileptic seizures?
The risk of seizures can be reduced by avoiding known triggers, taking prescribed medication regularly and adopting a healthy lifestyle.

What to do in the event of an epileptic seizure?
Protect the person from danger, don't put anything in their mouth, turn them on their side after the seizure and call for help if necessary.

What are the possible complications of epilepsy?
Complications include physical injury, cognitive impairment and, in rare cases, sudden unexplained death (SUDEP).

When should I consult a doctor about epilepsy?
A doctor should be consulted after a first seizure, if seizures change in frequency or nature, or if treatment seems less effective.