Smiley Australia




Information on Epilepsy


What is Epilepsy?

Epilepsy is an abnormal burst of electrical activity originating somewhere in the brain.

Epilepsy was once classified as a 'mental illness'. In the 'old days' people with epilepsy were locked away in mental institutions - this was before a neurological cause for epilepsy was discovered which reclassified it as an illness of 'physical' origins.

We can only hope that one day an exact physical cause will be found for all currently classified 'mental' illnesses.

You may wonder why we have included Epilepsy on this site?

Did you know that some medications actually lower the seizure threshold and may cause a patient to have seizures even though they have never had them before?

Did you know that psychosis can occur with certain types of epilepsy that is very difficult to distinguish between the psychosis of epilepsy and psychosis associated with schizophrenia, schizophreniform disorders and psychotic depression?

Did you know that having epilepsy can cause depression?

Did you know that the unusal behaviours associated with some seizure types can be misinterpreted as an aggressive act?

False Assumptions and the Potential for Misdiagnosis:

Many people believe that epilepsy is purely someone having a fit or convulsions, it is much more than that. Epilepsy can effect your behaviour and thinking without ever showing signs of the type of convulsive seizure most people associate and expect with epilepsy.

Epilepsy can and has been misdiagnosed as schizophrenia, depression, bipolar disorder, sleep disorders and various other neurological illnesses which is disasterous for the sufferer.

Certain types of seizures originating in specific areas of the brain include phases which can be mistaken for psychotic 'episodes'.

The aggressive acts and bizarre behaviours caused by some types of seizures may invoke a hostile response or even police involvement when there was no intention by the sufferer to cause harm or trouble.

If you have been diagnosed with a mental disorder and have good reason to believe you may be suffering from some type of epilepsy, insist on proper testing to exclude this diagnosis. Please note that having only one EEG test cannot confirm or exclude a diagnosis of epilepsy.

General Information on Seizures:

Epileptic Seizures do not only occur when a person is awake they can, and often do occur during sleep.

Signs of seizure can be subtle and include a brief loss of memory, a marching numbness of a part of the body, strange sensations in the stomach or a sensation of fear, sparkling or flashes, smelling an unpleasant odour.

Seizures can often be preceded by tachycardia (racing heart) that persists throughout the period of the seizure event.

Symptoms and signs will vary. Epileptic seizures can occur in different regions of the brain and depending on which area of the brain is involved will generate different symptoms and seizure types. Some types of Epilepsy are relatively mild others are very severe and debilitating.

For a diagnosis of epilepsy to be made you must have repeated unprovoked seizures, that is repeated seizures not initiated by external causes. One seizure does not constitute a diagnosis of epilepsy.

Frequency of seizures varies from person to person, some people go for years between seizures, for others it is a daily occurence. Frequency of seizures for most people falls somewhere in between the above.

External factors which affect the brain may provoke seizures. Seizures from external factors are not normally diagnosed as epilepsy, these external causes can include:

  • high fever (febrile convulsion),
  • infections, such as meningitis or encephalitis,
  • head injury
  • lack of oxygen to the brain (cerebral hypoxia),
  • low blood sugar level (hypoglycaemia),
  • hyponatremia (sudden drop of sodium levels in the blood),
  • lesions that occupy space in the brain such as abscesses or tumors,
  • arteriovenous malformation (AVM),
  • Illicit drug toxicity from cocaine and amphetamines
  • poisons and toxins including camphor, strychnine, and lead.
  • a lot of alcohol,
  • withdrawal from alchohol,
  • toxicity from prescription medication or local anaesthetics,
  • drugs that lower the seizure threshold such as tricyclic antidepressants,sedating antihistamines and some antipsychotics
  • withdrawal from prescribed drugs (anticonvulsants, benzodiazapenes and barbituates),
  • illicit drugs,
  • withdrawal from illicit drugs,
  • stroke
  • multiple schlerosis (rarely)

Seizures can sometimes occur after witnessing a traumatic event. These seizures are called psychogenic non-epileptic seizures. They are associated with post-traumatic stress disorder (PTSD).

Seizures caused by external factors such as these are not classed as epilepsy even though they appear the same both outwardly and on EEG testing.

Late Onset Epilepsy:

While many types of Epilepsy are present to some degree in childhood or adolescence, other forms occur later in life due to the ageing process or atrophy of parts of the brain itself due to damage or disease.

Late onset epilepsy typically occurs after age 45 years, with a mean age at onset of 62 years.

Causes can include atrophy or damage to the Hippocampus, benign and malignant tumors, various vascular problems obstructing blood flow to parts of the brain.

The Hippocampus is particularly succeptible to damage from lack of oxygen. This may be caused by major events such as heart attack or stroke, or less obvious events such as sleep apnoea.

Transient Epileptic Amnesia is a form of late onset epilepsy where the sufferer has periods of amnesia extending typically from 1/2 to one hour, but sometimes lasting for days although this is exceptional. Attacks occur usually upon waking and may range from repetitive questioning such as 'where am I?' to dream like states and confused wandering.

An important indicator in this type of epilepsy is olfactory aura which usually (but not always) preceed attacks. Olfactory auras are unusual odours or scents that the sufferer can smell that are not apparent to anyone else.

This form of epilepsy may also include progressive but patchy loss of autobiographical memory for major life events which often remains undiscovered until the person is specifically questioned.

Geographical memory may also be affected. Sufferers may have difficulty finding their way around previously well known areas, may fail to recognise known landmarks, become lost while driving home etc.

In some instances the only indication of this type of seizure is the person may appear to be a little 'distant'. During the amnesic period they may appear to function reasonably well in their environment and converse with family and others as if there is nothing wrong. They may drive their car, do shopping and any other normal daily activity. Later however, the person will have no memory of those conversations or activities undertaken during that period.

This type of epilepsy responds well to Antiepileptic medications however autobiographical memories that were lost may not be retrieved.

Migraine and Epilepsy:

Migraine and epilepsy are highly comorbid. Comorbid means 'occuring together'. Individuals who have one disorder are more than twice as likely to have the other. Diagnosis and treatment of one disorder should take into account the potential presence of the other.

This relationship between migraine and epilepsy has often been overlooked, possibly due to the similarities in some of the symptoms as the clinical presentation may overlap. Symptoms of migraine can include headaches, changes in vision, sense of smell and taste as well as gastrointestinal symptoms.

In people diagnosed with epilepsy many of the symptoms of migraine may be mistakenly attributed to seizures. In addition, antiepileptic drugs may mask migraine as they effectively treat the headaches.

In people diagnosed with migraine, a number of epileptic and non-epileptic syndromes may mimic migraine.

The diagnostic difficulties inherent in this situation make proper investigation of the patients history paramount. Where there is any doubt EEG monitoring may be usesful.

Causes of Epilepsy:

Idiopathic Epilepsy is Epilepsy of Unknown Cause:

In many cases, no cause for seizures can be found. Abnormal bursts of electrical activity may occur for no apparent reason and be completely out of the blue. Hereditary factors (genetics) may be involved in some cases. People with idiopathic epilepsy usually respond well to anticonvulsant medications. They usually have no other neurological (brain) condition.

Symptomatic Epilepsy:

Symptomatic epilepsy can occur from brain damage or some underlying condition. These conditions may be present at birth or develop later in life.

These conditions can include head injury, problems with some of the blood vessels in the brain, chemical and neurotransmitter imbalances in the brain, cerebral palsy, stroke, brain tumors, scar tissue in part of the brain causing the neurons to episodically fire abnormally, previous brain infections such as meningitis and encephalitis, and some genetic syndromes. Seizures can be triggered by irritation of the surrounding brain cells.

Some conditions can cause other problems or disabilities in addition to seizures, in other cases no symptoms apart from the seizures are apparent.

What can Trigger a Seizure in People diagnosed with Epilepsy?

There are no 'definitive' triggers for an epileptic seizure and every person is different however some people report the following:

  • Stress and anxiety

  • Hypertension

  • Some medications such as antidepressants, antipsychotics can lower the seizure threshold in the brain.

  • Lack of sleep or being tired.

  • Low blood sugar level caused by irregular meals

  • Heavy drinking

  • Illicit street drugs

  • Flickering lights (strobe lighting or computer games)

  • Illness which cause fever such as the flu or infections.

  • Cerebral Hypoxia (lack of oxygen to the brain).
  • Menstruation (periods)

How is Epilepsy Diagnosed?

An important part of confirming a diagnosis of epilepsy is a full description of the event. This may provide your doctor with sufficient information to ascertain if further testing is warranted.

Tests such as MRI or CT scan may show small areas of damage underlying symptoms.

For a first unprovoked seizure, blood tests, lumbar puncture or toxicology screening may suggest an underlying cause such as a drug overdose or underlying illness such as meningitis.

A blood test preferably within 10 to 20 minutes (but in any event within one hour) of the seizure to detect the presence of elevated serum prolactin levels. This can prove difficult due to the lack of warning of seizure events.

Elevated serum prolactin can help distinguish a non-epileptic seizure from generalized tonic clonic or complex partial seizures.

EEG (Electro Encephalogram) testing may show abnormal brain wave activity. An EEG records electrical activity in the brain through special stickers that are placed in different areas of the scalp. The EEG machine amplifies the electrical activity and records the pattern on paper or computer.

Surface EEG is the most commonly used first-line investigative tool in the diagnosis of epilepsy. Unfortunately 'surface' EEG is not necessarily a reliable indicator and the absence of abnormalities on an EEG is not an indication of an absense of epileptic activity.

It can take prolonged testing to ascertain this sometimes elusive display of abnormal electrical activity.

Some people with Epilepsy show no distinctive EEG patterns at all, yet they actually suffer seizures. 'Forced normalization' is a term used where EEG results are showing normal brain activity but the patient is obviously suffering seizure activity. There is still no explanation as to why this occurs.

It should be noted that returning an abnormal EEG does not mean you have epilepsy.

Treatments:

Medication is the most commonly used treatment. Anticonvulsant medications are used to stabilise electrical activity in the brain and prevent seizures. Medication is effective in about 4 out of 5 cases.

The type of medication used depends on the type of seizure being treated.

Anticonvulsant medications can cause some side effects including drowsiness, dizziness, blurred vision, headache, rash, weight gain and tingling.

Many anticonvulsant medications are also used in the treatment of Bipolar Disorder - these include Lamotrigine, Gabapentin, Valproic acid, and Carbamazepine.

Some of the medications act as sodium channel blockers which reduces seizures. Lithium and Trileptal are sodium channel blockers.

Surgery is only performed in relatively few cases and is dependant on the type of epilepsy, the region of the brain which is involved and risk.

Vagus Nerve Stimulation is an option for some. This treatment involves electrical stimulation of the vagus nerve to reduce the rate of seizures.

The Ketogenic Diet is a special diet (requires supervision of an experienced dietician) is useful for certain types of epilepsy.

We have general information on the various types of Epilepsy listed below.

Simple Partial Seizures:

There is no impairment of consciousness with simple partial seizures, although altered states of consciousness may occur.

There may be motor (movement), sensory (sight, smell, taste, hearing), and/or autonomic (involuntary activity controlled by the autonomic nervous system that governs temperature, heart rate, breathing, perspiration and other 'automatic' processes).

Motor signs include:

  • Alternating contraction and relaxtion (flexing) of muscle groups.

  • Asymmetrical posturing of the limbs.

  • Eye movements and turning the head to the same side.

  • Vocalization - making verbal noises and sounds.

  • Speech arrest

Sensory symptoms include:

  • Visual Aura - seeing flashes of lights or colours, illusions and hallucinations.

  • Auditory Aura - hearing humming, buzzing or hissing noises.

  • Olfactory Aura - smelling unpleasant odours, tasting unpleasant tastes.

  • Dizziness and lightheadedness.

Autonomic signs and symptoms can include:

  • Goose bumps (piloerection)

  • Flushing

  • Sweating

  • Rapid heart rate (tachycardia)

  • Dilation of the pupils

  • Stomach and abdominal rumbling noises (borborygmi)

  • Nausea and/or vomiting

  • Incontinence.

Psychic symptoms can include:

  • Detachment, depersonalization

  • Dreamy state

  • Distortion of Memory:

    • flashback

    • Deja vu (feeling that you've seen something before)

    • Deja entendu (feeling that you've heard something before)

    • Jamais vu (feeling that you've never seen something familiar)

    • Jamais entendu (feeling that you've never heard something before)

    • Panoramic vision (rapid recall of past events)

    • Time distortion

    • Unprovoked emotion - pleasure, elation, eroticism, displeasure, anger, depression.

Complex Partial Seizures:

Unlike simple partial seizures, Complex Partial Seizures cause a partial loss of consciousness. The person is not aware of their surroundings and may have a 'vacant' or 'frightened' look and can also display the signs and symptoms of a simple partial seizure.

Five groups of automatisms can occur during the unconscious phase of the seizure.

The automatisms are:

  • Mimetic Automatisms:
    • Facial expressions of bewilderment, fear, discomfort, tranquility, laughter and crying.

  • Gestural Automatisms:
    • Repetitive movements of the hands and/or fingers, sexual gestures.

  • Ambulatory:
    • Running or wandering.

  • Alimentary Automatisms:
    • Chewing
    • Stomach rumbling noises (borborygmi)
    • Increased Salivation

  • Verbal:
    • Swearing or repeated short phrases.

This type of seizure can arise from any part of the brain but most commonly starts in a Temporal Lobe. This seizure type is sometimes referred to as 'Temporal Lobe seizures' and 'Psychomotor Epilepsy'.

The temporal lobes are the part of the brain dealing with behaviour and moods. A seizure originating in this area of the brain can cause you to have strange feelings, emotions and sensations. You may feel like you are in a dream. Your surroundings may appear strange or even oddly familiar. You may have difficulty describing your feelings and sensations.

Someone witnessing a seizure of this type may observe that you are in a trance or behave in a strange manner for a few seconds or minutes. You may wander around without any apparent purpose, smack your lips, fumble at your clothes, figet, swallow repeatedly or other repetitive movements.

People who have experienced complex partial seizures over a period of years may develop 'drop attacks'. Drop attacks are where the person suddenly loses postural tone and falls with a sudden onset of unconsciousness.

Seizures of this type may develop into a generalised convulsive seizure - called a secondary generalised seizure.

Complex partial seizures can cause complications. The limbic system of the brain covers emotion and motivation, this can be damaged by seizure activity. The limbic structures include the hypothalamus, hippocampus and amygdala.

Damage to these areas can cause the person to develop behavioural and cognitive difficulties, these may include:

  • Poriomania - amnesia following prolonged aimless wandering.
  • Short Term Memory Loss caused by dysfunction in the hippocampus, the inability to recall the names of objects or words called 'anomia'.

  • Violent Behaviour including defensiveness and aggression when restrained during a seizure.

  • Interictal Personality - dependence, obsession, humorlessness, anger, emotionality, hypo or hyper sexuality.

(Interictal refers to the between seizure state from the latin inter = between and ictus = struck).

Tonic-Clonic (Grand Mal) Seizures:

Generalised Tonic-Clonic seizures may begin as simple or complex partial seizures. They may be preceded by an aura although often the patient has no memory of this.

The tonic phase usually consists of the following:

  • Loss of consiousness
  • Fall
  • Yelling out called a 'tonic cry'
  • Extension of the arms, legs and/or face
  • Clenching of jaw and fingers
  • Autonomic symptoms:
    • Heart Rate and Blood Pressure increased.
    • Increased salivation and increase bronchial secretion.
    • Increased bladder pressure
    • Flushing
    • Sweating
    • Apnea (cessation of breathing)

During the clonic phase the muscles relax completely followed by a return of muscle tone. Rythmic jerks of the body and head accompany this.

In the postical phase common symptoms are biting of the tongue, cheek or lips, drooling, urinary incontinence.

The person may remain unconscious for a period of time after the jerking movements cease. Seizures usually last between 5 and 20 minutes.

The person may pass directly into sleep without awakening or may awaken confused and then may sleep. Many experience prolonged weakness after the seizure.

Tonic-clonic seizures may cause injury to the person. Fractures from falls, biting injuries to the tongue, lips or cheeks and aspiration (breathing in) of vomited stomach contents or excess secretions.

Myoclonic Seizures

Myoclonic seizures are brief seizures which cause a sudden onset of muscle contractions. These contractions may be limited to a particular group of muscles, parts of the body or they may occur throughout the body.

Onset of these seizures may be sudden and cause the person to fall to the ground, or it may be so subtle as to look like a tremor. Because these seizures are so brief it is unknown whether consciousness is lost.

Status Epilepticus

Status epilepticus is where seizures recur without the person regaining consciousness in between events. It is a medical emergency.

A seizure that lasts more than 30 minutes is defined as Status epilepticus.

This condition may cause cognitive dysfunction or brain damage and may be fatal. It can develop in any type of seizure but is more common in tonic-clonic seizures.

Seizure First Aid

Many people who experience seizures get some form of warning up to several minutes before the seizure begins. Others have no warning at all.

If a person tells you they are about to have a seizure please take measures to ensure their safety. If a person is having a seizure the following are some things you can do:

Lay the person in the recovery position if possible or gently ease the person to the ground and place something soft under their head.

Remove any objects that may pose a danger and ensure their limbs cannot come into contact with walls, furniture or other items.

Do not attempt to restrain the person, there is a risk of injury to the person and to yourself.

If the person vomits their head should be placed to the side to prevent blocking of the airway and allow vomit to run out of the mouth.

Do not place anything in the persons mouth, this can cause the person to choke or bite their tongue (or you).

A person having a seizure cannot swallow their tongue.

Once a seizure begins it will run it's course.

When the seizure ends the person will cease convulsing, limbs will go limp and the person will be unconscious for a while.

When the person comes to, they will usually be tired and disoriented and unaware they have had a seizure.

Do not leave the person unattended until they are completely recovered.

If the person is known to have epilepsy and stops breathing at any time during or after the seizure, or injures themselves, then medical attention is needed and you should call an ambulance. A prolonged seizure (more than 5 minutes), or a second seizure before or after regaining consciousness is a medical emergency and urgent help must be sought.

If the person is not known to have epilepsy urgent medical attention must be sought.


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