Epilepsy is a common chronic neurological disorder affecting millions worldwide. It is characterized by recurrent seizures. These seizures manifest as various alterations in behavior, movement, sensation, or consciousness. They result from abnormal and excessive electrical activity of nerve cells in the brain. Understanding epilepsy aids in its management and supports individuals living with this condition.

Causes and Risk Factors of Epilepsy

The origins of epilepsy vary considerably. In approximately half of cases, no identifiable cause is found. This is then referred to as idiopathic or cryptogenic epilepsy. For other cases, various conditions can contribute to the development of epilepsy.

Structural Causes

• Brain Lesions: Traumatic brain injury, stroke, brain tumor, or severe infection (meningitis, encephalitis) can damage the brain and cause epilepsy.
• Congenital Abnormalities: Some individuals are born with brain malformations that increase their risk of epilepsy.

Genetic Factors

Genetics play a role in some individuals. Specific genetic mutations can make the brain more susceptible to seizures. They influence how brain cells communicate with each other. Epilepsy can also be genetic without any known family history.

Risk Factors

• High Fever: In young children, high fevers can cause febrile seizures. In rare cases, they increase the risk of epilepsy later in life.
• Alcohol or Drug Abuse: Substance abuse, or withdrawal, can trigger seizures.
• Lack of Sleep: Sleep deprivation is a common seizure trigger for many people with epilepsy.
• Stress: Intense stress can also influence the occurrence of seizures.

Many of these factors act together, making the causes of epilepsy complex and multifactorial.

Symptoms and Signs of Epilepsy

The symptoms of epilepsy vary considerably. They depend on the part of the brain affected and the type of seizure. An epileptic seizure is a temporary disturbance of the brain’s normal electrical activity.

Types of Seizures and Their Manifestations

• Generalized Seizures: These involve both cerebral hemispheres from the onset.
  • Tonic-Clonic Seizures (Grand Mal): They cause body rigidity (tonic phase), followed by rhythmic jerking of the limbs (clonic phase). The person loses consciousness.
  • Absence Seizures (Petit Mal): Brief losses of consciousness. The person appears to be daydreaming or staring blankly. These seizures are brief and often go unnoticed.
  • Myoclonic Seizures: Brief, sudden muscle jerks. They can affect part or all of the body.
  • Atonic Seizures: Sudden loss of muscle tone. This can cause a fall.
• Focal (Partial) Seizures: These begin in a specific area of the brain.
  • Simple Focal Seizures: The person remains conscious. They may experience tingling, jerky movements of a limb, or sensory hallucinations.
  • Complex Focal Seizures: Consciousness is impaired. The person may make involuntary repetitive movements (automatisms) such as chewing, wandering, or mumbling. They do not remember the seizure.

After a seizure, the person may feel confused, fatigued, or have headaches. This is called the post-ictal period. Recognizing symptoms is crucial for prompt diagnosis and management.

Diagnosis of Epilepsy

The diagnosis of epilepsy relies on several steps. It combines clinical observation, seizure history, and complementary examinations. Doctors aim to confirm the diagnosis, identify the type of epilepsy, and its underlying causes.

First Consultation

A neurologist conducts a detailed anamnesis (medical history). They gather information about the seizures: frequency, duration, description of symptoms before, during, and after. Witnesses sometimes describe seizures better than the person themselves. A comprehensive neurological examination assesses reflexes, muscle strength, coordination, and sensory functions.

Complementary Examinations

• Electroencephalogram (EEG): This test measures the electrical activity of the brain. It can show characteristic abnormalities of epilepsy, even between seizures. Long-term or video EEGs sometimes help capture a seizure.
• Brain Imaging: Magnetic Resonance Imaging (MRI) of the brain is the test of choice. It helps identify structural lesions (tumors, scars, malformations) that can cause epilepsy. A CT scan can also be used.
• Blood Tests: These rule out other possible causes of seizures, such as electrolyte imbalances, infections, or metabolic disorders.
• Neurocognitive Tests: These evaluate the impact of epilepsy on memory, attention, and other cognitive functions.

These examinations allow for an accurate diagnosis, which then guides appropriate treatment. The diagnosis of epilepsy is not made after a single seizure, but is based on the repetition and characteristics of the seizures.

Treatments and Management of Epilepsy

The treatment of epilepsy primarily aims to control seizures. It also seeks to improve the quality of life for affected individuals. The treatment plan is often personalized, depending on the type of epilepsy, the frequency and severity of seizures, and potential side effects.

Anti-Epileptic Drugs (AEDs)

Anti-epileptic drugs represent the first line of treatment for most people. They work by reducing the excitability of brain cells. Many AEDs are available, each with a different efficacy and side effect profile. The neurologist chooses the most appropriate medication and then adjusts the dose to achieve optimal seizure control with minimal side effects. Approximately 70% of people achieve good seizure control with AEDs.

• Examples of AEDs: lamotrigine, levetiracetam, valproate, carbamazepine, oxcarbazepine, etc.

Other Therapeutic Options

For individuals whose seizures are not controlled by medication (refractory epilepsy), other options exist:

• Epilepsy Surgery: Surgery may be considered if seizures originate from a well-defined area of the brain. Surgeons remove or disconnect this area, which reduces or eliminates seizures.
• Vagus Nerve Stimulation (VNS): A small implanted device electrically stimulates the vagus nerve. This helps reduce the frequency and intensity of seizures.
• Ketogenic Diet: This high-fat, low-carbohydrate diet can be effective for some children and adults with refractory epilepsy.
• Other Neurostimulation Therapies: Deep Brain Stimulation (DBS) and Responsive Neurostimulation (RNS) are options for some complex cases.

Management of Associated Conditions

Epilepsy is often accompanied by conditions such as depression, anxiety, or cognitive impairments. Psychological support and treatment of these comorbidities are important for holistic management. Educating the individual and their family about the disease is also essential.

Recent Scientific Advances in Epilepsy

Epilepsy research is very active. It aims to better understand the neurological mechanisms of seizures and optimize therapies. For the first half of 2025, several promising research areas stand out, although no major revolutionary breakthroughs have been globally published.

Gene and Cell Therapies

Studies continue to explore gene therapies for forms of epilepsy of genetic origin. New approaches are being tested. They aim to correct the responsible mutations. Other research focuses on implanting inhibitory neurons to restore neuronal balance. This reduces brain hyperexcitability.

Artificial Intelligence and Biomarkers

Artificial intelligence (AI) and machine learning are gaining importance. Researchers use them to analyze vast datasets of EEG, MRI, and genetic information. This helps identify new epilepsy biomarkers. These markers could predict treatment effectiveness. They would also help anticipate seizures before they occur. The development of predictive algorithms for seizures is a rapidly evolving field.

New Medications and Neurostimulation

The development of new, less invasive anti-epileptic molecules continues. They aim to minimize side effects. Adaptive and responsive neurostimulation systems, such as RNS (Responsive Neurostimulation), are undergoing continuous optimization. They offer options for refractory epilepsies. These systems detect abnormal electrical activity in real-time. Then, they deliver stimulation to prevent seizures.

These advances pave the way for more targeted treatments. They improve the quality of life for people with epilepsy.

Prevention of Epilepsy

Completely preventing epilepsy is a challenge. The causes are heterogeneous. However, reducing risk factors helps. Certain types of epilepsy can be minimized. The management of existing seizures is also optimized.

Prevention of Acquired Causes

• Prevention of Head Injuries: Wearing a helmet during sports activities or cycling is essential. Using a seatbelt in a car reduces the risk of serious accidents and brain injuries.
• Management of Cardiovascular Diseases: Controlling high blood pressure, diabetes, and cholesterol lowers the risk of stroke. Strokes can cause epilepsy.
• Vaccination and Hygiene: Vaccination reduces the risk of brain infections. Meningitis and encephalitis can lead to epilepsy. Good hygiene also prevents infections.
• Avoiding Alcohol and Drug Abuse: Limiting or avoiding excessive consumption of alcohol and illicit drugs reduces the risk of induced seizures.

Seizure Prevention for People Already Diagnosed with Epilepsy

For diagnosed individuals, seizure prevention focuses on several aspects:

• Medication Adherence: Taking anti-epileptic drugs regularly and as prescribed is the most important preventive measure.
• Trigger Management: Identifying and avoiding known factors that can provoke a seizure (lack of sleep, excessive stress, flashing lights, certain medications).
• Healthy Lifestyle: Maintaining a balanced diet, exercising regularly, and getting enough sleep.

These strategies help minimize risks. They do not guarantee the total absence of seizures or the development of epilepsy.

Living with Epilepsy

Living with epilepsy requires adjustments. It demands resilience. Many people lead full and productive lives. Good management and adequate support facilitate this adaptation.

Daily Adaptations

• Treatment Adherence: Regular intake of anti-epileptic drugs is crucial. Each person sets up reminders, such as phone alarms or pillboxes.
• Trigger Management: Identifying and avoiding factors that can cause a seizure (lack of sleep, stress, alcohol, flashing lights). A seizure diary helps identify these triggers.
• Safety: Adapting the home environment to prevent injuries during a seizure (thick rugs, avoiding sharp furniture). Informing those around you about what to do in case of a seizure.

Social and Emotional Aspects

Epilepsy can affect social and emotional life. Stigma or the fear of a seizure in public can generate anxiety. Psychological support, support groups, or patient associations offer a space to share experiences. This reduces feelings of isolation. Talking openly about epilepsy with family, friends, and colleagues contributes to better understanding. This allows for a safer environment.

Employment, Studies, and Driving

Many people with epilepsy pursue their education. They work in various professions. Certain restrictions apply to driving a car. This depends on local legislation and the seizure-free period. Organizations and laws protect people with epilepsy against discrimination in employment or education.

Living with epilepsy means managing a chronic condition. This does not prevent one from living a rich and fulfilling life with good control and adequate support.

Frequently Asked Questions (FAQ) about Epilepsy

Is epilepsy a mental illness?

No, epilepsy is not a mental illness. It is a neurological disorder that affects the brain and causes seizures. These result from abnormal electrical activity. It does not indicate any mental weakness. However, people with epilepsy can develop mood disorders if they do not receive appropriate treatment.

What to do if someone has an epileptic seizure?

Stay calm. Protect the person from injury. Move dangerous objects away. Do not put anything in their mouth. Do not restrain them. Time the seizure. Call emergency services if:

• the seizure lasts longer than 5 minutes.
• one seizure follows directly after a first seizure.
• the person is injured.
• the person does not regain consciousness.

Can epilepsy be cured?

In some cases, especially in children, epilepsy can resolve over time. For many, seizures are controlled by medication. Surgery can cure certain types of epilepsy. However, for many people, epilepsy is a chronic condition. Treatments allow them to live a normal life.

Is epilepsy hereditary?

In some cases, epilepsy has genetic components. This means there is a family predisposition. However, most epilepsies are not directly hereditary. Many factors play a role, not just genetics.

Can you drive with epilepsy?

Rules vary by country. Most require a seizure-free period. This period usually lasts 6 months to 1 year. The goal is to ensure the safety of the driver and other road users. Consult your neurologist and relevant local authorities.

Additional Resources

• Epilepsy Foundation (International)

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