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Epilepsy – What are the Causes of Epilepsy? Symptoms of Epilepsy

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What is Epilepsy & Symptoms of Epilepsy?

Epilepsy is a long-standing condition of the brain, where a person develops unprovoked seizures multiple times in a lifetime. Typically, a person suffering from epilepsy should experience at least two episodes of unprovoked seizures. In this article, you will know about signs and symptoms of Epilepsy, instead of it we will also cover all about causes of Epilepsy.

Seizure is a sudden, typically a short-lasting episode of excessive unsynchronised (out of sync) electrical discharge from a group of brain cells. This results in various sensory and motor function abnormalities.

Sensory abnormality: could range from an abnormality in various bodily sensations like smell, taste, hearing to an abnormality in awareness, or even loss of consciousness.

Motor abnormality: these are abnormalities affecting the muscle tone and contraction. It could consist of increased muscle stiffness, loss of muscle control, or abnormal rapid movements or jerking.

Unprovoked seizure: is a seizure that occurs in the absence of any precipitating factor. The precipitating factor should be a temporary ongoing or recent condition affecting the brain, such as fever. The unproved seizure may also occur from a remote nervous system or body condition or disease.

Provoked seizure: is any seizure that occurs during or within a week of any acute condition or disease affecting the nervous system or body. This can be caused by fever, alcohol withdrawal, certain drugs, and certain imbalances in the body, such as low blood sugar.

Epilepsy is one of the most common neurological diseases worldwide, affecting about 5 crore people in the world. About 80% of cases of epilepsy are seen in low and middle-income countries. So, below are the causes, signs and symptoms of epilepsy that will help you to take action against it on time.

Epilepsy can affect multiple aspects of a person’s life including safety, relationship, self-confidence, work, and others. The risk of premature death is up to 3 times higher in people with epilepsy.

It is important to diagnose and treat epilepsy as soon as possible, to reduce disability, and to prevent complications. It has been found that in about 70% of the cases of epilepsy, the seizures can be controlled effectively with proper management.

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What are the signs and symptoms of epilepsy?

In a person suffering from epilepsy, seizures are the main symptom of epilepsy.

There are various types of seizures which are broadly divided into two, depending upon whether the abnormal electrical activity has originated from a localized part of the brain or are generalized.

Different people experience different symptoms of epilepsy depending upon the type of seizure he or she develops.

The various types of seizures and the associated symptoms of epilepsy are given below:

causes and symptoms of epilepsy

1. Focal or Partial seizures:

These are the seizure that originates from an abnormal electrical activity occurring in just one area of the brain. They can be of two types depending on whether it affects awareness/ consciousness or not.

A) Focal seizure without loss of consciousness: previously known as a simple partial seizure. These seizure doesn’t involve loss of consciousness and may consist of following symptoms of Epilepsy:

• Change in perception of taste, smell, sight, hearing, or touch or change in emotions.

• Spontaneous motor symptoms such as twitching or jerking of an arm or leg.

• Sensory symptoms of Epilepsy such as tingling, dizziness, and others.

B) Focal seizures with impaired awareness: previously known as complex partial seizures. It causes loss of awareness or consciousness. Other symptoms of Epilepsy include:

• Staring blankly in space

• Unresponsiveness to environment

• Performing repetitive movements such as chewing, swallowing, or hand rubbing.

These signs and symptoms of Epilepsy could be mistaken for other conditions of the brain and thus needs to evaluated properly.

 

Generalized seizures

These are the seizures that involve all areas of the brain.

There are further classified into six types:

A) Absence seizures: mostly seen in children or teenagers. Less often in adults. Previously called “petit mal seizures,”. The person starts staring blankly in space and may develop subtle repetitive body movements such as lip-smacking or eye blinking. These seizures may come in groups several times a day and may cause a short loss of awareness. The seizures are not dangerous but tend to affect the child’s performance.

B) Tonic seizures: a person develops sudden stiffness of the muscles of the back and limbs, which may sometimes result in loss of balance and fall on the ground.

C) Atonic seizures: a person experiences loss of muscle control which usually results in the sudden collapse on the ground. Thus also called drop seizures.

D) Clonic seizures: a person develops repeated, rhythmic jerking of all limbs, neck and face.

E) Myoclonic seizures: the individual develops spontaneous brief twitching of the arms, face, and legs.

F) Tonic-clonic seizures: previously called “grand mal seizures”. These are the most dramatic type of seizures where the individual develops the following symptoms of Epilepsy:

• Stiffening and shaking of the body

• Biting of the tongue

• Loss of consciousness

• Sometimes loss of control over bladder or bowel

After an episode of seizure, a person may remain unaware of the seizure or may feel slightly sick for several hours.

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How common is epilepsy? How many people are affected by epilepsy?

Epilepsy is one of the commonest nervous system condition affecting about 5 crore people in the world and about 1 crore people in India. It is found to be more common in the rural part of India affecting about 2% of the population and less common in urban parts affecting about 0.6% population.

The higher rates of epilepsy in India especially in rural parts have been found to be due to a higher rate of infective causes such as malaria or neurocysticercosis, higher incidence of birth-related injuries or road traffic injuries, and lack of appropriate medical infrastructure and care.

What could be the complications of epilepsy?

After the signs and symptoms of Epilepsy also learn about the complications of Epilepsy. Seizures may affect the consciousness and muscle tone of the body and thus may lead to situations that become hazardous for the person and others.

The seizure may result in the following complications:

• Fall and head injury: changes in the muscle tone and awareness during a seizure may result in falling on the ground which can lead to head injury. It has been estimated that about 4% of people presenting with head injury due to falls are because of seizure.

• Road traffic accidents: it is estimated that a person with epilepsy is about 1.1 to 2.2 times at a higher risk of having an accident. Seizures may cause loss of awareness or control and may prove dangerous for the person and others around him.

Know more about driving and epilepsy

• Drowning: a person with epilepsy is 15 to 19 times more likely to drown and die while swimming or bathing in a water body than people without epilepsy because of the possibility of developing a seizure while in the water.

• Emotional and mental health problems: these people are more prone to have psychological issues such as anxiety, depression, and suicidal tendencies. This may occur due to the impact of the condition itself along with the side effects of the medicines.

• Pregnancy complications: people with epilepsy are as likely to get pregnant as people without epilepsy.

However, seizures in pregnancy may affect the health of both mother and the baby. Moreover, certain anti-epileptic medicines also increase the risk of birth defects in the baby.

However, most women can have a safe pregnancy and deliver healthy babies. They need to consult their doctors before getting pregnant and need to be carefully monitored throughout pregnancy with properly adjusted medicines.

• Status epilepticus: is a serious, sometimes difficult to treat condition which if left untreated can result in death in about 20% of the people. A person is said to develop status epileptics when he or she remains in a state of continuous seizure for more than 5 minutes or if he or she experiences recurrent seizures without regaining full consciousness in between. It is a medical emergency where 80% of the people who receive medication within 30 minutes of the seizure onset eventually stop having a seizure.

• Sudden unexpected death in epilepsy (SUDEP): rarely people with epilepsy may develop sudden unexpected death. The exact cause is unknown, but it is considered to be due to hypoventilation or cardiac arrhythmia. About 1 in 1000 people with epilepsy suffer from SUDEP each year. It is considered to be probably related to nonadherence to prescribed medicines and/or related to more difficult to control seizures.

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What are the causes of epilepsy?

Epilepsy can be caused by a variety of conditions. However, in about 50 % of the people, the cause of epilepsy remains unknown.

Any brain condition that causes intermittent development of episodes of abnormal electrical activity can result in seizures of epilepsy.

Following are the conditions that can lead to epilepsy:

Genetic factors: genetic factors play a role in some forms of epilepsy. People with a close family member such as parents having a genetic cause of epilepsy tend to have 2 to 5 times increased risk of epilepsy. Genetics may also play a role in predisposing some people to seizures from environmental triggers. Genetic causes may include conditions such as channelopathies, glucose transporter type 1 deficiency, and others.

Structural changes: changes in the structure of the brain and scarring in certain areas of the brain may cause epilepsy. These changes account for the majority of identifiable causes of epilepsy which include hippocampal sclerosis, cortical malformations, tuberous sclerosis, neurofibromatosis, and others.

Perinatal injury:

During pregnancy, delivery, or immediately after birth, the child’s brain is sensitive to injury from a number of factors such as low blood supply, poor nutrition, or infections which can cause damage and permanent scarring resulting in the development of epilepsy.

Infections: a number of infections of the brain and surrounding structures can result in seizures. These infections can be neurocysticercosis, tuberculomas, encephalitis, meningitis, cerebral malaria, HIV, cerebral toxoplasmosis, subacute sclerosing panencephalitis. NCC is the commonest cause of acquired epilepsy in childhood.

Stroke: is one of the common causes of epilepsy in adults over 35 years of age.

Tumor: tumors can result in disruption of the electrical activity of the brain producing seizures. The number of people with brain tumors presents with seizures as the main symptom.

Head injury: head injury can result in brain damage which may result in the development of epilepsy. This can be seen in cases of road traffic accidents, falls or assault, and others.

Brain inflammation due to autoimmune conditions: autoimmune conditions such as voltage-gated potassium channel antibody encephalitis and N-methyl-D-aspartate receptor antibody encephalitis and others may result in epilepsy.

Metabolic disorders of the brain: changes in the metabolites can interfere with the functioning of the brain resulting in epilepsy. These conditions can be glucose transporter type 1 deficiency and pyridoxine deficiency.

Unknown causes: these are cases where no causes of epilepsy could be identified. They are considered to account for 50% of cases of epilepsy.

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What are the risk factors for epilepsy?

There are certain conditions that are associated with a significantly increased risk of developing epilepsy and predisposes a person to develop epilepsy. These are as follows.

Head trauma: with a head injury the risk of developing epilepsy increases to 20 to 30 times. The risk of developing epilepsy after trauma correlates with the degree of trauma. The risk of developing epilepsy persists even 10 years after the injury.

Stroke: a patient of stroke has about 20 times increased risk of developing epilepsy. It is estimated that about 3 to 30% of people after stroke will develop epilepsy.

Degenerative changes: brain degenerative changes such as Alzheimer’s disease increases the risk by 10 times.

Central nervous system infection such as neurocysticercosis is responsible for 10% of epilepsy in endemic areas. NCC is estimated to cause epilepsy in 1 per 1000 people in India.

The neurologic deficit from birth such as cerebral palsy is associated with increased risk of developing epilepsy.

Developmental brain conditions such as neurocutaneous syndrome consisting of conditions Sturge-weber syndrome, neurofibromatosis, tuberous sclerosis.

There are certain factors that increase the risk of developing an episode of seizure in a person suffering from epilepsy:

• Alcohol and drugs: alcohol or CNS stimulant drugs such as cocaine.

• Withdrawal from alcohol and certain medicines such as benzodiazepines, and anti-epileptics.

• Photic stimulation such as flashing lights, rapidly altering bright images on television or video screens.

• Sleep deprivation

• Fever

• Lack of oxygen

• Increased urea in the body

• Migraine (migralepsy)

When someone known or a person himself experiences a seizure he or she should consult a doctor immediately. The seizure could indicate an underlying serious condition that needs immediate medical attention such as stroke, infection, or metabolite imbalance. In a known case of epilepsy on treatment, the development of seizure may indicate worsening, inadequate treatment, or non-compliance.

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How epilepsy is diagnosed?

To diagnose epilepsy, the doctor would review symptoms of Epilepsy and do certain tests. He would establish whether the event was a seizure or not. He would rule out other causes that can cause seizures. In the case of epilepsy, he would try to confirm the cause and direct management further.

The doctor would evaluate a person for epilepsy and seizure in the following sequences:

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