What is epilepsy?

Epilepsy is a neurological disorder characterized by recurrent seizures. Brain cells communicate with each other by means of tiny bursts of electrical activity. Sometimes a group of brain cells has an unexpected, erratic electrical discharge. This event produces a seizure. Someone who has multiple seizures is said to have epilepsy, which is defined as a functional disorder of the brain caused by sudden, brief malfunctions. These malfunctions may cause uncontrollable shaking (convulsions). They may also cause loss of awareness, confusion or even disturbance of the senses (visual and aural hallucinations, phantom odours, etc.).

Epilepsy is NOT a psychological disorder; it is NOT contagious.

Approximately one person in one hundred has epilepsy. In Canada, there are 330,000 people with epilepsy.

What causes epilepsy?

In many cases (60 to 75 percent), the cause of epilepsy is not known. In the remaining 25 to 40 percent, some of the causes include:

Types of Seizures

There are many different kinds of seizures, which fall under two main classifications: "focal" and "generalized."

Focal Seizures (formerly known as Partial Seizures): If the excessive electrical discharge in the brain is limited to one area, the seizure is partial. The two most common types of focal seizures are focal without impairment of consciousness aka focal (formerly simple partial) and focal with impairment of consciousness or focal dyscognitive (formerly complex partial). 

In a focal seizure, the person remains aware, and can experience a range of strange or unusual sensations, e.g. sudden jerky movements of one body part, distortions in sight or smell, sudden sense of fear, stomach discomfort, or dizziness. If these sensations act as a warning sign that a generalized seizure is about to occur, they are known as an "aura". 

In a focal dyscognitive seizure, the person loses awareness as the seizure begins and appears dazed and confused. The person will exhibit meaningless behaviours such as random walking, mumbling, head turning, or pulling at clothing. These behaviours cannot be recalled by the patient after the seizure.

Generalized Seizures: Generalized seizures affect the entire brain. The two most common forms are absence seizures and tonic-clonic (convulsive) seizures. 

During an absence seizure, the person appears to be staring into space and their eyes may roll upwards. This kind of seizure is characterized by 5 to 15 second lapses of consciousness and when it has ended, the person will not recall this lapse of consciousness.  An individual may experience many absence seizures per day.  Absence seizures most often occur in childhood and can disappear by adolescence. They are less prevalent in adulthood. 

In a tonic-clonic seizure, the person will usually emit a short cry, and fall to the floor. Their muscles will stiffen and their body extremities will jerk and twitch. With this type of seizure, bladder or bowel control may be lost, and consciousness is regained slowly. Tonic-clonic seizures typically last 1 to 3 minutes.

Postictal states: Postical states commonly follow both tonic-clonic and complex partial seizures. As a person regains consciousness after the seizure, they can experience fatigue, confusion and disorientation lasting from five minutes, up to hours or even days and, rarely, as long as one to two weeks. The person may fall asleep or gradually become less confused until full consciousness is regained.

Are Seizures Painful or Dangerous?

Seizures are not painful and are generally not harmful, but prolonged or recurrent seizures can cause damage to the brain.

A continuous seizure state known as status epilepticus is a life threatening condition. If seizures are prolonged (last longer than 5 minutes) and/or occur one after another without full recovery between seizures, immediate medical care is necessary. The seizures may be convulsive or non-convulsive. There is also an increased risk of injury in people with epilepsy. If seizures are uncontrolled, then a person is at greater risk.

Sudden Unexplained Death in Epilepsy (SUDEP)*

Sudden Unexplained Death in Epilepsy (SUDEP) refers to the unexpected death of a seemingly healthy person with epilepsy, where no cause of death can be found. Rather than pertaining to a specific disease or condition, it is used to denote a category to which these types of unexplained deaths are assigned. Sudden unexplained death also occurs in the general population but the risk is higher for people with epilepsy.

The cause of SUDEP is not well understood, and risk factors are still being researched.  However, the risk factors most consistently identified in case studies to date include:

Minimizing the Risk of SUDEP

In the current absence of a proven SUDEP prevention method, the recommended approach is to attempt to keep modifiable contributory factors to a minimum. As research indicates that SUDEP is largely a seizure-related phenomenon, optimizing seizure control is highly important. Recommendations to achieve this include:

For more information about SUDEP, please visit SUDEP Aware at:http://sudepaware.org/about_sudep.html*Credit to SUDEP Aware for this information