When I was ten years old, I was diagnosed with benign rolandic epilepsy, which was really frightening because I had no knowledge of epilepsy or neuroscience. I hope this article can help those going through a similar experience or are just interested in learning more! In this post, I will share some information about epilepsy and raise awareness of its causes, diagnosis, and treatment.
What is epilepsy?
Epilepsy is a neurological disorder marked by recurring seizures, or brief moments of involuntary movement in particular parts of the body or the entire body. Seizures occur when there is an excessive electrical discharge in a group of brain cells, and can happen in various parts of the brain. Seizures can present themselves as loss of consciousness, convulsions, muscle jerks, loss of bodily control, and can occur with varying frequency. Having a singular seizure does not signify epilepsy. According to the World Health Organization, “Epilepsy is defined as having two or more unprovoked seizures…Fear, misunderstanding, discrimination and social stigma have surrounded epilepsy for centuries.” Misconceptions about epilepsy throughout history created a stigma towards the condition; through challenging misinformation and increasing awareness of epilepsy’s neurobiological basis, this stigma can be diminished.
According to the American Brain Foundation, about 3.4 million people in the U.S. live with epilepsy, and 9% of the population experiences at least one seizure in their lives. Moreover, the WHO states that “around 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally.” At the same time, nearly 80% of those with epilepsy live in low and middle-income countries, demonstrating a correlation between higher rates of epilepsy with increased risk of endemic conditions and lower accessibility to genetic testing, neurological technology, and preventative care. The risk of premature mortality in people with epilepsy is proportionally higher in lower-income countries, where many deaths caused by falls, drowning, and prolonged seizures are preventable.
Types of Epilepsy and Symptoms
An individual’s specific type of seizures and epilepsy is used to diagnose and guide treatment plans. Firstly, focal seizures occur when there is an abnormal electrical discharge within a tiny brain region, which can spread widely throughout the brain and cause a tonic-clonic seizure (leading to loss of consciousness). According to NYU Langone Health, individuals with focal seizures often have normal MRI scans. So, the cause of their seizures may be cortical dysplasia (brain cells did not develop into proper layers), head trauma, stroke, infection, or tumors. When focal seizures impair awareness, they are categorized as complex partial seizures. Seizures can also be localized in one part of the brain. For example, temporal lobe seizures are the most common type of epilepsy in which people repeat a particular motion and feel a loss of reality.
Generalized epilepsy involves generalized seizures, which are divided into absence seizures (momentary loss of movement without shaking), myoclonic seizures (brief jerking movements), and generalized tonic-clonic seizures (body stiffens and then shakes).
The most common form of childhood epilepsy is benign rolandic epilepsy, in which most children outgrow the condition by puberty. Usually, benign rolandic epilepsy starts in children from three to thirteen years old with nighttime seizures, and treatment includes medication for children with frequent daytime seizures.
Different epilepsies have many underlying causes, which are often difficult to determine. In their article, “Causes of Epilepsy,” the Epilepsy Society (UK’s leading charity for epilepsy research) writes that some causes may be genetic, either an inherited genetic tendency or a genetic mutation increasing one’s likelihood of experiencing epilepsy. Genetic conditions like tuberous sclerosis and neurofibromatosis can cause growths that lead to structural changes in the brain. Prenatal and perinatal causes like lack of oxygen or trauma during birth can cause brain damage, that contributes to seizures. Structural changes are also a common factor, such as lack of proper brain development, brain injury, infections, or cancer. Current research is working on understanding how infections, developmental disorders, and dementia can cause epilepsy. According to the WHO, 50% of global epilepsy cases have an unknown cause, showing the importance of continued research in the field.
According to the WHO, “an estimated 25% of epilepsy cases are preventable.” This includes preventing head injury, ensuring adequate perinatal care, and decreasing the likelihood of febrile seizures with medication to lower body temperature. In general, maintaining a healthy lifestyle can help prevent seizures associated with stroke by improving cardiovascular health with exercise, a nutritious diet, and avoiding tobacco and alcohol.
An individual with two or more unprovoked seizures not caused by a known medical condition can be diagnosed with epilepsy. Often, neurologists will perform MRIs to get a brain scan or EEGs, which measure electrical activity in the brain. As the WHO reports, about 70% of patients with epilepsy can control their seizures with various forms of medical intervention. Some treatments include antiseizure medication, specialized diets, neuromodulation devices, and in some extreme cases, surgery. Some surgeries to combat epilepsy include focal resection (removing a small portion of the brain where seizures occur) and the more minimally invasive laser interstitial thermal therapy (computerized laser destroys a small piece of brain tissue).
Additionally, neurosurgeons may recommend a corpus callosotomy (removes the part of the brain that connects the brain hemispheres) or a hemispherectomy (removes one hemisphere of the cerebral cortex). Hemispherectomies are usually conducted for children with severe cases of epilepsy that spread to various parts of the brain. Generally, the type of epilepsy surgery will depend on the type of seizures, as well as their location.
Overall, epilepsy is a condition affecting millions of people throughout the world. Although there have been great leaps in neuroscience research and the understanding of epilepsy, there is still much more that we do not know or understand. Through continued epilepsy research, hopefully, we can identify more causes and treatment possibilities in the future.