Epilepsy and seizures: causes, tests, treatment and when to get help

Epilepsy is a long-term brain condition that causes repeated seizures. Myths about it still cause fear and stigma. This review explains what epilepsy is, how it is diagnosed and treated and when a seizure needs emergency help, using information from the NHS, the World Health Organization (WHO) and MedlinePlus.

1. Introduction

Epilepsy is a brain condition that causes repeated seizures, also called fits. Seizures happen when groups of nerve cells in the brain send out faulty signals ^[3]. WHO defines epilepsy as having two or more unprovoked seizures, and notes that one seizure alone does not mean a person has epilepsy. Up to 10 percent of people have a single seizure at some point in life ^[2].

About 50 million people worldwide have epilepsy, and nearly 80 percent of them live in low- and middle-income countries ^[2]. It is not contagious ^[2].

2. Signs and symptoms

The NHS says seizures are usually the only symptom. A seizure typically lasts seconds to minutes and stops on its own ^[1]. What it looks like depends on where in the brain it starts ^[2]. The NHS describes these types ^[1]:

• Tonic-clonic: loss of consciousness, stiffening and jerking or shaking.
• Tonic: sudden stiffening, possibly a fall, with quick recovery.
• Atonic: sudden loss of muscle tone, possibly a fall.
• Absence: a brief loss of awareness, such as staring blankly.
• Focal: unusual feelings, sensations or movements.
• Myoclonic: brief muscle jerks.

A person may have one type or several. Epilepsy often starts in young children and in people over 50, but it can begin at any age ^[1].

3. Causes and risk factors

Epilepsy happens when the normal electrical activity in the brain changes. The NHS says it is often linked to inherited genes, or can follow brain damage after a head injury, stroke or infection ^[1]. WHO adds brain injury around birth, birth differences in brain development, severe head injury, brain infections such as meningitis, and brain tumours. In about half of cases the cause is unknown ^[2]. MedlinePlus also notes that no cause is found in many cases ^[3].

4. Diagnosis and tests

A specialist asks what happened before, during and after the seizure, and an account from a witness helps. The NHS lists tests that may be used ^[1]:

• An EEG (electroencephalogram), which records the brain's electrical activity
• An ECG to check the heart
• MRI or CT scans of the brain
• Blood tests and sometimes genetic testing

The NHS says diagnosis is usually made after more than one seizure, or when tests show a high risk of more seizures ^[1]. MedlinePlus stresses starting treatment promptly after diagnosis ^[3].

5. Treatment and management

Your doctor chooses the plan. The NHS and MedlinePlus describe these options ^{[1, 3]}:

• Anti-seizure medicines are the main treatment. The choice depends on seizure type, age, sex and other health conditions, and it may take time to find the right one. WHO says up to 70 percent of people could become seizure-free with suitable medicine ^[2].
• Surgery, a vagus nerve stimulator or a special diet may be considered if medicines do not control seizures ^{[1, 3]}.
• Never change or stop medicine without medical advice. After two years without seizures a specialist may discuss slowly reducing it ^{[1, 2]}.
• Some epilepsy medicines can harm a developing baby, so anyone who may become pregnant should talk to a specialist before planning ^[1].

The NHS suggests regular check-ups and a care plan telling family what to do during a seizure ^[1]. The NHS page also links to separate first aid guidance, and says people who are trained should follow the person's care plan.

6. Safety and daily life

The NHS advises keeping a seizure diary to spot triggers such as tiredness, stress, periods, flashing lights, or food and drink. Other steps include telling family and friends what to do, wearing medical ID, making the home safer, choosing showers over baths and taking care when swimming or cooking ^[1]. WHO says about a quarter of cases may be preventable through head injury prevention, good care around birth, treating infections and controlling blood pressure, among other steps ^[2]. WHO also stresses that stigma can be harder to overcome than the seizures themselves ^[2].

Seizures usually cause no lasting harm, but they can lead to accidents or injuries. A very long seizure, or repeated seizures without recovery, is called status epilepticus and needs urgent treatment ^[1]. The NHS also notes that sudden unexpected death in epilepsy is rare and that treatment reduces the risk ^[1]. Pregnancy is possible with epilepsy, but extra monitoring may be needed, and medicine may need adjusting under specialist guidance ^[1].

7. When to see a doctor

Follow the person's care plan if there is one. The NHS says to call for emergency help if ^[1]:

• It is a first-time seizure.
• A seizure lasts longer than usual, or more than 5 minutes if the usual length is not known.
• The person does not recover as expected, or has repeated seizures without recovering between them.
• There have been 3 or more seizures in 24 hours.

See a doctor urgently if someone may have had a first seizure but did not go to hospital, or has a seizure after a long seizure-free period ^[1].

In an emergency, call your local emergency number (112 in India, 911 in the United States).

8. Conclusion

Epilepsy is a long-term brain condition, but most people can have good seizure control with the right medicine and support. Safe habits at home, clear advice for family and friends, and regular reviews with a specialist make daily life safer. Treatment decisions belong to your own doctor.