Overview
Epilepsy is a neurological condition characterised by a tendency to have recurrent seizures. A seizure occurs when there is a sudden burst of abnormal electrical activity in the brain. Seizures vary widely in appearance from brief absences to full convulsions. Epilepsy can usually be well controlled with medication.
How common is it?
About 600,000 people in the UK have epilepsy. It is the most common serious neurological condition, affecting people of all ages.
Causes and risk factors
Epilepsy can result from brain injury, abnormal brain development, or a genetic tendency for neurons to discharge abnormally. In many cases no cause is found.
Common risk factors
- Previous brain injury, stroke, or infection (meningitis, encephalitis)
- Brain tumours
- Genetic epilepsy syndromes
- Structural brain abnormalities
- Birth injury or oxygen deprivation
- Alzheimer's disease in older adults
- Unknown cause (about 40% of cases)
Symptoms
- Brief staring spells and loss of awareness (absence seizures)
- Sudden jerking movements of the arms and legs
- Full convulsion with muscle stiffening and rhythmic jerking (tonic-clonic seizure)
- Falling without warning
- Repetitive movements such as lip-smacking or hand rubbing (focal seizures)
- Confusion and tiredness after a seizure
- Warning sensations before a seizure (aura): smell, taste, feeling of fear
When to see a doctor
Call 999 if a seizure lasts more than 5 minutes, if another seizure follows before consciousness is regained (status epilepticus), or if the person does not return to normal within 20 minutes. See a doctor for a first seizure.
Diagnosis
EEG (electroencephalogram) records brain electrical activity and identifies seizure patterns. MRI scans the brain for structural causes. Blood tests identify metabolic triggers. Seizure diary tracks frequency and type.
Treatments
Anti-seizure medication
The mainstay of treatment. Around 70% of people with epilepsy achieve good seizure control with one or two medications. Drug choice depends on seizure type, sex, age, and side effect profile.
Epilepsy surgery
For people with focal epilepsy where a clear seizure focus is identified on MRI and EEG, surgery to remove the focus can be curative in selected cases.
Vagus nerve stimulation or ketogenic diet
For people who cannot take surgery or whose seizures are not controlled with medication. The ketogenic diet (high fat, low carbohydrate) has particularly good evidence in children.
Self-care and lifestyle
- Take medication at the same time every day and never stop abruptly
- Ensure adequate sleep as sleep deprivation commonly triggers seizures
- Avoid alcohol excess and recreational drugs
- Inform DVLA and observe the driving regulations (1 year seizure-free for most licences)
Prevention
Epilepsy itself cannot always be prevented, but preventing head injuries (helmets in sport, seatbelts), treating high fever in children, and reducing cardiovascular risk reduce the risk of acquired epilepsy.