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Epilepsy

Epilepsy is a series of seizures. Having one seizure is a seizure, having more than one is epilepsy.

Epilepsy is a series of seizures. Having one seizure is a seizure, having more than one is epilepsy.

Epilepsy is not a disease, it is not contagious, and we do not catch it. Epilepsy is, more than anything else, a pattern of brain behaviour.

Blackouts are not uncommon, near half of us will have one at some time in our lives. The importance is to work out why the blackout occurred. 40% of all suffer a faint at some point. This is connected to the blood system and circulation and will be dealt with by a GP, possibly in consultation with a cardiologist. Around 8 out of one hundred will have a seizure over the years.

The first stage is to distinguish between the two, faint and seizure. A seizure is when the electrical systems of the brain fire off in an uncoordinated fashion. The instructions that tell us to do something, have a thought, move a limb, are electrical across the cells of the brain. A seizure is when this happens in a cascade, perhaps a storm, instead of in the normal regulated manner.

The seizure can be localised, or it can be general. The effect might be to make us lose the function of that specific part of the brain concerned, say speech, or movement. It can be general and a grand mal (a tonic-clonic one more correctly) seizure will lead to violent contraction of the limbs and the loss of consciousness.

Epilepsy is when there is a repeat of a seizure rather than just the one incident. It is the repeat which makes the definition. Epilepsy is not uncommon.

About 3% of the population will have it at some point in their lives. At any one time some 1% have it. Epilepsy is something that can come and go – something that can be grown into and out of.

Any blackout, faint or seizure must be investigated to determine which it is or was. One importance is that you cannot drive for 6 months after a seizure.

Part of the treatment is this process of investigation. Which actually happened, faint or seizure? If it was a seizure, is it one of a series? It is the series of seizures that makes it epilepsy. When investigating the diagnosis will be helped by an eyewitness description of the episode.

If someone was there then their presence during the consultation will be helpful. If this is not possible then a written account is still useful. There can be physical causes of both faints and seizures. The diagnostic process will work to identify if this is the case and then direct for to the appropriate treatment for that underlying cause.

A series of seizures can be provoked, or symptomatic. Removing the alcohol, recreational drugs, other medications, that might have caused it will be that treatment.

It is possible for there to be a series of spontaneous seizures and this is the definition of epilepsy. Once this is diagnosed it is possible to treat the epilepsy.

Epilepsy is controlled through the use of pharmaceutical drugs. There are a number of possible such drugs that can be used to treat epilepsy, some 8 or 10 in common use.

Each of them have their own specific benefits, each of them have side effects. Which is the correct drug to use will depend upon the specifics of the case being considered. This is why epilepsy is investigated and treated by a consulting neurologist, not a GP.

Epilepsy treatment focuses upon the right drug to be using, not simply the diagnosis. Which drug to use will be determined by a number of different factors. Which side effects will be least costly to you, for example. One effective treatment for epilepsy can reduce verbal fluency.

That would not be the best one to use for an actor, or perhaps saleswoman. So, the correct treatment is not just dependent upon epilepsy itself, but also what you do, the wider social background. Some epilepsy drugs are teratrogenic - they can cause birth defects - and therefore will not be used upon young women.

The heart of epilepsy treatment is this selection of the best of the available drugs to treat the specific case. This can involve some test and replacement, a period on one course or drug and then a reconsideration. The neurologist will be able to zero in on the most likely to be acceptable balance just through consultation, but some experiment might be necessary.

Epilepsy treatment is holistic, in that it extends to much more of life that simply a drug regimen.

For some the seizures will continue, even if much more controlled. So the neurologist will offer advice on such matters as lifestyle, what to do if a seizure occurs, what to have at home to aid in recovery from one. One part of that advice is to make sure to take the pills regularly, of course.

There will also be advice upon driving, this being where epilepsy interacts with the law.

Epilepsy is not something that is cured, it is a condition that is treated. For many to most people epilepsy is something that leaves in its own good time.

Treatment is aimed at reducing, or eliminating, seizures until that happens. It does not disappear for everyone though, nor are all treated entirely free from seizures.

The recovery time from epilepsy treatment is really about when there will be another seizure.

The correct drug regime will mean being seizure free for 70% of patients over time, for 5 to 10 years.

As epilepsy is treated, not cured, recovery from epilepsy is an elastic concept.

Being seizure free is the aim and for the majority that is achieved once the drug treatment regime has been correctly identified and bedded in.

The risks of non-treatment of epilepsy are substantial. Repeated seizures would, for example, make it illegal to continue to drive.

It is also entirely possible to suffer injury in the course of a seizure. Each of the varied drugs that can be used to treat epilepsy have their own side effects.

Such side effects are also known as risk for reactions to them are not the same for everyone. Designing the correct treatment for a specific case of epilepsy is the trade-off of those risks against the life being interrupted by the seizures.

Some of the risk decisions are obvious, as with the possibility of birth defects and young women. Others are more personal and are about you and your life. What is it that you do, how do you do it?

This will drive the decision as to which side effects are more acceptable than others. This will aid in determining which drugs should be the course of treatment.

There are no acute risks to epilepsy treatment. It is not like surgery where there is always an infection risk and so on. With epilepsy the aim is to make life better.

As we all have different ideas of what is better in life, our estimations of the risks of epilepsy treatment are different – and so are the treatments.

Specialists offering Epilepsy

Dr Tabish Saifee

Consultant Neurologist

MBBS, BSc, MRCP, PhD

BMI The Clementine Churchill Hospital

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Dr Angus Nisbet

Consultant Neurologist

BM BS BMedSci CCST (Neurology) FRCP

BMI Goring Hall Hospital

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Dr Vishwajit Hegde

Consultant Clinical Neurophysiologist

MBBS, MD(Med), MD(Neurology, FRCP(Lond&Edin)

BMI The Meriden Hospital

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Mr Vivek Josan

Consultant Neurosurgeon

MBBS FRCS(Ed) FRCS(SN)

BMI The Alexandra Hospital

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Dr Craig Heath

Consultant Neurologist

MD, MB ChB, BSc(Hons)

BMI Ross Hall Hospital 1 more BMI Kings Park Hospital

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