Understanding Epilepsy
What is epilepsy?
Epilepsy
Feminine noun
“A chronic neurological condition characterized by absence seizures or convulsions with loss of consciousness“
(Le Robert Dictionary)
Epilepsy is a neurological condition quite common. It affects 1% of the world’s population, and in Quebec, it is estimated that over 87,000 people live with epilepsy. However, it affects even more people. Epilepsy disrupts the lives of entire families! The balance of family life and the workplace is disrupted, and everyone reacts differently!
How to define epilepsy?
Epilepsy is a brain dysfunction characterized by a permanent predisposition of the brain to exhibit electrical storms of variable duration. According to the official definition of the ILAE (The International League Against Epilepsy), the presence of epilepsy is confirmed when at least one of these situations occurs:
The occurrence of at least two unprovoked (or reflex) seizures, more than 24 hours apart
The occurrence of one unprovoked (or reflex) seizure and the detection of a high probability that subsequent seizures will occur within the next 10 years (60% chance or more)
The diagnosis of an epileptic syndrome
These epileptic seizures will have varied manifestations and frequencies of occurrence. Therefore, there is not one epilepsy, but epilepsies.
Triggers
Possible triggers of an epileptic seizure
Factors that can contribute to the onset of a seizure.
- High levels of stress, agitation, excitement, or upheaval
- Forgetting to take anti-seizure medication
- Sleep deprivation or an irregular sleep schedule
- Non-adherence to antiepileptic medication
- Hormonal changes (catamenial epilepsy)
- Alcohol or drug withdrawal or excessive consumption
- Certain visual (photosensitive epilepsy), auditory, or olfactory stimuli (reflex seizures)
Causes of Epilepsy
Factors causing epilepsy
Although extensive research has provided a better understanding of the factors causing epilepsy, its causes remain unknown in 60% of cases. This is one of the reasons why this neurological condition continues to be the subject of numerous scientific explorations in Quebec and elsewhere. As for known causes, they are divided into several categories.
Structural Causes
These refer to identifiable structural abnormalities of the brain, which may originate from cortical malformation, congenital abnormalities related to brain development, or acquired lesions.
Genetic Causes
They are linked to a genetic anomaly that directly affects the excitability of a more or less extensive area of the brain.
Infectious Causes
This type of cause is most frequently encountered in certain developing countries. Toxoplasmosis, HIV, malaria, and the Zika virus can cause brain damage that leads to epilepsy.
Metabolic Causes
Relatively rare concerning the onset of epilepsy, metabolic causes correspond, for example, to biochemical alterations, enzymatic deficiencies, or mitochondrial diseases.
Autoimmune Causes
Among the autoimmune causes that can play a role in epilepsy, these include certain immune system diseases and the presence of abnormal antibodies.
Treatments
Options for living better, one day at a time
Highly effective, 70% of people living with epilepsy control their seizures and manage to do so with medication.
However, due to the various possible causes and different manifestations of epilepsy, pharmacological treatments can vary considerably from person to person. This is why it is important to consult a qualified healthcare professional, such as a pharmacist or a neurologist, who can provide you with adequate information. While in some cases, a single molecule is sufficient to control seizures (monotherapy), other situations require the use of multiple molecules (polytherapy).
To find out if a generic anti-seizure medication prescribed by a doctor is reimbursed by RAMQ, visit
this online directory
.
Some individuals are found to be drug-resistant. Drug resistance refers to situations where medication alone is insufficient to satisfactorily control seizures. This occurs in
approximately 30% of cases
.
When regular intake of two anti-seizure medications tailored to the type of epilepsy fails to control seizures, the treating physician may suggest a more in-depth evaluation. This will serve to determine if surgery is indicated and possible.
To determine if surgery is feasible, the medical team first seeks to identify the location of the “epileptic focus” (the area where seizures originate). A hospitalization of 5 to 15 days in a specialized epilepsy unit is then necessary to locate this focus using video-electroencephalographic recording of seizures, as well as other complementary examinations. This stay ultimately allows for the evaluation of whether surgical intervention is possible.
If the epileptic focus is located in a brain area that performs essential functions (e.g., language), it cannot be surgically removed. If the focus is partially located in an essential area, the intervention will aim not to completely remove the focus, but to perform a partial resection to interrupt the neural networks promoting seizure propagation.
To learn more about the different epilepsy surgeries most commonly performed in Quebec, please follow this link:
follow the link to the Quebec Epilepsy Association
In some cases, the treating physician may suggest anti-seizure treatments complementary to medication or surgery.
Vagus nerve stimulation (VNS) is a treatment offered to individuals whose epilepsy is drug-resistant and for whom surgical options are not indicated or have proven ineffective. It involves implanting a device in the chest wall that stimulates the vagus nerve by means of an electrode placed along the nerve’s path in the neck. Once installed, the vagus nerve stimulator delivers electrical impulses at fixed time intervals.
VNS can reduce seizure frequency by half in nearly 50% of people with epilepsy. In rare cases, complete seizure control can be achieved in individuals who were initially drug-resistant, while maintaining medication intake.
Furthermore, as soon as the first symptoms (or signs) of a seizure appear, the person with a stimulator can trigger an impulse themselves using a small magnet, which can sometimes interrupt the seizure or reduce its duration. Similarly, a caregiver or family member can use the magnet to activate stimulation if the person concerned is unconscious or unable to do so.
Like any treatment, vagus nerve stimulation sometimes causes side effects such as:
- A low risk of infection during device implantation
- a hoarse voice, discomfort, or tickling in the throat
- a change in voice timbre during stimulations.
Individuals with a VNS device have certain restrictions to observe, particularly in the presence of high magnetic fields (e.g., a cerebral magnetic resonance imaging machine).
In individuals who do not respond sufficiently to pharmacological treatments, epileptic seizures can also be controlled by modifying their diet.
The diet then recommended is called the “ketogenic diet.” This is generally prescribed to young people under 12 years of age in cases of partial ineffectiveness of medications, and for a period of 2 to 3 years.
The ketogenic diet aims for metabolism to produce most of its energy by burning fats rather than carbohydrates. The diet is therefore rich in fats, but low in carbohydrates and proteins. On average, the ketogenic diet involves a fat intake 4 times higher. In some cases, the medical team may suggest supplementing the patient’s diet with vitamin supplements.
Although this treatment can be effective for some individuals, it is not recommended for everyone. Indeed, strict adherence is essential, as any deviation could lead to treatment failure and a return of seizures. Consequently, parents who choose this treatment must be prepared to commit to ensuring their child’s diet adheres to the medical team’s recommendations.
Cannabidiol or CBD is the non-psychoactive substance found in cannabis. However, extreme caution must be exercised if one wishes to use it, as it can, in rare cases, worsen the impact of seizures.
It is important to note that this therapeutic option is still very recent and therefore less documented. Its adoption must always be discussed with the treating medical team.
