Epilepsy

Epilepsy is a chronic brain disorder affecting around 50 million people worldwide.¹ In Australia, there are approximately 250,000 persons living with epilepsy.²

Epileptic seizures arise from abnormal electrical activity in the brain.^a In people with epilepsy, the brain has a persistent tendency to generate epileptic seizures.a The disorder has many possible causes and manifestations, with numerous distinct types of seizure and epilepsies.^b Epilepsy can have an impact on the person’s daily activities, such as driving.^a The social stigma surrounding epilepsy can also negatively affect the individual’s quality of life.^a

Many epilepsy types have a genetic basis – some epilepsy types involve single genes, while others involve multiple genes.^c A lack of oxygen in the brain and developmental abnormalities can result in brain lesions that increase a person’s risk of developing epilepsy.^c Epilepsy can be caused by trauma due to head injury, infectious diseases of the central nervous system, or tumours.^b Epilepsy may also be related to abnormalities of the immune or metabolic systems.^c

In some people with epilepsy, the cause of epilepsy is unknown.^c

http://www.epinet.org.au/articles/understanding_epilepsy/seizures__epilepsy#ue3

The hallmark feature of epilepsy is seizures.^d Seizures present in many different ways. For example, a person may experience an altered state of consciousness, or display strange behaviour, such as becoming non-responsive or confused. People with epilepsy may also experience involuntary movements, such as twitching or shaking of their arms or legs.^d,e

Seizures may be characterised by whether they involve the whole brain, or only part of the brain, as well as where the seizure 'originates’ from in the brain:^d

Focal seizures begin from a restricted location within the brain.^b Seizures in different regions of the brain may result in different symptoms.^a For example, seizures affecting the part of the brain responsible for hearing (known as the temporal lobe) may result in auditory hallucinations.^a

Generalised seizures involve the entire brain.^b Generalised seizures may be classified as:^e

• Tonic-clonic seizures:These seizures have two phases. In the tonic phase, the person initially stiffens and loses consciousness, and the back arches as the chest, arm and leg muscles tighten. During the clonic phase, the muscles spasm and jerk, gradually slowing down over time until these movements stop.^e

• Myoclonic seizures:“Myo” means muscle and “clonic” means jerk; myoclonic seizures appear as quick and sudden jerking movements.^e

• Atonic seizures:Atonic seizures are also known as “drop attacks”; the person’s muscles go limp as muscle tone is lost.^e

• Absence seizures:The person may appear to be staring without moving for brief periods (usually seconds), multiple times a day.^e

Epilepsy can have an impact on the individual’s day-to-day activities. For example, some people with epilepsy face driving restrictions which limit their independence and mobility, due to the risk of having a seizure whilst driving and losing control of their car.^a Seizures in epilepsy can affect a person’s confidence, and the social stigma surrounding the disease can add to the psychological burden on the person.^a As a result, people living with epilepsy may experience depression and anxiety, which can further decrease their quality of life.^d

• http://www.epilepsy.org.au/about-epilepsy/understanding-epilepsy/what-seizures-look-like
• http://www.epinet.org.au/articles/understanding_epilepsy/seizures__epilepsy#ue5
• http://resources.beyondblue.org.au/prism/file?token=BL/0835

A wide range of epilepsy syndromes can develop in young people during their infancy, early childhood and teenage years.^f Many of these are age-dependent and have variable long-term consequences.^f As in adults, seizures in children may be focal or generalised.^f

Absence seizures, a type of generalised seizure, generally occur during childhood.^b During an absence seizure, parents, carers or teachers may notice that the affected child has become very quiet and unresponsive.^b The child may not be aware that a seizure has occurred, and may continue an action or conversation as if nothing happened.^b Absence seizures can affect the quality of a child’s education and learning. ^b

Children under the age of 5 can develop seizures during a fever that do not appear to be caused by an infection (termed “febrile seizures”).^f,g Children with febrile seizures are not considered to have epilepsy,^g although some children with febrile seizures can develop epilepsy later in life.^f

• https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/epilepsy-in-children
• http://www.rch.org.au/kidsinfo/fact_sheets/Epilepsy_an_overview/
• http://www.rch.org.au/neurology/patient_information/about_epilepsy/

The diagnosis of epilepsy should be made by a neurologist with an interest in epilepsy.^b The neurologist may ask questions about the person’s symptoms and medical history.^d It is important that the person with seizures or, where possible, an eyewitness provides a thorough description of the seizure, which can help the neurologist to identify the type of seizure and to make an accurate diagnosis.^d

When reviewing the symptoms and history of seizures (including the person’s family history), the neurologist may perform an examination to check the person’s psychological and neurological state.d The neurologist may also order the following tests:

• Electroencephalogram (EEG) provides information about electrical activity in the brain, which can be used in some cases to detect abnormal brain activity that is typical of some forms of epilepsy.^d,h           
• Brain scans, such as computer tomography (CT) or magnetic resonance imaging (MRI) aid in the detection of lesions in the brain.^d,h            
• Blood tests are used to check possible causes of seizures (eg. infections, genetic conditions).^h

http://www.epinet.org.au/downloads/File/Epilepsy%20Australia%201353%20Diagnosing%20epilepsy_answering%20your%20questions_VIC_NSW%20(2).pdf 

General Information about Epilepsy:

• Epilepsy (Brain Foundation): http://brainfoundation.org.au/disorders/epilepsy-disorder
• Epilepsy Explained (Epilepsy Australia): http://www.epilepsyaustralia.net/epilepsy-explained/
• Fact Sheets (Epilepsy Foundation): http://www.epinet.org.au/articles/fact_sheets_1/fact_sheets
• Epilepsy (Better Health Channel and St Vincent’s Hospital, Melbourne): https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/epilepsy

Patient Organisations:

• Epilepsy Australia is the national coalition of Australian epilepsy organisations working together to keep communities informed on the latest medical breakthroughs, social research, publications, news and policy about epilepsy. Various regional patient organisations across Australia promote the well-being and interests of people with epilepsy and their families, friends and carers. Please select one of the following:

1. Epilepsy Association of Western Australia (Inc)

2. Epilepsy Australian Capital Territory (ACT)

3. Epilepsy Centre (South Australia and Northern Territory)

4. Epilepsy Queensland Inc

5. Epilepsy Tasmania

6. Epilepsy Action Australia undertakes research and advocacy, and delivers innovative, high quality services across Australia to optimise life outcomes for people with epilepsy.

7. The Epilepsy Foundation aims to provide services to people living with epilepsy and their families to help them achieve their goals. The foundation works to raise awareness of epilepsy in organisations and the broader community to reduce the stigma and create a more welcoming and inclusive society.

Other resources:

• HealthDirect Australia is a public company that delivers health services by contracting with service providers, managing ongoing operations and implementing governance structures so that health services are provided safely and efficiently. The epilepsy webpage provides information on epilepsy-related health services and information.
• The Epilepsy Foundation runs Epilepsy Information Sessions  for people living with epilepsy, their families and friends.
• The Epilepsy Wellbeing Map^TM  is a tool to help people with epilepsy prepare for consultations with the health care team.
• My Epilepsy Medical Review Appointment is a booklet developed by Epilepsy Foundation  to help people with epilepsy prepare for an appointment with the help of their support person.
• Epilepsy Action Australia provides a comprehensive list of resources, including an online Epilepsy Diary to help people with epilepsy keep track of seizures, triggers and medications, as well as fact sheets and brochures.

General Information about Epilepsy:

• Epilepsy in Children (Better Health Channel and St Vincent’s Hospital, Melbourne): https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/epilepsy-in-children

Patient Organisations:

• The Pediatric Epilepsy Network (New South Wales) aims to improve the standard of care and quality of life for each child or adolescent living with epilepsy across New South Wales.

Other resources:

• Epilepsy Action Australia provides specific information for parents of children with epilepsy.
• The Pediatric Epilepsy Network (New South Wales) provides resources for families on living with epilepsy. 
• The Royal Children’s Hospital Melbourne provides epilepsy resources for children with epilepsy and their families, including a seizure diary for children  to record the child’s seizures, headaches, falls, changes to medications, illnesses and other episodes.

For more information about epilepsy, please consult a healthcare professional.

1. WHO Fact Sheet. Epilepsy. Available from: http://www.who.int/mediacentre/factsheets/fs999/en/#

2. Epilepsy Action Australia. Facts and statistics about epilepsy. Available from: https://www.epilepsy.org.au/resources/for-media/facts-statistics-about-epilepsy

a. Whitehead J. InnovAiT. 2015; 8: 291-297.

b. Duncan J, Sander J, Sisodiya S, Walker M. Lancet. 2006; 367: 1087-1100.

c. Scheffer I, Berkovic S, Capovilla G, Connolly M, Guilhoto L, Hirsch E et al. The organisation of the epilepsies: report of the ILAE commission on classification and terminology. Available from: http://www.ilae.org/visitors/centre/Documents/OrganizationEpilepsy.pdf Accessed on: 11 June 2016.

d. Elger C and Schmidt D. Epilepsy and Behaviour. 2008; 12: 501-539.

e. Johns Hopkins Medicine. Types of seizures. Available from: http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/epilepsy/seizures/types/ Accessed on: 11 June 2016.

f. Guerrini R. Lancet. 2006; 367: 499-524.

g. Seinfield D and Pellock J. Journal of Neurology and Neurophysiology. 2013; 4(165): doi:10.4172/2155-9562.1000165.

h. Mayo Clinic. Epilepsy: diagnosis. Available from: http://www.mayoclinic.org/diseases-conditions/epilepsy/diagnosis-treatment/diagnosis/dxc-20117234 Accessed on: 15 June 2016.