What to know about epilepsy?
Epilepsy is a neurological condition quite widespread. It affects 1% of the world's population, and in Quebec it is estimated that over 87,000 people live with epilepsy. But epilepsy affects many more people. Epilepsy turns an entire clan's life upside down! The balance of the family and the workplace is disrupted, and everyone reacts differently!
Understanding epilepsy and its consequences is a necessity. Talking about it helps demystify epilepsy and elucidate a few unknowns!
What to do in a seizure?
Did you know that one of the best gifts you can give someone living with epilepsy is 2 minutes of information?
Stay calm! You can help the person in crisis.
It can be pretty impressive when an unconscious person experiences sudden jolts, i.e. convulsions. Knowing what to do in a crisis is reassuring for everyone!
Take a deep breath and follow these simple guidelines.
What is epilepsy?
Epilepsy is a cerebral dysfunction characterized by a permanent predisposition of the brain to present “electrical storms” of variable duration.
According to the official ILAE (International League Against Epilepsy) definition, epilepsy is present when at least one of these situations occurs:
1- The occurrence of a minimum of two unprovoked (or reflex) seizures more than 24 hours apart;
2- The onset of an unprovoked (or reflex) seizure and the detection of a high probability that subsequent seizures will occur within 10 years (60% chance or more);
3- Diagnosis of epileptic syndrome.
These epileptic seizures have a variety of manifestations and frequencies of occurrence.
So there is not one epilepsy, but many.
Classification of different epilepsies
The different types of epileptic seizures, which can be attributed to multiple points of origin in the brain, are accompanied by a wide variety of symptoms.
As a general rule, epileptic seizures are categorized on the basis of their various starting points in the brain.
Causes of epilepsy
Although much research has shed light on the factors behind epilepsy, its causes remain unknown in 60% of cases. This is one of the reasons why this neurological condition continues to be the focus of much research. several scientific explorations in Quebec and elsewhere. As for the known causes, they fall 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
These are the most common causes of epilepsy in certain developing countries. Toxoplasmosis, HIV, malaria and the Zika virus can all cause brain damage leading to epilepsy.
Metabolic causes
Metabolic causes, such as biochemical alterations, enzyme deficiencies or mitochondrial diseases, are rare when it comes to the onset of epilepsy.
Autoimmune causes
Autoimmune causes of epilepsy include certain immune system disorders and the presence of abnormal antibodies.
Possible triggers of an epileptic seizure
These are all factors that can contribute to the onset of a crisis.
- High levels of stress, agitation, excitement or upheaval;
- Forgetting to take your anti-crisis medication;
- Sleep deprivation or an irregular sleep schedule;
- Non-adherence to anti-epileptic medication;
- Hormonal changes (catamenial epilepsy);
- Alcohol or drug withdrawal or abuse;
- Certain visual stimuli (photosensitive epilepsy), auditory or olfactory stimuli (reflex seizures).
Treatments
Medication
Highly effective, 70% of people living with epilepsy control their seizures manage to control their seizures with medication.
However, because of the various possible causes and manifestations of epilepsy, the pharmacological treatments used vary enormously from one person to another. That's why only your pharmacist/neurologist can give you the right information.
While in some cases a single molecule is sufficient to control seizures (monotherapy), other situations require the use of several molecules (polytherapy).
To find out if a generic anti-crisis medication prescribed by a physician is reimbursed by the RAMQ, visit this online directory.
Bet on yourself! TAKE YOUR MEDICINE!
Some people turn out to be drug-resistant.
Drug resistance occurs when medication alone is insufficient to control seizures satisfactorily.
This is what happens in about 30% of cases.
When regular use of two anti-seizure medications adapted to the type of epilepsy fails to control seizures, the treating physician may suggest a more thorough evaluation. This will determine whether surgery is indicated and possible.
Epilepsy surgery
To determine whether surgery is possible, the medical team first tries to determine the location of the “epileptic focus” (the area where seizures start).
Hospitalization for 5 to 15 days in an epilepsy unit is then required to localize the epileptic focus through video-encephalographic recording of seizures and other complementary tests.
Ultimately, this stay should determine whether surgery is possible.
If the epileptic focus is located in an area of the brain that occupies essential functions (e.g. language), it cannot be surgically removed. If the focus partly overhangs an essential area, surgery will not be aimed at resection.
of the epileptic focus, but rather a partial resection to interrupt the networks of neurons that promote seizure propagation.
To find out more about the various epilepsy surgeries most commonly performed in Quebec, follow this link: follow the link of the Association Québecoise de l'Épilespie
In some cases, an attending physician may suggest anti-seizure treatments in addition to medication or surgery. Here are some of the most commonly used methods.
The vagus nerve stimulator
Vagus nerve stimulation (VNS) is a treatment offered to people with drug-resistant epilepsy for whom the above-mentioned surgical options are not indicated or ineffective.
This involves implanting a device in the chest wall that stimulates the vagus nerve via an electrode placed in the vagus nerve pathway in the neck. Once installed, the vagus nerve stimulator releases electrical impulses at fixed time intervals.
SNV allows you to halve seizure frequency in up to 50% of patients. In rare cases, total seizure control can be achieved in a person who was originally drug-resistant (by maintaining medication at the same time).
On the other hand, as soon as the first symptoms (or signs) of a seizure are felt, the stimulator wearer can trigger an impulse himself using a small magnet, which can sometimes stop the seizure or reduce its duration. Similarly, a loved one can use the magnet to activate the stimulation if the person is unconscious or unable to use it.
As with any treatment, vagus nerve stimulation sometimes causes side effects such as :
- Low risk of infection during device implantation
- a hoarse voice, discomfort or tickling in the throat
- a change in voice timbre during stimulation.
SNV wearers have certain restrictions to observe, particularly in the presence of high magnetic fields (e.g. cerebral magnetic resonance equipment).
The ketogenic diet
In people who do not respond sufficiently to pharmacological treatments, epileptic seizures can also be controlled by modifying their diet.
The diet recommended is known as the “ketogenic diet”. It is generally prescribed for children under 12 years of age in the event of partial ineffectiveness of medication, for a period of 2 to 3 years.
The aim of the ketogenic diet is for the metabolism to produce most of its energy by burning fat, not carbohydrates. The diet is therefore high in fat, but low in carbohydrates and protein. On average, the ketogenic diet involves a 4-fold increase in fat intake.
In some cases, the medical team may suggest supplementing the patient's diet with vitamin supplements.
Although this treatment may be effective for some people, it is not recommended for everyone. Rigor is essential, as any deviation could lead to treatment failure and a return to seizures. Consequently, parents who opt for this treatment must be prepared to invest a great deal of effort in ensuring that their child's diet complies with the medical team's recommendations.
Cannabidiol (CBD)
Cannabidiol or CBD is the non-psychoactive substance contained in cannabis. However, extreme caution should be exercised if you wish to use it, as it can, in rare cases, worsen the impact of seizures.
It's important to stress that this therapeutic option is still very recent, and therefore less well documented. Its adoption should therefore always be discussed with the attending physician.
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