Epilepsy

Epilepsy is a neurological disorder characterized by recurring seizures. Seizures are periods of abnormal electrical activity in the brain that can cause a person to lose consciousness, have hallucinations, and experience severe muscle spasms.

There are two main types of seizures that people with epilepsy may experience:

• Focal seizures, where abnormal electrical activity is limited to a specific region of the brain.

• Generalized seizures (also known as tonic-clonic or grand mal seizures), where abnormal electrical activity affects the whole brain.^[1]

The main symptoms of epilepsy are seizures, which vary considerably in severity, duration, and physical presentation.

For example, before the onset of a focal seizure, people may experience a phenomenon known as an aura, with feelings of déjà vu and hallucinations. Other common symptoms of a focal seizure include one-sided, uncontrollable bodily movements (e.g. twitching and jerking), loss of consciousness, and confusion.

Generalized seizure symptoms can vary greatly: from brief lapses in consciousness only, to loss of consciousness in addition to stiffening of muscles and uncontrollable muscle contractions on both sides of the body.

Additionally, people with epilepsy often suffer from comorbid conditions including depression, anxiety, sleep disorders, migraines, and cognitive dysfunction.^[1][2]

Seizures are usually first suspected based on the patient’s or family member’s self-reports and medical history. A healthcare provider must perform a full clinical assessment to rule out other potential causes of seizures as well as other medical conditions that present as seizures.^[3][2] Diagnostic tests which measure electrical activity in the brain, such as electroencephalography (EEG), are commonly used to diagnose epilepsy; other tests, such as computed tomography (CT) scans and magnetic resonance imaging (MRI), may be used to detect structural abnormalities that can contribute to seizures (e.g., tumors).^[1][2]

Anti-seizure drugs (e.g., phenytoin, lamotrigine) are the first-line treatment for epilepsy. However, some patients with epilepsy cannot tolerate the side effects of medications, and for about one-third of patients, medications do not work. If medications do not improve symptoms or aren’t tolerated, other treatments like surgery, neurostimulation, or dietary changes may also be tried.^[2]

Numerous supplements have been studied for epilepsy, including vitamin D, omega-3 fatty acids, vitamin B6, and CBD. However, the evidence for these supplements varies, and they should not be used in place of medications.^[4] Thus, it is important to consult a healthcare provider before using any supplements to treat epilepsy.

After noticing that people with epilepsy tend to have fewer seizures while fasting, there was an interest in trying ketosis-inducing diets to control seizures. Limited research suggests that a ketogenic diet, a medium-chain triglyceride diet, a modified Atkins diet, or a low-glycemic-index diet may be helpful for reducing seizures in some people with epilepsy. However, a strict ketogenic diet can be challenging to adhere to long-term and can increase the risk for adverse health effects such as nutritional deficiencies, growth impairment in children, and digestive problems.^[1][2]

Behavioral therapy to reduce stress and avoid known seizure triggers, such as lack of sleep, excessive alcohol, fevers, or flashing lights, can help manage epilepsy.^[2] Using sunglasses or specially tinted glasses may benefit people with seizures provoked by flashing lights and/or visual stimulation.^[5] Acupuncture has been studied for treating epilepsy, but it’s not clear if it works.^[6]

The cause of epilepsy in a majority of people is unknown. Numerous things — such as brain injuries, tumors, as well as strokes — can cause epilepsy and/or seizures. So if someone is experiencing a seizure, they may not have epilepsy.^[1][7] Mechanistically, seizures are usually caused by excessively synchronized neuronal discharges occurring in diffuse or focused areas of the brain.^[2] Seizures may occur without any identifiable cause (known as unprovoked seizures) or may occur after a stimulus like flashing lights (known as reflex seizures).