Seizures and Epilepsy

In the mind of the general public, epilepsy is misunderstood and misinterpreted, often associated with a negative impact on the individual’s life not only because of the impact of the disease itself but also because the society’s wrong beliefs and social stigma. Epilepsy can be misdiagnosed, leading to a wrong treatment and negative consequences on the individual personal life as well as their family.

Hence, timely detection and epilepsy treatment in Dubai is necessary to prevent the condition from worsening.

There are different types of seizures as well as epilepsies.  A seizure and/or epilepsy can occur as early as in the first month of life, in childhood, teenage, adult life or in the elderly. 

About two third of patients with epilepsy can have their seizures under control.

In addition, in many cases, mostly in idiopathic generalized epilepsies that start in childhood or teenage, seizures remit at the adult age. In some patients, seizure control is achieved with the first tried drug; in others, epilepsy is called refractory as not responding to medications, sometimes requiring two or three drugs, surgical intervention or other alternative therapeutic approaches such as vagal nerve stimulation or ketogenic diet.

A seizure is defined as a transient, excessive and synchronous activity of the brain neurons that can be localized or generalized. Seizure onset can be localized to a limited area of the brain, frontal or temporal, for example, or generalized when abnormal neuronal activity begins in a widespread distribution. The clinical manifestations depend on the area where the seizure originated. A seizure is called generalized when the patient loses consciousness, like in a tonic-clonic “classical” seizure or has only an impairment of consciousness, like in the child who has absence seizures. Absence seizures can be isolated or associated with eyes fluttering or automatisms such as lips smacking, chewing or hands rubbing.  

When the onset is partial or focal and followed by loss of consciousness, the seizure is called secondary generalized.

Epilepsy is a predisposition to generate epileptic seizures and is defined by the occurrence of two or more unprovoked seizures separated by at least 24 hours.

A seizure can be isolated or provoked by a triggering factor in some individuals with high susceptibility but is not considered to be an epilepsy. Examples of seizure triggers are stress, sleep deprivation, visual stimulations such as flashing lights, alcohol overdose or withdrawal, high fever, mostly in children, menstruation, severe hypoglycemia or electrolytes imbalance and some drugs.

Epilepsy can be idiopathic due to a genetic predisposition in which the brain is normal or symptomatic as a result of a brain lesion such as congenital malformations, traumatic injury, tumour, encephalitis or stroke.

Epilepsies in children are different from those in adults. Neurodevelopmental disorders, tuberous sclerosis, cerebral palsy and autism spectrum disorder can be associated with epilepsy.

 The prognosis of epilepsy depend on several factors: age of onset, type of seizures, and the epileptic syndrome, which includes EEG abnormalities and radiological findings. For example, in early childhood, some epilepsies are well-defined and known to have a bad prognosis, such as West syndrome and Lennox-Gastaut. On the contrary, partial epilepsy with centrotemporal spikes is a partial and benign form that remits at an early adult age.

Epilepsies that starts at late adult age or at the elderly are more commonly symptomatic as a result of brain lesion. The symptomatic seizures can be early at or soon after a lesion occurs or later on.

The treatment depends on several factors; the age of onset, epileptic syndrome, and eventual etiological cause. A wide range of drugs, surgery, neurostimulation, ketogenic diet and epilepsy treatment in Dubai are at our disposal. Effective treatment, as always in medicine, starts with the correct diagnosis. Accurate diagnosis of the type of epilepsy is the first step for an effective treatment. Anti-seizure medication is usually the first step. Antiseizure medications have particularities regarding the type of epilepsy they are most effective for; partial or generalized seizures, idiopathic or symptomatic epilepsies, in a child or adult person. Also, their side effects profile s different. Most seizures can be controlled with one drug, which is always preferable. If one treatment is unsuccessful in controlling the seizures, another drug may work. 

Some epilepsies, like temporal lobe with meso-temporal sclerosis or cortical malformations, are well known to respond to surgery, allowing to stop the medication. In general, epilepsy is considered resolved when a person remains seizure free for 10 years without medication for the past 5 years. The final aim of treatment is to help the patient to have a life-free seizure and to improve his/her family’s quality of life.