What is epilepsy?

What is epilepsy?
Epilepsy is a tendency to have recurring seizures. There are many different types of seizures but they are always due to abnormal electrical activity somewhere in the brain.

1. At least two unprovoked (or reflex) seizures occurring more than 24 hours apart.

1. One unprovoked (or reflex) seizure and a probability of further seizures similar to the general recurrence risk (at least 60%) after two unprovoked seizures, occurring over the next 10  years.

1. Diagnosis of an epilepsy syndrome.

How is epilepsy diagnosed?

• Is it epilepsy or is it something else?

• If it is epilepsy, what sort of epilepsy is it?

• Where does it start in the brain?

• Is there any structural abnormality in the brain?

What is needed for correct diagnosis?

• A full clinical history and a good description of the seizure/s;

• A physical and neurological examination;

• Investigations that may include an EEG recording and a CT scan or MRI brain scan

• Treatment

Medication is usually the first-line treatment of epilepsy- 70% of people diagnosed with epilepsy will gain seizure control with medication. While today epilepsy is mostly treated with medication, it is not a cure and only provides control of seizures. Medication comes in various forms such as capsules, tablets or syrup.
For some people who are having difficulty gaining seizure control, there may be other treatment options available.
Surgery, Vagus Nerve Stimulator (VNS), medication and dietary therapies are some other options.

Surgery

Depending on the type and cause of epilepsy, epilepsy surgery may be a treatment option for people who do not gain seizure control through medication.

Many people will have one seizure at some stage in their lives, but this is not necessarily epilepsy because there is a low risk of recurrence. Many children with epilepsy will eventually ‘grow out of it’ by the time they reach adulthood. For some people, the tendency to recurrent seizures may be a lifelong predisposition.

The International League Against Epilepsy (ILAE) classifies epilepsy as a disease of the brain that can be defined by the presence of any of the following conditions:

Syndromes are identified by the type of seizure/s, the age at onset, the EEG pattern and the pattern the seizures follow. They are sometimes associated with other underlying conditions. Identifying a seizure syndrome may be useful as sometimes this allows the most appropriate medication to be prescribed.

There are many stages in the diagnostic process. It is extremely important to get a correct diagnosis and this may need lots of tests and take considerable time. Questions need to be answered, such as:

 

Why surgery?

Epilepsy is sometimes caused by an area of abnormal brain tissue. There are many reasons why an abnormality occurs and it may be unimportant unless it causes seizures. The size and position of the area, referred to as the epilepsy focus, varies between individuals. If epilepsy surgery can remove the epilepsy focus, seizures can often be prevented. The chance of successful surgery and the risks of complications differ for each patient.

When is surgery an option?

Surgery is usually only used where medication fails and is not intended to be a substitute for medication. If surgery is considered a possible treatment for a person’s epilepsy, several months of extensive testing and counselling are undertaken before surgery is performed. Doctors will then discuss the possible outcomes and potential risks from surgery in the individual case so they can make an informed choice. Successful surgery can prevent seizures from occurring, or dramatically reduce seizure frequency and thereby change a person’s life forever. Epilepsy Queensland can provide you with specialised literature on this topic. See below for articles for further reading.

Epilepsy and dietary therapy 

Epilepsy dietary therapy is now a recognised treatment for epilepsy in children and adults and is offered by many specialists and epilepsy clinics.

There are a number of diets linked to the treatment of epilepsy. Children and adults with uncontrolled seizures may be helped by epilepsy dietary therapy, however, there is no way to predict beforehand whether they will be successful. The following provides a short overview of these diets, which should only be initiated under the supervision of a dietitian and with the approval of treating doctors and specialists.

 For more information, please find a more detailed fact sheet at the bottom of this page.

The Ketogenic Diet

The Ketogenic Diet is a special high-fat diet that is used for difficult-to-treat seizures. Heavy cream, butter and vegetable oils provide the necessary fat. It is low in carbohydrates thus eliminating sugar and other carbohydrate-rich foods such as bread, rice, pasta and cereals. The main source of carbohydrate is from small serves of measured fruits and vegetables.

Variations in this type of diet have developed over time. A distinction should be made between “The Classical Ketogenic Diet” and the “Modified Ketogenic Diet” (MKD).

Classical Ketogenic Diet

The ketogenic diet for epilepsy is now referred to as the “Classical” Ketogenic Diet. This differentiates the ratio-controlled diet from popular mainstream diets which may be referred to as ‘ketogenic’.

The “Classical” Ketogenic Diet is an exact diet where every meal must provide just the right amount of fat, protein and carbohydrates. The diet is calculated in terms of ratios such as 4:1, 3:1 and 2:1. In a 4:1 ratio, there is 4 times as much fat as there is protein and carbohydrate combined.  The dietitian devises meal plans that complete the required fat, protein and carbohydrate for each meal.

Recipes indicate the exact grams of each food ingredient that must be accurately weighed on a gram scale. 

Modified Ketogenic Diet (MKD)

This is less restrictive than the Classical Ketogenic Diet. It allows all protein-rich foods such as meat, chicken, eggs and fish to be eaten to appetite and fats are encouraged. Food does not need to be weighed and recipes do not need to be precise.

Carbohydrate foods are counted and spread throughout meals with the aim to keep within the daily gram limit set by the dietitian.

The MKD is often used for adolescents and adults as it allows more flexibility in mealtime choices compared with the Classical Ketogenic Diet.

Is this right for me?

For more information please read the “Diets and Epilepsy” fact sheet below. This provides more detailed information about the function, health, effectiveness and impact of these types of diets for people with epilepsy. It also includes referral information to consider.