About 1 in 30 people in the UK develop epilepsy at some stage. It most commonly starts in childhood and in people aged over 60. However, epilepsy can begin at any age. Seizures are well controlled by treatment in about 4 in 5 cases. There are different types of epilepsy. This leaflet is about epilepsy with partial seizures. Partial seizures are also called focal seizures. Other leaflets in this series include: 'Epilepsy - A General Introduction', 'Epilepsy - Childhood Absence Seizures', 'Epilepsy - Could It Be?', 'Epilepsy - Living With Epilepsy', 'Epilepsy - Treatments', 'Epilepsy - Tonic-clonic Seizures', 'Epilepsy - Dealing With a Seizure', 'Epilepsy - Contraception/Pregnancy Issues', 'Epilepsy and Sudden Unexpected Death'.
A seizure is a short episode of symptoms which is caused by a burst of abnormal electrical activity in the brain. Typically, a seizure lasts from a few seconds to a few minutes. (Older words for seizures include convulsions and fits.)
The brain contains millions of nerve cells (neurons). Normally, the nerve cells are constantly sending tiny electrical messages down nerves to all parts of the body. Different parts of the brain control different parts and functions of the body. Therefore, the symptoms that occur during a seizure depend on where the abnormal burst of electrical activity occurs.
There are different types of seizures but they are broadly divided into two main types - generalised and partial. Many people associate epilepsy with generalised convulsive seizures. However, some people develop partial seizures.
With a partial seizure, the burst of electrical activity stays in one part of the brain. Therefore, you tend to have localised (focal) symptoms. Different parts of the brain control different functions and so symptoms depend on which part of the brain is affected.
In this type of seizure you may have muscular jerks or strange sensations in one arm or leg. You may feel, hear, see, smell, or taste odd sensations. Some people develop pins and needles in one part of the body. However, you do not lose consciousness or awareness. A simple partial seizure usually lasts just a few seconds or minutes. For each individual, the same movement or sensation tends to recur each time a seizure occurs.
During this type of partial seizure, you are not aware of your surroundings, or of what you are doing. In effect, you have a partial loss of consciousness (which differs from a simple partial seizure). This type of seizure can arise from any part of the brain but most commonly arises from a temporal lobe (a part of the brain). Therefore, this type is sometimes called temporal lobe seizure.
The temporal lobes of the brain help to deal with mood and behaviour. Therefore, you may have strange feelings, sensations, and emotions during a complex partial seizure. It may feel like being in a dream. Your surroundings may appear strange or oddly familiar. It may be difficult to explain the feelings or sensations that occur. To an onlooker, you may appear to be in a trance or behave strangely for a few seconds or minutes. For example, you may wander with no apparent purpose. Some people smack their lips, fumble at clothes, appear to fidget, swallow repeatedly, or do other repetitive movements.
Sometimes a partial seizure develops into a generalised convulsive seizure. This is called a secondary generalised seizure.
If you have epilepsy, it means that you have had repeated seizures. If you have a single seizure, it does not necessarily mean that you have epilepsy. About 1 person in 20 has a seizure at some time in their life. It may be the only one that occurs. The definition of epilepsy is more than one seizure. The frequency of seizures in people with epilepsy varies. In some cases there may be years between seizures. At the other extreme, in some cases the seizures occur every day. For others, the frequency of seizures is somewhere in between these extremes.
Epileptic seizures arise from within the brain. A seizure can also be caused by external factors which may affect the brain. For example, a high fever may cause a febrile convulsion. Other causes of seizures include: lack of oxygen, a low blood sugar level, certain drugs, poisons, and a lot of alcohol. Seizures caused by these external factors are not classed as epilepsy.
In many cases, no cause for the seizures can be found. The abnormal bursts of electrical activity in the brain occur for no apparent reason. It is unclear why they start, or why they continue to occur. Genetic (hereditary) factors may play a part in some cases. People with idiopathic epilepsy usually have no other neurological (brain) condition. Medication to control seizures usually works well.
In some cases, an underlying brain condition or brain damage causes epilepsy. Some conditions are present at birth. Some conditions develop later in life. There are many such conditions. For example: a patch of scar tissue in a part of the brain, a head injury, stroke, cerebral palsy, some genetic syndromes, tumours of the brain, previous infections of the brain, such as meningitis or encephalitis. The condition may irritate the surrounding brain cells and trigger seizures.
Some underlying conditions may cause no other problems apart from seizures. In other cases, the underlying condition may cause other problems in addition to the seizures.
These days, with modern scans and tests, a cause can be found for some cases previously thought to be idiopathic (unknown cause). For example, a small piece of scar tissue in the brain, or a small anomaly of some blood vessels inside the brain. These may now be found by modern brain scanning equipment which is more sophisticated than in the past.
There is often no apparent reason why a seizure occurs at one time and not at another. However, some people with epilepsy find that certain triggers make a seizure more likely. These are not the cause of epilepsy, but may trigger a seizure on some occasions.
Possible triggers may include:
You should see your doctor if you have had a possible seizure or similar event. Sometimes it is difficult for a doctor to confirm that you have had a seizure. The most important part of confirming the diagnosis is the description of what happened. Other conditions can look like seizures - for example, faints, panic attacks, collapses due to heart problems, breath-holding attacks in children, and other problems.
Therefore, it is important that a doctor should have a clear description of what happened during the event. Preferably this is from the person affected, and also from an eyewitness. The description may be typical of a seizure.
However, sometimes it is difficult for a doctor to confirm the diagnosis definitely. Tests such as brain scans, electroencephalogram (EEG - brainwave recordings) and blood tests may help:
Although helpful, tests are not foolproof. It is possible to have epilepsy with normal test results. Also, if an abnormality is found on a brain scan, it does not prove that it causes seizures. However, tests may help to decide if the event was a seizure, or caused by something else. It is unusual for a diagnosis of epilepsy to be made after one seizure, as the definition of epilepsy is recurrent seizures. For this reason a doctor may suggest to wait and see if it happens again before making a firm diagnosis of epilepsy.
As partial seizures can take many different forms, bystanders need to take a common sense approach. Nearly all partial seizures stop within a few minutes by themselves. Gentle and quiet reassurance may be all that is needed until the seizure ends. If the affected person appears confused or is wandering, try to guide them away from any danger.
Sometimes a partial seizure develops into a convulsive one, so be aware of this. It may be best to guide the person to sit down in a soft chair or away from any dangerous places. Stay with the person until they are recovered and are fully aware of their surroundings.
Epilepsy cannot be cured with medication. However, various medicines can prevent seizures. They work by stabilising the electrical activity of the brain. You need to take medication every day to prevent seizures. Seizures are well controlled by medication in about 4 out of 5 cases.
Deciding on which medicine to prescribe depends on such things as: the type of epilepsy, age, other medicines that you may take for other conditions, possible side-effects, pregnancy, etc. One medicine can prevent seizures in most cases. A low dose is usually started at first. The dose may be increased if this fails to prevent seizures. In some cases two medicines are needed to prevent seizures.
The decision when to start medication may be difficult. A first seizure may not mean that you have epilepsy, as a second seizure may never happen, or may occur years later. The decision to start medication should be made by weighing up all the pros and cons of starting, or not starting, the medicine. A common option is to wait and see after a first seizure. If you have a second seizure within a few months, more are likely. Medication is commonly started after a second seizure that occurs within 12 months of the first. However, there are no definite rules and the decision to start medication should be made after a full discussion with your doctor.
Some points about medication for epilepsy include the following:
The success in preventing seizures by medication varies depending on the type of epilepsy. For example, if no underlying cause can be found for your seizures (idiopathic epilepsy), you have a good chance that medication can fully control your seizures. Seizures caused by some underlying brain problems may be more difficult to control.
The overall outlook is better than many people realise. The following figures are based on studies of people with epilepsy, which looked back over a five-year period. The figures are based on grouping people with all types of epilepsy together to give an overall picture:
A trial without medication may be an option if you have not had any seizures over 2-3 years. If a decision to stop treatment is made, a gradual reduction of the dose of medication is usually advised over several months. Never stop taking medication without discussing it with a doctor.
The above section on outlook (prognosis) relates just to seizures. Some underlying brain conditions which cause seizures may cause additional problems.
Most people with epilepsy live full and active lives, but may have to accept some changes to their lifestyle. For example, you must not drive for a period laid down by law. Below are further sources of information, help, and support on all aspects of epilepsy:
New Anstey House, Gateway Drive, Leeds, LS19 7XY
Helpline: 0808 800 5050 Web: www.epilepsy.org.uk
Chesham Lane, Chalfont St Peter, Gerrards Cross, Bucks, SL9 0RJ
Helpline: 01494 601 400 Web: www.epilepsysociety.org.uk
48 Govan Road, Glasgow, Scotland, G51 1JL
Helpline: 0808 800 2200 Web: www.epilepsyscotland.org.uk
PO Box 4168, Cardiff, CF14 0WZ
Helpline: 0800 228 9016 Web: www.epilepsy-wales.org.uk