Epilepsy is a neurological disorder, characterised by epileptic seizures (convulsive fits). There are various clinical patterns with certain forms of epileptic seizures and other characteristic features. These include, for example, EEG changes and a typical age at which seizures first occur and stop again on their own without treatment. The periodic occurrence of epileptic seizures without an identifiable cause is common to all forms. Seizures are caused by sudden and transient disruptions to the function of the brain. Around 5% of the population will experience an epileptic seizure once in their life (known as an occasional convulsion).
Epilepsy is present if at least two seizures have occurred which were not triggered by an immediately preceding recognisable cause. In principle, epilepsy can occur at any age, but it is most common for it to first appear during childhood. The majority of cases of epilepsy which occur during childhood stop again during puberty, and are then described as benign. Although benign, in addition to specific developmental problems, there are sometimes also problems with language, behaviour and mental retardation.
About 0.5–1% of the population suffer from epilepsy. There are around 5–10 new cases per 10,000 inhabitants. The condition can occur at any age, irrespective of culture or social class.
An epileptic seizure is not classified as the presence of epilepsy, but is an indication of a short-term functional disorder in the brain. The triggers may be high fever, excessive tiredness and brain injuries. Epilepsy is characterised by repeated seizures without a recognisable trigger. In the event of seizures with recognisable triggers, we speak of occasional convulsions. In addition to meningitis, the causes of epilepsy include problems with brain development in the foetus or brain tumours and accidents with brain injuries. In addition, bleeding disorders, strokes and age-related degeneration processes in the brain may cause epilepsy. Hereditary transmission also plays a part. It is not always possible to identify the causes of epilepsy.
The diagnosis of epilepsy is carried out using the anamnesis with a precise seizure description in combination with neurological investigations. These include: EEG, MRI (magnetic resonance imaging), PET (positron emission tomography) and SPECT (single photon emission computed tomography). Blood tests and lumbar puncture (examination of the spinal fluid) are also used.
The occurrence of focal (e.g. benign epilepsy in childhood) and generalised symptoms is standard. In addition, there are the following forms of epilepsy:
•Idiopathic epilepsy (hereditary transmission as the only cause)
•Symptomatic epilepsy (morbid change in the brain e.g. brain tumour, severe head injuries, stroke, consequences of inflammation)
•Cryptogenic epilepsy (assumption of a symptomatic form, definitive cause not clear)
In addition to medical treatment with anticonvulsants, there is the possibility for surgical and dietetic treatment (ketogenic diet). As further options, there are psychotherapeutic procedures and alternative medicine (homeopathy, biofeedback, acupuncture). In addition to the basic drugs, there are emergency drugs which interrupt a seizure and therefore can make it shorter. Medical treatment is the treatment of choice. However, for around 20–30% of patients this is not sufficiently successful. Around 5–10% of all patients (a quarter of cases resistant to medication) are suitable for surgical intervention. This has good to very good results in terms of freedom from seizures and should be carried out as early as possible. In addition to reducing the frequency of seizures, the treatment aims also include reducing the intensity of seizures, avoiding injuries due to the seizure and increasing quality of life.