Epilepsy is one of the most common disorders affecting the central nervous system. People diagnosed with epilepsy have recurrent episodes of seizures. Seizures are hyperexcitability of a group of neurons concerned to a part of the brain or brain as a whole. Disruption in the electrical activity temporarily causes disturbances in the messaging system of the neurons in the brain.
It is estimated that incidences of epilepsy are the highest than any other neurological disorder across the world.
In India, the incidence rates show that about six to ten people in a population of thousand individuals suffer from epilepsy. About 50 million people suffer from epilepsy across the globe, while 10 million people in India suffer from this neurological disorder.
Epilepsy is classified broadly as focal and generalized epilepsy. In focal epilepsy, a part of the brain is affected. This disruption of neuronal activity can be transferred to another part of the brain or the whole brain. In generalized epilepsy, all parts of the brain are involved. Most commonly, generalized epilepsy involves the impairment of consciousness and has more serious symptoms.
Although there are two main types of epilepsy, it is further divided into various subgroups. These types are classified according to the part of the brain involved, level of severity, and the group of symptoms they exhibit.
Types of epilepsy are important to understand the way of treatment approach, medication needed, and preventive role. Stages of epilepsy are also important so that one can interrupt it as soon as possible. If one understands that he or another person is expressing early signs of convulsions or seizures, one can seek medical help at the earliest.
Stages or Phases of Epilepsy:
Prodrome phase:These symptoms appear before a few days or several hours of the episode of epilepsy. This is a subjective feeling one can notice all by himself.
Mental symptoms:They include irritability, restlessness, irrelevant talk, euphoria, and fatigue.
Autonomic symptoms:Perspiration, trembling of extremities, nausea, etc. are autonomic symptoms.
Neurologic symptoms:They include hyperexcitability, hyperactivity, increased sensitivity towards light or sound & hypersomnia.
Constitutional symptoms:These symptoms vary according to the behavior of the person. These symptoms indicate the deviation of mood or different behavior of the person than the normal.
Pre ictal phase (Aura):Pre ictal phase is recognized as ‘aura’. Almost 80% of people experience aural symptoms. It is the initial symptom of the seizure itself, but it has been understood as warning signs of seizure. The time and duration of seizure are calculated from the initiation of the pre-ictal or phase of the aura stage.
Visual disturbances:The most common type of symptom is a visual aura, such as visual loss, difficult vision, blurriness of the vision, etc. When something is added extra to vision, it is called positive symptoms, such as seeing stars,
flickers, a flash of the light, visual hallucinations, that may be present. While in the stage when something is eluded, it is called negative symptoms, such as blackout, graying of visions is also called as ‘scotoma’.
Somato Sensory symptoms: Increased sensitivity can also cause hallucinations, such as olfactory hallucination, auditory hallucinations, which may be rare in some individuals. ‘Déjà vu’ and ‘Jamais vu’ are the common symptoms one can feel. Bitter taste or some change in the body shape can be wrongly perceived by the person in the pre-ictal stage. Tingling numbness of extremities or that of the face can be present.
Motor symptoms:Tremors, weakness of the muscles, and dropping off the things from the hand, and frequent stumbling while walking are a few motor symptoms.
Psychological symptoms:Sudden rush of emotions, such as sadness, joy, cheerfulness, irritability, aggressiveness, fear, or panic, can be experienced. Such a sudden change of emotional state can be noticed by people in the surroundings, close to a person like family members, friends, etc.
Ictal phase:This is a period from the beginning of aura to the end of seizure activity. It is a middle activity between the pre-ictal phase and the post-ictal phase. This phase is considered as convulsion or seizure.
Common symptoms of ictal phase are:
Loss of consciousness
Loss of vision
Loss of auditory impulse
Drooling of saliva
Twitching of eyebrows
Staring gaze without movements (In absent seizures)
Repetitive blinking of the eyes, smacking of the lips
Twitching of part of muscle or whole as a part of the body (in focal epilepsy)
A loss of control over passing the urine and stool.
Stiffness of the muscles
Biting of tongue
Falling during the episode.
Palpitation of heart
Postictal phase:Past the seizure episode, the phase of recovery from seizure called as the post-ictal phase. The duration of this period varies from person to person; some people might recover within minutes or a few hours, while some may take a few days to overcome the state. Recovery depends on the part of the brain affected, severity, and type of seizure that occurred.
Common symptoms of the post-ictal phase are:
Loss of memory of events
Fatigue or malaise
Body pain, particularly in the cases of fall.
The heaviness of the body
Feeling of embarrassment
The weakness of the muscles.
Since each phase exhibits different symptoms, there is a gradual progression of one phase to the other.
Epilepsy is a serious condition that involves cognitive impairment in severe cases. This causes ill effects on the intelligence, memory, and concentration of the person. Due to cognitive impairment, serious career loss could occur. Epilepsy patients or family members must take care of them, notice prodromal symptoms, identify and notify aura symptoms, and take emergency precautions.