Epilepsy is a chronic neurological disorder characterized by recurrent seizures. It is one of the most common neurological disorders worldwide, affecting approximately 50 million people globally.
The cause of an epileptic seizure is a change in the excitability of the cerebral cortex, leading to abnormal discharges of brain neurons. Seizures thus result from brief disturbances in the brain’s electrical activity.
Epilepsy is not a contagious disease.
Epilepsy affects people regardless of gender and age.
The prevalence of epilepsy in the population is about 0.5–1%.There are currently about 70,000 – 100,000 patients with epilepsy in the Czech Republic. In developed countries, 24–53 new cases occur annually per 100,000 inhabitants. In developing countries, the incidence of new cases is up to three times higher due to a greater occurrence of infections and injuries.
Epilepsy occurs in both childhood and adulthood. It is not uncommon for some individuals to develop epilepsy in old age, even though they have not suffered from the condition during their lifetime.
An epileptic seizure is not necessarily just a “grand mal”— “the big bad”, as grand mal seizures with convulsions and loss of consciousness were called in the past, which is what a layperson might imagine when the diagnosis of epilepsy is mentioned.
Epileptic seizures can have a very diverse clinical presentation depending on which part of the cerebral cortex is affected by the pathological discharges. For individual patients, the appearance of seizures is usually consistent and typical over a certain period of time. However, some patients may experience multiple types of seizures, which is related to different directions of pathological activity spread in the brain or multiple foci of their origin. Seizures that are typical for a given patient are called habitual seizures.
For an accurate diagnosis, it is important to describe to the doctor as precisely as possible what the seizure looks like and what you feel and do while it is occurring (a video recording of a seizure is ideal). Each part of the brain has its specific seizure manifestations, so a correct description of seizures can contribute to proper treatment.
According to their onset, we divide seizures into the following basic categories:
If the epileptic seizure affects only part of the cerebral cortex, it usually does not manifest with impaired consciousness. In such cases, motor manifestations (e.g., limb jerking, chewing) may occur, or the seizure remains without motor manifestations, and the patient experiences symptoms such as visual, auditory, or olfactory hallucinations, déjà vu, or other unusual physical or psychological feelings without losing consciousness. In older terminology, this type of seizure was called a simple partial seizure; in the case of only subjectively perceived sensations, the term aura is used.
This type of seizure often progresses to a larger seizure.
If an epileptic seizure begins in areas that have numerous connections with certain subcortical structures, it manifests as an impairment of consciousness with staring and aimless, stereotypical movements, which are called motor automatisms. The patient may manipulate objects, shift positions, walk around, frequently smack their lips, swallow, etc.
Since the seizure affects consciousness, the person may be confused, speak incoherently, or be unable to respond at all.
This type of seizure is also called a “psychomotor seizure,” and in older terminology, it was referred to as a “partial seizure with complex symptomatology.”
This type of seizure begins similarly to FAS or FIAS, originating in a specific area of one of the brain’s hemispheres. However, if the epileptic activity spreads to most of the brain, the seizure typically results in impaired consciousness and other symptoms resembling a generalized seizure. The older term for these seizures is “secondarily generalized seizures.”
In FBTCS (Focal to Bilateral Tonic-Clonic Seizure), the first tonic phase of the seizure involves the patient losing consciousness, stiffening, often letting out a cry, collapsing, and sometimes biting their tongue. Due to the spasm of respiratory muscles, breathing temporarily stops, and the patient turns pale. The upper and lower limbs become symmetrically extended (lasting 3–30 seconds).
The seizure then transitions into the clonic phase, characterized by symmetrical, rhythmic jerking movements of the limbs, lasting 30 seconds to 2 minutes. Unlike generalized seizures, FBTCS may end with asymmetrical jerking movements.
After the jerking subsides, involuntary urination or defecation may occur. The seizure is often accompanied by groaning sounds and excessive salivation.
Once the seizure ends and consciousness returns, the patient is typically drowsy, disoriented, and has complete amnesia regarding the seizure for several minutes.
Absences are more common in pediatric patients.
Typical absences are defined as short-lasting generalized seizures characterized by a sudden onset and abrupt cessation of impaired consciousness. Their traditional historical term is “petit mal” (French for “small evil” or “minor illness”).
During an absence seizure, the patient exhibits a fixed, blank stare, or their eyes may roll upward. They suddenly stop whatever activity they were engaged in.
Absences can be spontaneous or reflexive (typically triggered by visual stimuli), and they are commonly provoked by hyperventilation. Some episodes may be very brief (as short as 3 seconds), and they rarely last longer than 30 seconds.
Another type of seizure is the myoclonic seizure, characterized by sudden, rapid, irregular jerking movements of the body—often affecting the upper limbs. Patients may involuntarily drop objects they are holding, and in some cases, experience a sudden buckling of the legs, resulting in a fall. Myoclonic jerks are commonly more pronounced during drowsiness or shortly after awakening.
The most well-known form of seizure is the generalized tonic-clonic seizure (formerly referred to as grand mal). These typically begin with a sudden loss of consciousness, followed by a fall and generalized tonic-clonic convulsions. The seizure originates simultaneously in both hemispheres of the brain.
In the tonic phase, the patient becomes unconscious, the body stiffens, a vocal sound may occur, and the person falls—often biting the tongue. Due to muscle spasms of the respiratory system, breathing temporarily stops and the person may appear pale. The arms and legs become symmetrically extended, usually lasting 3 to 30 seconds. This is followed by the clonic phase, which involves symmetric, rhythmic jerking of the limbs, typically lasting 30 seconds to 2 minutes. After the convulsions subside, involuntary urination or defecation may occur. Additional signs can include gurgling sounds and excessive salivation. Once the seizure ends and consciousness returns, the patient is often drowsy, disoriented, and unable to recall the seizure, with this postictal state lasting several minutes.
Epilepsy and epileptic syndromes are generally classified into two main categories based on their cause: symptomatic and idiopathic.
A symptomatic epilepsy has a clearly defined, identifiable cause. These may include traumatic brain injury, brain tumors, stroke, neuroinfections, developmental abnormalities of the brain, autoimmune conditions, and others.
In contrast, idiopathic epilepsy refers to cases where no specific cause can be identified. These are often presumed to have a genetic origin, meaning they may run in families, although the exact mechanism is not always clear.
There are a number of different factors that may contribute to the onset and progression of epilepsy. In children, epilepsy is most commonly associated with neurodevelopmental disorders, while in adults, the most frequently identified cause is acquired structural damage to the brain. However, a definitive cause is identified in only about one-third of newly diagnosed cases.
For some individuals with epilepsy, seizures may be brought on by specific triggers. Common seizure triggers include:
Additional Triggers May Include:
Not all seizures are epileptic in nature. Some may be caused by other physical conditions or psychological states (see more in the section Non-Epileptic Seizures).
Even a confirmed epileptic seizure does not necessarily mean that the person has epilepsy. Seizures that occur in connection with an acute insult to the central nervous system—such as during an illness or as a result of another underlying medical condition—are referred to as acute symptomatic seizures.
In these cases, we do not diagnose epilepsy, as the seizure is a direct response to a specific, identifiable cause. Once the underlying condition resolves or is treated, further seizures usually do not occur (see more in the section Acute Symptomatic Seizures).
