Epilepsy is a disorder that causes people to have seizures, which occur when several brain cells misfire or discharge at once causing altered sensations, behaviors and consciousness. Having a seizure does not automatically mean someone has epilepsy. A seizure is a single event, which may be caused by any number of things from a medication to a brain injury to a brain tumor.
In most cases it is not possible to pinpoint an exact cause of epilepsy, but there are known risk factors like genetics and traumatic brain injury. There are several drugs that can cause seizures as side effects, including antipsychotics like Abilify and there are several medications used to treat epilepsy that can cause serious and dangerous side effects.
What is a Seizure?
Many people have an image of a person having a seizure as someone convulsing violently on the floor. This is sometimes, but not always the case. There are different types of seizures, but all occur when neurons in the brain misfire. These are the nerve cells of the brain and they discharge electricity in an orderly way with occasional misfires. When many misfire at the same time there is a sudden and large discharge of electricity in the brain. This causes the person to experience changes in sensation, consciousness, and behavior to varying degrees.
A seizure may be generalized if it affects all areas of the brain, or partial if it only affects one area. There are three stages to a seizure: the aura, ictus, and postictal. The aura is the beginning of a partial seizure and a person may feel a little strange, have unusual sensations, a feeling of déjà vu, dizziness, lightheadedness, nausea, headache, or unusual emotions.
A person may only experience the aura stage, in which case it is called a simple partial seizure. If the seizures stays localized in the brain but causes a change in consciousness, it is a complex partial seizure, and if it spreads throughout the brain it is called a generalized seizure. The stage that comes after the aura is called the ictus and this is the physical attack that can be observed as loss of consciousness with or without convulsions. In the postictal, or post-attack stage a person may feel numbness, have a headache, lose bladder or bowel control, feel confused, or be partially paralyzed. These effects go away after a period of time that varies by person.
Types of Seizures
Partial seizures may be simple or complex. Generalized seizures, which affect the entire brain, can be further classified as one of several types. An absence, or petit mal seizure, causes someone to stare into space and may cause subtle unusual movements like lip smacking or eye blinks. The person may lose awareness, but not consciousness.
Generalized seizures may also be tonic or atonic. Tonic seizures cause muscles to stiffen and may result in a fall. An atonic seizure causes loss of muscle control, which also leads to falls. Clonic seizures cause jerking, rhythmic muscle movements, most often in the face, neck, and arms. Myoclonic seizures are sudden, not rhythmic jerks in muscles. A tonic-clonic, or grand mal seizure, is the most violent type of seizure during which a person stiffens, shakes, and convulses, typically losing consciousness. This kind of seizure can also cause loss of bladder and bowel control and puts a person at risk of biting the tongue.
Causes and Risk Factors
Epilepsy is a seizure disorder characterized by having more than one seizure. What causes it is not fully understood, but has been connected to genetics and some kinds of seizures run in families. Other factors may include having certain brain conditions. Having a stroke, for instance, can lead to epilepsy. Head and brain trauma, infections, birth injuries, and developmental disorders have also been associated with epilepsy.
There are also risk factors that put someone at a greater risk of having epilepsy. These include being either a young child or over the age of 60, having a family history of epilepsy, having brain infections, having a stroke, suffering a brain injury, or having dementia.
Causes of Isolated Seizures
Not all seizures are categorized as epilepsy. A person must have more than one seizure for that to be considered as a diagnosis. While the underlying cause of epilepsy is not known, there are many possible causes of an isolated, or provoked, seizure. Alcohols or drug abuse, withdrawal from drugs, head trauma, a brain disease, a stroke, a tumor in the brain, medications, and certain brain conditions all have the potential to trigger a seizure in someone.
Treatment of epilepsy is important because there are serious and even life-threatening complications of having this condition. It is nearly impossible to predict when a seizure will occur, which means that an unexpected seizure could lead to a dangerous fall, a car accident, a drowning, or other accidents. Seizures during pregnancy can cause serious complications and people with epilepsy are more likely to struggle with mental health issues like depression.
Medications are the most common treatment strategies for epilepsy and usually the first line attempt at controlling seizures. If medications do not work, or if the location of the brain causing seizures can be determined, surgery may be done to remove that brain tissue. Other treatment strategies include a ketogenic diet for children—high in fat and low in carbohydrates—stimulation of the vagus nerve, or cannabis oil.
Doctors typically begin treating epilepsy in patients by using medications called anticonvulsants. If these work and are well tolerated, more drastic treatments like surgery may not be needed. Some people may benefit from just one seizure medications while others may need to use a combination of more than one drug. Anticonvulsants may work by increasing the neurotransmitters in the brain that relax nerve cells.
These drugs can be helpful and life-changing, but some of them may cause side effects that range from mild to severe and dangerous. Side effects that are more common and mild include dizziness, weight gain, bone density loss, fatigue, speech difficulties, loss of coordination, and memory problems. Rarer, but serious are suicidal thoughts, depression, liver inflammation, and a severe rash.
Depakote is a common anticonvulsant used to treat epilepsy and it carries three FDA black box warnings, the warnings reserved for the most serious possible side effects. Depakote may cause liver failure, pancreatitis, and birth defects. The maker of Depakote, Abbot Laboratories, has faced lawsuits from plaintiffs who claimed the company never adequately warned them of the risks of using the drug. In one case a girl won a settlement of $23 million because her mother used Depakote during pregnancy and she was born with spina bifida.
Topamax is another anticonvulsant commonly used for epilepsy that may come with serious side effects including birth defects. It may also increase the risk of having suicidal thoughts and acting on them. During trials for the drug, four people attempted suicide. Many lawsuits have been filed against Johnson & Johnson over Topamax birth defects.
Medications That May Cause Seizures
In addition to anticonvulsants used to treat epilepsy that can cause serious side effects, there are also drugs that treat other conditions but may cause seizures. These include antipsychotic drugs like Abilify, used to treat schizophrenia and bipolar disorder, narcotic painkillers like hydrocodone, antidepressants like Effexor, and anti-anxiety drugs like Valium. For many of these drugs the risk is low, but certainly possible.
Epilepsy is a serious chronic seizure disorder and it can cause complications ranging from physical injuries to emotional distress and depression. Treatment is important, but can also be dangerous. Anticonvulsant medications may cause serious and even life-threatening side effects. Other medications can also cause seizures. While treatment is important all patients need to consider the risks and the benefits before using these medications.