Epilepsy:
causes, course and treatment

Epilepsy is a disease of the brain that leads to epileptic seizures – usually involving muscle twitching or other involuntary movements. An epileptic seizure is caused by the overactivity of certain nerve cells (neurons) and usually lasts no longer than two minutes. An estimated 80,000 people live with epilepsy in Switzerland, including up to 20,000 children.

Epilepsy can occur at any age. Children under the age of five and men and women of advanced age are affected by epilepsy at an above-average rate. In a population of 100,000 people, around 40 to 70 are newly diagnosed with epilepsy each year.

There are two basic types of epileptic seizures:

• Generalized seizures occur in both hemispheres of the brain. Often the entire body is affected.
• Focal seizures originate in a limited part of the brain known as the focus. Often only individual areas of the body are affected.

Neither generalised epilepsy nor focal epilepsy have uniform symptoms. Sometimes it’s hard to recognise them at all. Diagnostic methods such as electroencephalography (EEG), computed tomography (CT) and magnetic resonance imaging (MRI) are used to examine the brain.

Epileptic seizures can vary greatly, and there are different sub-divisions of epileptic seizures.

Epilepsy occurs in people whose brain function is so altered that repeated seizures may occur. Possible causes of epilepsy include genetic mutations, circulatory disorders and inflammation of the brain. Stroke, brain tumour or diabetes can also trigger epilepsy. Often, however, there is no discernible cause.

Epileptic seizures may occur in people with epilepsy, but also in people who do not have epilepsy. Factors that can trigger a seizure include:

• Regular, heavy alcohol consumption
• Medicines
• Withdrawal from alcohol, drugs or sleeping pills
• Heavy physical strain
• High fever (in children)
• Extreme lack of sleep
• Mental stress
• Sensory stimuli (e.g. flickering lights)

Between two epileptic seizures, most sufferers do not experience any physical discomfort related to epilepsy.

Various epilepsy treatments are available:

• Medicines are given to prevent future epileptic seizures. There are more than twenty active substances that suppress seizures. They must be taken regularly, often for many years.
• In the case of focal seizures, surgical procedures can ideally result in the permanent removal of the epileptic site from the brain.
• The ketogenic diet (keto diet) is intended to mimic a metabolic state of fasting. This very high-fat and low-carbohydrate diet is thought to positively influence the metabolism.
• Brain stimulation via the vagus nerve is intended to reduce the number and severity of epileptic seizures.

Anyone affected by epilepsy needs intensive medical support – to clarify, for example, whether they are allowed to drive a car or participate in certain sports. Women who use contraceptive pills need to know whether their anti-epileptic medication reduces the effectiveness of the pill. Epileptic seizures often occur at certain intervals or consistently at the same time of day – a seizure calendar can help to clarify this.

After being provided with thorough information and medical care, many people affected by epilepsy can live largely without restrictions. Nevertheless, many questions may arise, including for relatives. Charities such as the patient organisation Epi-Suisse and the specialist organisation Swiss Epilepsy League offer support here.