Questions &
Answers

Faq1

What is epilepsy?



Epilepsy is a chronic brain disease that manifests in the form of unexpected and spontaneous epileptic seizures with a tendency to recur. These seizures are triggered by excessive electrical activity among a group of hyperexcitable neurons.1,2

These seizures are brief episodes of involuntary movements that can affect only a part of the body (focal) or the entire body (generalised) and that can be accompanied by a loss of sphincter control or even awareness.2

It must be taken into account that the concept of epilepsy includes not only the presence of these epileptic seizures, but also their physical, psychological and social repercussions.1

 

1. Ápice. ¿Qué es la epilepsia? Disponible en: https://www.apiceepilepsia.org/que-es-la-epilepsia/que- es-la-epilepsi a- defi ni ci on/.
2. Asociación Nacional de Personas con Epilepsia (ANPE). ¿Qué es la epilepsia? Disponible en: https://www.anpeepilepsia. org/informacion-epilepsia.

Faq2

How many people suffer from epilepsy?



Epilepsy is one of the most common neurological diseases.1 Globally, it affects 50 million people. The World Health Organisation (WHO) estimates that one in ten people suffers an epileptic seizure in their lifetime if they live to be 80 years old.2

Epilepsy can appear at any age, although it affects children (between 6 and 14 years old), teenagers and older people (over 60 years old) to a greater extent. Regarding the affectation by sex, epilepsy affects men and women equally.1,3

 

1. Sociedad Española de Neurología. Libro blanco de la epilepsia en España. 2012. Disponible en: https://www.apiceepilepsia.org/Descargas/Libro_Blanco_de_Epilepsia. pdf.
2. García Morales I, et al. Documento de consenso para el tratamiento del paciente con crisis epiléptica urgente. Emergencias 2020; 32: 35 3- 62.
3. Sociedad Española de Neurología. Grupo de Epilepsia. Pacientes. Disponible en: http: //epile ps ia. se n. es /? pag e _i d= 3.

Faq3

What are the causes of epilepsy?



It is important to be clear that, when an epileptic seizure appears, it does not always result from an obvious cause-effect relationship.1

Although most people think that it is a hereditary disease,2 this is not usually the case. Except in cases where epilepsy is associated with hereditary neurological diseases (such as tuberous sclerosis, neurofibromatosis or lipidosis), the genetic component of a predisposition to suffering epileptic seizures is limited.1

The causes of epilepsy are very varied, and are usually grouped into structural, genetic, infectious, metabolic, immunological and unknown. In addition to those mentioned, those that can be highlighted are:1,3

  • Brain damage from prenatal or perinatal causes (for example, hypoxia or trauma during childbirth, low birth weight)
  • Hereditary congenital malformations
  • Severe head injuries
  • Strokes that limit the delivery of oxygen to the brain
  • Infectious diseases such as meningitis, encephalitis or bacterial abscesses
  • Genetic syndromes
  • Brain tumours
  • Drugs (including alcohol)
 

On the other hand, anyone can present an isolated seizure under exceptional conditions. For example, lack of sleep, stimulant drug abuse (amphetamines, cocaine), alcohol or fever can increase the risk of seizures.4

 

1. Ápice. Causas de la epilepsia y factores de riesgo (Etiología). Disponible en: https://www.apiceepilepsia.org/que-es-la-epilepsia/causas-de-la-epilepsia-y-factores-de-riesgo- etiologia/.
2. Sociedad Española de Neurología. Libro blanco de la epilepsia en España. 2012. Disponible en: https://www.apiceepilepsia.org/Descargas/Libro_Blanco_de_Epilepsia. pdf.
3. Organización Mundial de la Salud. Epilepsia. 9 de febrero de 2022. Disponible en: https://www.who.int/es/news-room/fact- sheets/detail/epilepsy#:~:text=Las%20causas%20de%20la%20epilepsia,bajo%20peso%20al%20nacer)% 3B.
4. Sociedad Española de Neurología. Grupo de Epilepsia. Pacientes. Disponible en:
http: //epile ps ia. se n. es /? pag e _i d= 3.
 

Faq4

If I have had an epileptic seizure, do I have epilepsy?



The first thing to be clear about is that epileptic seizures by themselves are not epilepsy. This is important, because approximately half of the people who have a first spontaneous epileptic seizure do not experience it again and therefore do not have epilepsy.1

In this sense, to have epilepsy you must have had more than one seizure.2 However, it is also true that the latest studies suggest that if a person suffers a seizure and there are factors that increase the probability of experiencing more seizures, it starts to be considered that there is underlying epilepsy.2

 

1. Ápice. ¿Qué es la epilepsia? Disponible en: https://www.apiceepilepsia.org/que-es-la-epilepsia/que- es- la-epilepsia- defi nici on/.
2. Asociación Nacional de Personas con Epilepsia (ANPE). Available: https://www.anpeepilepsia.org/la-epilepsia/que-es-la-epilepsia

Faq1

How to act in the event of an epileptic seizure?



If you are with someone who is experiencing an epileptic seizure, you have to be clear about some practical advice that will allow you to know how to act and be of help.

The first thing to do is to stay calm and try to prevent the patient from getting hurt. That is, you have to protect the person from blows without holding them with excessive force. To do this, you must remove the furniture or objects around them.1,2

Then, the person should be placed lying on their side on the floor, turning their head to the side (safety position) with a pillow underneath so that they do not get hurt. 1.2

Then you have to wait for the seizure to pass, something that happens spontaneously, normally in less than 5 minutes. It is very important that during this time you do not give them anything to drink, or put any object in their mouth or perform assisted breathing.1,2

 

1. Asociación Madrileña de Epilepsia. ¿Qué hacer ante una crisis epiléptica? Disponible en: https://www.amepilepsia. org/que-hacer-ante-una-crisis-epileptica/?reload=717982.
2. Sociedad Española de Neurologí a. Grupo de Epilepsia. Pacientes. Disponibl e en: http: //epile ps ia. se n. es /? pag e _i d= 3.

Faq2

Under what circumstances should you call A&E?



If the seizure lasts more than five minutes, or is repeated, or if you don't know if it is their first seizure, notify A&E. Likewise, do the same in the event that they had a hard fall, are pregnant or you know if they are diabetic or hypertensive.1

 

1. Asociación Madrileña de Epilepsia. ¿Qué hacer ante una crisis epiléptica? Disponible en: https://www.amepilepsia. org/que-hacer-ante-una-crisis-epileptica/?reload=717982.

Faq3

Can patients with epilepsy drive?



Epilepsy affects cognitive and motor capacity, and with it the ability to drive, being associated with a greater risk of accident for those who suffer from it. However, if the prescribed treatment and the healthcare professional's recommendations are followed, this risk is minimised.1

In this sense, people who control their epilepsy have a low risk of accidents. Thus, if the patient has been free of seizures for a year, they will be able to drive, as long as the underlying disease, the medication and their physician allow it.2

Likewise, it is possible to renew the driving licence if there is a favourable report from the neurologist stating the diagnosis, compliance with treatment, the frequency of seizures and the medication without side effects related to driving.2

On the other hand, Spanish law prohibits people with active epilepsy who have had seizures in the last year from driving. Individuals who have had a single seizure are prohibited from driving until 6 episode-free months have elapsed.3

In any case, it is very important to follow some tips, such as:3

  • Avoid driving long distances and always rest as recommended
  • Continue taking antiepileptic treatment as prescribed
  • When a change in medication is made for any reason, avoid driving for a while (to see the effects), even if you have not had a seizure in the last year
In the event of a diagnosis of epilepsy, the possibility of driving should always be discussed with the physician.1

 

1. Dirección General de Tráfico. Epilepsia: la importanci a del control. Disponible en: https://revista. dgt.es/es/salud-vial/2021/0930-Epilepsia-Salud-num-259.shtml.
2. Fundación M apfre. Epilepsia y recomendaci ones en la conducci ón. Disponibl e en: https://www.fundacionmapfre.org/educacion-divulgacion/seguridad-vial/movilidad-segura- salud/temas-conduccion-segura/enfermedades- neurologicas/epilepsia/#:~:text=El%20conductor%20con%20epilepsia%20tiene,que%20interfieran%20c on%20la% 2 0c onduc ci% C3 % B3 n.
3. Ápice. Epilepsia y conducción. Disponible en: https://www.apiceepilepsia.org/epilepsia-y- empleo/epil epsia- conducir/.

Faq4

What factors can precipitate an epileptic seizure?



It is evident that pharmacological treatment is essential for the control of an epileptic syndrome, but prevention of possible precipitating factors must often be emphasised.1

Some of these factors, for which there is sufficient scientific evidence, are as follows:1

  • Intermittent light stimulation: Response after exposure to light, both with natural stimuli (for example, sunlight between trees when driving in a car) and artificial ones (video games, television, computer screens, lights in nightclubs, etc.). In these cases, it is advisable to watch television or look at other screens in well-lit places, at a distance; use the remote control; if it is necessary to get very close to the screen, cover one eye with the palm of your hand; avoid looking at a screen for a long time, particularly if you are tired or sleepy.1
  • Sleep: in some types of epilepsy, lack of sleep (including sudden awakening from sleep) or circadian rhythm disturbances can trigger epileptic seizures.1
  • Alcohol: Patients are often advised not to consume any amount of alcoholic beverages, although there is less evidence in this regard.1
1. Sociedad Española de Neurología. Grupo de Epilepsia. CAPÍTULO 16. FACTORES PRECIPITANTES EN EPILEPSIA. Disponible en: http://epilepsia.sen.es/?p=34.
 

Faq1 (1)

What factors can precipitate an epileptic seizure?



It is evident that pharmacological treatment is essential for the control of an epileptic syndrome, but prevention of possible precipitating factors must often be emphasised.1

Some of these factors, for which there is sufficient scientific evidence, are as follows:1

  • Intermittent light stimulation: Response after exposure to light, both with natural stimuli (for example, sunlight between trees when driving in a car) and artificial ones (video games, television, computer screens, lights in nightclubs, etc.). In these cases, it is advisable to watch television or look at other screens in well-lit places, at a distance; use the remote control; if it is necessary to get very close to the screen, cover one eye with the palm of your hand; avoid looking at a screen for a long time, particularly if you are tired or sleepy.1
  • Sleep: in some types of epilepsy, lack of sleep (including sudden awakening from sleep) or circadian rhythm disturbances can trigger epileptic seizures.1
  • Alcohol: Patients are often advised not to consume any amount of alcoholic beverages, although there is less evidence in this regard.1
1. Sociedad Española de Neurología. Grupo de Epilepsia. CAPÍTULO 16. FACTORES PRECIPITANTES EN EPILEPSIA. Disponible en: http://epilepsia.sen.es/?p=34.
 

Faq1 (1) (1)

What type of epileptic seizures are there?



A seizure is defined as the transient appearance of signs and / or symptoms due to excessive neuronal activity in the brain.1 These epileptic seizures are classified according to their onset, the presence / absence of motor symptoms, and whether or not the awareness is affected.2

In this sense, the onset is the first determinant of classification. Thus, there are two main types of epileptic seizures: generalised seizures and focal seizures, which were previously known as partial seizures.3

  • Generalised seizures involve distributed neural networks on both sides of the body. There is a combined activation of all neurons on the brain surface2,3
  • Focal seizures originated in neuronal networks and limited to a single hemisphere of he body. Abnormal firing occurs in neurons on a limited area of the brain surface2,3  

Occasionally, the firing may initiate in one area of the brain and subsequently spread to the entire surface of the brain, resulting in focal seizures progressing to bilateral tonic-clonic seizures, formerly known as secondarily generalised seizures.2,3

In addition, in cases in which it is not possible to determine exactly whether it is a focal or generalised seizure, we define seizures of unknown onset.2,3

1. Fischer RS, et al. Clasificación operacional de los tipos de crisis por la Liga Internacional contra la Epilepsia: Documento - Posición de la Comisión para Clasificación y Terminología de la ILAE. Epilepsia. 2017;58(4):522- 30.
2. Sociedad Española de Neurología. Manual de Práctica Clínica en Epilepsia: Recomendaci ones diagnóstico-terapéuticas de la SEN. 2019 (Edición revisada abril de 2022).
3. Ápice. Diferentes tipos de crisis epilépticas. Disponible en: https://www.apiceepilepsia.org/que-es-la- epilepsia/diferentes-tipos-de-crisis-epilepticas/.
 

Faq2

What subtypes can focal seizures be divided into?



In general, focal seizures are more frequent than generalised ones.1 Initially, they can be subdivided based on whether the level of awareness is unaltered (aware seizures) or it is altered (impaired awareness seizures).1,2 In the latter, the affected person loses consciousness and their connection to their surroundings, remaining absorbed and unresponsive to external stimuli, but maintaining muscle tone (also associated with automatic movements, such as chewing or hand movements).1

Likewise, since the manifestations associated with these seizures depend on the area of the brain affected, we will also differentiate between seizures according to the presence / absence of motor signs and their type:1,2

  • Motor: characterised by involuntary movements, abnormal postures or paralysis of a part of the body1
  • Sensory: symptoms of tingling, sensation of heat or cold, perception of strong odours, visual disturbances, or pain affecting one part of the body1
  • Autonomic: manifested in the form of changes in temperature, sweating, excessive salivation or "goosebumps"1
  • Cognitive: characterised by difficulty in expressing or understanding, with the experience of memories, a feeling of Déjà vu, or a feeling of repetitive thought1
  • Emotional: the characteristic symptoms are intense emotions unrelated to the situation that is being experienced1
1. Ápice. Diferentes tipos de crisis epilépticas. Disponible en: https://www.apiceepilepsia.org/que-es-la- epilepsia/diferentes-tipos-de-crisis-epilepticas/.
2. Sociedad Española de Neurología. Manual de Práctica Clínica en Epilepsia: Recomendaci ones diagnóstico-terapéuticas de la SEN. 2019 (Edición revisada abril de 2022).

Faq3

What subtypes can generalised seizures be divided into?



In the case of generalised seizures, they are classified based on the presence or absence of motor symptoms, and the type of symptom.1 Thus, there are multiple subtypes of generalised seizures, although the most common are as follows:2

  • Generalised tonic-clonic seizure: there is a sudden loss of consciousness (if the person is standing, they can suddenly fall to the ground), followed by rigidity of the entire body (tonic phase) and subsequent convulsive movements of all the extremities (clonic phase)2
  • Generalised absence seizure: they are usually short-lived; the person suffers a loss of contact with their surroundings for a few seconds (being absorbed, immobile and with a fixed gaze). They may be accompanied by eye movements, blinking or movements of other parts of the body2
  • Generalised myoclonic seizure: also very brief, in this case characterised by jerks of the whole body or a part of it, generally of the arms2
  • Generalised atonic seizure: sudden loss of muscle tone across the entire body or part of it (causing falls, loss of strength in some extremities, etc.). The main problems caused by them are fractures or injuries2
1. Sociedad Española de Neurología. Manual de Práctica Clínica en Epilepsia: Recomendaci ones diagnóstico-terapéuticas de la SEN. 2019 (Edición revisada abril de 2022).
2. Ápice. Diferentes tipos de crisis epilépticas. Disponible en: https://www.apiceepilepsia.org/que-es-la- epilepsia/diferentes-tipos-de-crisis-epilepticas/.

Faq4

What is the general prognosis in epilepsy?



The prognosis for epilepsy is generally good. The probability that a patient, both an adult and a child, will remain seizure-free for at least two years while taking treatment is around 80-90%.1 However, it must be taken into account that this situation may take time and always following the prescription instructions for the treatments prescribed by the neurologist.

 

1. Guía ÁPICE de epilepsia. 2018. Disponible en: https://www.apiceepilepsia.org/guia-apice-de-epilepsia- algunos-la-padecen-entre-todos-la- tratamos/#:~:text=La%20Gu%C3%ADa%20%C3%81pice%20de%20Epilepsia,%C3%A1mbitos%20de%20la %20vida%20coti dia na.

Faq1

What factors are associated with a greater probability of relapse after a first unprovoked epileptic seizure?



Following a first unprovoked epileptic seizure, that is, one that does not occur as a direct consequence of or is closely related in time to a precipitating factor, there are certain factors that increase the risk of its repetition (recurrence).1

In this sense, it has been identified that a remote symptomatic etiology (associated with a brain injury) and the presence of abnormalities in the electroencephalogram are associated with a higher risk of recurrence. Likewise, a first seizure that occurs during sleep and brain injuries in the neuroimaging study are also correlated with a higher risk of relapse.1

Finally, it is also worth mentioning other related factors, although the level of relationship is lower than for the previous ones, such as the focal onset of the seizure, an abnormal neurological examination, the age at which the first seizure occurs (under 2 years, under 16 and over 50) and the duration of this first seizure.1

1. Sociedad Española de Neurología. Manual de Práctica Clínica en Epilepsia: Recomendaciones diagnóstico-terapéuticas de la SEN. 2019 (Edición revisada abril de 2022).

Faq2

How are epileptic seizures different form so-called psychogenic non-epileptic seizures?



It is important to be clear that not all sudden events involving a loss of consciousness are epileptic seizures. This is the case for psychogenic non-epileptic seizures, which are a frequent cause of misdiagnosis in epilepsy (which in turn can be associated with a worse prognosis), since they also manifest as an apparent loss of consciousness with fainting or agitation.1-3

The difference is that these psychogenic seizures are due to psychological causes and mechanisms.2 The most reliable indicators to distinguish a psychogenic seizure from an epileptic one are:3

  • In the case of a psychogenic seizure, awareness is preserved, blinking is often associated, and companions may intensify or improve the intensity
  • In the case of an epileptic seizure, the onset and end of the seizure are abrupt, it manifests with eye opening / increased eye opening, and is associated with confusion or post-episode sleeping
1. Guía ÁPICE de epilepsia. 2018. Disponible en: https://www.apiceepilepsia.org/guia-apice-de-epilepsia- algunos-la-padecen-entre-todos-la tratamos/#:~:text=La%20Gu%C3%ADa%20%C3%81pice%20de%20Epilepsia,%C3%A1mbitos%20de%20la %20vida%20coti dia na.
2. Ápice. Diagnóstico de la epilepsia. Disponible en: https://www.apiceepilepsia.org/diagnostico-de-la- epilepsia/.
3. Sociedad Española de Neurología. Manual de Práctica Clínica en Epilepsia: Recomendaci ones diagnóstico-terapéuticas de la SEN. 2019 (Edición revisada abril de 2022).

Faq3

Can a patient with epilepsy perform physical exercise?



Although people with epilepsy have traditionally been discouraged from engaging in physical exercise for fear of possible injury or induction of epileptic seizures, the reality is that studies confirm the beneficial effects, both physical and psychological, of regular exercise.1

It seems that physical activity helps reduce the frequency of and control epileptic seizures, as well as promote favourable changes within the brain. In addition, it has also shown beneficial effects on mood, self-esteem, weight loss, cardiovascular risk factors and quality of life.1

Likewise, there is a low risk of injury and its practice in these patients is generally safe. In any case, it must always be the healthcare professional who defines a personalised exercise programme based on a careful evaluation, considering the control of seizures over the preceding year, possible precipitating factors and the sport to be practised.1

1. Cartagena Y, et al. El ejercicio como estrategia terapéutica en la epilepsia: revisión bibliográfica. Rev Neurol. 2020;71:31-37.

Faq4

What is refractory epilepsy?



About 60%-70% of patients with epilepsy are controlled with the antiepileptic drugs prescribed by their neurologist; however, up to a third of patients may continue to develop seizures despite medication.1

In these cases, we speak of epilepsy that is refractory to antiepileptic drugs, or drug-resistant epilepsy (DRE), and it is defined as those cases of epilepsy that do not respond adequately to treatment with at least two antiepileptic drugs (whether used as single therapy or in combination), which have been well tolerated and adequately selected and used to achieve sustained freedom from seizures over time.1

The main factors that are related to the possible development of DRE are the etiology of epilepsy, the epileptic syndrome to be treated, the presence of an epileptogenic injury in the cerebral magnetic resonance imaging scan and the treatment history.1

It is important that patients with DRE are evaluated by an epileptologist in an Epilepsy Unit. In patients with established DRE, sequential changes in treatment with antiepileptic drugs can achieve seizure control, as well as reduce their severity. However, this decision should always be evaluated and taken by the healthcare professional who regularly monitors the patient.1

 

1. Sociedad Española de Neurología. Manual de Práctica Clínica en Epilepsia: Recomendaciones diagnóstico-terapéuticas de la SEN. 2019 (Edición revisada abril de 2022).

Faq1

What causes can simulate resistance to antiepileptic drugs?



Given the belief that a particular case of epilepsy is not responding adequately to the prescribed drugs (refractory epilepsy), you should see your neurologist to confirm this diagnosis and rule out pseudoresistance.1

These pseudoresistances with which refractory epilepsies can be confused are due to:1

  • Misdiagnosis: the patient exhibits another type of event such as syncope, psychogenic non-epileptic seizure, movement disorders, parasomnias, etc
  • Misclassification of the type of epilepsy: patients with generalised epilepsies who are diagnosed as focal or vice versa, leading to inappropriate drug selection
  • Misclassification of seizure type: there are antiepileptic drugs that can worsen some types of seizures
  • Inadequate drug dosage
  • Inappropriate lifestyle: lack of sleep, consumption of alcohol and drugs, not properly following the treatment as prescribed, etc.
1. Sociedad Española de Neurología. Manual de Práctica Clínica en Epilepsia: Recomendaciones diagnóstico-terapéuticas de la SEN. 2019 (Edición revisada abril de 2022).

Faq2

Is the ketogenic diet useful in childhood epilepsy?



In most people, epileptic seizures can be controlled with antiepileptic drugs if prescribed recommendations are followed. However, some patients continue to have seizures (refractory or drug-resistant epilepsy). In the event that this occurs in children, a special diet, a ketogenic diet, may be considered.1

The ketogenic diet consists of foods high in fat, low in carbohydrates and adequate levels of protein.2

Although the reason for this has not been fully elucidated, the ketogenic diet is positioned as an effective and safe alternative in refractory childhood epilepsy. It seems to show a positive impact on behavioural and cognitive functioning in children and teenagers with this type of epilepsy, particularly evident in attention, level of alertness and activity, socialisation, and quality of sleep.3

However, these types of diets should always be started and maintained under the strict supervision of a physician and a team of experts, including a nutritionist.2

1. Martin-McGill KJ, et al. Ketogenic diets for drug-resistant epilepsy. Cochrane Database Syst Rev. 2020 Jun 24;6(6):CD001903.
2. Healthychildren.org. Dieta cetogénica: el tratamiento con alimentos para niños con convulsiones. Disponible en: https://www.healthychildren.org/Spanish/health- issues/conditions/seizures/Paginas/Ketogenic-Diet.aspx.
3. García-Peñas JJ. Epilepsia, cognición y dieta cetogénica. Rev Neurol. 2018;66 (Supl. 1):S71-S75.

Faq3

What limitations does the patient with epilepsy face in their day-to-day lives?



When a person receives a diagnosis of epilepsy, they tend to think about potential difficulties within the school, social and work environments. However, the vast majority of people with epilepsy will be able to lead a normal life, achieving full social integration and employability without major limitations.1,2

In any case, people with epilepsy should follow some basic health recommendations, mainly leading a healthy lifestyle, including frequent physical exercise, a healthy and balanced diet, regular sleep and avoiding the use of drugs, alcohol and tobacco, that is, maintaining certain lifestyle habits that contribute to better seizure control and avoid factors that trigger epileptic seizures.1,2

 

Particularly in the case of those patients who exhibit seizures despite treatment, in addition to following a healthy lifestyle, they will have to adopt safety measures at home and in their daily activities, and they must inform those around them so that they will know how to act in the event of a seizure.2

Regarding one of these points, it is important to follow some simple recommendations to minimise the possible domestic risks that these patients face in the event of a seizure. Thus, furniture without edges, low beds, avoiding glass doors, security systems for hot water, etc. are all advisable. Regarding the care of babies, it is advisable to hold them while sitting down on the floor surrounded by cushions or in soft surroundings.1

1. Sociedad Española de Neurología. Manual de Práctica Clínica en Epilepsia: Recomendaciones diagnóstico-terapéuticas de la SEN. 2019 (Edición revisada abril de 2022).
2. Ápice. La epilepsia, dieta, sustancias estimulantes y luces centelleantes. Disponible en: https://www.apiceepilepsia.org/la-epilepsia-y-el-estilo-de-vida/la-epilepsia-dieta-sustancias-estimulant e-y-luces-centelleantes/.

Faq4

Does a person with epilepsy have work limitations?



Although most people with epilepsy can perform normal working activities, they have great difficulties finding stable employment if their condition is known and they may even experience discrimination.1

Therefore, in the workplace, epilepsy must be assessed considering the potential physical dangers secondary to the unpredictability of the attacks, without this involving social exclusion.2

It is also very important and necessary that, given the high incidence of this disease within the general population, professionals from all fields, unions and business leaders, be educated so that they know what epilepsy is and how to act in the event of a seizure, and to put aside prejudices and provide employment opportunities to these patients.1

 

1. Ápice. El trabajo en las personas con epilepsia. Disponible en: https://www.apiceepilepsia.org/epilepsia-y-empleo/el-trabajo-en-las-personas-con-epilepsia/.
2.Vicente-Herrero MT, et al. La incapacidad laboral en epilepsia. Criterios de valoración. Medicina de Familia. SEMERGEN. 2016;42(2):103-9.

Faq1

How does epilepsy affect a child's school life?



Fundamentally due to the general ignorance about what epilepsy is, a child with epilepsy can suffer significant discrimination and rejection by teachers and peers. Epileptic seizures cause fear in those who observe them, which tends to separate the child from normal activity.1

It is true that children with epilepsy tend to achieve lower levels of academic development due to factors associated with the pathology itself, the effects of medications and the psychosocial factors that surround them. However, the effects of epilepsy on the educational process and the learning potential vary from one person to another, so the psycho-pedagogical decisions that are made with respect to the student must be individualised.2

The most likely difficulties that children with epilepsy may have, and on which in-depth action is usually most necessary, occur in the following learning areas:2

  • Specific problems in reading and writing
  • Language and communication problems
  • Memory problems
  • Socio-emotional problems
1. Sociedad Española de Neurología. Grupo de Epilepsia. Pacientes. Disponible en:http://epilepsia.sen.es/?page_id= 3.
2. Ápice. Implicaciones educativas de la epilepsia. Disponible en: https://www.apiceepilepsia.org/educacion-y-epilepsia/implicaciones-educativas-de-la-epilepsia/.
 

Faq2

How does epilepsy influence the family and common environment of society?



Epilepsy not only affects the person who suffers from it, but also the family environment of the patients. It is very important to fully understand the disease that our family member suffers from, and to understand the prognosis and treatment recommendations, so as not to fall into a common family overprotection, something more common in the case of paediatric patients and which is usually characterised by excessive concern and nervousness from parents when their children do something without their help or supervision, continuous advice on how the child should act, or paying attention only to imperfections (which reaffirms the perception of the child's incapacity).1,2

In some cases, this overprotection can have consequences for the patient, such as:1

  • Excessive dependence: total insecurity in the patient and lack of initiative that will have repercussions, in the long run, in the form of low autonomy and poor social integration.
  • Tyranny and egocentrism: in many cases, overprotection causes them to become tyrannical and egocentric with their environment, and they may suffer from Emperor Syndrome (challenging behaviour, violation of rules, low tolerance for frustration, little empathy).
  • Work overload within the family: which can lead to two types of behaviour. Family members dedicate all of their time to work, using work as an escape route to avoid seeing the reality, or, on the contrary, they pay all their attention to the person with epilepsy, forgetting about themselves, which generates physical and mental exhaustion.
On the other hand, within society as a whole, it is common for those who witness an epileptic seizure to experience surprise, bewilderment and fear, conditioning reactions that stigmatise the individual suffering from the problem.2

This fact will produce feelings of rejection in those people unfamiliar with the condition, in addition to potentially making the person with epilepsy feel ashamed of suffering a seizure in front of those who are not within their circle of trust, giving rise to insecurity and potentially causing isolation.2

That is why it is important to manage to balance personal safety and independence. Consider that the acceptance of the condition and normal social integration, in addition to optimal seizure control, is the goal to be achieved in the treatment of the epileptic patient.2

 

1. Ápice. Influencia de la epilepsia en la familia. Disponible en: https://www.apiceepilepsia.org/influencia-de-la-epilepsia-en-la-familia/.
2. Sociedad Coruñesa de Epilepsia. Epilepsia y psicología.Influencia de la familia y la sociedad. Disponible en: https://www.asociacionepilepsiacoruna.org/influencia-de-la-familia-y-la-sociedad-en-las-personas- con-epile psi a/.

Faq3

Is it a risk for a woman with epilepsy to become pregnant?



This is a very common concern in patients with epilepsy. In fact, most of them (57.5%) do not know if epilepsy entails any added risk when becoming pregnant, 30.8% consider that there are added risks and only 11.7% affirm that the disease does not entail any specific risk.1 But does such a risk really exist?

Well, if the risk of congenital malformations ranges between 1.6% and 2.1% among the general population, in women with epilepsy treated with a single antiepileptic drug, it rises to 4.8% and in polymedicated women (using more than one drug) to 8.6%.2

However, despite this risk, treatment should be maintained, since seizures have worse consequences for the child and the mother. In addition, taking folic acid seems to reduce the risk of some malformations, so it is usually advisable to plan the pregnancy and start taking folic acid at least 6 months in advance, although this decision should always be made by the healthcare professional.2

1. Sociedad Española de Neurología. Libro blanco de la epilepsia en España. 2012. Disponible en: https://www.apiceepilepsia.org/Descargas/Libro_Blanco_de_Epilepsia. pdf.
2. Ápice. Riesgo durante la gestación de los hijos de mujeres en tratamiento FAE (Fármacos anti- Epilépticos). Disponible en: https://www.apiceepilepsia.org/ser-mujer-con-epilepsia/riesgo-durante-la-gestacion/

Faq4

Is breastfeeding advisable for a woman being treated with antiepileptic drugs?



In relation to breastfeeding, this is recommended by all Health Organisations and Medical Societies as long as there is no specific contraindication for the drug in question, since the benefits that breastfeeding brings to the mother and child, in most cases, outweigh possible adverse effects. In any case, it is usually recommended to breastfeed before taking the medication, thus decreasing the drug concentration in breast milk.1

However, the recommendations of the neurologist and paediatrician should always be followed, since each case is different.1

 
1. Ápice. La lactancia en la mujer que toma FAE (Fármacos anti-Epilépticos). Disponible en: https://www.apiceepilepsia.org/ser-mujer-con-epilepsia/lactancia-epilepsia/

Faq1

Does epilepsy influence the menstrual cycle?



Many patients with epilepsy (around 40%) present an increase or worsening of their seizures in relation to certain points of the menstrual cycle, which is known as catamenial epilepsy and has a significant negative impact on quality of life.1

There are specific times within the menstrual cycle when women are most at risk: in the days prior to the menstrual period, at the time of ovulation, and in the second half of the cycle.1

Recording the dates of seizures and menstruation over a series of months can help to determine whether you have catamenial epilepsy. Knowing the times with the highest frequency of seizures can help the healthcare professional to plan a reinforcement of pharmacological treatment on those days.2

 

1. Maguire MJ, Nevitt SJ. Treatments for seizures in catamenial (menstrual-related) epilepsy. Cochra ne Database Syst Rev. 2021 Sep 16;9(9):CD013225.
2. Ápice. Influencia del ciclo menstrual en la epilepsia. Disponible en: https://www.apiceepilepsia.org/ser- mujer-con-epilepsia/ciclo-menstrual/.

Faq2

How does smoking affect epilepsy?



Although smoking is common among people with epilepsy, to date there has been little evidence to link smoking and the clinical features of epilepsy. However, a recently published study shows that smokers of 8 or more cigarettes a day were almost four times more likely than non-smokers to have had a seizure in the previous year.1

Therefore, this data suggests that cigarette smoking is associated with increased risk of seizures and less effective seizure control. Thus, it is very important to advocate the need to quit smoking habits, not only for the health benefits, but because there are studies that point to a relationship between less effective seizure control and smoking.

 

1. Johnson AL, et al. The role of cigarette smoking in epilepsy severity and epilepsy-related quality of life. Epilepsy Behav. 2019;93:38-42.

Faq3

Does epilepsy affect partnerships and sexual relationships?



It is evident that people with active epilepsy have greater problems when it comes to forming relationships than the general population. However, it must be made clear that this fact is generally a consequence of the lack of knowledge and fear that exist in our society about this pathology, so relevant education and information will help to overcome these barriers.1

Regarding sexual relations, studies have shown that people with epilepsy experience a higher rate of sexual problems, mainly lower sexual desire (libido), problems related to orgasm, erectile dysfunction and vaginal dryness. These symptoms cause dissatisfaction in patients, being associated with a worse quality of life.2

The causes of these major sexual problems are multiple, but they are mainly due to a lack of self-esteem, the fear of having seizures during sexual intercourse, side effects of antiepileptic drugs or depression or anxiety.3

It is essential to share these types of problems honestly and openly with your neurologist, to help them understand what is happening so that they can provide you with the appropriate help to resolve them.3

 

1. Sociedad Española de Neurología. Grupo de Epilepsia. Pacientes. Disponible en:http://epilepsia.sen.es/?page_id=3.
2. Henning OJ, et al. Sexual problems in people with refractory epilepsy. Epilepsy Behav. 2016;61:174- 179.
3. Ápice. Fertilidad y sexualidad. Disponible en: https://www.apiceepilepsia.org/fertilidad-y-sexualidad/.

Faq4

What psychological/psychiatric disorders can a person with epilepsy experience?



Between 20-30% of people with epilepsy have some type of psychological / psychiatric disorder. The most common affectations are depression, anxiety disorder, attention deficit and psychosis.1

This affectation is greater in patients with drug-resistant epilepsy and in those patients who already had a history of some psychiatric condition. In the specific case of a psychiatric disorder such as psychosis, the severity of the epilepsy has been identified as a risk factor for suffering it, understanding as such a higher frequency of seizures, early onset age, specific locations, multiple injuries, etc. Factors related to the treatment of epilepsy also have an influence, such as polytherapy, that is, the consumption of several medications.2

Regarding depression, there is a bidirectional relationship with epilepsy. Therefore, it is very important that the management of both pathologies be carried out through coordinated work between a mental health team and the neurologist, who must be clear about the repercussions that antiepileptic drugs may have on depression, with the aim of improving the prognosis of both pathologies and the quality of life of the patient.1,3

 

1. Sociedad Española de Neurología. Manual de Práctica Clínica en Epilepsia: Recomendaciones diagnóstico-terapéuticas de la SEN. 2019 (Edición revisada abril de 2022).
2. D'Alessio L, et al. Psicosis y epilepsia: características clínicas y abordaje terapéutico. Rev Arg de Psiquiat. 2012; 23: 26 5- 2 70.
3. Á pice. Trastornos psicológic os más frecuent es en las personas con epilepsia. Disponible en: https://www.apiceepilepsia.org/trastornos-psicologicos-en-la-epilepsia/.

Faq1

When to consider withdrawal from antiepileptic treatment?



In general terms, the prognosis of epilepsy is good. In fact, in the long term, at least 50-60% of patients (children and adults) can stop taking the treatment, since this is not necessarily a lifelong treatment.1

Normally, withdrawal from treatment can be considered from the moment that at least two years have elapsed without any seizures. However, the risk of having a seizure after withdrawal from medication in this population is 30-40% (20-30% in children), but it must also be taken into account that continuation of treatment does not guarantee that the person will remain seizure-free.1

Likewise, antiepileptic treatment must be suspended progressively.1 In any case, decisions regarding the continuation or suspension of treatment must always be prescribed by the neurologist and must be followed according to their indications.

 

1. Ápice. Pronóstico de la epilepsia. Disponible en: https://www.apiceepilepsia.org/pronostico-de-la-epilepsia/.
 

Faq2

How can a patient association help me?



The existence of associations of patients with epilepsy has the following purposes, among others:1

  • To represent and defend the rights of people affected by epilepsy
  • To socially and educationally support these people, their families and their environment
  • To promote social equality for people with epilepsy and to seek the necessary resources for it
  • To carry out informative and awareness-raising work among the general population about epilepsy
  • To cooperate with different organisations and entities in promoting knowledge and research on the disease
 

1. Asociación Nacional de Personas con Epilepsia (ANPE). Fines ANPE. Disponible en: https://www.anpeepilepsia. org/fines.

Faq3

KEEPING
EPILEPSY
IN MIND

 

Faq4

KEEPING
PATIENTS
IN MIND

 

Faq4 (1)

KEEPING
YOU
IN MIND

 

 

 

 

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