Young Person with a History of Epilepsy

Young Person with a History of Epilepsy

Joanne Blair


Defined by Sun et al. (2021) as a neurological disorder caused by abnormal brain activity, epilepsy has been noted as one of the most common neurological disorders in childhood, with potential to impact on physical, psychological, and social health (Fisher et al. 2005). Referred to as a disorder rather than a disease, epilepsy is a complex spectrum of symptoms which can manifest in up to 40 different types of seizure activity (Fisher et al. 2005). The main characteristic of epilepsy is recurrent, unprovoked seizures due to the presence of excess electrical activity in the brain, which causes a temporary disruption in the normal nerve impulses passing between brain cells (Epilepsy Research UK 2010; Glasper & Richardson 2020). Hauser and Banerjee (2008) further add that the recurrent seizures are separated by more than 24 hours. In some cases, it is possible for one person to have several types of seizure. Refer to Activity 15.1 for additional definitions.

NICE 2021 estimate the prevalence of epilepsy in the UK to be 5–10 cases per 1000 people and it is thought to affect approximately 63,400 children and young people under the age of 18 years in the UK (Joint Epilepsy Council (JEC) 2011). Those who have other neurological problems, for example a learning disability, show a higher incidence with risk of developing epilepsy increasing with the severity of learning disability (Whittaker 2004). Epilepsy is most commonly diagnosed during the first year, after a child has had two or more unprovoked seizures (Camfield & Camfield 2006) and although normally diagnosed in childhood, it can affect people of any age as a result of trauma to the brain such as injury or infection (Ricci & Kyle 2009).

The causes of epilepsy fall into three categories (National Society for Epilepsy (NSE) 2010a; Wolraich et al. 2008):

  • Idiopathic epilepsy: has no apparent cause, but a genetic defect is thought to be involved. It is known that epilepsy can be inherited. In some cases, single or combinations of two or more genes can be involved, and environmental factors cannot be underestimated.
  • Symptomatic epilepsy: has a definite cause, for example meningitis, birth trauma, anoxia, or congenital abnormalities, for example hydrocephalus.
  • Cryptogenic epilepsy: has a likely cause, but for which nothing definite can be found.

According to Scheffer et al. (2007) there is growing evidence of the role of genes in symptomatic and cryptogenic epilepsies. Gene defects do not lead directly to epilepsy, but can affect the excitability of the brain, making it more susceptible to seizures. Each of us is born with a genetically inherited seizure threshold. Those with low thresholds are more susceptible to having a seizure when exposed to certain circumstances or triggers, for example sleep deprivation. Conversely, those with higher thresholds are less likely to have a seizure in similar circumstances. According to the NSE (2009a) anyone has the potential to have a seizure given the right circumstances, or a strong enough stimulus (Whittaker 2004).

Seizures are a clinical manifestation or symptom of epilepsy associated with a disturbance of the electrical activity in the brain; however, it is important to note that not all seizures are due to epilepsy. They may also be associated with other non-epilepsy conditions, such as infections of the central nervous system, hypoglycaemia, syncope, hyponatraemia, and hypoxia, which can disturb the neuronal environment. Dissociative seizures (previously known as pseudo seizures and also known as functional seizures or psychogenic seizure) are thought to be a severe reaction to emotional or psychological distress. Due to the unconscious nature of these and their similarity to epileptic seizures, these can initially be misdiagnosed as epilepsy. Whilst all seizure types may have much in common, they differ in their cause, and therefore must be investigated in order to make an accurate diagnosis.


Question 1. Describe what is meant by pre-ictal, ictal, post-ictal, and inter-ictal phases?

The pre-ictal phase refers to the period immediately before a seizure. This phase may include an aura.

The ictal phase refers to the actual seizure and associated activity.

The post-ictal phase refers to the period following the seizure when the individual is recovering and may be confused or sleepy. This recovery phase is often longer than the ictal phase.

The inter-ictal phase refers to the period of time between seizures after the individual has recovered from the post-ictal phase.

Question 2. Describe the classification of seizures

The NSE (2010b) classifies seizures into two main groups. This classification was carried out by the International League against Epilepsy (ILAE 1981), based on the manifestation of seizure activity. The ILAE carried out a further review and reclassification of epilepsy, the purpose of which was to provide a clearer description of an individual’s seizure thus enabling doctors to prescribe treatment more specific to an individual’s needs (Scheffer et al. 2017). This followed on from recommendations made during a public consultation in 2013. Classifications are outlined in Boxes 15.1 and 15.2.


Partial seizures (focal or localised seizures), affect a small area of the cerebral cortex, for example a single lobe. Consciousness is not usually lost, but can be altered, as typically the motor or sensory areas are affected (Glasper & Richardson 2020); thus the symptoms can vary depending on which part of the brain is involved. There are two types of partial seizure as shown in Box 15.1.

In some people, a partial seizure can extend as the electrical activity spreads to involve both cerebral hemispheres. Such seizures are referred to as partial seizures, secondarily generalized resulting in loss of consciousness.


Generalised seizures involve both hemispheres of the cerebral cortex and are characterised by bilateral synchronous electrical discharges from the onset. Consciousness is usually lost. The main types are described in Box 15.2.

Classification of seizures by type alone in many instances ignores other important clinical manifestations, such as age of onset, triggers, genetics, EEG readings, or presence of a learning disability. Taking all these into consideration, we can define a particular epilepsy syndrome, for example West syndrome, Lennox-Gastaut syndrome, Angelman syndrome, Rett syndrome, and Ohtahara syndrome, which can present during childhood.

In the hours or days preceding a seizure (prodromal period) some people may experience mood or behavioural changes manifesting as insomnia, anxiety, depression, or aggression. These are harbingers of a forthcoming seizure, but are not part of it (Panayiotopolus 2010). They should not be confused with auras, which occur minutes to seconds before a seizure, and are considered part of the seizure. Auras differ in individuals but manifest themselves in symptoms similar to a simple partial seizure which becomes secondarily generalised (David 2009). Normally it is not possible to prevent the seizure from occurring; however, it is possible in some cases to act on the warning signs.

Mar 23, 2024 | Posted by in Uncategorized | Comments Off on Young Person with a History of Epilepsy

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