Types of Epilepsy

There are currently more than 600,000 people in the UK living with epilepsy, approximately 1% of the population. These numbers show no signs of slowing down, with 87 people being diagnosed with epilepsy every day in the UK.

Epilepsy is a serious condition that can affect a person’s life expectancy. According to Public Health England (PHE), people with epilepsy die on average eight years earlier, compared to the general population. In fact, more than 1,000 people die every year as a result of epilepsy.

Today, we are going to take a look at epilepsy in more detail, specifically focusing on the different types of epilepsy.

What is Epilepsy?

Epilepsy is a type of neurological disease that can affect someone of any age. It is the fourth most common neurological condition in the world and is both chronic and recurrent. Epilepsy is characterised by recurrent, unprovoked seizures. Unprovoked means that the seizures cannot be attributed to another cause, such as medication, alcohol, low blood sugar or another medical condition.

Epilepsy is the condition of the brain that causes seizures. A seizure is a sudden burst of electrical activity in the brain. This electrical activity is caused by complex chemical changes occurring in the nerve cells in the brain. This can result in either too much or too little activity in the cells which can cause an imbalance in the way the brain cells send messages.

In typically functioning brain cells, messages will be sent that either excite or inhibit other brain cells from sending messages. During a seizure, there will be an imbalance between activity that excites and activity that inhibits. These chemical changes lead to a surge of electrical activity and temporary disruption to the way the person’s brain usually functions. This results in an epileptic seizure.

Seizures can differ significantly in the way they present and cause a huge range of symptoms. Some seizures can be completely disabling or incapacitating, whereas others may be difficult to notice.

In order to be diagnosed with epilepsy, you must meet one of the conditions listed below.

1. The occurrence of at least two unprovoked seizures that occur more than 24 hours apart.

2. One unprovoked seizure with the probability of further seizures occurring.

3. A diagnosis of an epilepsy syndrome.

Epilepsy can start at any age, although diagnoses are more common in young children and adults over the age of 60.

What are the different types of epilepsy?

Epilepsy isn’t just one condition. Instead, there are many different types of epilepsy, which all have different symptoms and patterns. However, all types of epilepsy involve seizures. The types of seizures you are having will impact the type of epilepsy you will be diagnosed with.

The classifications of the different types of epilepsy recently changed. This was done to allow medical professionals to achieve easier classification and an easier, more accurate diagnosis. This new classification categorises epilepsy by the type of seizures the individual is experiencing.

There are now four main types of epilepsy.

1. Generalised Epilepsy.

2. Focal Epilepsy.

3. Combined Generalised and Focal Epilepsy.

4. Unknown if Generalised or Focal Epilepsy.

1. Generalised Epilepsy

This type of epilepsy involves generalised onset seizures that either begin on both sides of the brain or quickly affect brain cells on both sides of the brain. Seizures can cause impaired consciousness or a loss of consciousness.

Generalised epilepsy is associated with the following types of seizures:

Generalised Motor Seizures

This includes:

– Tonic-clonic seizures.
– Myoclonic seizures.
– Tonic seizures.
– Clonic seizures.
– Atonic seizures.

Generalised Non-Motor Seizures (Absence Seizures)

This includes:

– Typical absence seizures.
– Atypical absence seizures.
– Myoclonic absence seizures.

2. Focal epilepsy

This type of epilepsy involves seizures developing on one side of the brain. These seizures may develop in a specific network of brain cells and are known as focal seizures. They were previously known as partial seizures.

Focal epilepsy is characterised by the following types of seizures:

• Focal aware seizures.
• Focal impaired awareness seizures.
• Focal motor seizures.
• Focal non-motor seizures.

3. Combined generalised and focal epilepsy

This is when both generalised seizures and focal seizures occur. Generalised and focal seizures may occur together or separately. It could be that one type of seizure occurs much more frequently than the other or that both types occur with the same frequency.

Different individuals who have been diagnosed with both combined generalised and focal epilepsy may experience significantly different symptoms, depending on where their seizures are occurring and the type of seizures they are experiencing.

4. Unknown if generalised or focal epilepsy

In some cases, it may not be possible for medical professionals to determine whether seizures are generalised or focal. This could be for a number of reasons, such as not enough medical information available, an electroencephalogram (EEG) that produces normal results, and nobody being present when your seizures occurred who can describe how your symptoms presented.

In this situation, a doctor is likely to diagnose you as having unknown if generalised or focal epilepsy. This classification may change as more information becomes available.

Epilepsy syndromes

As well as the four types of epilepsy, there are also epilepsy syndromes. These can be diagnosed alongside one of the types of epilepsy and are more specific in their classification. Where a type of epilepsy only indicates the type of seizure you experience, epilepsy syndromes also describe other characteristics of your epilepsy.

Each epilepsy syndrome refers to a set of medical features that often appear together.

This includes:

• Types of seizures.
• The age when seizures typically begin.
• The results of the EEG, CT or MRI.
• Common triggers.
• The time of day seizures typically occur.
• Genetic factors.
• The response to anti-epileptic drugs (AEDs).
• The outlook.
• Any other symptoms experienced, e.g. physical or cognitive difficulties.

There are currently more than 30 known epilepsy syndromes. Epilepsy syndromes often occur in childhood.

 Some of the most common epilepsy syndromes include:

• Gervais syndrome.
• Dravet syndrome.
• Benign Rolandic epilepsy (BRE).
• West syndrome.
• Lennox-Gastaut syndrome.
• Gelastic epilepsy.
• Childhood absence epilepsy.

How many types of epileptic seizures are there?

As we have already briefly looked at, there are many different types of epileptic seizures. The nature of epileptic seizures can also vary greatly. This is because different seizures affect different areas of the brain, with some seizures even spreading across multiple areas. The different lobes of the brain control different behaviours, movements and even experiences and this can significantly affect the type of seizure you experience.

The different types of seizures are divided into groups, based on:

• The part of the brain the seizure originated in.
• Whether the seizure affects the individual’s awareness.
• Whether the seizure affects the individual’s movement.
• Any other symptoms associated with the seizure.

Epileptic seizures are now classified into three main groups.

1. Focal onset seizures – This refers to seizures that start in one area or group of cells, on one side of the brain.

2. Generalised onset seizures – This refers to seizures that affect both sides of the brain, or groups of cells on both sides of the brain.

3. Unknown onset seizures – This refers to seizures where the origin of the seizure is unknown.

Let’s take a look at some of the different types of epileptic seizures in more detail.

Focal aware seizure

This is when the individual is fully aware of what is happening, even if they are unable to move or respond. The individual is both awake and alert, although they may have movements or feelings that are out of their control. Focal aware seizures occur in one area of the brain and usually last for two minutes or less.

Focal impaired awareness seizure

This is when the individual is not aware of their surroundings during the seizure. A focal impaired awareness seizure usually affects a larger part of the brain than a focal aware seizure but is still limited to only one hemisphere. They usually last for one to two minutes.

Focal motor seizure

This is where the main symptoms involve muscle activity. The type of movement is likely to depend on the area of the brain where the seizure occurs but could include jerking, muscle contractions, unusual movements, numbness, tingling, loss of muscle tone or abdominal pain.

Focal non-motor seizure

This is where the main symptoms of the seizure don’t involve muscle activity. It can include changes in thinking, emotions or sensations. The type of changes you experience will depend on the lobe of the brain the seizure occurs in.

Tonic-clonic seizures

Tonic-clonic seizures are a type of generalised seizure, as they affect both hemispheres of the brain. A tonic-clonic seizure can be separated into two phases, the tonic phase and the clonic phase.

During the tonic phase you may:

• Lose consciousness.
• Experience a stiffening of the muscles.
• Experience air being pushed out of your voice box, which may sound like you are crying out.
• Bite down on your tongue.

During the clonic phase you may:

• Experience your limbs jerking.
• Lose control of your bladder and/or bowel.
• Experience your breathing being affected.

Tonic-clonic seizures usually last between one and three minutes. If a seizure lasts longer than five minutes, you may need emergency medical attention. After a tonic-clonic seizure has occurred, you are likely to experience some after-effects. This may include pain, tiredness, confusion and memory problems. These effects may last minutes, hours or even days.

Typical absence seizures

Typical absence seizures are a type of generalised seizure, as they affect both hemispheres of the brain. They involve the individual becoming unconscious for a few moments. They may appear to be daydreaming and will have suddenly stopped whatever they were doing, although they will not fall.

Typical absence seizures may not be noticeable but signs can include fluttering eyelashes, slight jerking movements, or short repeated actions.

If an individual is experiencing a typical absence seizure, they will not be aware of what is happening around them. They also cannot be brought out of the seizure by another person. This type of seizure almost always begins in childhood, before 14 years of age.

Some people experience hundreds of these seizures every day. They are often worse when the individual is just waking up or is just about to go to sleep. Typical absence seizures usually last around 10 seconds.

Atypical absence seizures

This type of seizure lasts longer than typical absence seizures. The individual’s muscles may go limp, and although they may be able to move around, the floppiness of their muscles will cause them to appear clumsy.

Atypical absence seizures usually start and end more slowly and sometimes individuals can respond to others while experiencing this type of seizure.

In most cases, individuals who experience atypical absence seizures usually have a learning disability or another condition that affects their brain. This type of seizure usually lasts around 30 seconds.

Myoclonic seizures

Myoclonic seizures can be either focal or generalised. They are characterised by sudden jerks. These jerks are short-lasting and can affect some or all of your body. They can be either mild or forceful. Myoclonic seizures usually last for less than a second. However, some individuals experience them in clusters, meaning they will experience several seizures in a short time frame.

Tonic seizures

Tonic seizures can be both focal and generalised, meaning they can affect one area of the brain or both hemispheres. A tonic seizure involves the tightening of your muscles. You may feel your body go stiff and you may fall to the floor.

During a tonic seizure, you may:

• Feel your neck extend.
• Feel your eyes opening wide and rolling upwards.
• Feel your arms raise up.
• Feel your legs stretch and contract.
• Cry out.
• Stop breathing.

Tonic seizures usually last 60 seconds. After you have experienced a seizure, you may feel tired or confused.

Atonic seizures

Atonic seizures can be both focal and generalised. During this type of seizure, you may experience all your muscles going limp and you may fall to the floor. They are sometimes known as drop seizures. They are usually very short, lasting only a couple of seconds.

Photosensitive epileptic seizures

This is a type of epilepsy where seizures are triggered by flashing or flickering lights or patterns. Lights that flash or flicker between 16 and 25 times a second are the most likely to trigger a photosensitive epileptic seizure, although different people are sensitive to different rates.

Any type of seizure can be triggered, but the most common type is tonic-clonic seizures. Around 3% of all people with epilepsy have photosensitive epilepsy and it is most commonly diagnosed in those between 7 and 19 years of age.

Reflex epilepsy seizures

This is a type of epilepsy where nearly all seizures are caused by one specific trigger. This trigger can be either external or internal. Some examples of reflex epilepsy triggers include reading, hot water, flashing lights, strong patterns, lack of sleep, stress and certain sounds.

Status epilepticus

This refers to any seizures that last for a long period of time or a series of seizures where the individual does not regain consciousness in between. Status epilepticus is a medical emergency and should be treated as such if the seizure has not stopped after 5 minutes, or if the person does not regain consciousness.

Signs and symptoms of the different types of epilepsy?

As seizures are the main symptom of epilepsy, to diagnose the type of epilepsy, medical professionals will look at the type of seizures you are experiencing.

As we have looked at above, each type of seizure is characterised by different signs and symptoms. In order to determine the type of seizure, doctors must determine the exact symptoms the individual is experiencing.

This can help them determine the type of seizure and whether the seizures are focal or generalised. The doctor can then use this information to diagnose the individual with a specific type of epilepsy.

 To understand the signs and symptoms the individual is experiencing, doctors will consider:

• Does the individual lose consciousness?
• Does the individual experience stiffening of the muscles?
• Does the individual experience involuntary movements, such as jerking?
• Do the involuntary movements involve the whole body or specific parts of the body?
• Does the individual appear to daydream or switch off?
• Is the individual aware of their surroundings at the time of the seizure?
• Does the individual lose muscle tone?
• Do the muscles extend or contract during the seizure?
• Does the individual experience psychological, sensory or autonomic symptoms?
• Are seizures triggered by the same thing every time?

Long-term effects of the different types of epilepsy

Repeated seizures can have long-term effects on the individual. It is important to bear in mind that every person’s seizures are different and not everyone experiences the same long-term effects.

Repeated seizures can result in a loss of brain cells and changes in the brain. The long-term effects of this will vary, depending on the area of the brain the seizures take place. If the repeated seizures originate in the temporal lobe, these changes could result in a decline in memory activity or memory function. You could also experience permanent personality changes.

Some other long-term effects may be psychological, social or emotional. For example, some people experience an increase in anxiety, a decrease in spontaneous activities, and avoidance of crowds and unfamiliar places. Some people with epilepsy also develop depression, as a result of the difficulties they face because of their epilepsy. Anxiety disorders and social isolation may also occur in some individuals.

If seizures are not under control, the individual may also experience a decline in their quality of life. This could be because they are unable to drive, may have repeated absences from school or work and may not be able to engage in sports and leisure activities that they previously enjoyed.

People with epilepsy may also be at risk of Sudden Unexpected Death in Epilepsy (SUDEP). This is when a person dies for no apparent reason during or after a seizure. However, SUDEP may be preventable by controlling seizures through medication.

Short-term effects of the different types of epilepsy

When you are first diagnosed with epilepsy, you are likely to experience some short-term effects. Some of these will be physical, whereas others will be psychological, social and emotional.

The first thing to be aware of is the physical short-term effects you may feel after a seizure. You may experience a headache, tiredness, confusion, muscle pain, nausea, difficulty talking or thinking normally, or difficulty breathing. These effects should disappear within a few minutes, hours or days of the seizure happening.

People who experience a seizure may also be at risk of an injury or even death. If the individual is close to dangerous or hazardous items when a seizure occurs, the risk to them is much higher. Some examples include water, fire, cigarettes, a stove, or if climbing a ladder or crossing a road. Injuries may also occur if the individual falls to the ground during the seizure.

Some people who have been recently diagnosed or who have just experienced a seizure may also have feelings of embarrassment, especially if the seizure happened in a public place around people who were not aware of their epilepsy.

If you are an adult and you have been newly diagnosed with epilepsy, you must stop driving immediately and inform the Driving and Vehicle Licence Agency (DVLA) about your seizures. You may have your licence taken away until you have not had a seizure for a certain period of time.

If you are working or currently attend school or university, you should also inform them of your diagnosis. This is because you are likely to need additional support, reduced or changed hours and short breaks during the day – especially in the period after your diagnosis.

Causes of the different types of epilepsy

The causes of the different types of epilepsy can vary greatly from person to person. The age of the individual can be a major factor in the cause of their epilepsy, as can their genetics. In many cases, the cause of epilepsy is unknown.

Some of the most common causes of epilepsy are listed below.

• Genetics – Around 1 in 3 people with epilepsy also have a family member with epilepsy. The relationship between genes and seizures is not yet fully known.
• Changes in the structure of the brain from:
  – A stroke – This is the most common cause of epilepsy in people over the age of 65.
  – Head injuries.
  – A brain tumour.
  – An infection in the brain.
  – Being deprived of oxygen during birth.
  – Drug abuse or alcohol misuse.

A link has also been discovered between autism and epilepsy. The National Autistic Society reports that people with autism are more likely to develop epilepsy than neurotypical people. For people with autism and no intellectual disability (ID), the risk of epilepsy is 8%. For those with autism and an ID, the risk is 20%. For those with autism and a severe ID, the risk is 40%. This is compared to 1% in the general population. For more information about autism, consult our knowledge base.

Living with the different types of epilepsy

As there are so many different types of seizures and multiple different types of epilepsy, each person’s experience of living with epilepsy will be different. However, there are certain things people with epilepsy can do to make it much easier to live with the disease.

1. Take your medication

Controlling your seizures can make it much easier for you to live a ‘normal’ life. Not only can your seizures be inconvenient, but they can also be dangerous. Once your doctor has established the correct type of medication for your epilepsy, ensure you take it correctly.

If you encounter any problems with your medication, let your doctor know immediately. Once your seizures have been under control for a significant amount of time, you may be able to gradually stop taking your medication – although this should only be done with your doctor’s guidance.

2. Identify any triggers

Although not all people with epilepsy have specific triggers, many people find it beneficial to keep a diary that will help them identify any triggers. Once you have identified any triggers, you can then avoid these as much as possible, reducing the number of seizures you experience.

3. Attend any reviews

Your GP or specialist epilepsy team or doctor will conduct regular reviews (at least once a year) of your epilepsy. Make sure you attend these reviews so your doctor has the most up-to-date information and you can ask any questions you may have.

4. Reduce any potential dangers or hazards in your life

As a seizure could happen at any time, it is important to remove any dangers that could cause you to become injured, or even put you at risk of death.

Some advice you could follow includes:

• Have a shower instead of a bath.
• Don’t lock the bathroom door.
• Take someone with you when you are swimming.
• Make sure your smoke detectors are working.
• Cover any sharp edges on your furniture.
• Use a fireguard.
• Place any pans on the back of your hob, not the front.
• Don’t walk with lit candles or matches.
• Be careful using certain gym equipment, such as weights.
• Take care when taking part in sports and other physical activities.
• Take particular care when driving – you will have to inform the DVLA of your epilepsy and may have your driving licence taken away until your seizures are under control.

5. Speak to your doctor before becoming pregnant

This is because certain Anti-Epileptic Drugs (AEDs) can be harmful to an unborn baby. If you plan to have a baby in the near future, your doctor may change your AED for a different one to ensure both you and your baby are safe.

6. Join a support group

A support group can help you adjust to living with epilepsy and can provide important information on topics such as free prescriptions, working with epilepsy, your driving licence, and any financial support you may be able to receive. A support group can also offer emotional support.

When to get medical help

If you know or even suspect that you have had a seizure for the first time, you should book an appointment to see your GP as soon as possible. Your GP can help to rule out any other illnesses or conditions that may have caused your symptoms or refer you to a neurologist or another specialist to confirm your seizures.

If you or someone you know has a diagnosis of epilepsy, it can be useful to know when you need to get medical help.

It is recommended to seek emergency medical help, usually by calling 999 and requesting an ambulance, if:

• The seizure lasts for longer than 5 minutes.
• The person experiences a cluster of seizures – a lot of seizures in a row.
• The person seriously injures themselves, for example, if they fall and hit their head or cut themselves when the seizure occurs.
• The person is experiencing breathing problems of any kind.

If you or someone you know has a seizure for the first time, it may be recommended to call 999 just to be safe.

How doctors diagnose different types of epilepsy

If you have experienced one or more seizures, your GP will refer you to a specialist doctor, usually a neurologist. A neurologist is a specialist doctor who is an expert in the brain and nerves. Epilepsy can be a difficult disease to diagnose as similar symptoms can be found in a range of other conditions.

For this reason, the specialist will require as much information as possible about the seizures, such as:

• When you had the seizure.
• What you were doing when the seizure occurred.
• How you felt before, during and after the seizure occurred.
• Any information you can gather from anyone who witnessed the seizure.

When diagnosing what type of epilepsy you have, your doctor will perform several different tests.

These can include:

• An electroencephalogram (EEG) – This checks for any unusual electrical activity in the brain. An EEG will involve small sensors being attached to your scalp that pick up the electrical signals from your brain cells. These will be recorded, and the doctor can examine the recordings to look for any unusual activity.
• A magnetic resonance imaging (MRI) scan – This is a type of brain scan that can help to locate anything in your brain that may be causing your epilepsy, such as any brain damage, scarring or unusual growths. The MRI uses magnetic fields and radio waves to create an image of your brain.
• A physical exam – This will test your motor skills and check whether you have any physical problems separate from the seizures.
• Blood tests – This will look for any markers that may be related to your seizures. This could include low blood sugars.
• Neuropsychological exam – This tests your cognition, speech and memory. It can help determine where in the brain your seizures are happening.
• Your medical history – There is a genetic link to epilepsy, with a diagnosis being more likely if another member of your family has also been diagnosed with epilepsy.

Treating the different types of epilepsy

Effective treatment can stop many people with epilepsy from having seizures completely or reduce the number of seizures they have. The type of treatment you are offered and its effectiveness can depend on the type of seizures you have and the type of epilepsy you are diagnosed with.

Some common treatments for the different types of epilepsy are:

• Anti-Epileptic Drugs (AEDs) – This is the most common treatment for epilepsy and helps control seizures in the majority of people. AEDs change the chemical levels in your brain and can be taken in several forms, including tablets, capsules and liquids. AEDs need to be taken every day. There are several different types of AEDs. Your doctor will decide which one you should take based on:
  – The type of seizures you have.
  – Your age.
  – Whether you plan to have a baby in the near future.
• Brain Surgery – This could be an option if your seizures cannot be controlled with AEDs. It is only recommended if tests have shown that your seizures are being caused by only a small part of your brain.
• Vagus Nerve Stimulation (VNS) – This involves a small electrical device being placed under the skin of your chest. The wire from the device is connected to the vagus nerve in your neck. Bursts of electricity are then sent to the nerve from the wire. This changes the electrical signals in your brain, and although it doesn’t stop seizures from happening, it can reduce their frequency and make them less severe. VNS is recommended if AEDs don’t work and if you are not suitable for brain surgery.
• Deep Brain Stimulation (DBS) – This is similar to a VNS, but the wires connect directly to the brain instead of to the neck. The bursts of electricity are then sent directly to the brain.
• A Ketogenic Diet – This is a diet high in fats and low in carbohydrates and protein. It can change the levels of chemicals in the brain and make seizures less likely. It is sometimes recommended for children whose symptoms cannot be controlled with AEDs, although it should only be implemented with the support of a specialist.

Support

There are several places that people with epilepsy, and their families and friends, can go to for advice, support and guidance.

Epilepsy action

Epilepsy Action is a community of people who are working towards a better life for everyone with epilepsy. They offer a huge amount of advice and information, virtual groups, an epilepsy forum and epilepsy training. They have dedicated support for different groups of people, including parents, children, young people, schools, professionals and care workers.

You can visit Epilepsy Action’s website, email them at helpline@epilepsy.org.uk, text them on 07479638071 or contact their helpline on 0808 800 5050.

Epilepsy society

Epilepsy Society is the UK’s leading charity for epilepsy research and support. They are a leading care provider with care tailored to the needs of every individual, a world-leading researcher, an advocate for people with epilepsy and a place for people with epilepsy and to go for information, support and advice.

You can visit Epilepsy Society’s website, email them at helpline@epilepsysociety.org.uk, or call the helpline on 01494 601 400.

Alternatively, you can speak to your GP or epilepsy team who can put you in contact with support groups in your local area.