Epilepsy: Do All Cases Have Underlying Causes?

Is there always an underlying cause for epilepsy?

Hello, doctor.
A few days ago, I suddenly experienced full-body convulsions while sleeping, with my eyes rolling back, clenched jaws, and my limbs exerting force.
I fell off the bed without being aware of it, and the episode lasted about 5 minutes.
Within 6 hours, I had 3 more episodes.
During this time, I sought treatment and took medication.
After 5 days, I had 5 more episodes.
However, after taking medication, I have not had any more episodes.
Each time I had an episode, I experienced severe headaches, muscle soreness, significant memory loss, cognitive decline, and sometimes episodes of confusion and dizziness.
As I am a soldier, I went to the Taichung Military General Hospital and then to the Tri-Service General Hospital.
The attending physicians, due to my military status, diagnosed me with suspected epilepsy, as there were no abnormalities in my brain, only irregular electrical discharges.
I underwent three tests, all showing abnormal discharges.
However, when I visited Taichung Veterans General Hospital, the doctor told me it was epilepsy.
I am unsure whom to believe.
I am not trying to evade military service; I am concerned about my health.
Could you please help me determine what symptoms I am experiencing so that I can prepare for prevention? Thank you, doctor!

A Cun, 20~29 year old female. Ask Date: 2005/02/11

Dr. Huang Yingzhe reply Neurology

Dear A-Chun,
It is generally stated that if there is a record of abnormal electrical discharges in the brain waves and you are experiencing symptoms, it is likely that you have epilepsy.
CT scans or MRIs may not necessarily show abnormalities.
However, since you have had multiple seizures, you should be on medication for at least 2-3 years.

Wishing you good health and all the best from Tainan Hospital!
Sincerely,
Dr.
Huang Ying-Che
Director, Department of Neurology
Tainan Hospital, Department of Health, Executive Yuan

Reply Date: 2005/02/11

More Info

Understanding epilepsy and its underlying causes is crucial for effective management and treatment. Epilepsy is a neurological disorder characterized by recurrent seizures, which are sudden bursts of electrical activity in the brain. These seizures can vary significantly in their manifestations, ranging from brief lapses in attention to severe convulsions.
In your case, the symptoms you described—full-body convulsions, eye rolling, teeth clenching, and loss of consciousness—are indicative of a generalized tonic-clonic seizure, which is one of the most recognizable forms of epilepsy. The fact that you experienced multiple seizures within a short period, followed by postictal symptoms such as severe headache, muscle soreness, memory loss, and cognitive decline, further supports this diagnosis.

Regarding the underlying causes of epilepsy, it is essential to understand that not all cases have a clear or identifiable origin. Epilepsy can be classified into two main categories: idiopathic and symptomatic. Idiopathic epilepsy refers to cases where no specific cause can be determined, often suggesting a genetic predisposition. On the other hand, symptomatic epilepsy is linked to identifiable factors such as brain injury, structural abnormalities, infections, or metabolic disturbances.

In your situation, the medical evaluations you underwent, including EEGs (electroencephalograms), indicated abnormal electrical activity in the brain, which is consistent with epilepsy. However, the absence of structural abnormalities on imaging studies (like CT or MRI scans) suggests that your epilepsy may be idiopathic or due to functional changes in the brain rather than structural lesions.

It is also important to consider the potential triggers for your seizures. Stress, sleep deprivation, alcohol consumption, and certain medications can exacerbate seizure activity. As a military personnel, the stress of your duties may also play a role in your condition.
The management of epilepsy typically involves antiepileptic medications, which aim to reduce the frequency and severity of seizures. Since you mentioned that you have been prescribed medication and have not experienced further seizures, it appears that your treatment plan is effective at this time. However, it is crucial to maintain regular follow-ups with your neurologist to monitor your condition and adjust your treatment as necessary.

In terms of your concerns about the differing opinions from various healthcare providers, it is not uncommon for medical professionals to have varying interpretations based on the same set of symptoms and test results. It may be beneficial to seek a second opinion from a neurologist who specializes in epilepsy, as they can provide a more focused evaluation and management plan tailored to your specific needs.

Lastly, it is essential to educate yourself about epilepsy and its management. Understanding your condition can empower you to make informed decisions about your health and lifestyle. Joining support groups or seeking counseling can also help you cope with the emotional and psychological aspects of living with epilepsy.

In conclusion, while not all cases of epilepsy have identifiable underlying causes, your symptoms and medical evaluations suggest a diagnosis of epilepsy that requires ongoing management. Regular communication with your healthcare team, adherence to your treatment plan, and lifestyle modifications can significantly improve your quality of life and reduce the risk of future seizures.

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