Epilepsy

Epilepsy is a chronic neurological condition characterized by recurrent, unprovoked seizures. It is not a single disease, but a spectrum of disorders with a common feature: disturbed and uncontrolled electrical activity in the brain, temporarily disrupting normal function³.

Diagnosis

The diagnosis is usually made after two unprovoked seizures, or one seizure with a high probability of recurrence, provided it is not caused by a reversible medical condition such as alcohol withdrawal or hypoglycemia³.

A seizure is defined as an abnormal, uncontrolled electrical discharge in the cortical gray matter of the brain. This may result in altered consciousness, sensory symptoms, focal motor movements, or generalized convulsions⁴.

Epilepsy is one of the world’s most common neurological disorders, particularly in children. When seizures are confined to one area of the brain, they may be mild or go unnoticed. When larger areas of the brain are involved, seizures may present as the classic tonic–clonic seizures, with loss of consciousness, stiffness, and rhythmic jerking of the whole body¹.

Historically, epilepsy was misunderstood as supernatural or divine possession, which contributed to strong cultural stigma².

Causes and Risk Groups

The causes of epilepsy vary with age⁴:

• Before 2 years: Febrile seizures, hereditary neurological disorders, birth complications, metabolic diseases

• 2–14 years: Idiopathic epileptic syndromes

• Adults: Trauma, stroke, tumors, alcohol withdrawal, or unknown cause

• Elderly: Stroke and tumors are the most common causes

Much remains unknown about the pathophysiology of epilepsy, but central mechanisms related to plasticity and network regulation in the central nervous system may in some cases increase seizure risk².

Classification and Seizure Types

In 2017, the International League Against Epilepsy (ILAE) introduced a new classification system for epileptic seizures. The first level of classification is based on onset:

• Generalized seizures – begin simultaneously in both hemispheres

• Focal seizures – start in one region and cause symptoms in the corresponding body part

• Unknown onset – used when the origin is uncertain

Seizures can then be classified as:

• Motor seizures – e.g., tonic, clonic, myoclonic, or tonic–clonic

• Non-motor seizures – such as altered awareness or affective disturbances

Epilepsy in Children and Cerebral Palsy

Among children with cerebral palsy, around 35% experience epileptic seizures. The types of seizures vary:

• Absence seizures: Staring episodes and small movements such as blinking or lip-smacking

• Atonic seizures: Sudden loss of muscle tone – the child falls abruptly

• Clonic seizures: Rhythmic jerks in the face, arms, or neck

• Myoclonic seizures: Brief, rapid jerks of the arms and legs

• Tonic–clonic seizures: The most severe – the body stiffens, followed by rhythmic convulsions and loss of consciousness⁵

Diagnosis of Epilepsy

Diagnosis of Epilepsy

Diagnosing epilepsy and identifying the correct seizure type requires information from multiple sources. Accurate classification is essential for effective treatment.

Diagnostic elements include³:

• Detailed medical history

• Description of seizures (from patient and witnesses)

• Blood tests and laboratory analyses

• EEG – records electrical activity in the brain and is a key tool in epilepsy diagnosis⁶

• Imaging – CT and MRI are used to identify underlying structural causes

Surface EEG provides the best overview of epileptic activity and can help localize the epileptogenic area.

Treatment and Physiotherapy in Epilepsy

Treatment Approach

Saying a person has epilepsy is as general as saying someone is ill – there are many causes and types. Epilepsy may result from head injury, genetic factors, or other conditions affecting the brain. In some cases, epilepsy is associated with neurological comorbidities and intellectual disabilities, but most people live completely normal lives between seizures¹.

Treatment is individualized, with the goal of achieving seizure freedom and safety in daily life. People with uncontrolled seizures should avoid activities that pose a risk in the event of loss of consciousness, such as driving or swimming without supervision¹.

Treatment principles⁴:

• Eliminate triggering cause if possible

• Ensure safety in risk situations

• Pharmacological seizure control

• Surgical treatment for medication-resistant epilepsy

Pharmacological Treatment

Most forms of epilepsy can be well controlled with medication. In recent decades, treatment options have expanded with:

• More antiepileptic drugs

• Improved imaging for precise localization of epileptogenic areas

• Increased understanding of mechanisms behind different epilepsy types¹

For patients where the cause of seizures can be anatomically localized, surgery may provide a permanent solution. There are also implants that can detect and modulate seizure activity in the brain¹.

Treatment Response and Prognosis

• 50–60% achieve seizure freedom with the first drug

• 11–20% gain control with combination therapy or second-line agents

• 25% develop medication-resistant epilepsy

• In children, 74% become seizure-free within two years

• 9% of children will have persistent uncontrolled seizures after several years

Physiotherapy and Physical Activity in Epilepsy

Exercise as Complementary Treatment

Physical activity and physiotherapy are playing an increasingly important role in comprehensive epilepsy care. Exercise has documented positive effects on both seizure control and general well-being and should be considered a valuable, non-pharmacological supplement to medical treatment⁷.

Benefits of physical activity:

• Improved physical fitness, strength, and energy

• Better mood and reduced stress

• Increased oxygen supply to the brain

• Increased bone mineral density and muscle strength

• Greater sense of mastery and control over health

Neuroprotection and Seizure Reduction

Studies suggest that regular physical activity may have both neuroprotective and antiepileptic effects. This is partly due to increased cerebral blood flow, reduction in inflammatory processes, and activation of “feel-good” hormones that strengthen brain function and resilience⁷.

Practical Advice and Adaptation

Many people with epilepsy avoid exercise due to fear or lack of information. It is important that healthcare providers, social workers, exercise instructors, and support staff collaborate to make physical activity safe and accessible.

Physiotherapists have a key role in:

• Assessing fall or injury risk

• Developing safe exercise programs

• Patient education and coping strategies

• Coordinating with physicians and specialists when needed

Classification and Epilepsy in Children

How is Epilepsy Classified?

In 2017, the International League Against Epilepsy (ILAE) developed a new classification system that provides a more precise and functional description of different seizure types. This offers a better foundation for treatment and prognosis.

Classification is first based on the area of seizure onset:

• Generalized seizures – begin simultaneously in both hemispheres; cause bilateral symptoms such as stiffness, jerking, and loss of consciousness

• Focal seizures – begin in a specific region and affect functions linked to that area; consciousness may be preserved or impaired

• Unknown onset – used when the starting point cannot be determined (e.g., nocturnal seizures without witnesses)

All seizures are further classified as:

• Motor seizures (e.g., tonic, clonic, myoclonic, atonic)

• Non-motor seizures (e.g., affective changes, staring episodes, sensory experiences)

Epilepsi hos barn og ved cerebral parese

Epilepsi hos barn kan arte seg annerledes enn hos voksne, og diagnostikk er ofte mer utfordrende. Anfallene kan være subtile og forbigående, og det er viktig med nøye observasjon og god anamnese.

Cerebral parese og epilepsi

Ifølge CDC opplever rundt 35 % av barn med cerebral parese epileptiske anfall. Typen anfall varierer og krever individuelt tilpasset oppfølging.

Vanlige anfallstyper hos barn med CP:

• Absensanfall– Barnet stirrer ut i luften og kan blunke eller smatte med leppene. Anfallet varer ofte bare noen sekunder.

• Atoniske anfall– Plutselig tap av muskeltonus; barnet kan falle rett ned uten forvarsel.

• Kloniske anfall– Rytmiske rykninger i ansikt, armer eller ben – kan være ensidige.

• Myokloniske anfall– Korte, raske rykninger i armer og bein, uten bevissthetstap.

• Tonisk-kloniske anfall– De mest dramatiske: kroppen stivner (tonisk fase), deretter rytmiske kramper (klonisk fase), ofte med bevissthetstap og eventuell inkontinens⁵.

Clinical Relevance and Multidisciplinary Approach

Diagnosing epilepsy in children requires:

• History from parents and possible witnesses

• EEG with specific pediatric protocols

• MRI or CT if structural causes are suspected

• Collaboration between neurologist, pediatrician, physiotherapist, and educational support staff

For children with complex needs, such as those with cerebral palsy, physiotherapy is essential – both for motor development and safe movement. This includes:

• Training in safe environments

• Adaptation to enable physical activity despite seizure risk

• Focus on participation and quality of life, not just medical control

References

1. The Conversation. Epilepsy: sorting the myths from the facts of a common disorder. Available from: https://theconversation.com/epilepsy-sorting-the-myths-from-the-facts-of-a-common-disorder-47276 (last accessed 05.07.2025).

2. Scharfman HE. The neurobiology of epilepsy. Current Neurology and Neuroscience Reports. 2007 Jul 1;7(4):348–54. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2492886/ (last accessed 05.07.2025).

3. Epilepsy Foundation. Epilepsy. Available from: https://www.epilepsy.com/learn/about-epilepsy-basics/what-epilepsy (last accessed 05.07.2025).

4. MSD Manual. Seizure disorders. Available from: https://www.msdmanuals.com/en-au/professional/neurologic-disorders/seizure-disorders/seizure-disorders (last accessed 05.07.2025).

5. Cerebral Palsy and Associated Conditions.

6. Liman MN, Al Sawaf A. Epilepsy EEG. StatPearls [Internet]. 2020 Jun 14. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558912/ (last accessed 05.07.2025).

7. Yakasai AM. The role of physiotherapy in the management of children with epilepsy. Available from: https://www.numss.com/Thesis/ABDULSALAM%20MOHAMMED%20YAKASAI%20PHYSIOTHERAPY%20INTERVENTION%20IN%20CHILDREN%20WITH%20EPILEPSY.pdf (last accessed 05.07.2025).