Introduction
Definition of epilepsy
Epilepsy is a chronic neurological disease that is caused by the increase in neural brain activity.1
Types of seizures
Two main types of seizures can happen:
- Focal onset - usually starts in one area and then spreads to the rest of the brain, causing mild to severe symptoms, depending on the electrical discharge spread across the brain
- Generalised seizures - they start like focal seizures as they spread to both sides of the brain. However, generalised onset seizures start on both sides of the brain at the same time.
Definition of high blood pressure (Hypertension)
High blood pressure is when the blood force against the artery walls is too high, causing the heart to work harder to pump blood throughout the body. Eventually, damage is caused to arteries and organs, resulting in severe heart conditions, such as stroke, heart disease and kidney disease.
Classifications
High Blood pressure can be classified into two types:
- Primary hypertension - the most common type of high blood pressure often due to age and lifestyle factors
- Secondary hypertension - caused by different medical diseases and/or different medications2
Epidemiology and prevalence3
Prevalence of epilepsy
Epilepsy is a common condition that affects every 50 per 100,000 individuals, which is around 70 million people worldwide. This condition has a greater effect on those from developing regions as well as children, adolescents and the elderly.
Prevalence of high blood pressure
High blood pressure is also a common condition that has recently been on the rise, with the number of deaths caused by high blood pressure reaching 8 million worldwide. Additionally, 88% of the 8 million deaths occurred in developing countries.
Pathophysiology
Mechanisms of epilepsy
Epilepsy happens when electrical discharges in a small area of the brain spread to neighbouring brain regions, because of the numerous neurons that produce this electrical discharge.4
Mechanisms of high blood pressure
The renin-angiotensin-aldosterone system is essential to maintain and control blood pressure. The kidneys release a hormone called renin when it senses low blood pressure. Renin converts a substance in the blood into angiotensin I, which then changes into angiotensin II in the lungs. Angiotensin II makes blood vessels tighten, increasing blood pressure.5
Potential link between epilepsy and hypertension
High blood pressure can increase the risk of seizures as it also affects the brain. The brain always requires oxygen and nutrients from the blood, so when blood pressure is affected, it also affects the blood flow in the brain, resulting in seizures.
Not everyone with high blood pressure will indeed experience seizures, but if an individual has very severe high blood pressure and/or uncontrolled blood pressure, they will be at a higher risk. Also, individuals with underlying conditions, such as diabetes and kidney diseases, are susceptible to seizures from high blood pressure.6
Clinical implications5
Diagnostic challenges
Conducting individual diagnoses for high blood pressure and epilepsy is easy, but when an individual has both conditions, diagnosis is a challenge because both conditions have similar symptoms. This is why anyone seeking a diagnosis should consult their doctor and ensure a comprehensive health history review.
Treatment considerations
As for the treatment of the two conditions, doctors will discuss the best treatment option with those affected by both conditions. Some of these considerations include:
- Managing epilepsy in high blood pressure patients
- Monitoring and having control of high blood pressure in epileptic patients
- Monitoring and adjusting the antiepileptic medications AEDs to ease off the blood pressure effects
Management and lifestyle modifications6
Managing high blood pressure is one of the main steps in reducing the risk of seizures and other complications. There are different management approaches available for those affected by high blood pressure and epilepsy. These approaches include:
- Regular exercise
- Maintaining a healthy weight
- Consuming a diet with low sodium
- Avoiding smoking and tobacco
- Stopping alcohol
- Managing stress levels
Summary
High blood pressure and epilepsy are conditions that affect each other, and currently, very little is known about their link and why seizures can happen to individuals with high blood pressure. So if you suffer from high blood pressure, be sure to speak with your doctor if there are any changes in your symptoms.
References
- Types of seizures [Internet]. 2021 [cited 2024 May 23]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/epilepsy/types-of-seizures
- Cleveland Clinic [Internet]. [cited 2024 May 23]. High blood pressure: what you need to know. Available from: https://my.clevelandclinic.org/health/diseases/4314-hypertension-high-blood-pressure
- Sun Z, Jiang T, Zhang M, Li Y, Zhang J, Sun Y, et al. Causal relationship between hypertension and epilepsy: a mendelian randomization study. Acta Epileptologica [Internet]. 2024 Mar 8 [cited 2024 May 23];6(1):8. Available from: https://doi.org/10.1186/s42494-024-00152-9
- Hesdorffer DC, Hauser WA, Annegers JF, Rocca WA. Severe, uncontrolled hypertension and adult-onset seizures: a case-control study in Rochester, Minnesota. Epilepsia. 1996 Aug;37(8):736–41.
- Gasparini S, Ferlazzo E, Sueri C, Cianci V, Ascoli M, Cavalli SM, et al. Hypertension, seizures, and epilepsy: a review on pathophysiology and management. Neurol Sci [Internet]. 2019 Sep 1 [cited 2024 May 23];40(9):1775–83. Available from: https://doi.org/10.1007/s10072-019-03913-4
- https://www.coveringcfl.net/ [Internet]. [cited 2024 May 23]. Can high blood pressure cause seizures? | covering central florida. Available from: https://www.coveringcfl.net/can-high-blood-pressure-cause-seizures/
