Dystonia
of brain nerves and spinal cord

Movements are often repetitive and cause unusual, awkward and sometimes painful postures. Tremor (shaking) is often associated with some types of dystonia.

Dystonia can be a condition on its own (primary dystonia). Some people experience dystonia as a symptom of another condition (secondary dystonia).


Dystonia can be a condition on its own (primary dystonia). Some people experience dystonia as a symptom of another condition (secondary dystonia).

Symptoms

Symptoms of dystonia can include:

uncontrolled muscle spasms parts of your body twisting into unusual positions – like your neck being pulled to the side or your feet turning inwards shaking (tremors) excessive blinking

The symptoms may be continuous or come and go. They may be triggered by voluntary movements.

Causes

Dystonia is thought to be caused by a problem with the part of the brain that controls movement.

Primary and secondary dystonia may have different underlying causes.

Causes of primary dystonia

Primary dystonia often begins in childhood. This type of dystonia is more likely to have a recognised genetic cause.

Causes of secondary dystonia

You might experience dystonia as a symptom of another condition.

Secondary dystonia might be caused by:

Parkinson’s disease cerebral palsy certain medications (like some antipsychotics and some anti sickness medications) injury to the brain stroke

Diagnoses

If your GP thinks you have dystonia, they may refer you to a specialist neurologist.

You may need to have tests to confirm whether you have primary or secondary dystonia.

Depending on your symptoms, you might have a blood test or scan.

Treatments

There are treatments that can control the involuntary movements and spasms of dystonia.

You might need to try several treatment options to find out which one works best.

Botulinum toxin

If you have focal dystonia, you might be offered botulinum toxin.

Botulinum toxin is injected into the affected muscles. It blocks the neurotransmitters within the nerve, reducing muscle spasms.

The effects of the injection can last from around 3 months to 6 months.

Medication

Oral medications, like tablets, can be effective for some people with generalised dystonia.

The following are medications which might be used to treat dystonia:

anticholinergics baclofen muscle relaxants

Physiotherapy

Depending on the type of dystonia you have, physiotherapy might help you improve your range of movement.

Surgery

You might have surgery if your dystonia symptoms don’t improve with other treatments.

Deep brain stimulation (DBS) Deep brain stimulation (DBS) is a type of brain surgery. It’s offered to some people with dystonia where other treatments haven’t been successful. The surgeon will place a small device, like a pacemaker, under the skin of your chest or tummy. The device sends electrical signals along wires placed in the part of the brain that controls movement. It’ll be several weeks or months before you begin to feel the benefit of DBS. Read more about deep brain stimulation

Earache
of ears nose and throat

Earache can be a sharp, dull or burning ear pain that comes and goes or is constant. One or both ears may be affected.



Contact your GP or local out-of-hours service if: you or your child also have other symptoms, such as a high temperature (fever), vomiting, a severe sore throat, hearing loss, swelling around the ear, or discharge from the ear there is something stuck in your or your child’s ear the earache doesn’t improve within a few days

Symptoms

Eardrops or olive oil drops should not be used if the eardrum has burst, and they will not help an ear infection.

If you or your child has an ear infection, you should avoid putting objects in the ear, such as cotton buds, or getting the affected ear wet.

Causes

This information should not be used to self-diagnose your condition, but it may give you an idea as to what might be causing your earache.

It does not include every possible cause, but outlines some of the most common reasons for earache.

Ear infections If the cause of earache is an ear infection, there may be a watery or pus-like fluid coming out of the ear. Outer ear infections (infections of the tube connecting the outer ear and eardrum) and middle ear infections (infections of the parts of the ear behind the eardrum) are very common causes of earache. Many ear infections clear up on their own without treatment in a few days or weeks, but in some cases your GP may prescribe eardrops or antibiotics. Read more about treating outer ear infections and treating middle ear infections

Glue ear Glue ear (also known as otitis media with effusion, or OME) is a build-up of fluid deep inside the ear, which commonly causes some temporary hearing loss. The condition tends to be painless, but sometimes the pressure of this fluid can cause earache. Glue ear will often clear up on its own, although this can take a few months. If the problem is particularly persistent, a minor procedure to place small tubes called grommets in the ear may be recommended to help drain the fluid. Read more about glue ear

Damage to the ear Earache can sometimes result from injury to the inside of the ear. For example, by scraping earwax from the ear canal using a cotton bud, or poking a cotton bud too far into your ear, which can puncture the eardrum. The ear canal is very sensitive and can easily become damaged. The ear should heal on its own without treatment, but it can take up to two months for a perforated eardrum to heal. If you have a perforated eardrum, eardrops shouldn’t be used.

Earwax or an object in the ear A build-up of earwax or an object stuck inside the ear can sometimes cause earache. If there is something in your or your child’s ear that seems be causing pain, don’t attempt to remove it yourself. You may push it further inside and you may damage the eardrum. If you have a build-up of earwax in your ear, your pharmacist will be able to recommend eardrops to soften it so it falls out naturally. In some cases, your GP will need to remove the wax (once softened with eardrops) by flushing the ear with water. This is known as ear irrigation. If there is an object in the ear, your GP may need to refer you or your child to a specialist to have it removed.

Throat infections If you find it painful to swallow and you have a sore throat, your earache could be a symptom of a throat infection, such as tonsillitis or quinsy (an abscess on one side of the back of your throat, which can sometimes make it very difficult to swallow even fluids). Some types of tonsillitis will clear up after a few days without the need for antibiotics. But if you have quinsy, you will need to see your GP as soon as possible for treatment. You may have quinsy if your sore throat gets worse very quickly.

A problem with your jaw Earache is occasionally caused by a problem with the joint of your jaw bone (where the jaw meets the skull). This is known as temporomandibular joint pain and can be caused by problems such as arthritis or teeth grinding. Jaw pain can often be treated with painkillers, warm or cold compresses, and trying not to clench your jaw and grind your teeth.

A dental abscess A dental abscess is a collection of pus that can form in your teeth or gums as a result of a bacterial infection. The main symptom is pain in your affected tooth, which can be intense and throbbing, although the pain can sometimes spread to your ear. If you think you may have a dental abscess, make a dentist appointment as soon as possible. They may need to remove the abscess and drain the pus. Read more about treating dental abscesses

Treatments

It’s not always necessary to see your GP if you or your child have earache. Your local pharmacist is always on hand to offer help and advice on how you can manage the problem. The pain will often improve in a few days and there are things you can do to help in the meantime.

Contact your GP or local out-of-hours service if: you or your child also have other symptoms, such as a high temperature (fever), vomiting, a severe sore throat, hearing loss, swelling around the ear, or discharge from the ear there is something stuck in your or your child’s ear the earache doesn’t improve within a few days


If you have earache you can get advice and treatment directly from a pharmacy.

Earache isn’t usually serious and can be treated by a pharmacist. Your pharmacist may recommend that you contact your GP practice if required.

Find your local pharmacy


You can ask your pharmacist about using over-the-counter painkillers such as paracetamol or ibuprofen to treat the pain. Children under the age of 16 should not take aspirin.

Placing a warm flannel against the affected ear may also help relieve the pain.

Your pharmacist may also be able to recommend over-the-counter eardrops for your earache. But let them know your symptoms and ask for their advice first.

Eardrops or olive oil drops should not be used if the eardrum has burst, and they will not help an ear infection.

If you or your child has an ear infection, you should avoid putting objects in the ear, such as cotton buds, or getting the affected ear wet.

Earwax build-up
of ears nose and throat

A build-up of earwax is a common problem that can often be treated using eardrops bought from a pharmacy.

If pharmacy treatment doesn’t work, contact your GP practice. They may suggest having your ears washed out.

If these treatments don’t help, your GP may refer you to an ear, nose and throat (ENT) department for specialised treatment.


If pharmacy treatment doesn’t work, contact your GP practice. They may suggest having your ears washed out.

If these treatments don’t help, your GP may refer you to an ear, nose and throat (ENT) department for specialised treatment.


If these treatments don’t help, your GP may refer you to an ear, nose and throat (ENT) department for specialised treatment.

Symptoms

A build-up of earwax in your ear can cause:

earache hearing loss tinnitus (hearing sounds from inside your body) itchiness in or around the ear vertigo (a spinning sensation) ear infections

These problems will usually improve once the excess earwax has been removed.

Causes

Some people regularly get blocked ears because they naturally produce a lot of earwax.

Other factors that can increase the risk of too much earwax include:

producing naturally hard or dry earwax having narrow or hairy ear canals (the tube between the opening of the ear and the eardrum) being elderly, as earwax becomes drier with age bony growths in the outer part of the ear canal

Earwax can also block your ear if you frequently insert objects into your ear canal, such as cotton buds, ear plugs or hearing aids.

Treatments

Contact your GP practice if: you have particularly troublesome symptoms eardrops haven’t helped after 3 to 5 days

Your GP or practice nurse will look inside your ears to check if they’re blocked and might carry out some simple hearing tests.

They may suggest using eardrops for a bit longer, or they may carry out a minor procedure called ear irrigation (previously syringing) to clean out your ear canal. Not all GP practices offer this service. You may have to pay to have this treatment privately.

If these treatments aren’t suitable or don’t help, your GP may consider referring you to the ENT department of your nearest hospital for more specialised treatments.


There are several different earwax removal treatments available.

The main treatments are:

eardrops – drops used several times a day for a few days to soften the earwax so that it falls out by itself ear irrigation – a quick and painless procedure where an electric pump is used to push water into your ear and wash the earwax out microsuction – a quick and painless procedure where a small device is used to suck the earwax out of your ear aural toilet – where a thin instrument with a small hoop at one end is used to clean your ear and scrape out the earwax

Not all these treatments are suitable for everyone. Your pharmacist or doctor can let you know what treatments may work for you and they can tell you about any associated risks or side effects.

Preventions

Some people are naturally prone to earwax building up in their ears and may need frequent treatment to remove it when it becomes a problem.

It’s not clear if there’s anything you can do to stop earwax blocking your ears, although some doctors recommend using eardrops regularly to keep your earwax soft.

Don’t try to scrape out the earwax with your finger or an object inserted into your ear, as this this can make the problem worse.

Speak to your doctor for advice if earwax builds up in your ears regularly.

Ebola virus disease
of infections and poisoning

The 2014 to 2015 outbreak of Ebola mainly affected 3 countries in west Africa: Guinea, Liberia and Sierra Leone. Some cases also occurred in parts of central Africa.

Around 28,000 cases and more than 11,000 deaths were reported by the World Health Organization. This was the largest known outbreak of Ebola.


Around 28,000 cases and more than 11,000 deaths were reported by the World Health Organization. This was the largest known outbreak of Ebola.

Symptoms

A person infected with Ebola virus will typically develop:

a high temperature (fever) a headache joint and muscle pain a sore throat severe muscle weakness

These symptoms start suddenly between 2 and 21 days after becoming infected.

Diarrhoea, vomiting, a rash, stomach pain and reduced kidney and liver function can follow. The person may then bleed internally, and may also bleed from the ears, eyes, nose or mouth.

Ectopic pregnancy
of pregnancy and childbirth

This usually happens in one of the fallopian tubes which lead from your ovaries to your womb. If an egg implants there, it can’t develop into a baby.

Ectopic pregnancy puts your health at risk too, and can be very serious if it isn’t treated.

About 1 in 100 pregnancies are an ectopic pregnancy.


Ectopic pregnancy puts your health at risk too, and can be very serious if it isn’t treated.

About 1 in 100 pregnancies are an ectopic pregnancy.


About 1 in 100 pregnancies are an ectopic pregnancy.

Symptoms

Symptoms usually start when you’re about 6 weeks pregnant and can include:

pain low down and on one side of your abdomen bleeding from your vagina pain in the tip of your shoulder discomfort when going to the toilet a brown watery discharge from your vagina

You might also have:

other more general symptoms such as pale skin and sweating missed a period some of the early signs of being pregnant, such as feeling tired or having sore breasts

It’s important to get medical help quickly if you have any of these symptoms.

Edwards’ syndrome
of chromosomal conditions

In the UK, around 3 in every 10,000 births are affected by Edwards’ syndrome.



Humans normally have 23 pairs of chromosomes. In each pair, 1 of the chromosomes is inherited from the mother and 1 is inherited from the father.

If a baby has Edwards’ syndrome, they have inherited an extra copy of chromosome 18. This extra copy can be present in some or all of the baby’s cells and can lead to health problems for the baby.

There are 3 different forms of Edwards’ syndrome:

Full form In full form Edwards’ syndrome, the baby has inherited a complete extra copy of chromosome 18. This extra copy is present in all of the baby’s cells. Around 94% of babies born with Edwards’ syndrome have the full form of the syndrome.

Mosaic form In mosaic form Edwards’ syndrome, the baby has inherited a complete extra copy of chromosome 18, but the copy is only present in some of the baby’s cells.

Partial form In partial form Edwards’ syndrome, the baby has only inherited part of an extra copy of chromosome 18. This is a very rare form of Edwards’ syndrome.

Causes

Most cases result from a random change in the egg or sperm in healthy parents. This change is not caused by anything the parents did before or during pregnancy.

Endometriosis
of womens health, girls and young women puberty to around 25, periods and menstrual health

Speak to your doctor if: You’re experiencing: pain in the lower abdomen (tummy), pelvis, lower back or legs painful periods which affect your day to day life – for example, you can’t go to school or work or take part in day to day activities that you enjoy pain during ovulation heavy or prolonged (long lasting) periods spotting or bleeding between periods pain during and after sex pain or bleeding when going to the toilet (pain before or after peeing or pooing) bleeding from your back passage (rectum) blood in your poo (usually at the same time as your period) persistent exhaustion and tiredness (fatigue) difficulty getting pregnant These symptoms may be endometriosis, but could also be a number of other health conditions.

Endometriosis: a hidden condition

Symptoms

Symptoms can be different from person to person and month to month. Some people have no symptoms at all.

Speak to your doctor if: You’re experiencing: pain in the lower abdomen (tummy), pelvis, lower back or legs painful periods which affect your day to day life – for example, you can’t go to school or work or take part in day to day activities that you enjoy pain during ovulation heavy or prolonged (long lasting) periods spotting or bleeding between periods pain during and after sex pain or bleeding when going to the toilet (pain before or after peeing or pooing) bleeding from your back passage (rectum) blood in your poo (usually at the same time as your period) persistent exhaustion and tiredness (fatigue) difficulty getting pregnant These symptoms may be endometriosis, but could also be a number of other health conditions.

Endometriosis: a hidden condition

Causes

The exact cause of endometriosis is not known but it is sometimes believed to be genetic. That means, if someone in your family has the condition, it’s more likely you may have it too.

Diagnoses

It can be difficult to diagnose endometriosis because symptoms can vary a lot and many other conditions can cause similar symptoms. If you think you have symptoms of endometriosis, it’s important that you speak to your doctor. Share as much information as possible during your first appointment. This’ll hopefully help speed up your diagnosis.

It can be helpful to keep a note of your period dates and symptoms using a calendar, a diary or an app. You can then discuss this with your doctor to give then a better understanding of what you are experiencing.

If you’re seeing your doctor, there are some useful pieces of information to think about beforehand:

the first day of your last period (when it started) how many days your period usually lasts what was the shortest time between your periods (from the first day of one period to the first day of the next) what was the longest time between your periods (from the first day of one period to the first day of the next) how often you need to change your period products on a heavy day if you are over 25, when you had your last smear test

When you see your doctor about your symptoms, they’ll carry out what is called a pelvic examination. They will look at your vulva, vagina and cervix (the opening between the vagina and the womb). Sometimes other tests might be needed. Your doctor will discuss this with you and you can ask any questions that you might have.

As this is an intimate examination, the doctor who performs it will have another person (chaperone) present. You can ask for a female doctor to carry it out. If there isn’t a female doctor available, you can ask if there’s a female health professional who could carry out the examination.

If symptoms continue, your doctor may refer you to a gynaecologist.

Laparoscopy

The only way to confirm endometriosis is by a laparoscopy. This is an operation in which a camera (a laparoscope) is inserted into the pelvis via a small cut near the belly button. Sometimes it’s possible to remove some endometrial tissue at the same time. After the laparoscopy, the doctor will be able to tell you if you have endometriosis. This is known as a ‘confirmed diagnosis’. It’s also possible that no endometriosis is seen at laparoscopy. Your doctor will discuss the findings and any further treatment after laparoscopy.

Not everyone with endometriosis will need a laparoscopy if the symptoms can be managed. Your doctor will discuss your treatment options with you so you can decide what’s best for you.

If you have a type of endometriosis that needs additional treatment, you might be referred to a specialist centre. These are located in Edinburgh, Glasgow and Aberdeen. Your doctor will discuss the best option for you.

Whether you’re having, or have had a laparoscopy, you can access the Recovering well patient information leaflet for more information.

Epilepsy
of brain nerves and spinal cord

Epilepsy affects more than 600,000 people in the UK. Almost one in every 100 people has the condition.



The cells in the brain, known as neurons, conduct electrical signals. They communicate with each other in the brain using chemical messengers. During a seizure, there are abnormal bursts of neurons firing off electrical impulses. This can cause the brain and body to behave strangely.

The severity of seizures can differ from person to person. Some people experience an odd feeling with no loss of awareness, or may have a “trance-like” state for a few seconds or minutes. Others lose consciousness and have convulsions (uncontrollable shaking of the body).

Some people might only have a single seizure. If they do not have a high risk of having further seizures, they would not be regarded as having epilepsy.

Types of seizures

People with epilepsy can experience any type of seizure, although most people have a consistent pattern of symptoms.

Seizures can occur when you’re awake or asleep.

The type of seizure depends on how much of the brain it affects. There are:

focal (or partial) seizures – where only a small part of the brain is affected generalised seizures – where most or all of the brain is affected

Some seizures do not fit into these categories and are known as unclassified seizures.

Focal seizures

There are two main types of focal seizure.

Focal aware seizures Focal aware seizures are where you remain fully conscious throughout. Symptoms of a focal aware seizure can include: a general strange feeling that is hard to describe a “rising” feeling in your tummy – sometimes likened to the sensation in your stomach when on a fairground ride an intense feeling that events have happened before (déjà vu) experiencing an unusual smell or taste a tingling sensation, or “pins and needles”, in your arms and legs a sudden intense feeling of fear or joy stiffness or twitching in part of the body, such as an arm or hand These seizures are sometimes known as “warnings” or “auras”, because they can be a sign that another type of seizure is on its way. This can give you time to warn people around you and make sure you’re in a safe place.

Focal impaired awareness seizures Focal impaired awareness seizures are when you lose your sense of awareness. You won’t remember what happened after this type of seizure. The symptoms of a focal impaired awareness seizure can involve random bodily behaviour, like: smacking your lips rubbing your hands making random noises moving your arms around picking at clothes fiddling with objects adopting an unusual posture chewing or swallowing During a focal impaired awareness seizure, you’ll not be able to respond to anyone else. You’ll usually have no memory of it.

Generalised seizures

There are 6 main types of generalised seizure.

Absences Absence seizures mainly affect children, but they also occur in adults. They cause the person to lose awareness of their surroundings, usually for up to 15 seconds. The person will seem to stare vacantly into space. Some people will flutter their eyes or smack their lips. The person will have no memory of the seizure. Absences can occur several times a day. They may affect a child’s performance at school. They can be dangerous if they occur at a critical time, like crossing a busy road.

Myoclonic seizures These types of seizures cause your arms, legs or upper body to jerk or twitch, as if you have received an electric shock. They often only last for a fraction of a second, and you’ll normally remain conscious during this time. Myoclonic jerks often happen in the first few hours after waking up. They can occur in combination with other types of generalised seizures.

Clonic seizures These cause the same sort of twitching as myoclonic jerks, except the symptoms will last longer, normally up to 2 minutes. You might lose consciousness during a clonic seizure.

Atonic seizures Atonic seizures cause all your muscles to relax suddenly. There’s a chance you may fall to the ground and you could injure yourself.

Tonic seizures Tonic seizures cause all your muscles to suddenly become stiff. You might lose balance and fall over. Like atonic seizures, there’s a risk of injury.

Tonic-clonic seizures Tonic-clonic seizures or convulsions have 2 stages. Your body will initially become stiff and then your arms and legs will begin twitching. You’ll lose consciousness and some people will wet themselves. The seizure normally lasts a minute, but can last longer. This type of seizure is what most people think of as an epileptic fit.

Myoclonic-tonic-clonic seizures and Myoclonic-atonic are seizures involving a combination of the generalised seizures above.

Symptoms

The main symptoms of epilepsy are repeated seizures. There are different types of seizure, depending on which part of the brain it affects.

The cells in the brain, known as neurons, conduct electrical signals. They communicate with each other in the brain using chemical messengers. During a seizure, there are abnormal bursts of neurons firing off electrical impulses. This can cause the brain and body to behave strangely.

The severity of seizures can differ from person to person. Some people experience an odd feeling with no loss of awareness, or may have a “trance-like” state for a few seconds or minutes. Others lose consciousness and have convulsions (uncontrollable shaking of the body).

Some people might only have a single seizure. If they do not have a high risk of having further seizures, they would not be regarded as having epilepsy.

Types of seizures

People with epilepsy can experience any type of seizure, although most people have a consistent pattern of symptoms.

Seizures can occur when you’re awake or asleep.

The type of seizure depends on how much of the brain it affects. There are:

focal (or partial) seizures – where only a small part of the brain is affected generalised seizures – where most or all of the brain is affected

Some seizures do not fit into these categories and are known as unclassified seizures.

Focal seizures

There are two main types of focal seizure.

Focal aware seizures Focal aware seizures are where you remain fully conscious throughout. Symptoms of a focal aware seizure can include: a general strange feeling that is hard to describe a “rising” feeling in your tummy – sometimes likened to the sensation in your stomach when on a fairground ride an intense feeling that events have happened before (déjà vu) experiencing an unusual smell or taste a tingling sensation, or “pins and needles”, in your arms and legs a sudden intense feeling of fear or joy stiffness or twitching in part of the body, such as an arm or hand These seizures are sometimes known as “warnings” or “auras”, because they can be a sign that another type of seizure is on its way. This can give you time to warn people around you and make sure you’re in a safe place.

Focal impaired awareness seizures Focal impaired awareness seizures are when you lose your sense of awareness. You won’t remember what happened after this type of seizure. The symptoms of a focal impaired awareness seizure can involve random bodily behaviour, like: smacking your lips rubbing your hands making random noises moving your arms around picking at clothes fiddling with objects adopting an unusual posture chewing or swallowing During a focal impaired awareness seizure, you’ll not be able to respond to anyone else. You’ll usually have no memory of it.

Generalised seizures

There are 6 main types of generalised seizure.

Absences Absence seizures mainly affect children, but they also occur in adults. They cause the person to lose awareness of their surroundings, usually for up to 15 seconds. The person will seem to stare vacantly into space. Some people will flutter their eyes or smack their lips. The person will have no memory of the seizure. Absences can occur several times a day. They may affect a child’s performance at school. They can be dangerous if they occur at a critical time, like crossing a busy road.

Myoclonic seizures These types of seizures cause your arms, legs or upper body to jerk or twitch, as if you have received an electric shock. They often only last for a fraction of a second, and you’ll normally remain conscious during this time. Myoclonic jerks often happen in the first few hours after waking up. They can occur in combination with other types of generalised seizures.

Clonic seizures These cause the same sort of twitching as myoclonic jerks, except the symptoms will last longer, normally up to 2 minutes. You might lose consciousness during a clonic seizure.

Atonic seizures Atonic seizures cause all your muscles to relax suddenly. There’s a chance you may fall to the ground and you could injure yourself.

Tonic seizures Tonic seizures cause all your muscles to suddenly become stiff. You might lose balance and fall over. Like atonic seizures, there’s a risk of injury.

Tonic-clonic seizures Tonic-clonic seizures or convulsions have 2 stages. Your body will initially become stiff and then your arms and legs will begin twitching. You’ll lose consciousness and some people will wet themselves. The seizure normally lasts a minute, but can last longer. This type of seizure is what most people think of as an epileptic fit.

Myoclonic-tonic-clonic seizures and Myoclonic-atonic are seizures involving a combination of the generalised seizures above.

Causes

In some cases of epilepsy a cause cannot be found.

If there’s an identifiable cause, it usually involves the brain being affected by a condition.

The brain is a delicate mix of nerve cells, electrical impulses and chemicals, known as neurotransmitters. Any damage has the potential to disrupt the workings of the brain and cause seizures.

The categories of epilepsy can be separated by their causes which might be:

Structural Causes of structural epilepsy can include: cerebrovascular disease (problems with the blood vessels that supply the brain) – such as a stroke or subarachnoid haemorrhage brain tumours severe head injuries

Genetic A genetic abnormality can cause epilepsy. Research has found more genetic causes of epilepsy. Sometimes epilepsy is hereditary (passed on from one or both parents) or it can be a new gene abnormality.

Infectious Infections like meningitis can cause damage to the brain which can result in epilepsy. Viral infections like HIV can also cause epilepsy.

Metabolic Sometimes epilepsy is caused by an imbalance of the bodies chemicals. This is very rare.

Immune Autoimmune conditions that cause encephalitis (inflammation of the brain) can cause someone to develop epilepsy.

Unknown In many cases, no cause of epilepsy is found. This may be because medical investigations are not advanced enough to identify the cause.

Seizure triggers

For many people with epilepsy, seizures can occur without any obvious trigger. However, certain circumstances or the use of certain substances can sometimes come before a seizure. These include:

stress lack of sleep withdrawal from alcohol following heavy drinking some medications illegal drugs your menstrual cycle or period flashing lights (this is an uncommon trigger that affects less than 5% of people with epilepsy, and is known as photosensitive epilepsy)

Keeping a seizure diary is a good way to help find out what might trigger your seizures. Every time you have a seizure, record it and make a note of what you were doing. Over time, you might notice some avoidable things that seem to trigger your symptoms.

Diagnoses

Epilepsy is usually difficult to diagnose quickly. In most cases, it cannot be confirmed until you have had more than one seizure.

It can be difficult to diagnose because many other conditions, like fainting, migraines and panic attacks, can cause similar symptoms.

If you’ve had a seizure, you’ll be referred to a specialist in epilepsy. This will normally be a neurologist (a doctor who specialises in conditions affecting the brain and nervous system).

Describing your seizures

Some of the most important pieces of information needed to diagnose epilepsy are the details about your seizures.

The doctor will ask you what you can remember and any symptoms you may have had before it happened – things like feeling strange before the seizure or experiencing any warning signs. It is extremely useful to talk to anyone who seen your seizure and ask them exactly what they saw, especially if you cannot remember.

The doctor will also ask about your medical and personal history. They’ll ask whether you use any medicines, drugs or alcohol.

The doctor may be able to make a diagnosis of epilepsy from the information you give. They might run further tests like an electroencephalogram (EEG) or magnetic resonance imaging (MRI) scan.

Even if these tests don’t show anything, it’s still possible that you have epilepsy based on your symptoms and description of your seizures.

Magnetic resonance imaging (MRI) scan An MRI scan is a type of scan which uses strong magnetic fields to produce detailed images of the inside of your body. It can be useful in cases of suspected epilepsy. It can often detect possible causes of the condition, such as defects in the structure of your brain.

Electroencephalogram (EEG) An EEG test can detect unusual brain activity associated with epilepsy. It measures the electrical activity of your brain through electrodes placed on your scalp. During the test, you may be asked to breathe deeply or close your eyes and you may be asked to look at a flashing light. The test will be stopped immediately if it looks like the flashing light could trigger a seizure. In some cases, an EEG may be carried out while you’re asleep (sleep EEG). Or you may be given a small, portable EEG recording device to monitor your brain activity over 24 hours (ambulatory EEG). You might be asked to come into the hospital for a few days to have a video telemetry and EEG. During this, an EEG and video will be used to monitor you.

Treatments

Most people with epilepsy can be successfully treated with anti-seizure medication (ASMs). ASMs do not cure epilepsy, but can prevent seizures from occurring.

There are many different ASMs. They work by changing the levels of the chemicals in your brain that conduct electrical impulses. This reduces the chance of a seizure.

The type of ASM recommended for you will depend on a number of factors like:

the type of seizures you have your age whether there are any concerns about a certain ASM interacting with other medicines (like the contraceptive pill) whether you’re thinking of having a baby

Examples of commonly used ASMs include sodium valproate, carbamazepine, lamotrigine and levetiracetam.

Taking ASMs ASMs are available in different forms, including tablets, capsules, liquids and syrups. It’s important you follow any advice about when to take ASMs and how much to take. Never suddenly stop taking an ASM because it could cause a seizure. You shouldn’t take any other medicines whilst taking ASMs without speaking to your GP or epilepsy specialist. This includes over-the-counter medicines or complementary medicines such as St John’s Wort. Other medicines could have a dangerous interaction with your ASM and cause a seizure. Sodium valproate is not usually prescribed for women of childbearing age. This is because it could cause a baby to have physical defects or developmental problems. It can be used if there is no alternative, or if your specialist has assessed you and it’s unlikely you’ll respond to or tolerate other treatments. Your specialist or GP will also need to check you’re using a reliable form of contraception. Learn more about the risks of valproate medicines during pregnancy. Side effects are common when starting treatment with ASMs. They’re usually short-lived and pass in a few days. Speak to your healthcare team for more information on the side effects.

Brain surgery If your epilepsy is still poorly controlled after trying treatment with ASMs, you may be referred to a specialist epilepsy centre. They’ll assess if you’re suitable for surgery. This involves having various types of brain scans to find out where the epilepsy is focused. Memory and psychological tests will assess how the surgery might affect you. Surgery is only recommended when: a single area of the brain is causing seizures (focal seizures) removing that part of the brain would not cause any significant loss of brain function Most people recover from the effects of surgery after a few days. But it could be several months before you’re feeling fit and able to return to work.

Alternative procedures

Your doctor might suggest an alternative procedure if:

your epilepsy is still poorly controlled after trying treatment with ASMs brain surgery is not suitable for you

This might be vagus nerve stimulation (VNS).

Vagus nerve stimulation (VNS) VNS involves surgically implanting a small electrical device under your skin, near your collarbone. The device is like a pacemaker. The device has a wire that’s wrapped around one of the nerves in the left side of your neck, known as the vagus nerve. The device passes a regular dose of electricity to the nerve to stimulate it. This can help reduce the frequency and severity of seizures. If you feel the warning sign of a seizure coming on, you can activate an extra “burst” of stimulation. This might prevent the seizure from occurring. The stimulation normally occurs every five minutes and lasts for 30 seconds. How and why VNS works is not fully understood. It’s thought that stimulating the vagus nerve alters the chemical transmissions in the brain. Most people who undergo VNS still need to take ASMs. The battery for the VNS device typically lasts up to 10 years. After 10 years you’ll need another procedure to replace it.

Ketogenic diet A ketogenic diet is a diet high in fats and low in carbohydrates and protein. It’s thought that it may make seizures less likely by altering the chemical composition of the brain. A ketogenic diet is sometimes advised for children with seizures that are difficult to control and have not responded to ASMs. This is because it’s reduces the number of seizures in some children. It should only be used under the supervision of an epilepsy specialist with the help of a dietitian. It can also be effective in adults with certain types of epilepsy.

Erectile dysfunction (impotence)
of sexual and reproductive

Erectile dysfunction (ED), also known as impotence, is the inability to get and maintain an erection.

Erectile dysfunction is a very common condition, particularly in older men. It is estimated that half of all men between the ages of 40 and 70 will have it to some degree.

Symptoms

The main symptom of erectile dysfunction (ED) is the inability to get and maintain an erection for satisfactory intercourse.

ED should not be confused with ejaculation problems such as premature ejaculation, which is a condition where the process of arousal, orgasm and ejaculation occurs very rapidly.

Causes

Erectile dysfunction can have a range of causes, both physical and psychological. Physical causes include:

narrowing of the blood vessels going to the penis – commonly associated with high blood pressure (hypertension), high cholesterol or diabetes hormonal problems surgery or injury

Psychological causes of ED include:

anxiety depression  relationship problems

Sometimes erectile dysfunction only occurs in certain situations. For example, you may be able to get an erection during masturbation, or you may find that you sometimes wake up with an erection but you are unable to get an erection with your sexual partner.

If this is the case, it is likely the underlying cause of erectile dysfunction is psychological (stress related). If you are unable to get an erection under any circumstances, it is likely that the underlying cause is physical.

Erectile dysfunction can also be a side-effect of using certain medicines.

Read more about the causes of erectile dysfunction


Erectile dysfunction (ED) can have many causes, such as certain medical conditions, medications and stress.

It’s important to identify the cause of erectile dysfunction and treat any underlying conditions.


There are four main types of health conditions that can cause physical problems resulting in erectile dysfunction. These are:

conditions affecting the flow of blood to your penis – vasculogenic conditions affecting your nervous system, which is made up of your brain, nerves and spinal cord – neurogenic conditions affecting your hormone levels – hormonal conditions affecting the physical structure of your penis – anatomical

Injuries and surgery

Penis injuries or surgical treatment of the penis, pelvis or surrounding areas can sometimes lead to erectile dysfunction.

Erectile dysfunction is also thought to occur in up to 15-25% of people who experience a severe head injury.

Vasculogenic conditions

Examples of vasculogenic conditions that cause erectile dysfunction include:

cardiovascular disease – a disease of the heart or blood vessels, such as atherosclerosis (hardening of the arteries)  high blood pressure (hypertension) diabetes – a condition caused by high blood sugar levels. This can affect both the blood supply and the nerve endings in your penis, so it is also a neurogenic condition

Erectile dysfunction is strongly associated with cardiovascular disease. For this reason, it may be one of the first causes your GP considers when making a diagnosis and planning your treatment.

Neurogenic conditions

Examples of neurogenic conditions that cause erectile dysfunction include:

multiple sclerosis – a condition that affects the body’s actions, such as movement and balance  Parkinson’s disease – a condition that affects the way that the brain coordinates body movements, including walking, talking and writing a spinal injury or disorder a stroke – a serious condition that occurs when the blood supply to the brain is interrupted

Hormonal conditions

Examples of hormonal conditions that cause erectile dysfunction include:

hypogonadism – a condition that affects the production of the male sex hormone, testosterone, causing abnormally low levels  an overactive thyroid gland (hyperthyroidism) – where too much thyroid hormone is produced an underactive thyroid gland (hypothyroidism) – where not enough thyroid hormone is produced  Cushing’s syndrome – a condition that affects the production of a hormone called cortisol

Anatomical conditions

Peyronie’s disease, which affects the tissue of the penis, is an example of an anatomical condition that can cause erectile dysfunction.


Possible psychological causes of erectile dysfunction include:

depression – feelings of extreme sadness that last for a long time anxiety – a feeling of unease, such as worry or fear

Erectile dysfunction can often have both physical and psychological causes. For example, if you have diabetes, it may be difficult for you to get an erection, which may cause you to become anxious about the situation. The combination of diabetes and anxiety may lead to an episode of erectile dysfunction.

There are many emotional issues that may also affect your physical ability to get or maintain an erection. These include:

relationship problems lack of sexual knowledge past sexual problems past sexual abuse being in a new relationship 


Other possible causes of erectile dysfunction include:

excessive alcohol intake  tiredness using illegal drugs, such as cannabis, heroin or cocaine

Cycling

Men who cycle for more than three hours per week may be recommended to try a period without cycling to see if this helps improve erectile dysfunction.

Riding in the correct position with a properly fitted seat may also help to prevent regular cycling from leading to erectile dysfunction.

Diagnoses

Although you may be embarrassed, it’s important to get a diagnosis so that the cause can be identified.

Your GP can usually diagnose erectile dysfunction. This will involve answering questions about your symptoms, as well as a physical examination and some simple tests.

Read more about diagnosing erectile dysfunction


Erectile dysfunction (ED) can often be diagnosed by your GP. They will talk to you about your situation and may carry out a physical examination.

Your GP may ask you about:

your symptoms your overall physical and mental health your alcohol consumption whether you take drugs whether you are currently taking any medication

If you do not want to talk to your GP about erectile dysfunction, you can visit a genitourinary medicine (GUM) clinic. You can find your nearest GUM clinic on the British Association for Sexual Health and HIV (BASHH) website.


A physical examination of your penis may be carried out to rule out anatomical causes (conditions that affect the physical structure of your penis).

If you have symptoms of an enlarged prostate, such as weak or irregular urination, a digital rectal examination (DRE) may be suggested. 

Blood tests can also check for underlying health conditions. For example, measuring the levels of hormones such as testosterone can rule out hormonal conditions, such as hypogonadism (an abnormally low level of testosterone).


In some cases you may be referred to a specialist for further testing. This might be the case if you are unusually young to be experiencing erectile dysfunction as it’s rare in men under 40 years of age. 

Intracavernous injection test

An intracavernous injection test involves injecting a man-made (synthetic) hormone into your penis to increase the blood flow. This helps assess any abnormalities in your penis and plan surgery. 

If the injection doesn’t result in an erection it may indicate a problem with the blood supply to your penis. In some cases, you may also need an ultrasound scan.

Arteriography and dynamic infusion cavernosometry or cavernosography

These specialised tests involve injecting dye into the blood vessels of your penis and studying the dye on a scanner. These are likely to be used if you are being considered for surgery or if a problem has been detected with your blood vessels.

Treatments

See your GP if you have erectile dysfunction for more than a few weeks. They will assess your general state of health because the condition can be the first sign of more serious health conditions, such as heart disease (when the heart’s blood supply is blocked or interrupted).

Find your local GP practice




Erectile dysfunction is primarily treated by tackling the cause of the problem, whether this is physical or psychological.

The narrowing of the arteries (called atherosclerosis) is one of the most common causes of ED. In these cases your GP may suggest lifestyle changes, such as losing weight, to try to reduce your risk of cardiovascular disease. This may help to relieve your symptoms as well as improving your general health.

You may also be given medication to treat atherosclerosis, such as cholesterol-lowering statins and drugs to reduce your blood pressure.

A number of treatments have been successful in the treatment of erectile dysfunction. Medication, such as sildenafil (sold as Viagra), can be used to manage it in at least two-thirds of cases. Vacuum pumps that encourage blood to flow to the penis and cause an erection are also successful in 90% of cases.

Psychological treatments include cognitive behavioural therapy (CBT) and sex therapy.

Overall, treatments for erectile dysfunction have improved significantly in recent years. Most men are eventually able to have sex again.

Read more about treating erectile dysfunction


If you have erectile dysfunction (ED), treatment will depend on what’s causing it. The various treatments for erectile dysfunction are outlined below. 


If your erectile dysfunction is caused by an underlying health condition, such as heart disease or diabetes, that condition may need to be treated first. In some cases, treating the underlying cause may also resolve the problem.

If you are taking medication that can cause erectile dysfunction, there may be an alternative. It is important never to stop taking a prescribed medication unless you are advised to do so by your GP or another qualified healthcare professional responsible for your care.


If your erectile dysfunction has an underlying psychological cause then you may benefit from a type of treatment called sensate focus.

If conditions such as anxiety or depression are causing your erectile dysfunction, you may benefit from counselling (a talking therapy).

Sensate focus

Sensate focus is a type of sex therapy that you and your partner complete together. It starts with you both agreeing not to have sex for a number of weeks or months. During this time, you can still touch each other, but not in the genital area (or a woman’s breasts). The idea is to explore your bodies knowing that you will not have sex.

After the agreed period of time has passed, you can gradually begin touching each other’s genital areas. You can also begin to use your mouth to touch your partner, for example, licking or kissing, them. This can build up to include penetrative sex.

You can find out more about sensate focus from the College of Sexual and Relationship Therapists (COSRT).

Psychosexual counselling

Psychosexual counselling is a form of relationship therapy where you and your partner can discuss any sexual or emotional issues that may be contributing to your erectile dysfunction. By talking about the issues, you may be able to reduce any anxiety that you have and overcome your erectile dysfunction.

The counsellor can also provide you with some practical advice about sex, such as how to make effective use of other treatments for erectile dysfunction to improve your sex life.

Psychosexual counselling may take time to work and the results achieved have been mixed.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is another form of counselling that may be useful if you have erectile dysfunction. CBT is based on the principle that the way you feel is partly dependent on the way you think about things. CBT helps you realise that your problems are often created by your mindset. It is not the situation itself that is making you unhappy, but how you think about it and react to it.

Your CBT therapist can help you to identify any unhelpful or unrealistic thoughts that may be contributing to your erectile dysfunction – for example, to do with:

your self-esteem (the way you feel about yourself)  your sexuality  your personal relationships

Your CBT therapist will be able to help you to adopt more realistic and helpful thoughts about these issues.

Escherichia coli (E. coli) O157
of infections and poisoning

E. coli O157 is found in the gut and faeces of many animals, particularly cattle. It’s an uncommon cause of gastroenteritis but can be caught by:

eating contaminated food, such as raw leafy vegetables or undercooked meat – always wash all vegetables, including salad leaves, that will be eaten raw, unless they have been pre-prepared and are labelled ‘ready to eat’ (washing may reduce the risk of infection, but will not eliminate any risk of infection completely) touching infected animals or accidentally coming into contact with their faeces contact with people who have the illness, particularly if you do not wash your hands thoroughly after using the toilet or before handling food drinking water from inadequately treated water supplies swimming or playing in contaminated water, such as ponds or streams


eating contaminated food, such as raw leafy vegetables or undercooked meat – always wash all vegetables, including salad leaves, that will be eaten raw, unless they have been pre-prepared and are labelled ‘ready to eat’ (washing may reduce the risk of infection, but will not eliminate any risk of infection completely) touching infected animals or accidentally coming into contact with their faeces contact with people who have the illness, particularly if you do not wash your hands thoroughly after using the toilet or before handling food drinking water from inadequately treated water supplies swimming or playing in contaminated water, such as ponds or streams


People usually notice symptoms 3 to 4 days after they have been infected. But symptoms can start any time between 1 and 14 days afterwards.

These symptoms can last up to 2 weeks.

A small number of people with E. coli O157 infection go on to develop a serious condition called haemolytic uraemic syndrome (HUS). This can sometimes lead to kidney failure and death, although this is rare. The risk of HUS is highest in children aged under 5 years.

Some people become infected but don’t develop symptoms.

Further information about gastroenteritis 

Symptoms

Symptoms include diarrhoea, stomach cramps and occasionally fever. About half of people with the infection will have bloody diarrhoea.

People usually notice symptoms 3 to 4 days after they have been infected. But symptoms can start any time between 1 and 14 days afterwards.

These symptoms can last up to 2 weeks.

A small number of people with E. coli O157 infection go on to develop a serious condition called haemolytic uraemic syndrome (HUS). This can sometimes lead to kidney failure and death, although this is rare. The risk of HUS is highest in children aged under 5 years.

Some people become infected but don’t develop symptoms.

Further information about gastroenteritis 

Treatments

There is no specific treatment for E. coli O157 infection. People who are infected can usually be cared for at home and most will get better without medical treatment.

It’s important to drink plenty of fluids, as diarrhoea can lead to dehydration.

Contact your GP practice if: you or your child has bloody diarrhoea

Antibiotics are not recommended, and may increase the risk of complications.

Anti-diarrhoea drugs such as loperamide (Imodium) are also not recommended as they may prolong your exposure to the toxin.

Find out more about caring for a child with gastroenteritis and caring for an adult with gastroenteritis.

Preventions

Strict hygiene measures are essential to stop others getting infected.

Do wash your hands thoroughly with soap in running water and dry them completely – use liquid soap and warm water if you can everyone must wash their hands after contact with an infected person, particularly after handling their clothes or bedding always wash your hands after going to the toilet or changing babies’ nappies, and before preparing or serving food or eating meals if you’ve been infected, avoid cooking or preparing food until 48 hours after your symptoms have cleared up wash soiled clothing and bed linen separately from other clothes in a washing machine at the highest temperature possible (for example 60°C) wipe down the outside of the washing machine with hot water and detergent after any heavily soiled load clean toilet seats, toilet flush handles, basin taps, surfaces and toilet door handles at least daily, preferably more often, using hot water and detergent disinfection sprays and wipes or alcohol-based wipes may be used on toilet seats and other surfaces, but only after any visible soiling has been removed thick household bleach is highly effective – dilute one part bleach to every 10 parts water for soiled surfaces and one part bleach to every 100 parts water for other hard surfaces ideally, use heavy-duty domestic rubber gloves and disposable cloths for cleaning dispose of cloths by placing them in a plastic bag, sealing the neck and placing in household waste thoroughly wash rubber gloves in hot water and detergent after use, then rinse and allow to dry deal with any spillage of faeces immediately – clean the soiled area with hot water and detergent using heavy-duty domestic rubber gloves then clean gloves and wash hands thoroughly

Don’t do not share towels or nappy changing matsdo not clean soiled items in the kitchen