Epilepsy is a central nervous system disorder (neurological disorder) in which nerve cell activity in the brain becomes disrupted, causing seizures or periods of unusual behavior, sensations and sometimes loss of consciousness.
Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others repeatedly twitch their arms or legs.
About 1 in 26 people in the United States will develop a seizure disorder. Nearly 10 percent of individuals may have a single unprovoked seizure. However, a single seizure doesn’t mean you have epilepsy. At least two unprovoked seizures are generally required for an epilepsy diagnosis.
Even mild seizures may require treatment because they can be dangerous during activities such as driving or swimming. Treatment with medications or sometimes surgery can control seizures for about 80 percent of people with epilepsy. Some children with epilepsy may also outgrow their condition with age.
IF YOU OR SOMEONE YOU KNOW IS CONCERNED ABOUT HAVING SEIZURES, PLEASE INQUIRE ABOUT SCHEDULING A NEUROLOGICAL EVALUATION.
Seek immediate medical help if:
- The seizure lasts more than five minutes.
- Breathing or consciousness doesn’t return after the seizure stops.
- A second seizure follows immediately.
- You have a high fever.
- You’re pregnant.
- You have diabetes.
- You’ve injured yourself during the seizure.
If you experience a seizure for the first time, seek medical advice.
Most Common Symptoms
- Temporary confusion
- A staring spell
- Uncontrollable jerking movements of the arms and legs
- Loss of consciousness or awareness
- Psychic symptoms
When seizures appear to result from abnormal activity in just one area of your brain, they’re called focal (partial) seizures. These seizures fall into two categories.
Focal seizures without loss of consciousness (simple partial seizures)
These seizures don’t cause a loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste or sound. They may also result in involuntary jerking of a body part, such as an arm or leg, and spontaneous sensory symptoms such as tingling, dizziness and flashing lights.
Focal dyscognitive seizures (complex partial seizures)
These seizures involve a change or loss of consciousness or awareness. During a complex partial seizure, you may stare into space and not respond normally to your environment or perform repetitive movements, such as hand rubbing, chewing, swallowing or walking in circles.
Symptoms of focal seizures may be confused with other neurological disorders, such as migraine, narcolepsy or mental illness. A thorough examination and testing are needed to distinguish epilepsy from other disorders.
Six types of generalized seizures exist.
Absence seizures, previously known as petit mal seizures, often occur in children and are characterized by staring into space or subtle body movements such as eye blinking or lip smacking. These seizures may occur in clusters and cause a brief loss of awareness.
Tonic seizures cause stiffening of your muscles. These seizures usually affect muscles in your back, arms and legs and may cause you to fall to the ground.
Atonic seizures, also known as drop seizures, cause a loss of muscle control, which may cause you to suddenly collapse or fall down.
Clonic seizures are associated with repeated or rhythmic, jerking muscle movements. These seizures usually affect the neck, face and arms.
Myoclonic seizures usually appear as sudden brief jerks or twitches of your arms and legs.
Tonic-clonic seizures, previously known as grand mal seizures, are the most dramatic type of epileptic seizure and can cause an abrupt loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control or biting your tongue.
Test and Diagnosis
To diagnose your condition, your doctor will review your symptoms and medical history. Your doctor may order several tests to diagnose epilepsy and determine the cause of seizures.
Your doctor may test your behavior, motor abilities, mental function and other areas to diagnose your condition and determine the type of epilepsy you may have.
Your doctor may take a blood sample to check for signs of infections, genetic conditions or other conditions that may be associated with seizures.
This is the most common test used to diagnose epilepsy. In this test, doctors attach electrodes to your scalp with a paste-like substance. The electrodes record the electrical activity of your brain.If you have epilepsy, it’s common to have changes in your normal pattern of brain waves, even when you’re not having a seizure. Your doctor may monitor you on video while conducting an EEG while you’re awake or asleep, to record any seizures you may experience. Recording the seizures may help the doctor determine what kind of seizures you’re having or rule out other conditions.
Your doctor may give you instructions to do something that will cause seizures, such as getting little sleep prior to the test.
Computerized tomography (CT) scan
A CT scan uses X-rays to obtain cross-sectional images of your brain. CT scans can reveal abnormalities in your brain that might be causing your seizures, such as tumors, bleeding and cysts.
Magnetic Resonance imaging (MRI)
An MRI uses powerful magnets and radio waves to create a detailed view of your brain. Your doctor may be able to detect lesions or abnormalities in your brain that could be causing your seizures.
Functional MRI (fMRI)
A functional MRI measures the changes in blood flow that occur when specific parts of your brain are working. Doctors may use an fMRI before surgery to identify the exact locations of critical functions, such as speech and movement, so that surgeons can avoid injuring those places while operating.
Positron emission tomography (PET) scan
PET scans use a small amount of low-dose radioactive material that’s injected into a vein to help visualize active areas of the brain and detect abnormalities.
Single-photon emission computerized tomography (SPECT) scan
This type of test is used primarily if you’ve had an MRI and EEG that didn’t pinpoint the location in your brain where the seizures are originating.A SPECT test uses a small amount of low-dose radioactive material that’s injected into a vein to create a detailed, 3-D map of the blood flow activity in your brain during seizures.
Doctors also may conduct a form of a SPECT test called subtraction ictal SPECT coregistered to magnetic resonance imaging (SISCOM), which may provide even more detailed results.
In these tests, doctors assess your thinking, memory and speech skills. The test results help doctors determine which areas of your brain are affected.
Finding the right medication and dosage can be complex. Your doctor will consider your condition, frequency of seizures, your age and other factors when choosing which medication to prescribe. Your doctor will also review any other medications you may be taking, to ensure the anti-epileptic medications won’t interact with them.
Most people with epilepsy can become seizure-free by taking one anti-seizure medication, called anti-epileptic medication. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications. Your doctor will advise you about the appropriate time to stop taking medications.
Your doctor likely will first prescribe a single medication at a relatively low dosage and may increase the dosage gradually until your seizures are well-controlled. Many adults potentially can discontinue medications after two or more years without seizures.
Surgery is most commonly done when tests show that your seizures originate in a small, well-defined area of your brain that doesn’t interfere with vital functions such as speech, language, motor function, vision or hearing. In surgery, your doctor removes the area of your brain that’s causing the seizures.
Vagus Nerve Stimulation (VNS)
- In vagus nerve stimulation, doctors implant a device called a vagus nerve stimulator underneath the skin of your chest, similar to a heart pacemaker. Wires from the stimulator are connected to the vagus nerve in your neck.The battery-powered device sends bursts of electrical energy through the vagus nerve and to your brain. It’s not clear how this inhibits seizures, but the device can usually reduce seizures by 20 to 40 percent.Most people still need to take anti-epileptic medication, although some people may be able to lower their medication dose. You may experience side effects from vagus nerve stimulation, such as throat pain, hoarse voice, shortness of breath or coughing. We are able to manage VNS patients here.