Signs and symptoms
When to seek medical advice
Screening and diagnosis
Epilepsy is a chronic disorder of the brain that causes a tendency to have recurrent seizures. Two or more seizures must occur before a person can receive the diagnosis of epilepsy, also known as a seizure disorder. It’s not uncommon for children to have a single seizure — especially associated with a high fever — and an estimated one in 10 people will experience a seizure at some time in life.
Seizures occur when there’s a sudden change in the normal way your brain cells communicate through electrical signals. During a seizure, some brain cells send abnormal signals, which stop other cells from working properly. This abnormality may cause temporary changes in sensation, behavior, movement or consciousness.
The onset of epilepsy is most common during childhood and after age 65, but the condition can occur at any age. Treatments may be able to leave you free of seizures, or at least reduce their frequency and intensity. Many children with epilepsy outgrow the condition with age.
Signs and symptoms
Because abnormal brain cell activity causes seizures, having a seizure can result in the sudden occurrence of any activity that’s coordinated by your brain. This can include temporary confusion, complete loss of consciousness, a staring spell, or uncontrollable, jerking movements of the arms and legs. Signs and symptoms may vary depending on the type of seizure. Most people with epilepsy experience the same type of seizure, with similar symptoms, each time they have a seizure, but others may experience a wide range of types and symptoms.
Doctors classify seizures as either partial or generalized, based on how the abnormal brain activity begins. When seizures appear to result from abnormal activity in just one part of the brain, they’re called partial seizures. When seizures seem to involve most or all of the brain, the seizures are called generalized.
Both classifications are broken up further into smaller, more specific categories:
Partial seizures are separated into simple partial, complex partial and secondary generalized seizures.
Primary generalized seizures are separated into absence (petit mal), myoclonic, atonic and generalized tonic-clonic (grand mal) seizures.
Simple partial seizures. These seizures begin from a small area in your brain and don’t result in loss of consciousness. They may cause uncontrolled shaking of an arm, leg, or any other part of your body; alter emotions; change the way things look, smell, feel, taste, or sound; or cause speech disturbance.
Complex partial seizures. These seizures also begin from a small area of your brain. They alter consciousness and usually cause memory loss (amnesia). They can cause staring and nonpurposeful movements, such as repeated hand rubbing, lip smacking, posturing of your arm, vocalization or swallowing. After the seizure ends, you may be confused or sleep for a few minutes and may be unaware you had the seizure.
Secondary generalized seizures (partial seizures with secondary generalization). These seizures occur when simple or complex seizures spread to involve your entire brain. They may begin as a complex partial seizure with staring and nonpurposeful movements. The seizure then becomes more intense, leading to generalized convulsions characterized by stiffening and shaking of your extremities and your body with loss of consciousness.
Absence (petit mal seizures). These seizures are characterized by staring, subtle body movement and brief lapses of awareness. They’re usually brief, and typically no confusion or sleepiness occurs when the seizure is over.
Myoclonic seizures. These seizures usually appear as sudden jerks of your arms and legs. Myoclonic seizures may last only a short time — from less than a second for single jerks to a few seconds for repeated jerks.
Atonic seizures. Also known as drop attacks, these seizures cause you to suddenly collapse or fall down. After a few seconds, you regain consciousness and are able to stand and walk.
Generalized tonic-clonic (grand mal seizures). The most intense of all types of seizures, these are characterized by a loss of consciousness, body stiffening and shaking, and sometimes tongue biting or loss of bladder control. After the shaking subsides, a period of confusion or sleepiness usually occurs, lasting for a few minutes to a few hours.
Doctors look at the type or types of seizures you experience along with numerous other factors to determine whether you have a classifiable type of epilepsy syndrome. There are hundreds of epilepsy syndromes, defined by shared characteristics such as seizure triggers, behavior during a seizure, hereditary factors and brain wave patterns on electroencephalography (EEG) tests. If your signs and symptoms fit a known epilepsy syndrome, it provides useful information about your prognosis and which treatments are likely to be most effective.
Epilepsy syndromes include:
Febrile seizures. A febrile seizure is a convulsion triggered by a high fever that occurs in young children. The seizure typically lasts less than 5 minutes, after which your child may cry or be sleepy. These are the most common types of seizures in children, and usually stop by the time a child is 5 or 6 years old.
Benign rolandic epilepsy. This type of epilepsy is characterized by seizures that begin as partial — often affecting the face and tongue, causing drooling and speech problems — and then progress to tonic-clonic convulsions. These seizures usually occur during sleep. Benign rolandic epilepsy appears most often in children younger than age 15, and is almost always in remission within five years of the first seizure.
Absence epilepsy. People with this type of epilepsy have momentary lapses of consciousness, or staring spells, often accompanied by jerking arms, lip-smacking and rapidly blinking eyes. Most people recover quickly after the seizure ends. Children who develop absence epilepsy before age 10 are likely to go into remission when they reach puberty.
Juvenile myoclonic epilepsy. This type of epilepsy is characterized by seizures involving sudden jerking of the arms and legs. Juvenile myoclonic epilepsy usually appears at puberty and isn’t generally outgrown.
Infantile spasms. This syndrome, which usually develops in babies younger than 12 months, involves seizures in which a baby “jackknifes” at his or her midsection and jerks his or her arms forward. Babies usually cry after a spasm, and this condition is often mistaken for colic. Most affected babies outgrow the condition by age 5, but some develop long-term problems including mental retardation and a lasting epilepsy syndrome, most often Lennox-Gastaut syndrome.
Lennox-Gastaut syndrome. Children with Lennox-Gastaut syndrome, which usually develops before age 6, have severe epilepsy involving several different types of seizures. Atonic seizures are common, requiring many affected children to wear protective helmets. Children with this condition may have impaired intellectual development and behavior problems. This syndrome is difficult to treat and usually persists through adulthood.
Reflex epilepsies. People with a type of reflex epilepsy have seizures that are triggered by certain stimuli, most often intense, flickering or flashing light (photosensitive epilepsy). In rare cases, reflex triggers may include certain sounds, tastes and mental activities such as reading and writing. Most people with reflex epilepsy respond well to medication or, in some cases, special sunglasses that minimize the impact of light. Many people outgrow this syndrome.
Temporal lobe epilepsy. This syndrome is characterized by complex partial seizures that originate in the side regions (temporal lobes) of your brain. These seizures often are preceded by a warning sensation — called an aura — that can cause a wide range of thoughts and emotions, including deja vu, anxiety, panic, joy or overwhelming, strange sensations that are impossible to describe. Many people with this type of epilepsy also experience simple partial seizures and generalized tonic-clonic seizures.
Frontal lobe epilepsy. Frontal lobe epilepsy affects only the front regions of your brain (frontal lobes), which are responsible for thinking and control of voluntary movement. This disorder is associated with partial seizures that may cause weakness, involuntary thrashing or jerking motions and a temporary inability to speak. Other symptoms may include involuntary laughter, screaming, bicycling motions and sexually suggestive movements.
Progressive myoclonic epilepsies. This rare form of epilepsy involves both myoclonic and tonic-clonic (grand mal) seizures. Over time, the condition may cause rigid muscles, balance problems and a decline in cognitive abilities.
Landau-Kleffner syndrome. This rare disorder causes children to develop problems speaking and understanding speech. Although EEGs show epilepsy-related abnormalities in affected children, not all of them experience seizures. Those who do have seizures may experience infrequent partial or tonic-clonic seizures, usually while sleeping. The syndrome typically begins in children ages 3 to 7 years old. Many children will experience improved language abilities as they age.
Rasmussen’s syndrome. Simple partial seizures affecting movement are usually the first sign of this syndrome, also called Rasmussen’s encephalitis, which begins in childhood and may be triggered by a viral infection. Rasmussen’s syndrome eventually deteriorates one half of the brain, causing lost function on the opposite side of the body, language development problems and, in some cases, mental retardation.
The onset of epilepsy can often be traced to an accident, disease or medical trauma — such as a stroke — that injures your brain or deprives it of oxygen, often causing a small scar in your brain. In rare occasions, epilepsy may be caused by a tumor in your brain. However, in many cases there’s no identifiable cause for the disease.
Epilepsy isn’t a mental disease, although mental health can influence the control of seizures in epilepsy. Epilepsy doesn’t cause psychiatric problems or mental retardation, even though people with epilepsy may also have those conditions.
Research suggests that genetic abnormalities contribute significantly to epilepsy. If you have a family history of the disease, you may be at increased risk.
Head injuries are responsible for many cases of epilepsy. You can reduce your risk by always wearing a seat belt while riding in a car and by wearing a helmet while bicycling, skiing, riding a motorcycle, or engaging in other activities with a high risk of head injury.
Stroke and other diseases that affect your vascular system can lead to brain damage that may trigger epilepsy. You can take a number of steps to reduce your risk of these diseases, including limiting your intake of alcohol, following a healthy diet, managing your weight, exercising regularly and avoiding cigarettes.
Other epilepsy risk factors include:
Poisoning from exposure to lead, carbon monoxide and other toxins
When to seek medical advice
Having a known diagnosis of epilepsy may not mean you need to seek medical help each time you have a seizure, as long as you and your family members are well versed in what to do when a seizure occurs. Seek medical advice if you experience a seizure for the first time. Also, seek medical help if any of the following occur:
The seizure lasts more than five minutes.
Recovery from your seizure is slow.
A second seizure follows immediately.
You’re pregnant or have diabetes.
Signs of injury or illness are present.
Your seizures change in frequency and severity.
There’s a change in the way you feel during and after the seizures occur.
Your seizure is preceded by a sudden, severe headache or other signs and symptoms of stroke, including weakness or numbness on one side of your body, vision loss, confusion, coordination or speech problems.
You change your seizure medication or begin taking other medicines.
If you see someone having a seizure, call for medical help immediately and then follow these tips:
Gently roll the person onto one side and put something soft under his or her head.
Loosen tight neckwear.
Don’t try to put your fingers or anything else in the person’s mouth to prevent the swallowing of his or her tongue. The tongue can’t be swallowed, and you can cause harm to the person having a seizure or to yourself by trying to put something in his or her mouth.
Don’t try to restrain the person or shake or shout at him or her. If the person is moving, remove dangerous objects from his or her path.
Look for a medical alert bracelet. The bracelet should state who to contact in an emergency and what medications the person uses. Allergies to medications may be noted.
Stay with the person until medical personnel arrive. If possible, observe the person closely so that you can provide details on his or her signs and symptoms and how long the seizure lasted.
Screening and diagnosis
Because the possible causes of seizures are many, doctors may need to ask detailed questions and perform several tests to diagnose epilepsy, including:
Medical history. Descriptions of your past seizures — from yourself and from others who have observed your seizures — may help your doctor identify the type and cause of your problem. Your doctor may also need to know about your current and past medical conditions and how they’ve been treated.
Physical and neurological examination. A neurological examination may include testing your reflexes, muscle tone and strength, the function of your senses, and your gait, posture, coordination and balance. Your doctor may also ask questions to test your thinking, judgment and memory.
Blood tests. Your doctor may want to take samples of your blood to be tested for chemical imbalances that may be the cause of your seizures.
Electroencephalogram (EEG). This procedure records the electrical activity of your brain. An EEG helps determine what type of seizures or epilepsy you have and from which part of the brain seizures may start. During the procedure, which takes about a half-hour, you lie down. Between 16 and 30 small electrodes may be attached to your scalp with paste or an elastic cap. You remain still during the test, but at times you may be asked to breathe deeply and steadily for several minutes or to stare at a patterned board. At times a light may be flashed in your eyes. These actions are intended to stimulate your brain in ways that might be seen on the EEG. The electrodes pick up the electrical impulses from your brain and send them to the EEG machine, which records your brain waves on a moving sheet of paper or digitally on a computer screen.
Computerized tomography (CT). A CT scan produces detailed cross-sectional images of your brain. The images may reveal abnormalities in brain structure, including tumors, cysts, strokes or tangled blood vessels.
Magnetic resonance imaging (MRI). An MRI scan uses a powerful magnetic field and radio waves to produce images of your brain. Like CT scans, MRI images may reveal abnormalities in brain structure.
Recurrent seizures may put you and others at risk of physical harm. Seizures may produce injuries associated with falling, such as a head injury. A seizure that occurs while swimming could cause you to drown.
A seizure that causes either loss of awareness or control can be dangerous if you’re driving a car or operating other equipment. Drugs used to control seizures also can cause drowsiness, which may affect your driving ability. Many states have licensing restrictions related to your ability to control seizures.
Seizures during pregnancy can cause health problems for a pregnant woman and her baby, and certain anti-epileptic medications increase the risk of birth defects. If you have epilepsy and you’re considering becoming pregnant, talk to your doctor. Most women with epilepsy can become pregnant and have a healthy baby, but many need to adjust their medications and be carefully monitored throughout pregnancy.
Life-threatening complications from epilepsy are uncommon, but do occur. People who have severe, prolonged or continuous seizures (status epilepticus) are at increased risk of permanent brain damage and death.
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Functions of the brain
Most people with epilepsy can become free of their seizures by using a single anti-epileptic drug. For others, medication can make seizures less frequent and less intense. More than half of children with epilepsy whose seizures are controlled by medications can eventually stop their medications and live a seizure-free life. Many adults also can discontinue medication after two or more years without seizures.
Finding the right medication and dosage can be complex. It might take more than one drug, or trying several different drugs until the right one is found. Anti-seizure (anticonvulsant) medications include: phenytoin (Dilantin, Phenytek), carbamazepine (Carbatrol, Tegretol), valproic acid (Depakene), divalproex (Depakote), levetiracetam (Keppra), gabapentin (Neurontin), phenobarbital, ethosuximide (Zarontin), clonazepam (Klonopin), primidone (Mysoline), oxcarbazepine (Trileptal), lamotrigine (Lamictal), topiramate (Topamax), felbamate (Felbatol), tiagabine (Gabitril) and zonisamide (Zonegran).
For prolonged or cluster seizures, your doctor may prescribe a sedative, such as diazepam (Diastat, Valium) or lorazepam (Ativan, Lorazepam Intensol). For a child who has infantile spasms, or severe seizures that don’t respond to more commonly used medications, a steroid drug called adrenocorticotropic hormone (ACTH) is sometimes prescribed and given as an injection.
All of these medications have some side effects, which may include mild fatigue, dizziness and weight gain. More severe side effects include depression, skin rashes, loss of coordination, speech problems and extreme fatigue. Discuss any of these side effects with your doctor as soon as possible. Many people with epilepsy use these medications for years without significant problems. Ask your doctor to explain these issues to you when you receive the prescription.
Your doctor likely will first prescribe a single drug at a relatively low dosage, and may increase the dosage gradually until your seizures are well controlled. If you’ve tried two or more single drug regimens without success, your doctor may recommend trying a combination of two drugs.
To achieve the best seizure control possible, take medications exactly as prescribed. Always call your doctor before switching to a generic version of your medication or taking other prescription medications, over-the-counter drugs or herbal remedies.
Never stop taking your medication without talking to your doctor.
Some people with epilepsy have seizures that medications can’t control, because the drugs either cause intolerable side effects or don’t provide satisfactory seizure control. In such cases, surgery may be an option.
Surgery is most commonly done when tests show that your seizures originate in a small, well-defined area, or focus, in the temporal lobes or the frontal lobes of your brain. Surgery is rarely an option if you have seizures that start in several areas of the brain or if you have seizures originating from a region of the brain that contains vital brain functions.
During the procedure, your surgeon makes an incision in your scalp and removes a piece of the skull bone. Using electrical recordings that monitor brain activity, the surgeon cuts into or removes the area of the brain that’s causing the seizures.
Although many people continue to need some medication to help prevent seizures after surgery, you may be able to take fewer drugs and reduce your dosages. In some cases, surgery for epilepsy can cause complications such as permanently altering your cognitive abilities and your personality. Talk to your surgeon about his or her experience, success rates and complication rates with the procedure you’re considering.
Other treatment options for epilepsy may include:
Ketogenic diet. If your child doesn’t benefit from medication or if the side effects are intolerable, your doctor may suggest a rigid diet that’s high in fat and low in protein and carbohydrates. The goal of the diet is to get the body to produce ketones, which cause the body to use fat instead of glucose for energy. The process has an effect against seizures, although the exact way in which it works is unclear. The diet, which prescribes exact amounts of specific foods and beverages for each meal, must be strictly followed in order to be effective. Even a tiny intake of sugar can significantly alter the effectiveness of the diet. Nonetheless, it has proved helpful in two out of three children placed on the diet. It’s usually implemented for a limited period of time and isn’t as effective in adults as it is in children.
Vagus nerve stimulation. A device called a vagus nerve stimulator may be a treatment option if medications are ineffective or cause serious side effects. The stimulator is implanted into your chest under the collarbone. Wires from the stimulator are wrapped around the vagus nerve in your neck. The vagus nerve connects the lower part of your brain to your heart, lungs and gastrointestinal tract. The device turns on and off according to an adjustable program, stimulating your brain. It’s not clear how brain stimulation via the vagus nerve inhibits seizures, but the device reduces seizures by about 20 percent to 40 percent on average. Most people still need to take anti-epileptic medication, but many can reduce their dosage.
Understanding your condition can help you control it. Be sure to take your medication correctly. Don’t take it upon yourself to adjust your dosage levels. Instead, talk to your doctor if you feel something should be changed.
It’s also important to keep a detailed seizure record. This record can help your doctor better understand your condition and may help direct your treatment. Each time a seizure occurs, write down the time, the type of seizure it was and how long it lasted. Also make note of any unusual circumstances, such as changes in medication, increased stress or other events that might trigger seizure activity. Seek input from people who may observe your seizures — including family, friends and co-workers — so that you can record information you may not know.
As with many chronic conditions, maintaining your overall health is an important step in controlling epilepsy. Sleep deprivation is a powerful trigger of seizures. Be sure to get adequate rest every night, and make a conscious effort to eat a balanced diet, exercise and manage stress effectively. Drinking alcoholic beverages and smoking cigarettes also may trigger seizures. If you have difficulty avoiding alcohol and cigarettes, ask your doctor for help.
Wear a medical bracelet to help emergency personnel. The bracelet should state who to contact in an emergency and what medications you use. Any allergies to medications also can be noted.
Each person who has epileptic seizures experiences them in a different way. Many people gain complete control of seizures as soon as they begin treatment. Other people take longer to find the right treatment regimen, and some people may never have complete seizure control.
As is the case with other chronic conditions, having epilepsy may cause you to experience emotional or psychological stress. The stress may be due to personal difficulties in adjusting to epilepsy. You may have to give up some of your independence for a period of time, including driving. You may also encounter stressful relationships with family and friends because of your condition. Following these tips may help you cope with your condition:
Know what to expect. Find out everything you can about your condition and how to treat it. The more you know, the more active you can be in your own care.
Be proactive. Although you may feel tired and discouraged, don’t simply let others — including your family or your doctor — make important decisions for you. Take an active role in your treatment.
Maintain a strong support system. Having a support system can help you cope with any issues and anxieties that might occur. Although friends and family can be your best allies, the concern and understanding of a formal support group or others coping with epilepsy also may be helpful. Support groups can also be a good source of practical information. You may find you develop deep and lasting bonds with people who are going through the same things you are.
Set reasonable goals. Having goals helps you feel in control and can give you a sense of purpose. But be realistic — don’t choose goals you can’t possibly reach. It may take time to get your condition under control, so be patient.
Stay active. Receiving the diagnosis of epilepsy doesn’t mean you have to stop doing the things you enjoy or normally do. You may have to modify activities such as driving, but you can still lead a full and active life.
Epilepsy surgery: A viable option Epilepsy surgery: A viable option