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Epilepsy Education
For Patients & Families
What is a seizure?
A seizure is a sudden, temporary disturbance in the normal operation of the brain's electrical system from excessive activity of nerve cells, or neurons. Symptoms can include alteration in sensation, emotion, behavior, consciousness, and/or muscle activity.
What is epilepsy?
Epilepsy is a disease characterized by recurrence of seizures. Approximately 4 out of 100 people will have a single seizure in their lifetime, but this does not necessarily mean they have epilepsy. People are usually considered to have epilepsy after having two or more seizures. Tests such as electroencephalograms (EEG) and brain scans can also help make the diagnosis.
What causes epilepsy?
There are numerous causes. Examples of causes include developmental aberrations, genetic abnormalities, central nervous system infections, traumatic brain injury, tumors, Alzheimer's Disease, and stroke. Essentially anything that can irritate the neurons of the brain can cause epilepsy.
Who gets epilepsy?
Anyone! People who are at particular risk are those with a family history (but usually only for certain types of epilepsy), birth injury, complicated childhood febrile seizures, developmental delay or other central nervous system disorders, brain tumors, brain infection, traumatic brain injury, Alzheimer's Disease, MS, or stroke. Even with the currently available improved testing methods, we still cannot figure out the cause in about half the people with epilepsy. More genes are being discovered.
Seizure types
There are many types of seizures. The names can be confusing, since patients (and even doctors) can sometimes use the terms loosely. Seizures can be divided into three main categories:
Partial onset (also known as focal or localization-related). The abnormal electrical activity starts in a limited area of the brain.
- Simple partial seizure: The abnormal activity remains limited, causing a change in function of a limited part of the brain (manifested as altered vision, speech, emotion, sensation or motor activity without loss of consciousness.
- Complex partial seizure: Abnormal activity spreads through a larger area of brain, causing confusion and change in awareness.
- Secondarily generalized seizure: Abnormal activity can sometimes spread to all of the brain, resulting in loss of consciousness, falling, and convulsions of the body. Some people call this "grand mal" or "generalized tonic clonic" seizure, but these names are also used to describe seizures that are of generalized, rather than localized, onset (see below).
Generalized onset (also known as primary generalized). The abnormal electrical activity starts throughout the entire brain all at once. Seizure types in this category include.
- Generalized tonic clonic: This type of seizure causes loss of consciousness, falling, and convulsions of the body, with the abnormal brain activity starting all over at once.
- Absence: Usually seen in children, this causes brief loss of consciousness and staring. This type of seizure used to be called "petit mal".
- Myoclonic: This type of seizure causes sudden, brief muscle jerks. There are, however, other causes of myoclonus which are not related to epilepsy.
- Tonic: This is characterized by sudden bilateral flexion or extension of the trunk, arms, and/or legs.
Other seizure types
Febrile Seizures: These are generalized convulsions in the context of fever which occur in childhood in about 5% of the U.S. population. Most children who experience febrile seizures are not at increased risk of epilepsy in the future.
Provoked seizures: Seizures which occur because of some immediate and brief insult to the brain are considered to be different from the recurrent seizures of epilepsy. An example would be alcohol withdrawal seizures or seizures due to the side effect of a medication.
Seizure mimics
Other non-neurological and neurological disorders can come and go and mimic seizures. Examples are circulatory disorders such as fainting (syncope), cardiovascular disorders, movement disorders, sleep disorders, migraine disorders, or psychiatric disorders.
How is epilepsy treated?
Medication:
- Once a diagnosis of epilepsy is made, a physician will decide the best treatment strategy. Seizures can be controlled with medications in the majority (about two-thirds) of patients with epilepsy. Specific medications are used for specific seizure types, and some medications work in a number of kinds of seizures.
Here are some helpful hints to improving your epilepsy treatment:
- Tell a physician immediately if you don't feel well when you take your medication, because in most cases, it is possible to adjust the medication or change to another one. It is important to always first talk to your physician before stopping or changing your seizure medication.
- Keep a "seizure log" or write down on a calendar when you have a seizure and any relevant details to bring to your appointment. This will help your physician help you better.
- Keep in your wallet or purse at all times a complete list of your medications with the names, doses, and times you take them.
- Check with your physician or pharmacist before taking any new medications, over the counter drugs or herbal treatments to make sure they will not interact with your seizure medication.
- If you start having more frequent or severe seizures than usual, call your physician.
- Make sure you understand how you can reach your physician when you have a problem.
- Most importantly, when something is unclear to you, ask questions! You are the most important partner in your epilepsy treatment.
Non-pharmacologic therapy (treatment other than medications):
- Other treatment options are available when medications are ineffective and disabling seizures continue. A neurologist can determine which options are best for each patient. Here is a brief description of each:
- Ketogenic diet- A special diet rich in fats and low in carbohydrates which must be carefully administered by a physician and nutritionist. This option is used with severe and multiple types of generalized seizures most frequently in children.
- Vagal Nerve Stimulator - This device is implanted in the chest wall and has a wire ("lead") which connects to a nerve in the neck. The device is programmed to deliver regularly timed electrical impulses to the nerve which are then relayed to the brain. This sometimes reduces seizures.
Epilepsy Surgery
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Resective surgery: For some patients, removal of the area of brain identified to cause the seizures can be performed. Extensive testing is necessary first to determine if this can be done safely.
- Disconnection procedures: For some patients with disabling seizures, surgical procedures can be performed to limit the spread of seizures. This type of surgery is performed when it is not safe to resect the seizure focus. Examples are callosotomy or multiple subpial transections.
- Clinical Research
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