Epilepsy

Epilepsy is a chronic disorder that causes unprovoked, recurrent seizures. A seizure is a sudden rush of electrical activity in the brain.

There are two main types of seizures. Generalized seizures affect the whole brain. Focal, or partial seizures, affect just one part of the brain.

A mild seizure may be difficult to recognize. It can last a few seconds during which you lack awareness.

Stronger seizures can cause spasms and uncontrollable muscle twitches, and can last a few seconds to several minutes. During a stronger seizure, some people become confused or lose consciousness. Afterward you may have no memory of it happening.

There are several reasons you might have a seizure. These include:

• high fever
• head trauma
• very low blood sugar
• alcohol withdrawal

Epilepsy is a fairly common neurological disorder that affects 65 million people around the world. In the United States, it affects about 3 million people.

Anyone can develop epilepsy, but it’s more common in young children and older adults. It occurs slightly more in males than in females.

There’s no cure for epilepsy, but the disorder can be managed with medications and other strategies.

Seizures are the main symptom of epilepsy. Symptoms differ from person to person and according to the type of seizure.

Focal (partial) seizures

A simple partial seizure doesn’t involve loss of consciousness. Symptoms include:

• alterations to sense of taste, smell, sight, hearing, or touch
• dizziness
• tingling and twitching of limbs

Complex partial seizures involve loss of awareness or consciousness. Other symptoms include:

• staring blankly
• unresponsiveness
• performing repetitive movements

Generalized seizures

Generalized seizures involve the whole brain. There are six types:

Absence seizures, which used to be called “petit mal seizures,” cause a blank stare. This type of seizure may also cause repetitive movements like lip smacking or blinking. There’s also usually a short loss of awareness.

Tonic seizures cause muscle stiffness.

Atonic seizures lead to loss of muscle control and can make you fall down suddenly.

Clonic seizures are characterized by repeated, jerky muscle movements of the face, neck, and arms.

Myoclonic seizures cause spontaneous quick twitching of the arms and legs.

Tonic-clonic seizures used to be called “grand mal seizures.” Symptoms include:

• stiffening of the body
• shaking
• loss of bladder or bowel control
• biting of the tongue
• loss of consciousness

Following a seizure, you may not remember having one, or you might feel slightly ill for a few hours.

Some people are able to identify things or situations that can trigger seizures.

A few of the most commonly reported triggers are:

• lack of sleep
• illness or fever
• stress
• bright lights, flashing lights, or patterns
• caffeine, alcohol, medicines, or drugs
• skipping meals, overeating, or specific food ingredients

Identifying triggers isn’t always easy. A single incident doesn’t always mean something is a trigger. It’s often a combination of factors that trigger a seizure.

A good way to find your triggers is to keep a seizure journal. After each seizure, note the following:

• day and time
• what activity you were involved in
• what was happening around you
• unusual sights, smells, or sounds
• unusual stressors
• what you were eating or how long it had been since you’d eaten
• your level of fatigue and how well you slept the night before

You can also use your seizure journal to determine if your medications are working. Note how you felt just before and just after your seizure, and any side effects.

Bring the journal with you when you visit the doctor. It may be useful in adjusting your medications or exploring other treatments.

There may be as many as 500 genes that relate to epilepsy. Genetics may also provide you with a natural “seizure threshold.” If you inherit a low seizure threshold, you’re more vulnerable to seizure triggers. A higher threshold means you’re less likely to have seizures.

Epilepsy sometimes runs in families. Still, the risk of inheriting the condition is fairly low. Most parents with epilepsy don’t have children with epilepsy.

In general, the risk of developing epilepsy by age 20 is about 1 percent, or 1 in every 100 people. If you have a parent with epilepsy due to a genetic cause, your risk rises to somewhere between 2 to 5 percent.

If your parent has epilepsy due to another cause, such as stroke or brain injury, it doesn’t affect your chances of developing epilepsy.

Certain rare conditions, such as tuberous sclerosis and neurofibromatosis, can cause seizures. These are conditions that can run in families.

Epilepsy doesn’t affect your ability to have children. But some epilepsy medications can affect your unborn baby. Don’t stop taking your medications, but do talk to your doctor before becoming pregnant or as soon as you learn you are pregnant.

If you have epilepsy and are concerned about starting a family, consider arranging a consultation with a genetic counselor.

For 6 out of 10 people with epilepsy, the cause can’t be determined. A variety of things can lead to seizures.

Possible causes include:

• traumatic brain injury
• scarring on the brain after a brain injury (post-traumatic epilepsy)
• serious illness or very high fever
• stroke, which is a leading cause of epilepsy in people over age 35
• other vascular diseases
• lack of oxygen to the brain
• brain tumor or cyst
• dementia or Alzheimer’s disease
• maternal drug use, prenatal injury, brain malformation, or lack of oxygen at birth
• infectious diseases such as AIDS and meningitis
• genetic or developmental disorders or neurological diseases

Heredity plays a role in some types of epilepsy. In the general population, there’s a 1 percent chance of developing epilepsy before 20 years of age. If you have a parent whose epilepsy is linked to genetics, that increases your risk to 2 to 5 percent.

Genetics may also make some people more susceptible to seizures from environmental triggers.

Epilepsy can develop at any age. Diagnosis usually occurs in early childhood or after age 60.

If you suspect you’ve had a seizure, see your doctor as soon as possible. A seizure can be a symptom of a serious medical issue.

Your medical history and symptoms will help your doctor decide which tests will be helpful. You’ll probably have a neurological examination to test your motor abilities and mental functioning.

In order to diagnose epilepsy, other conditions that cause seizures should be ruled out. Your doctor will probably order a complete blood count and chemistry of the blood.

Blood tests may be used to look for:

• signs of infectious diseases
• liver and kidney function
• blood glucose levels

Electroencephalogram (EEG) is the most common test used in diagnosing epilepsy. First, electrodes are attached to your scalp with a paste. It’s a noninvasive, painless test. You may be asked to perform a specific task. In some cases, the test is performed during sleep. The electrodes will record the electrical activity of your brain. Whether you’re having a seizure or not, changes in normal brain wave patterns are common in epilepsy.

Imaging tests can reveal tumors and other abnormalities that can cause seizures. These tests might include:

• CT scan
• MRI
• positron emission tomography (PET)
• single-photon emission computerized tomography

Epilepsy is usually diagnosed if you have seizures for no apparent or reversible reason.

Most people can manage epilepsy. Your treatment plan will be based on severity of symptoms, your health, and how well you respond to therapy.

Some treatment options include:

• Anti-epileptic (anticonvulsant, antiseizure) drugs: These medications can reduce the number of seizures you have. In some people, they eliminate seizures. To be effective, the medication must be taken exactly as prescribed.
• Vagus nerve stimulator: This device is surgically placed under the skin on the chest and electrically stimulates the nerve that runs through your neck. This can help prevent seizures.
• Ketogenic diet: More than half of people who don’t respond to medication benefit from this high fat, low carbohydrate diet.
• Brain surgery: The area of the brain that causes seizure activity can be removed or altered.

Most people can manage epilepsy. Your treatment plan will be based on severity of symptoms, your health, and how well you respond to therapy.

Some treatment options include:

• Anti-epileptic (anticonvulsant, antiseizure) drugs: These medications can reduce the number of seizures you have. In some people, they eliminate seizures. To be effective, the medication must be taken exactly as prescribed.
• Vagus nerve stimulator: This device is surgically placed under the skin on the chest and electrically stimulates the nerve that runs through your neck. This can help prevent seizures.
• Ketogenic diet: More than half of people who don’t respond to medication benefit from this high fat, low carbohydrate diet.
• Brain surgery: The area of the brain that causes seizure activity can be removed or altered.

Research into new treatments is ongoing. One treatment that may be available in the future is deep brain stimulation. It’s a procedure in which electrodes are implanted into your brain. Then a generator is implanted in your chest. The generator sends electrical impulses to the brain to help decrease seizures.

Another avenue of research involves a pacemaker-like device. It would check the pattern of brain activity and send an electrical charge or drug to stop a seizure.

Minimally invasive surgeries and radiosurgery are also being investigated.

Another avenue of research involves a pacemaker-like device. It would check the pattern of brain activity and send an electrical charge or drug to stop a seizure.

Minimally invasive surgeries and radiosurgery are also being investigated.

The first-line treatment for epilepsy is antiseizure medication. These drugs help reduce the frequency and severity of seizures. They can’t stop a seizure that’s already in progress, nor is it a cure for epilepsy.

The medication is absorbed by the stomach. Then it travels the bloodstream to the brain. It affects neurotransmitters in a way that reduces the electrical activity that leads to seizures.

Antiseizure medications pass through the digestive tract and leave the body through urine.

There are many antiseizure drugs on the market. Your doctor can prescribe a single drug or a combination of drugs, depending on the type of seizures you have.

Common epilepsy medications include:

• levetiracetam (Keppra)
• lamotrigine (Lamictal)
• topiramate (Topamax)
• valproic acid (Depakote)
• carbamazepine (Tegretol)
• ethosuximide (Zarontin)

These medications are generally available in tablet, liquid, or injectable forms and are taken once or twice a day. You’ll start with the lowest possible dose, which can be adjusted until it starts to work. These medications must be taken consistently and as prescribed.

Some potential side effects may include:

• fatigue
• dizziness
• skin rash
• poor coordination
• memory problems

Rare, but serious side effects include depression and inflammation of the liver or other organs.

Epilepsy is different for everybody, but most people improve with antiseizure medication. Some children with epilepsy stop having seizures and can stop taking medication.

If medication can’t decrease the number of seizures, another option is surgery.

The most common surgery is a resection. This involves removing the part of the brain where the seizures start. Most often, the temporal lobe is removed in a procedure known as temporal lobectomy. In some cases, this can stop seizure activity.

In some cases, you’ll be kept awake during this surgery. That’s so doctors can talk to you and avoid removing part of the brain that controls important functions such as vision, hearing, speech, or movement.

If the area of the brain is too big or important to remove, there’s another procedure called multiple subpial transection, or disconnection. The surgeon makes cuts in the brain to interrupt the nerve pathway. That keeps seizures from spreading to other areas of the brain.

After surgery, some people are able to cut down on antiseizure medications or even stop taking them.

There are risks to any surgery, including a bad reaction to anesthesia, bleeding, and infection. Surgery of the brain can sometimes result in cognitive changes. Discuss the pros and cons of the different procedures with your surgeon and seek a second opinion before making a final decision.

The ketogenic diet is often recommended for children with epilepsy. This diet is low in carbohydrates and high in fats. The diet forces the body to use fat for energy instead of glucose, a process called ketosis.

The diet requires a strict balance between fats, carbohydrates, and protein. That’s why it’s best to work with a nutritionist or dietitian. Children on this diet must be carefully monitored by a doctor.

The ketogenic diet doesn’t benefit everybody. But when followed properly, it’s often successful in reducing the frequency of seizures. It works better for some types of epilepsy than others.

For adolescents and adults with epilepsy, a modified Atkins diet may be recommended. This diet is also high in fat and involves a controlled carb intake.

About half of adults who try the modified Atkins diet experience fewer seizures. Results may be seen as quickly as a few months.

Because these diets tend to be low in fiber and high in fat, constipation is a common side effect.

Talk to your doctor before starting a new diet and make sure you’re getting vital nutrients. In any case, not eating processed foods can help improve your health.

Children with epilepsy tend to have more learning and behavioral problems than those who don’t. Sometimes there’s a connection. But these problems aren’t always caused by epilepsy.

About 15 to 35 percent of children with intellectual disabilities also have epilepsy. Often, they stem from the same cause.

Some people experience a change in behavior in the minutes or hours before a seizure. This could be related to abnormal brain activity preceding a seizure, and may include:

• inattentiveness
• irritability
• hyperactivity
• aggressiveness

Children with epilepsy may experience uncertainty in their lives. The prospect of a sudden seizure in front of friends and classmates can be stressful. These feelings can cause a child to act out or withdraw from social situations.

Most children learn to adjust over time. For others, social dysfunction can continue into adulthood. Between 30 to 70 percent of people with epilepsy also have depression, anxiety, or both.

Antiseizure medications can also have an effect on behavior. Switching or making adjustments to medication may help.

Behavioral problems should be addressed during doctor visits. Treatment will depend on the nature of the problem.

You might also benefit from individual therapy, family therapy, or joining a support group to help you cope.

Epilepsy is chronic disorder that can affect many parts of your life.

Laws vary from state to state, but if your seizures aren’t well controlled, you may not be allowed to drive.

Because you never know when a seizure will occur, many everyday activities like crossing a busy street, can become dangerous. These problems can lead to loss of independence.

Some other complications of epilepsy may include:

• risk of permanent damage or death due to severe seizures that last more than five minutes (status epilepticus)
• risk of recurring seizures without regaining consciousness in between (status epilepticus)
• sudden unexplained death in epilepsy, which affects only about 1 percent of people with epilepsy

In addition to regular doctor visits and following your treatment plan, here are some things you can do to cope:

• Keep a seizure diary to help identify possible triggers so you can avoid them.
• Wear a medical alert bracelet so people know what to do if you have a seizure and can’t speak.
• Teach the people closest to you about seizures and what to do in an emergency.
• Seek professional help for symptoms of depression or anxiety.
• Join a support group for people with seizure disorders.
• Take care of your health by eating a balanced diet and getting regular exercise.