Epilepsy is a disorder of the central nervous system in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of consciousness. Anyone can develop epilepsy. Epilepsy affects both males and females of all races and ages.
Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others twitch their arms or legs repeatedly. Having a single seizure doesn’t mean you have epilepsy. At least two unprovoked seizures are generally required for an epilepsy diagnosis.
Treatment with medications or sometimes surgery can control seizures for the majority of people with epilepsy. Some people require lifelong treatment to control seizures, but for others, the seizures eventually go away. Some children with epilepsy may outgrow the condition with age.
Symptoms of Epilepsy
Epilepsy is caused by abnormal activity in the brain, so seizures can affect any process your brain coordinates. Signs and symptoms of seizure may include:
- Uncontrollable jerking movements of the arms and legs
- Temporary confusion
- A staring spell
- Loss of consciousness or awareness
- Psychic symptoms such as fear or anxiety
Symptoms of epilepsy vary depending on the type of seizure. A person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode.
Doctors usually classify seizures as either focal or generalized, based on how the abnormal brain activity begins.
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.Once called 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 seizures with impaired awareness.Once called 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, mental illness, or narcolepsy. A thorough examination and testing are required to differentiate epilepsy from other disorders.
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Seizures that appear to involve all areas of the brain are called generalized seizures. Six types of generalized seizures exist.
- Absence seizures.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.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.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.Clonic seizures are associated with repeated or rhythmic, jerking muscle movements. These seizures usually affect the neck, face and arms.
- Myoclonic seizures.Myoclonic seizures usually appear as sudden brief jerks or twitches of your arms and legs.
- Tonic-clonic seizures.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.
Causes of Epilepsy
Epilepsy has no detectible cause in about half the people with the condition. However, the condition may be traced to various factors, including:
- Genetic influence.Some types of epilepsy, which are categorized by the type of seizure you experience or the part of the brain that is affected, run in families. In these cases, it’s likely that there’s a genetic influence.
Researchers have linked some types of epilepsy to specific genes, but for most people, genes are only part of the cause of epilepsy. Certain genes may make a person more sensitive to environmental conditions that trigger seizures.
- Head trauma.Head trauma as a result of a car accident or other traumatic injury can cause epilepsy.
- Brain conditions.Brain conditions that cause damage to the brain, such as brain tumors or strokes, can cause epilepsy. Stroke is a leading cause of epilepsy in adults older than age 35.
- Infectious diseases.Infectious diseases, such as meningitis, AIDS and viral encephalitis, can cause epilepsy.
- Prenatal injury.Before birth, babies are sensitive to brain damage that could be caused by several factors, such as an infection in the mother, poor nutrition or oxygen deficiencies. This brain damage can result in epilepsy or cerebral palsy.
- Developmental disorders.Epilepsy can sometimes be associated with developmental disorders, such as autism and neurofibromatosis.
Certain factors may increase your risk of epilepsy:
- The onset of epilepsy is most common in children and older adults, but the condition can occur at any age.
- Family history.If you have a family history of epilepsy, you may be at an increased risk of developing a seizure disorder.
- Head injuries.Head injuries are responsible for some cases of epilepsy. You can reduce your risk by 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 vascular diseases.Stroke and other blood vessel (vascular) diseases 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 and avoiding cigarettes, eating a healthy diet, and exercising regularly.
- Dementia can increase the risk of epilepsy in older adults.
- Brain infections.Infections such as meningitis, which causes inflammation in your brain or spinal cord, can increase your risk.
- Seizures in childhood.High fevers in childhood can sometimes be associated with seizures. Children who have seizures due to high fevers generally won’t develop epilepsy. The risk of epilepsy increases if a child has a long seizure, another nervous system condition or a family history of epilepsy.
Having a seizure at certain times can lead to circumstances that are dangerous to yourself or others.
- If you fall during a seizure, you can injure your head or break a bone.
- If you have epilepsy, you’re 15 to 19 times more likely to drown while swimming or bathing than the rest of the population because of the possibility of having a seizure while in the water.
- Car accidents.A seizure that causes either loss of awareness or control can be dangerous if you’re driving a car or operating other equipment.
Many states have driver’s license restrictions related to a driver’s ability to control seizures and impose a minimum amount of time that a driver be seizure-free, ranging from months to years, before being allowed to drive.
- Pregnancy complications.Seizures during pregnancy pose dangers to both mother and 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 as you plan your pregnancy.
Most women with epilepsy can become pregnant and have healthy babies. You’ll need to be carefully monitored throughout pregnancy, and medications may need to be adjusted. It’s very important that you work with your doctor to plan your pregnancy.
- Emotional health issues.People with epilepsy are more likely to have psychological problems, especially depression, anxiety and suicidal thoughts and behaviors. Problems may be a result of difficulties dealing with the condition itself as well as medication side effects.
Other life-threatening complications of epilepsy are uncommon, but may happen, such as:
- Status epilepticus.This condition occurs if you’re in a state of continuous seizure activity lasting more than five minutes or if you have frequent recurrent seizures without regaining full consciousness in between them. People with status epilepticus have an increased risk of permanent brain damage and death.
- Sudden unexpected death in epilepsy (SUDEP).People with epilepsy also have a small risk of sudden unexpected death. The cause is unknown, but some research shows it may occur as a result of respiratory disease.
People with frequent tonic-clonic seizures or people whose seizures aren’t controlled by medications may be at higher risk of SUDEP. Overall, about 1 percent of people with epilepsy die of SUDEP.
When to see a doctor
Seek immediate medical help if any of the following occurs:
- The seizure lasts more than five minutes
- You have diabetes
- Breathing or consciousness doesn’t return after the seizure stops
- A second seizure follows immediately
- You have a high fever
- You’re experiencing heat exhaustion.
- You’re pregnant
- You’ve injured yourself during the seizure
To diagnose your condition, your doctor will review your symptoms and medical history. Then several tests may be carried out to diagnose epilepsy and determine the cause of seizures. Tests may include:
- Blood tests.Your doctor may take a blood sample to check for signs of infections, genetic conditions that may be linked with seizures.
- A neurological exam.Your behavior, motor abilities, mental function and other areas will be examined to determine the type of epilepsy you may have.
Your doctor may also suggest tests to detect brain abnormalities, such as:
- Electroencephalogram (EEG).This is the most common test used for epilepsy diagnosis which has to do with attaching 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 would observe you on video while conducting an EEG while you’re awake or asleep, to record any seizures you may experience.
- High-density EEG. High-density EEG may be recommended. This spaces electrodes more closely than conventional EEG, which may be about a half a centimeter apart. High-density EEG may help your doctor to determine which areas of your brain are affected by seizures.
- 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 exact parts of your brain are functioning. Doctors may use an fMRI before surgery to identify the exact sites of critical functions, such as speech and movement, so that surgeons can avoid injuring those places while operating.
- Positron emission tomography (PET).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). This is used if you’ve had an MRI and EEG that didn’t locate 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 MRI (SISCOM), which may provide even more-detailed results.
- Neuropsychological tests.In these tests, doctors assess your thinking, memory and speech skills. The test results help doctors determine which areas of your brain are affected.
Along with your test results, your doctor may use a combination of analysis techniques to help pinpoint where in the brain seizures start:
- Statistical parametric mapping (SPM).SPM is a method of comparing areas of the brain that have increased metabolism during seizures to normal brains, which can give doctors an idea of where seizures begin.
- Curry analysis.Curry analysis is a technique that takes EEG data and projects it onto an MRI of the brain to show doctors where seizures are occurring.
- Magnetoencephalography (MEG).MEG measures the magnetic fields produced by brain activity to identify potential areas of seizure onset.
Accurate diagnosis of your seizure type and where seizures begin gives you the best chance for finding an effective treatment.
Doctors generally begin by treating epilepsy with medication. If medications don’t treat the condition, doctors may propose surgery or another type of treatment.
Most people with epilepsy can become seizure-free by taking one anti-seizure medication, which is also called anti-epileptic medication. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications.
Many children with epilepsy who aren’t experiencing symptoms can eventually stop medications and live a seizure-free life. Many adults can stop medications after two or more years without seizures. Your doctor will advise you about the best time to stop taking medications.
Your doctor will consider your condition, frequency of seizures, your age and other factors when choosing which medication to prescribe. 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.
Anti-seizure medications may have some mild side effects like:
- Speech problems
- Weight gain
- Loss of bone density
- Skin rashes
- Loss of coordination
- Memory and thinking problems
More-severe but rare side effects include:
- Severe rash
- Suicidal thoughts and behaviors
- Inflammation of certain organs, such as your liver
To achieve the best seizure control possible with medication, follow these steps:
- 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.
- Notify your doctor immediately if you notice new or increased feelings of depression, suicidal thoughts, or unusual changes in your mood or behaviors.
- Tell your doctor if you have migraines. Doctors may prescribe one of the anti-epileptic medications that can prevent your migraines and treat epilepsy.
At least half the people newly diagnosed with epilepsy will become seizure-free with their first medication. If anti-epileptic medications don’t provide satisfactory results, your doctor may suggest surgery or other therapies. You’ll have regular follow-up appointments with your doctor to evaluate your condition and medications.
When medications fail to control or stop seizures, surgery may be the next option. A surgeon removes the area of your brain that’s causing epileptic seizures.
Doctors usually perform surgery when tests show that:
- Your seizures originate in a small, well-defined area of your brain
- The area in your brain to be operated on doesn’t interfere with vital functions such as speech, language, motor function, vision or hearing
Although many people continue to need some medication to help prevent seizures after successful surgery, you may be able to take fewer drugs and reduce your dosages.