Epilepsy and Seizures

About

What are epilepsy and seizures?

Epilepsy is a disease of the central nervous system that causes abnormal brain activity, which in turn can cause seizures or periods of unusual behavior, sensations and sometimes loss of awareness. Almost 5% of the United States population will develop epilepsy.

Anyone can develop epilepsy and not all seizures mean you have epilepsy. Seizures can be mild, such as a blank stare for a few seconds. Other seizures can be very severe, with symptoms lasting a day or so. Treatment with medications helps most people; some people grow out of their seizures as they age. 

The current definition of epilepsy disease indicates a person has epilepsy if they have any of the following conditions:

  • At least two unprovoked (or reflex) seizures that occur at least 24 hours apart.
  • Over the next 10 years, one unprovoked or reflex seizure, plus the probability of more seizures after two unprovoked seizures.
  • Diagnosis of any epilepsy syndrome.

Why should I worry about epilepsy and seizures?

Having epilepsy and seizures affects your safety, relationships, work, ability to legally drive, and virtually every aspect of your life. Uncontrolled seizures can cause brain damage, memory loss and other problems. If you fall during a seizure, you may injure your head or break bones. If you’re bathing or swimming and have a seizure, you’re 19 times more likely to drown. Most states have driver restrictions related to drivers who have seizures. 

The public’s fear and misunderstanding about epilepsy and seizures often cause the most anguish for people with epilepsy. This contributes to problems with emotional and mental health, especially depression, anxiety and suicidal thoughts. 

People with epilepsy also have a small risk (1%) of sudden unexpected death, usually because of heart or respiratory conditions. The risk of sudden death from a seizure is greater with severe epilepsy that isn’t controlled by medication.

Causes

What causes epilepsy?

For about half the people who have epilepsy there is no known cause. For the other half, the cause can be:

  • Head injury, such as a fall or car accident.
  • Genetic (inherited from your parents). Some types of epilepsy are linked to specific genes. Or, certain genes can make the person more sensitive to factors that trigger seizures.  
  • Brain abnormalities such as brain tumors or malformed blood vessels.
  • Stroke is a leading cause of epilepsy in adults over age 35.
  • Infections such as meningitis, HIV, viral encephalitis and some parasites.
  • Fetal injury before birth can be caused by an infection in the mother, poor nutrition or oxygen deficiencies.
  • Developmental disorders in children, such as autism.

Who’s most at risk for developing epilepsy?

Certain factors can increase your risk of developing epilepsy:

  • Age - most common in children and older adults, but it can occur at any age 
  • Family history of epilepsy
  • Head injuries
  • Stroke and other vascular diseases because they can cause brain damage that may trigger epilepsy
  • Dementia (gradual deterioration of intelligence)
  • Brain infections such as meningitis that cause brain or spinal cord inflammation 
  • Seizures in childhood

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Symptoms

What are the symptoms of epilepsy and seizures?

Epilepsy symptoms vary depending on the type of seizure. Usually, the patient has the same type of seizure with each episode. 

Sometimes called an electrical storm in the brain, seizures are caused by abnormal brain activity and can affect any activity that the brain processes. Although seizures can affect any part of the body, the exact location of the electrical event, the amount of brain affected, and how long it lasts determine the seizure’s impact on the patient. 

Seizure signs and symptoms can include:

  • Temporary confusion
  • Staring blankly for a few seconds
  • Stiff muscles
  • Uncontrollable jerking movements of arms and legs
  • Loss of consciousness or awareness
  • Psychological symptoms such as fear, anxiety or deja vu
  • Fatigue after the seizure ends

Many people with epilepsy have a trigger that occurs before their seizures. A trigger occurs fairly consistently and happens more often than just by chance. It’s helpful for patients to identify their triggers and let their family and work colleagues know what they are. This helps others know how to protect and help you during a seizure. Reflex epilepsy causes seizures in response to a specific trigger, such as flashing lights, noises or other stimuli. By knowing your triggers, you can find ways to avoid them or lessen their impact. 

Try these suggestions to help identify your triggers. With every seizure, be sure to:

  • Write down the time of day, type of seizure, how long it lasted, conditions that occurred just before the seizure, and how you felt. Ask those who observed it to provide information that you weren’t able to observe.
  • Make note if your previously identified triggers were present before the seizure.
  • Write down every time a suspected trigger event happens if you think it might be a trigger. By noting every time it occurs, not just when you have a seizure, you can discover a pattern of specific events and determine which ones are true triggers for you.

What happens in the brain during a seizure?

Seizures are not a disease, but a symptom of many different diseases and disorders. The brain produces electrical activity that is caused by chemical changes in the brain’s nerve cells. Brain cells can start or stop other brain cells from sending messages. During a seizure, there’s too much or too little activity, leaving the brain unbalanced. Chemical imbalances cause a surge in electrical activity that produces a seizure. 

Are there different types of seizures?

Yes, seizures are classified based on where the abnormal brain activity begins. A focal seizure occurs in only one area of the brain; generalized seizures affect all areas of the brain. 

Focal seizures that don’t cause loss of consciousness, also called simple partial seizures, can cause altered emotions, change the way things look, smell, taste, feel or sound, or cause deja vu. Uncontrollable jerking of one body part, tingling, dizziness and flashing lights can also occur.

Focal seizures that cause impaired awareness, also called complex partial seizure, can feel like being in a dream. You may not respond normally to your environment, and have repetitive movements such as chewing, swallowing, rubbing your hands, or walking in circles.

Generalized seizures are classified into six types:

  • Absence seizures (previously called as petit mal seizures) typically occur in children. The child may stare into space, and may or may not have subtle body movements such as eye blinking or lip smacking. They last about 10 seconds. These seizures may occur in clusters, happening as often as 100 times per day, and cause a brief loss of awareness.
  • Tonic seizures cause stiff muscles and may affect consciousness. They can cause a fall and usually affect back, arm and leg muscles. 
  • Atonic seizures, also known as drop seizures, cause a loss of muscle control, usually in the legs, causing a sudden collapse or fall.
  • Clonic seizures can cause rhythmic, jerking muscle movements, usually in the neck, face and arms.
  • Myoclonic seizures usually cause sudden brief jerks or twitches in the upper body, arms and legs.
  • Tonic-clonic seizures, previously called grand mal seizures, are the most dramatic type, causing a sudden loss of consciousness and body stiffening, twitching and shaking. They may also cause the patient to bite their tongue or lose bladder control.

Diagnosis

How is epilepsy diagnosed?

An accurate diagnosis helps determine the type of seizures and where they begin. This information helps you find effective treatment. Your doctor will review your symptoms, medical history and order tests. Your evaluation may include:

  • Neurological exam to test behavior, motor abilities and mental function.
  • Blood tests check for infections, genetic conditions or other diseases that can cause seizures.

To look for brain abnormalities, you may have the following tests:

  • Electroencephalogram (EEG) records electrical activity in your brain by using electrodes attached to your scalp. Your doctor will monitor your brain waves and record any seizures you have. It also determines the kind of seizures and rules out other seizure-causing conditions. Ambulatory EEGs can be worn at home to record seizure activity over several days. A high-density EEG uses more closely spaced electrodes to better identify the specific areas affected by seizures.
  • Computerized tomography (CT) scan uses X-rays to obtain cross-sectional images of the brain to look for structure abnormalities such as tumors, bleeding or cysts.
  • Magnetic resonance imaging (MRI) can detect lesions or brain abnormalities.
  • Functional MRI (fMRI) measures changes in blood flow that occur when specific parts of your brain are working. It’s used before surgery to identify areas of critical brain functions such as speech and movement, so they can be avoided during surgery.
  • Positron emission tomography (PET) scans use a small amount of radioactive material injected into a vein to show the brain’s metabolic activity. Seizures can occur in areas with low metabolism.
  • Single-photon emission computerized tomography (SPECT) can be used if an EEG or  MRI didn’t pinpoint the location where seizures originate. 
  • Neuropsychological tests can assess thinking, memory and speech skills to determine what brain areas are affected.

Treatment

What are the treatment options for epilepsy?

Not all seizures are treated because some of them are very minor. Some patients do not want the side effects of medications. If you and your doctor decide to treat your seizures, it usually begins with medications. If the medications don’t control seizures, surgery or other treatments may be recommended. 

Treatment options include:

  • Medication can be just one anti-epileptic medication, or a combination of medications. It can be difficult to find the right medication and effective dosage. Generally you’ll start with a low dosage and increase it until seizures are well controlled. There are more than 20 types of anti-seizure medications. The type prescribed depends on the type of seizure, patient age and other health conditions. Medications can cause side effects including fatigue, dizziness, weight gain, loss of bone density, skin rash, loss of coordination, speech problems, and memory and thinking problems. You’ll need regular follow-up visits with your doctor to evaluate the effectiveness of your medications. More than half of seizure patients can be seizure-free with their first medication. 
  • Surgery may be recommended if medications don’t control seizures. The section of your brain that’s causing seizures will be removed. Surgery is an option for seizures that originate in a small and well-defined area of your brain, and its removal won’t affect any vital functions. Medications may be continued after successful surgery but can be fewer and at lower dosages.
  • MRI-guided stereotactic laser ablation may be used if surgery is too risky. A thermal laser probe is directed at the specific area and destroys that tissue.
  • Other therapies provide alternative ways to treat seizures. Vagus nerve stimulation can reduce seizures by 20-40% with an implanted device similar to a heart pacemaker. A ketogenic diet can help reduce seizures. Deep brain stimulation requires electrodes to be implanted into your brain; used when medications don’t control seizures. Responsive neurostimulation uses a pacemaker-like device to reduce the number of seizures. The device analyzes brain activity patterns to detect seizures as they begin, delivering an electrical charge or drug to stop the seizure. It has few side effects and provides long-term reduction in seizures.

If a person has been seizure-free for at least 10 years and has not taken any anti-seizure medication for the past five years, their epilepsy is considered resolved. That doesn’t guarantee that epilepsy won’t return, but the chances are small.

References

Mayo Clinic. (Oct. 2021). Epilepsy. Retrieved 11-22-21, {https://www.mayoclinic.org/diseases-conditions/epilepsy/symptoms-causes/syc-20350093}
Mayo Clinic. (Oct. 2021). Epilepsy. Retrieved 11-22-21, {https://www.mayoclinic.org/diseases-conditions/epilepsy/diagnosis-treatment/drc-20350098}
Epilepsy Foundation. (N.d.) What is Epilepsy? Retrieved 11-23-21, {https://www.epilepsy.com/learn/about-epilepsy-basics/what-epilepsy}
Epilepsy Foundation. (N.d.) Triggers of Seizures. Retrieved 11-23-21, {https://www.epilepsy.com/learn/triggers-seizures}
Epilepsy Foundation. (N.d.) Treating Seizures and Epilepsy. Retrieved 11-23-21,{https://www.epilepsy.com/learn/treating-seizures-and-epilepsy}

Information

Medically reviewed by:

Dr. Desiree Levyim

Dr. Desiree Levyim is a board eligible neurologist in practice since 2020. She joins TeleMed2U in our mission to provide increased access to healthcare.

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