Epilepsy and Seizures
What is epilepsy?
Epilepsy is a neurological condition involving the brain that makes people more susceptible to having recurrent seizures. It is one of the most common disorders of the nervous system and affects people of all ages, races, and ethnic background. Almost 2.2 million Americans live with epilepsy.
Anything that interrupts the normal connections between nerve cells in the brain can cause a seizure. This includes a high fever, low blood sugar, high blood sugar, alcohol or drug withdrawal, or a brain concussion. Under these circumstances, anyone can have one or more seizures. However, when a person has two or more seizures, he or she is considered to have epilepsy. There are many possible causes of epilepsy, including an imbalance of nerve-signaling chemicals called neurotransmitters, tumors, strokes, and brain damage from illness or injury, or some combination of these. In the majority of cases, there may be no cause that can be discovered for epilepsy.
What is a seizure?
The brain is the center that controls and regulates all voluntary and involuntary responses in the body. It consists of nerve cells that communicate with each other through electrical activity.
A seizure happens when part(s) of the brain receives a burst of abnormal electrical signals that temporarily interrupt normal electrical brain function.
What are the different types of seizures?
The type of seizure depends on which part and how much of the brain is affected and what happens during the seizure. The two broad categories of epileptic seizures are generalized seizures (absence, atonic, tonic-clonic, myoclonic) and partial (simple and complex) seizures. Within these categories, there are several different types of seizures, including:
Focal or partial seizures. Focal seizures take place when abnormal electrical brain function happens in one or more areas of one side of the brain. Focal seizures may also be called partial seizures. With focal seizures, particularly with complex focal seizures, a person may experience an aura, or warning, before the seizure happens. The most common aura involves feelings, such as deja vu, impending doom, fear, or a feeling of great happiness or well-being. Visual changes, hearing abnormalities, or changes in the sense of smell can also be auras. Two types of focal seizures include:
Simple focal seizures. The person may have different symptoms depending on which area of the brain is involved. If the abnormal electrical brain function is in the occipital lobe (the back part of the brain that is involved with vision), sight may be altered, but muscles are more commonly affected. The seizure activity is limited to an isolated muscle group, such as the fingers, or to larger muscles in the arms and legs. Consciousness is not lost in this type of seizure. The person may also experience sweating, nausea, or become pale.
Complex focal seizures. This type of seizure commonly happens in the temporal lobe of the brain, the area of the brain that controls emotion and memory function. Consciousness is usually lost during these seizures. Losing consciousness may not mean that a person passes out. Sometimes, a person stops being aware of what's going on around him or her. The person may look awake, but may have a variety of unusual behaviors. These behaviors may range from gagging, lip smacking, running, screaming, crying, and/or laughing. When the person regains consciousness, he or she may complain of being tired or sleepy after the seizure. This is called the postictal period.
Generalized seizures. Generalized seizures involve both sides of the brain. There is loss of consciousness and a postictal state after the seizure happens. Types of generalized seizures include the following:
Absence seizures (also called petit mal seizures). These seizures are characterized by a brief, altered state of consciousness and staring episodes. Typically, the person's posture is maintained during the seizure. The mouth or face may twitch or the eyes may blink rapidly. The seizure usually lasts no longer than 30 seconds. When the seizure is over, the person may not recall what just happened and may go on with his or her activities, acting as though nothing happened. These seizures may happen several times a day. This type of seizure is sometimes mistaken for a learning problem or behavioral problem. Absence seizures almost always start between ages 4 to 12 years.
Atonic (also called drop attacks). With atonic seizures, there is a sudden loss of muscle tone and the person may fall from a standing position or suddenly drop his or her head. During the seizure, the person is limp and unresponsive.
Generalized tonic-clonic seizures (GTC or also called grand mal seizures). The classic form of this kind of seizure, which may not happen in every case, is characterized by 5 distinct phases. The body, arms, and legs will flex (contract), extend (straighten out), and tremor (shake), followed by a clonic period (contraction and relaxation of the muscles) and the postictal period. Not all of these phases may be seen in everyone with this type of seizure. During the postictal period, the person may be sleepy, have problems with vision or speech, and may have a bad headache, fatigue, or body aches.
Myoclonic seizures. This type of seizure refers to quick movements or sudden jerking of a group of muscles. These seizures tend to happen in clusters, meaning that they may happen several times a day, or for several days in a row.
Infantile spasms. This rare type of seizure disorder happens in infants before six months of age. There is a high occurrence rate of this seizure when the child is awakening, or when he or she is trying to go to sleep. The infant usually has brief periods of movement of the neck, trunk, or legs that lasts for a few seconds. Infants may have hundreds of these seizures a day. This can be a serious problem, and can have long-term complications that affect growth and development.
Febrile seizures. This type of seizure is associated with fever and is not epilepsy, although a fever may trigger a seizure in a child who has epilepsy. These seizures are more commonly seen in children between three months and six years of age. Also, there may be a family history of this type of seizure. Febrile seizures that last less than 15 minutes are called simple, and typically do not have long-term neurological effects. Seizures lasting more than 15 minutes are called complex and there may be long-term neurological changes in the child. Febrile seizures often happen while the child's body temperature is rising, so often the child is not already known to have a fever.
What causes a seizure?
A person may experience one or many different types of seizures. While the exact cause of the seizure may not be known, the more common seizures are caused by the following:
Other possible causes of seizures may include the following:
Use of unlawful drugs
What are the symptoms of a seizure?
The person may have varying degrees of symptoms depending on the type of seizure. The following are general symptoms of a seizure or warning signs of seizures. Symptoms or warning signs may include:
Jerking movements of the arms and legs
Stiffening of the body
Loss of consciousness
Breathing problems or breathing stops
Loss of bowel or bladder control
Falling suddenly for no apparent reason, especially when associated with loss of consciousness
Not responding to noise or words for brief periods
Appearing confused or in a haze
Nodding the head rhythmically, when associated with loss of awareness or even loss of consciousness
Periods of rapid eye blinking and staring
During the seizure, the person's lips may become bluish and breathing may not be normal. The movements are often followed by a period of sleep or disorientation.
The symptoms of a seizure may resemble other problems or medical conditions. Always consult your healthcare provider for a diagnosis.
How are seizures diagnosed?
The full extent of the seizure may not be completely understood immediately after onset of symptoms. It may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a seizure is made with a physical exam and diagnostic tests. During the exam, the healthcare provider obtains a complete medical history of the person and family and asks when the seizures happened. Seizures may be due to neurological problems and require further medical follow-up.
Diagnostic tests may include:
Electroencephalogram (EEG). A procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp.
Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
Lumbar puncture (spinal tap). A special needle is placed into the lower back, into the spinal canal. This is the area where the spinal cord and nerves travel to and from the brain. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes the brain and spinal cord.
Treatment of a seizure
Specific treatment for a seizure will be determined by your healthcare provider based on:
Your age, overall health, and medical history
Type of the seizure
Frequency of the seizures
Your tolerance for specific medicines, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference
The goal of seizure management is to control, stop, or decrease the frequency of the seizures without interfering with the normal activities of daily living (ADLs). The major goals of seizure management include the following:
Proper identification of the type of seizure
Using medicine specific to the type of seizure
Using the least amount of medicine to achieve adequate control
Maintaining appropriate medicine levels
Getting adequate rest, as seizures are more likely to happen when one is sleep-deprived
Avoiding things that may trigger a seizure
Treatment may include:
Medicines. There are many types of medicines used to treat seizures and epilepsy. Medicines are selected based on the type of seizure, age of the patient, side effects, the cost of the medicine, and the adherence with the use of the medicine.
Medicines used at home are usually taken by mouth (as capsules, tablets, sprinkles, or syrup), but some can be given rectally (into the person's rectum). If the person is in the hospital with seizures, medicine may be given by injection or intravenously by vein (IV).
It is important to take your medicine on time and as prescribed by your healthcare provider. Different people use up the medicine in their body differently, so adjustments (schedule and dosage) may need to be made for the most effective seizure control.
All medicines can have side effects, although some people may not experience certain side effects. Discuss your medicine's possible side effects with your healthcare provider.
While you are taking medicines, different tests may be done to monitor the effectiveness of the medicine. These tests may include the following:
Blood work. Frequent blood draws testing is usually needed to check the level of the medicine in the body. Based on this level, the healthcare provider may increase or decrease the dose of the medicine to achieve the desired level. This level is called the therapeutic level and is where the medicine works most efficiently. Blood work may also be done to monitor the effects of medicines on body organs.
Urine tests. These tests are sometimes performed to see how the person's body is responding to the medicine.
Electroencephalogram (EEG). An EEG is a procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp. This test is done to monitor how the medicine is helping the electrical problems in the brain.
Vagus nerve stimulation (VNS). Some people, whose seizures are not being well-controlled with seizure medicines, may benefit from a procedure called vagus nerve stimulation (VNS). VNS is currently most commonly used for people over age 12 who have partial seizures that are not controlled by other methods.
VNS attempts to control seizures by sending small pulses of energy to the brain from the vagus nerve, which is a large nerve in the neck. This is done by surgically placing a small battery into the chest wall. Small wires are then attached to the battery and placed under the skin and around the vagus nerve. The battery is then programmed to send energy impulses every few minutes to the brain. When the person feels a seizure coming on, he or she may activate the impulses by holding a small magnet over the battery. In many cases, this will help to stop the seizure.
There are some side effects that may happen with the use of VNS. These may include, but are not limited to, the following:
Surgery. Another treatment option for seizures is surgery. Surgery may be considered in a person who:
Has seizures that are unable to be controlled with medicines.
Has seizures that always start in one area of the brain.
Has a seizure in a part of the brain that can be removed without disrupting important behaviors, such as speech, memory, or vision.
Surgery for epilepsy and seizures is very complicated and performed by a specialized surgical team. The operation may remove the part of the brain where the seizures are happening, or, sometimes, the surgery helps to stop the spread of the bad electrical currents through the brain.
A person may be awake during the surgery. The brain itself does not feel pain. With the person awake and able to follow commands, the surgeons are better able to make sure that important areas of the brain are not damaged.
Surgery is not a choice for everyone with seizures. Discuss this treatment choice with your healthcare provider for more information.
More information regarding the person with seizures or epilepsy
Make sure you or your child (if age appropriate) understand the type of seizure that is happening and the type of medicine(s) that are needed.
Know the dose, time, and side effects of all medicines.
Consult your healthcare provider before taking other medicines. Medicines for seizures can interact with many other medicines, causing the medicines to work improperly and/or causing side effects.
Young women of childbearing age who are on seizure medicines need to be informed that seizure medicines are harmful to a fetus, and the medicine may also decrease the effectiveness of oral contraceptives.
Some vitamins, such as folic acid, can reduce the risks to the fetus from taking seizure medicines. Ask your healthcare provider if folic acid is recommended.
Check with your state to understand any laws about people with epilepsy or seizures operating a motor vehicle.
If a person has good control over the seizures, only minimal restrictions need to be placed on activities, in most cases.
Specific follow-up will be determined by your healthcare provider.
Medicines for seizures may not be needed for the person's entire life. Some people may be taken off their medicines if they have been seizure-free for one to two years. This will be determined by your healthcare provider.