Epilepsy is a disorder of the brain's electrical system. Abnormal electrical impulses cause brief changes in movement, behavior, sensation, or awareness. These interruptions, known as seizures, may last from a few seconds to a few minutes. People who have had two or more seizures are considered to have epilepsy.
Epilepsy is best known for causing convulsions. But seizures can trigger a wide range of symptoms, from staring to falling to fumbling with clothes. Doctors divide seizures into several types depending on how the brain is affected. Each type has a distinct set of symptoms.
Absence seizures are often described as staring spells. The person stops what he or she is doing and stares vacantly for a few seconds, then continues as if nothing happened. This type of seizure is more common in children and usually starts between the ages of 4 and 12. Some children experience up to 100 absence seizures in a day.
Generalized Tonic Clonic Seizures
Generalized tonic clonic seizures (formerly known as grand mal seizures) are the most easily recognized. They usually begin with a stiffening of the arms and legs, following by jerking motions. The convulsions last up to 3 minutes, after which the person may be tired and confused. This type of seizure involves abnormal electrical activity involving both sides of the brain.
In partial seizures, just one side of the brain is affected. Simple partial seizures may cause jerking motions or hallucinations, but the person often remains aware of what is happening. During complex partial seizures, people may wander, mumble, smack their lips, or fumble with their clothes. They appear to be conscious to observers, but are actually unaware of what they are doing.
Causes of Epilepsy
Epilepsy may result from anything that disrupts the brain's natural circuitry, such as:
Severe head injury
Brain infection or disease
In nearly two-thirds of people with epilepsy, a specific cause is never found.
Epilepsy in Children
Children who are diagnosed with epilepsy may outgrow the condition in a few years. In the meantime, many kids are able to prevent seizures by taking regular medication. If drugs fail to keep seizures under control, other precautions may be needed. A well-informed school staff can help a child with epilepsy safely participate in most activities.
To diagnose epilepsy a doctor will review the description of an individual's seizures, along with a medical history and physical exam. An EEG (electroencephalogram) can confirm the diagnosis and offer more information about the seizures. This painless procedure records the brain's electrical activity as wavy lines. The pattern changes during a seizure and may reveal which part of the brain is prone to seizures. Results may help guide treatment.
Diagnosis: Brain Scan
Detailed images of the brain from CT or MRI scans can help doctors rule out tumors or blood clots as a possible cause of seizures. This information is essential in planning surgery to treat epilepsy.
Most people with epilepsy live a normal lifespan and rarely suffer injuries from their seizures. Patients who tend to fall during seizures may need a special helmet to protect the head. Some types of seizures may increase the risk of sudden, unexplained death in epilepsy (SUDEP), but this is extremely uncommon. The best way to avoid complications is to find a treatment that controls seizures and stick to it.
Epilepsy Safety Precautions
Because seizures often strike without warning, certain activities are dangerous for people with epilepsy. Losing consciousness while swimming or even taking a bath could be life-threatening. The same goes for many extreme sports, such as mountain climbing. Most states require a person with epilepsy to be seizure-free for a certain time before driving a car.
Anti-seizure drugs are the most common treatment for epilepsy. If medication is not successful at first, your doctor may adjust the dosage or switch to a different drug. About two-thirds of people with epilepsy become seizure-free by taking their medication regularly.
Treatment: Ketogenic Diet
When followed carefully, a ketogenic diet can eliminate or nearly eliminate seizures in a third of children with epilepsy who try it. The diet is very high in fat and low in carbs, a combination that makes the body burn fat instead of sugar. This creates changes in the brain that reduce or eliminate seizures. It's a very strict diet that is created by a dietitian and monitored by a medical team. It may be recommended when medications fail or cause unacceptable side effects.
VNS stands for vagus nerve stimulation, a treatment that is sometimes called a "pacemaker for the brain." It uses a small surgically implanted device to send electrical pulses to the brain. The pulses travel via the vagus nerve, a large nerve in the neck. VNS is an option for people who don't do well with medication.
In people who have partial seizures, surgery can sometimes offer a cure. First, the medical team must determine that the seizures consistently begin in a single area of the brain. If so, removing this area may stop the seizures for good or make them easier to manage with medication. Surgery may also be done to treat an underlying condition that's causing seizures, such as a brain tumor.
First Aid for Seizures
If you see someone having a seizure, take the following steps:
Time the seizure with your watch.
Clear the area of anything hard or sharp.
Loosen anything at the neck that may impair breathing.
Turn the person onto his or her side.
Put something soft beneath the head.
Do not place anything inside the mouth.
Call 911 if a seizure lasts more than 5 minutes, recurs, or the person is pregnant, injured, or diabetic.
Treatment for Status Seizures
Prolonged or recurring seizures may be a condition called status epilepticus. This can have serious complications and requires emergency treatment. To bring the seizures to an end quickly, hospitals typically administer a sequence of drugs by IV and supplemental oxygen.
Epilepsy and Pregnancy
In most cases, it is safe for women with epilepsy to become pregnant and start a family. More than 90% of babies born to women with epilepsy are healthy. However, it's best to consult your doctor before getting pregnant. It may be necessary to adjust your anti-seizure medication. Some drugs appear to be less risky during pregnancy than others.
Some dogs appear to sense a person's seizure before it begins, providing an early warning system. But more research is needed before seizure alert dogs are widely used. In the meantime, many dogs can be trained to behave a certain way during a seizure. For example, the dog can lie next to the person to help prevent injury. In the case of a child, a dog may be trained to alert the parents during a seizure.
Researchers continue to pursue new therapies for epilepsy with two important goals. The first is to increase the number of people who can fully control their seizures. The second is to reduce the side effects of treatment. Some researchers are also studying implantable devices that could alert patients when a seizure is about to occur.
Living With Epilepsy
People with epilepsy can enjoy full, active lives. Most are able to live seizure-free by taking medication on schedule. For the remainder, there are many resources for coping with uncontrolled seizures. A specialist can help create strategies for reducing the impact seizures have on your life. The American Academy of Neurology and the Epilepsy Foundation provide listings of neurologists who specialize in epilepsy.
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