1. What is epilepsy?
Epilepsy is a chronic (long-lasting) medical condition marked by recurrent epileptic seizures. An epileptic seizure is an event of altered brain function caused by abnormal or excessive electrical discharges from brain cells. Epilepsy is one of the most common neurologic disorders, affecting up to 1% of the U.S. population.
There are different types of seizures, different types of epilepsy syndromes, and different causes of epilepsy. For example, both brain tumors and stroke can cause seizures and lead to chronic epilepsy. Some of the causes can be diagnosed and treated with medications and some require surgery.
2. What causes epilepsy?
Approximately 65% of people newly diagnosed with epilepsy have no obvious cause. Of the remaining 35%, the more common reasons include stroke, congenital abnormalities (conditions we are born with), brain tumors, trauma, and infection.
3. Who treats epilepsy?
A neurologist, a doctor who specializes in the brain and nervous system, is best able to diagnose and treat epilepsy. Some neurologists take advanced training and become epileptologists, specialists in the diagnosis and treatment of epilepsy. Many internists and family practice doctors also treat epilepsy.
4. How is epilepsy diagnosed?
To diagnose epilepsy, doctors try to determine the type of seizure you are having and the cause, since various seizure types respond best to specific treatments. The diagnosis is based on your medical history and a complete physical and neurological exam.
Additional testing may often be required, including an electroencephalogram (EEG). The EEG is the only test that can directly detect electrical activity in the brain (seizures are defined by abnormal electrical activity in the brain). During an EEG, electrodes (small metal disks) are attached to specific locations on your head. The electrodes are also attached to a monitor to record the brain's electrical activity. Your doctor may order brain imaging tests such as an MRI or head CT.
If you become unconscious during a seizure, others who have often seen you before, during, and after seizures, such as family and close friends, should be present to provide details of your seizures.
5. How is epilepsy treated?
The majority of epileptic seizures are controlled with drug therapy, particularly anticonvulsant medications. The type of treatment prescribed will depend on several factors, including the type of epilepsy, the frequency and severity of the seizures, your age, overall health, and medical history. An accurate diagnosis of the type of epilepsy (not just the type of seizure, since most seizure types occur in different types of epilepsy) is critical to choosing the best treatment.
6. What precautions should pregnant women take?
Women who have seizures can have healthy children, provided they receive good prenatal care. It is very important that women who have epilepsy discuss pregnancy with their doctors before getting pregnant.
Many seizure medications can prevent birth control pills from working effectively, which may lead to unplanned pregnancy. If pregnancy occurs unexpectedly, women should not discontinue their seizure medication without first consulting with their doctors. Abruptly discontinuing seizure medication commonly leads to more frequent seizures, which can harm the baby.
7. What is epilepsy surgery?
Epilepsy surgery involves the surgical removal of the region of the brain responsible for the abnormal electrical signals that cause seizures. This region of the brain is called the epileptogenic zone. It is determined by neuroimaging studies, electrical recordings from the scalp (EEG), and clinical signs during a seizure. Epilepsy surgery can provide a "cure" for epilepsy, in that it can eliminate the source of seizures and epilepsy.
Surgery can also be done to implant devices to treat epilepsy. In vagus nerve stimulation (VNS), a device that electronically stimulates the vagus nerve (which controls activity between the brain and major internal organs) is implanted under the skin. This reduces seizure activity in some patients with partial seizures. There’s also the responsive neurostimulation device (RNS), which consists of a small neurostimulator implanted within the skull under the scalp. The neurostimulator is connected to one or two wires (called electrodes) that are placed where the seizures are suspected to originate within the brain or on the surface of the brain. The device detects abnormal electrical activity in the area and delivers electrical stimulation to normalize brain activity before seizure symptoms begin.
8. What are the side effects of epilepsy medications?
As is true of all drugs, the medications used to treat epilepsy have side effects. The occurrence of side effects depends on the dose, type of medication, and length of treatment. The side effects worsen with higher doses but tend to be less severe with time as the body adjusts to the medication. Anti-epileptic drugs are usually started at lower doses and increased gradually to make this adjustment easier.
Side effects of epilepsy drugs can include blurry or double vision, fatigue, sleepiness, unsteadiness, stomach upset, skin rashes, low blood cell counts, liver problems, swelling of the gums, hair loss, weight gain, and tremor.
9. Are there alternative treatments for epilepsy?