Epilepsy is a condition where there is unusual electrical activity in your brain, resulting in seizures.
Sudden, involuntary movements like jerking or twitching in your arms or legs may be seizures.
Seizures themselves aren't usually dangerous, and they only last for a short period of time. But you could get hurt if you have one while driving or doing another activity.
Epilepsy affects everyone differently. Your doctor will help you find the right treatment to keep your seizures under control.
What Causes Epilepsy?
Doctors aren't sure what causes epilepsy in most folks. But there are conditions that affect the brain that could make it more likely that you get seizures, such as:
- Severe head injuries
- Stroke and blood vessel diseases
- Changes in brain structure
- Brain infections
Epilepsy sometimes runs in families. One or more genes may cause changes to the brain that trigger seizures.
What Are the Types of Seizures?
Doctors classify seizures based on where in your brain they start, and what symptoms they cause. You may hear your doctor use one of these terms when they talk to you about your epilepsy:
Focal seizures start on one side of your brain.
- Focal aware seizures mean you're awake and you can respond to others
- Focal impaired seizures mean you're not completely aware
- Focal motor seizures cause your body to jerk, twitch, or move in other ways
- Focal non-motor seizures affect how you feel or think
Generalized seizures start on both sides of your brain.
- Generalized motor seizures make your body move or twitch
- Generalized non-motor seizures don't cause movement
What Are the Symptoms?
Seizures can make you move, have unusual feelings, or both. Which symptoms you have depend on the type of seizure you get.
During a seizure, you might:
- Stare into space
- Get confused or be unsure of where you are
- Pass out
- Jerk or twitch your arms and legs
- Rub your hands, smack your lips, or make other unusual movements
- Notice strange smells, tastes, sounds, or sights
- Feel strange in general
These problems can last from a few seconds to a few minutes. Most people have the same symptoms each time they have a seizure.
How Is It Diagnosed?
If you think you have epilepsy, start with a visit to your primary care doctor. You might be referred to a specialist in brain disorders, called a neurologist.
Your doctor will ask questions about your seizures, such as:
- When did you have your first one?
- What were you doing before it happened?
- What did the seizure feel like?
- Have you had more than one? How many?
- Were you tired or confused afterward?
You may get a neurological exam, a series of tests that show how well your brain and the rest of your nervous system are working. Your doctor will check your:
- Walking skills
- Reflexes and coordination
- Thinking ability
Other tests your doctor may suggest to find out if you have epilepsy:
- EEG. It checks for problems with the electrical activity in your brain.
- Blood tests. They look for signs of infections and other medical problems that can cause seizures.
- CT scan. It's a powerful X-ray that makes detailed pictures of your brain. A CT scan can find other causes of seizures, like a tumor or infection.
- MRI. It uses powerful magnets and radio waves to make pictures of your brain. An MRI can also look for problems in your brain, like tumors or infection.
To get an epilepsy diagnosis, you typically must have had two or more seizures at least 24 hours apart. In some cases, you may be diagnosed with epilepsy after one seizure if you’re at higher risk of another.
How Is It Treated?
Doctors treat epilepsy with medicine, surgery, devices, and sometimes diet. Your doctor may suggest you try some of these treatments:
Anti-seizure drugs. They're the main way to control epilepsy. Your doctor may recommend one or more medicines such as:
- Brivaracetam (Briviact)
- Cannabidiol (Epidiolex)
- Carbamazepine (Tegretol)
- Cenobamate (Xcopri)
- Clonazepam (Klonopin)
- Clobazam (Onfi)
- Diazepam (Valium)
- Diazepam nasal spray (Valtoco, Neurelis)
- Divalproex sodium (Depakene, Depakote)
- Eslicarbazepine (Aptiom)
- Ethosuximide (Zarontin)
- Ezogabine (Potiga)
- Fenfluramine (finteplax)
- Gabapentin (Neurontin)
- Lacosamide (Vimpat)
- Lamotrigine (Lamictal)
- Levetiracetam (Keppra)
- Lorazepam (Ativan)
- Oxcarbazepine (Trileptal)
- Perampanel (Fycompa)
- Phenytoin (Dilantin)
- Pregabalin (Lyrica)
- Primidone (Mysoline)
- Rufinamide (Banzel)
- Stiripentol (Diacomit)
- Tiagabine (Gabitril)
- Topiramate (Topamax)
- Valproic acid (Valproic Acid)
- Vigabatrin (Sabril)
- Zonisamide (Zonegran)
Which medication you get depends on the type of seizure you have. If the first drug you try doesn't work, your doctor may switch you to another one or may add another medication to what you are already taking.
Rescue Medications There are medicines and treatments which can and should be used in specific situations. They do not take the place of daily medications and should only be used to help stop a seizure quickly in emergency situations. Depending on the circumstance, they can be administered:
- Nasally - Sprayed up the nose
- Orally - Swallowed in pill form
- Sublingually - Placed under the tongue to dissolve
- Buccally - Placed between the cheek and the gum to dissolve
- Rectally - Given via a gel through the anus
The most commonly used medications are benzodiazepines because they get into the bloodstream quickly to start working on the brain to stop the seizure. They include:
- Diazepam - given orally (if the person is awake),
- Midazolam - can be given nasally (Nayzilam), buccally, orally
Surgery. It could be an option for you if medicine doesn't control your seizures, or if your seizures are caused by a brain problem like a tumor or stroke.
During surgery, the doctor removes a small part of your brain that's causing your seizures, or they may make small cuts in the brain to prevent seizures from spreading.
Devices. Two types are approved to treat epilepsy:
- Vagus nerve stimulation (VNS) sends regular pulses of electrical energy to your brain to prevent seizures. A doctor puts the device under the skin of your chest.
- Responsive neurostimulation (RNS) also sends pulses to the brain, but through a device that your doctor places under your scalp.
Ketogenic diet. It's a high-fat, low-carb food plan that helps control seizures in children. It might work for adults, too, but more research is needed.
The ketogenic diet is strict and complicated. You'll need to work closely with your doctor.
Questions to Ask Your Doctor About Epilepsy
If you were recently diagnosed with epilepsy, ask your doctor these questions at your next visit.
- What type of epilepsy do I have?
- Am I likely to have more seizures if I don't get medication or other treatments?
- If I need medication, what side effects can I expect? What should I do when I notice these side effects?
- What should I do if I have another seizure?
- Should I have a seizure action plan?
- Is it safe for me to drive? If not, when will it be safe to start driving again?
- Is it safe for me to swim? Are there any other activities I should be careful about doing?
- Is it safe for me to drink alcohol?
- Could brain surgery be effective in stopping my seizures?
- What should I tell my friends, co-workers, and family members about this condition?
- What support organizations for epilepsy are in my area?