How Do I Know If I Have Epilepsy?
To diagnose epilepsy, your doctor will take a detailed medical history (including a family history of seizures), gather information about your behavior before, during, and after the episode, and do a physical exam. Make sure someone who witnessed the seizure goes to the doctor with you.
An electroencephalogram (EEG) -- a brain wave study -- can reveal abnormal brain waves characteristic of epilepsy. Keeping someone awake for 24 hours (sleep deprivation) increases the chances of finding abnormalities on an EEG. Imaging tests such as an MRI or CT scan can identify brain abnormalities that may be causing seizures.
What Are the Treatments for Epilepsy?
Epilepsy can often be well controlled by a wide variety of medication. Those with epilepsy should wear a Medic Alert bracelet so that other people can quickly recognize what is happening during a seizure and lend effective assistance.
Surgery is recommended for the minority of patients whose seizures can't be controlled with drugs:
- The most successful procedures are those in which the affected area of the brain is identified and surgically removed.
- There are other surgeries that involve disconnecting pathways between parts of the brain to prevent the seizure from spreading to other parts of the brain.
- In vagus nerve stimulation, a device that electronically stimulates the vagus nerve (which controls activity between the brain and major internal organs) is implanted under the skin, reducing 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.
The ketogenic diet -- a high-fat, low protein and carbohydrate regimen -- is sometimes used to treat children aged 1-10 who have not responded to other treatments. For many children, this will result in fewer seizures. It may have some long-term benefits since some children can stop the ketogenic diet after several years and still remain seizure free. Close medical supervision and consultation with a dietician are required.
In the great majority of cases, seizures can be reduced in frequency and severity, or eliminated altogether, with medication. Side effects vary, but most are mild. There are many antiseizure drugs. Some of the commonly prescribed drugs include brivaracetam (Briviact), carbamazepine (Tegretol), eslicarbazepine (Aptiom), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), phenytoin (Dilantin), phenobarbital (Luminal), topiramate (Topamax) and valproic acid (Depakote). There are also some newer drugs such as cenobamate (Xcopri), oxcarbazepine (Oxtellar XR, Trileptal), and pregabalin (Lyrica). In addition, the FDA has recently approved the drug Epidiolex, which is made from cannabidiol (CBD), as a therapy for people with very severe or hard-to-treat seizures.
There are a growing number of anticonvulsant drugs available that can be used alone or in combination to treat seizures that are resistant to standard treatment.