Epilepsy

Overview

What is Epilepsy?

Epilepsy is a chronic neurological disease characterized by recurrent seizures. At times, the cause is known, but in almost 50% of patients the cause is unknown. It is not a mental illness or developmental disability, but a condition involving abnormal, hyper excitable electrical disturbances in parts of the brain. This abnormal electrical activity is manifested through a clinical seizure.

Epilepsy can develop at any age though it is especially common in the very young or those over 65. Almost 0.5 to 1% of the population will develop epilepsy.

Signs & Symptoms

What Are The Signs of Epilepsy?

The primary sign is recurrent seizures, at least 24 hours apart, or a single seizure accompanied by an EEG that suggests high risk for further seizures.

While many people think of a specific kind of episode when they hear the word “seizure” — loss of consciousness, jerking and twitching movements — there are several different types of seizures, each with distinct symptoms.

Focal onset seizures begin in a specific area of the brain and involve localized symptoms.

  • During focal onset “aware” seizures, the person is aware of what’s happening as the seizure occurs.
  • Focal onset seizures with impaired awareness involve a temporary loss of awareness during the seizure or confusion.

Generalized onset seizures involve the whole brain and a loss of awareness or consciousness.

  • The person may suddenly fall down, their whole body may stiffen or their limbs may twitch or jerk rhythmically. They will often bite their tongue or become incontinent.
  • Tonic-clonic seizures (previously known as grand mal seizures) are what most people think of as a “seizure” and involve both muscle stiffening (tonic) and spasming (clonic).
  • Absence seizures (previously known as petit mal seizures) involve no motor symptoms and look similar to daydreaming.

While some people with epilepsy will have the same type of seizure each time, many will have different types of seizures during different episodes.

Learn more about seizures

Causes

What Causes Epilepsy?

There are many different causes of epilepsy. Historically, no cause can be determined for about half of epilepsy cases, while other cases may be the result of:

  • Genetic predisposition to epilepsy or certain seizure triggers (e.g. alcohol withdrawal)
  • Brain malformation or prenatal injury
  • Brain infection, like meningitis or viral encephalitis 
  • Head trauma (significant)
  • Stroke, Alzheimer’s disease or another condition that affects brain function
  • Brain tumor

Not all people who experience one of these conditions will develop epilepsy, and there is no known way to prevent epilepsy from developing.

Diagnosis

How is Epilepsy Diagnosed?

First, it’s important to remember that seizures and epilepsy are not the same thing. While every person with epilepsy has seizures, not all people who have seizures are epileptic. Epilepsy is generally diagnosed when a person has had two or more unknown onset seizures more than 24 hours apart. In some cases, an epilepsy diagnosis is made after one seizure, if the patient has certain risk factors that suggest recurrent seizures are likely proven with an abnormal EEG.

Your doctor may order a variety of tests to attempt to determine the cause of your seizures, as well as their likelihood to recur.

  • Neurological exams can help reveal other symptoms of a brain disease.
  • Blood tests and lumbar punctures (spinal taps) can help identify infections and abnormal blood chemistry.
  • Electroencephalograms (EEGs) measure electrical activity in the brain, helping to pinpoint which part of the brain is affected.
  • MRIs provide a detailed image of your brain to identify abnormalities.
  • CT scans can reveal tumors and other obstructions.
  • PET scans help create a map of the active areas of your brain and their level of function.
  • SPECT tests help measure blood flow in your brain during a seizure.

Based on certain factors, including (but not limited to) your age when seizures began, the type of seizures you have, your genetic information, and the part of the brain affected, doctors may diagnose a specific epilepsy syndrome to help determine the best course of treatment.

Treatment

What Treatment Options Are Available?

There are a number of treatment options available to help control the severity and frequency of seizures. In the majority of cases, about two-thirds, patients can be controlled by medications. And some carefully selected epilepsy patients are candidates for surgery that can potentially stop the seizures.

In many cases, doctors will prescribe anti-seizure medication to help limit seizure frequency. Medication is the first line of treatment for epilepsy.

If medications alone aren’t effective, your doctor may recommend a surgical treatment (such as vagal nerve stimulation, laser ablation, or surgical resection) or a more invasive surgical option. Each case is different, and each person responds differently to treatment, so it’s important to talk to your doctor about your individual treatment plan.

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