Epilepsy
Epilepsy is a brain condition that’s also known as a seizure disorder and causes recurring seizures. The cause of epilepsy can be identified in some people, but in many cases, the exact cause isn’t known. The condition is common and affects people of all genders, ethnic backgrounds, ages, and races.
Patients with epilepsy can experience different seizure symptoms. Some patients lose awareness, while others are blank for a few seconds during the seizure. An extreme seizure can cause convulsions, leading to repeated twitching of the arms and/or legs.
Just one seizure doesn’t mean a person has epilepsy. Doctors will diagnose the condition based on symptoms, including the frequency of seizures. Many patients need medication for their entire life, while others may outgrow seizures with age.
Epilepsy Symptoms
Epilepsy seizure symptoms may vary, including temporary confusion, a staring spell, muscle stiffness, uncontrollable jerking and twitching of arms and legs, and loss of consciousness. Some patients may also have psychological symptoms, such as fear, anxiety, or deja vu. Before a seizure, some patients may experience a few warning signs called an aura. Such signs include a feeling in the stomach, fear, an unusual taste or smell, or even visual cues, such as a flashing light.
Call a doctor immediately if someone is having a lasting seizure for more than five minutes, as seizures lasting more than five minutes are considered prolonged seizures and require immediate medical attention, or if consciousness doesn’t return after the seizure.
Categories of Epilepsy
Multiple seizures can occur in clusters, meaning two or more seizures happen within a specific timeframe. Seizure clusters are clinically significant as they may be associated with drug-resistant epilepsy and increased need for emergency care. Seizures in epilepsy are classified into three categories:
Focal Seizures
Focal seizures originate in one area of the brain and can be further classified based on whether awareness is preserved or impaired. These are also called partial seizures, as the patient doesn’t always lose consciousness. Symptoms include involuntary movement or jerking of a body part, such as an arm. Focal seizures can come from any part of the brain. There are temporal lobe seizures, frontal lobe seizures, and occipital lobe seizures.
Generalized Seizures
Generalized seizures involve abnormal neuronal activity that rapidly emerges on both sides of the brain. Absence seizures are a type of generalized seizure characterized by brief lapses in awareness, often accompanied by subtle movements. Tonic seizures involve a stiffening of the back, arms, and legs, while atonic seizures result in a sudden loss of muscle control. Clonic seizures typically affect the neck, face, and arms with repeated jerking movements. Tonic-clonic seizures involve both stiffening and shaking of the body, often accompanied by loss of bladder control or biting the tongue. Myoclonic seizures are also a type of generalized seizure involving sudden, brief jerks or twitches of the muscles.
Febrile Seizures
Febrile seizures are a type of seizure that occurs in children in response to a high fever, usually during an illness. Unlike epileptic seizures, febrile seizures are typically harmless and are not caused by epilepsy, but they may require evaluation to rule out other causes.
Causes of Epilepsy
The causes of epilepsy are diverse. Some people develop epilepsy after a traumatic brain injury, brain tumors, or central nervous system infections. Others may have genetic factors or developmental disorders that increase their risk. In many cases, seizures are unprovoked, meaning they occur without a clear trigger. However, certain seizure triggers, such as stress, lack of sleep, or specific medical conditions, can increase the likelihood of an episode. Identifying and managing these triggers is an important part of controlling seizures and reducing seizure frequency.
The underlying cause of epilepsy is often unknown. About half of people with epilepsy do not have a clear identifiable cause. However, epilepsy can result from brain injury, stroke, infections, tumors, or genetic conditions. In other cases, epilepsy can be related to:
- Genetics
Epilepsy that runs in the family.
- Tuberous Sclerosis Complex
This genetic disorder is strongly associated with epilepsy and involves structural brain abnormalities.
- Head Injury
Injury to the head can lead to nerve damage or brain abnormalities, which may trigger epileptic seizures. A severe head injury is a common cause of epilepsy, especially in young adults.
- Other Neurological Disorders
In older adults, epilepsy can sometimes be due to underlying neurological issues such as stroke or brain tumors.
- Injury During Pregnancy
Babies may have brain damage due to infections in the mother, poor nutrition, and a lack of oxygen. Brain damage can eventually cause epilepsy.
- Other Conditions
Patients with developmental conditions, such as autism, are more likely to have epilepsy than others.
- Brain Factors
Factors like brain tumors, arteriovenous malformations, and cavernous malformations can cause seizures. Brain abnormality as a result of injury, infection, or tumor is also a known cause. Meningitis, HIV, and viral encephalitis are also known factors.
Living with epilepsy can be challenging, but with the right support and treatment, people with epilepsy can manage their condition and lead active, fulfilling lives. Ongoing research, specialized care, and increased awareness continue to improve outcomes and quality of life for those affected by this complex seizure disorder.
Diagnosing Epilepsy
Your doctor will understand your symptoms and the frequency and types of a person’s seizures to diagnose epilepsy and plan treatment. Identifying patterns in a person’s seizures is important for determining the best management approach.
You May Need the Following:
- A neurological exam to test behavior, movement, and mental function
- Blood tests for infections, genetic conditions or other conditions
- Genetic testing – Often considered for children
- An electroencephalogram (EEG) records the electrical activity of the brain. EEG and imaging help identify the seizure focus and seizure onset zones, which are crucial for diagnosis and surgical planning.
- Computerized tomography (CT) scan
- Magnetic resonance imaging (MRI)
- Functional MRI (fMRI)
- Positron emission tomography (PET)
If MRI and EEG don’t detect the point in the brain where seizures start, your doctor may recommend Single-photon emission computed tomography (SPECT). Advanced imaging tests such as SPECT, SPM, MEG, and ESI can help determine where seizures originate in the brain, which is essential for planning surgery or neuromodulation treatments.
Your doctor will decide which tests you will need. You should schedule an appointment immediately after your first seizure. Tracking seizures and potential triggers in a seizure diary can help identify patterns and improve diagnosis and management.
Treating Epilepsy
Treatment for epilepsy aims to manage seizures, reduce seizure frequency, and achieve seizure control. Treatment can reduce the frequency of seizures or stop them completely. Here are the standard treatments:
Medication
The most common approach to treating epilepsy is to prescribe antiseizure medications. There are more than 40 different antiseizure medications available today, each with different benefits and side effects. Anti-seizure medications work by stabilizing the electrical activity of nerve cells in the brain. Most seizures can be controlled with one drug, but some may require combination therapy if seizures are not well-controlled with monotherapy. Patients don’t always need these medications for the rest of their lives. Many adults take medicines for one to two years and then stop entirely. Usually, a lower dose of a medicine is first prescribed to assess the response, but the choice of drug depends on the specific symptoms. Seizure reduction is an important measure of treatment success.
Surgery
Surgery is typically only considered after a person with epilepsy has unsuccessfully tried at least two medications to prevent seizures. Surgical procedures for treating epilepsy disorders include resection, disconnection, and implantation of neuromodulation devices. Usually, epilepsy surgery is recommended when the seizures are found to originate from one small and identified part of the brain. In some cases, MRI-guided stereotactic laser ablation is also helpful, which is minimally invasive and less risky than traditional surgery. Patients with medically-resistant epilepsy are often treated at specialized epilepsy centers in a multi-disciplinary fashion.
Deep Brain Stimulation
If medication doesn’t help a patient, doctors may also recommend it, which sends electrical pulses to the brain to reduce seizures.
Vagus Nerve Stimulation
Besides medication and surgery, therapies can also help epilepsy patients. If a patient isn’t benefiting from drugs or surgery isn’t feasible, this treatment using a vagus nerve stimulator can help reduce seizures by up to 40%. Even with the treatment, anti-seizure medicines are often necessary.
Responsive Neurostimulation
The treatment involves using implantable devices that look like a pacemaker to reduce seizures.
In many patients, a ketogenic diet, which is a non-pharmacological treatment option used primarily in children with drug-resistant epilepsy, has been seen to help with epilepsy. This dietary therapy is available in certain specialized centers. Always talk to your doctor and discuss diet or medicines before you start anything. Epilepsy treatments largely depend on the symptoms and diagnosis, and you shouldn’t ignore early symptoms.
When to Reach Out
Seizures need immediate attention, especially the first one. Epilepsy doesn’t have to affect your time, provided you seek medical care. At Chester Neurology, we offer comprehensive treatment plans for Epilepsy, starting with the diagnosis and a personal treatment plan to address symptoms and reduce seizures.
If you want help for yourself or someone you love who is experiencing seizures or has a history of epilepsy, call us today at (914) 816-1941 or email info@chesterneurology.com to schedule an appointment.
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