Epilepsy

Epilepsy is a central nervous system disorder (neurological disorder) in which nerve cell activity in the brain becomes disrupted, causing seizures or periods of unusual behavior or sensations. They may also have violent muscle spasms or lose consciousness.

Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others repeatedly twitch their arms or legs.

Epilepsy has many possible causes, including illness, brain injury, and abnormal brain development. In many cases, the cause is unknown.

About 1 in 26 people in the United States will develop a seizure disorder. Nearly 10 percent of individuals may have a single unprovoked seizure. However, a single seizure does not mean you have epilepsy. At least 2 unprovoked seizures are generally required for an epilepsy diagnosis.

There is no cure for epilepsy, but medicines can control seizures for most people. When medicines are not working well, surgery or implanted devices may help. Special diets can help some children with epilepsy.

Even mild seizures may require treatment because they can be dangerous during activities such as driving or swimming. Treatment with medications or sometimes surgery can control seizures for about 80 percent of people with epilepsy. Some children with epilepsy may also outgrow their condition with age.

Epilepsy is caused by abnormal activity in brain cells, so seizures can affect any process your brain coordinates. Seizure signs and symptoms may include:

• Temporary confusion
• A staring spell
• Uncontrollable jerking movements of the arms and legs
• Loss of consciousness or awareness

Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode.

Seizures are generally classified as either focal or generalized, based on how the abnormal brain activity begins.

Focal (partial) seizures appear to result from abnormal activity in just one area of your brain. Focal seizures without loss of consciousness (simple partial seizures) do not cause a loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste or sound. They may also result in involuntary jerking of a body part, such as an arm or leg, and spontaneous sensory symptoms such as tingling, dizziness and flashing lights. Focal dyscognitive seizures (complex partial seizures) involve a change or loss of consciousness or awareness. During a complex partial seizure, you may stare into space and not respond normally to your environment or perform repetitive movements, such as hand rubbing, chewing, swallowing or walking in circles.

Symptoms of focal seizures may be confused with other neurological disorders, such as migraine, narcolepsy, or mental illness. A thorough examination and testing are needed to distinguish epilepsy from other disorders.

Generalized seizures appear to involve all areas of the brain. There are 6 types of generalized seizures:

• Absence seizures. Absence seizures, previously known as petit mal seizures, often occur in children and are characterized by staring into space or subtle body movements such as eye blinking or lip smacking. These seizures may occur in clusters and cause a brief loss of awareness.
• Tonic seizures. Tonic seizures cause stiffening of your muscles. These seizures usually affect muscles in your back, arms and legs and may cause you to fall to the ground.
• Atonic seizures. Atonic seizures, also known as drop seizures, cause a loss of muscle control, which may cause you to suddenly collapse or fall down.
• Clonic seizures. Clonic seizures are associated with repeated or rhythmic, jerking muscle movements. These seizures usually affect the neck, face and arms.
• Myoclonic seizures. Myoclonic seizures usually appear as sudden brief jerks or twitches of your arms and legs.
• Tonic-clonic seizures. Tonic-clonic seizures, previously known as grand mal seizures, are the most dramatic type of epileptic seizure and can cause an abrupt loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control or biting your tongue.

Epilepsy has no identifiable cause in about half of those with the condition. In the other half, multiple factors contribute to the condition including:

• Genetic influence. Some types of epilepsy, which are categorized by the type of seizure you experience or the part of the brain that is affected, run in families. In these cases, it is likely that there's a genetic influence. Researchers have linked some types of epilepsy to specific genes, though it is estimated that up to 500 genes could be associated with the condition. For most people, genes are only part of the cause of epilepsy. Certain genes may make a person more sensitive to environmental conditions that trigger seizures.
• Head trauma. Head trauma as a result of a car accident or other traumatic injury can cause epilepsy.
• Brain conditions. Brain conditions that cause damage to the brain, such as brain tumors or strokes, can cause epilepsy. Stroke is a leading cause of epilepsy in adults older than age 35.
• Infectious diseases. Infectious diseases, such as meningitis, AIDS and viral encephalitis, can cause epilepsy.
• Prenatal injury. Before birth, babies are sensitive to brain damage that could be caused by several factors, such as an infection in the mother, poor nutrition or oxygen deficiencies. This brain damage can result in epilepsy or cerebral palsy.
• Developmental disorders. Epilepsy can sometimes be associated with developmental disorders, such as autism and neurofibromatosis.

• Age. The onset of epilepsy is most common during early childhood and after age 60, but the condition can occur at any age.
• Family history. If you have a family history of epilepsy, you may be at an increased risk of developing a seizure disorder.
• Head injuries. Head injuries are responsible for some cases of epilepsy. You can reduce your risk by wearing a seat belt while riding in a car and by wearing a helmet while bicycling, skiing, riding a motorcycle or engaging in other activities with a high risk of head injury.
• Stroke and other vascular diseases. Stroke and other blood vessel (vascular) diseases can lead to brain damage that may trigger epilepsy. You can take a number of steps to reduce your risk of these diseases, including limiting your intake of alcohol and avoiding cigarettes, eating a healthy diet, and exercising regularly.
• Dementia. Dementia can increase the risk of epilepsy in older adults.
• Brain infections. Infections such as meningitis, which causes inflammation in your brain or spinal cord, can increase your risk.
• Seizures in childhood. High fevers in childhood can sometimes be associated with seizures. Children who have seizures due to high fevers generally won't develop epilepsy, although the risk is higher if they have a long seizure, other nervous system conditions or a family history of epilepsy.

To diagnose epilepsy, your doctor will review your symptoms and medical history. Your doctor may order several tests to diagnose epilepsy and determine the cause of seizures.

• Neurological examination. Your doctor may test your behavior, motor abilities, mental function, and other areas to diagnose your condition and determine the type of epilepsy you may have.
• Blood tests. Your doctor may take a blood sample to check for signs of infections, genetic conditions or other conditions that may be associated with seizures.
• Your doctor may also suggest tests to detect brain abnormalities, such as:
• Electroencephalogram (EEG). An EEG records the electrical activity of your brain via electrodes affixed to your scalp. EEG results show changes in brain activity that may be useful in diagnosing brain conditions, especially epilepsy and other seizure disorders.
• Computerized tomography (CT) scan. A CT scan uses X-rays to obtain cross-sectional images of your brain. CT scans can reveal abnormalities in your brain that might be causing your seizures, such as tumors, bleeding and cysts.
• Magnetic resonance imaging (MRI). An MRI uses powerful magnets and radio waves to create a detailed view of your brain. Your doctor may be able to detect lesions or abnormalities in your brain that could be causing your seizures.
• Functional MRI (fMRI). A functional MRI measures the changes in blood flow that occur when specific parts of your brain are working. Doctors may use an fMRI before surgery to identify the exact locations of critical functions, such as speech and movement, so that surgeons can avoid injuring those places while operating.
• Positron emission tomography (PET). PET scans use a small amount of low-dose radioactive material that's injected into a vein to help visualize active areas of the brain and detect abnormalities.
• Single-photon emission computerized tomography (SPECT). This type of test is used primarily if you have had an MRI and EEG that did not pinpoint the location in your brain where the seizures are originating. A SPECT test uses a small amount of low-dose radioactive material that is injected into a vein to create a detailed, 3-D map of the blood flow activity in your brain during seizures.

Understanding epilepsy can help you control it. You can take several steps to help prevent seizures and live a normal life:

• Take your medication correctly. Do not adjust your dosage before talking to your doctor. If you feel your medication should be changed, discuss it with your doctor.
• Get enough sleep. Lack of sleep can trigger seizures. Be sure to get adequate rest every night.
• Wear a medical alert bracelet. This will help emergency personnel know how to treat you correctly.
• Exercise. Exercising may help keep you physically healthy and reduce depression. Make sure to drink enough water and rest if you get tired during exercise.
• In addition, make healthy life choices, such as managing stress, limiting alcoholic beverages, and avoiding cigarettes.

Uncontrolled seizures and their effect on your life may at times feel overwhelming or lead to depression. Do not let epilepsy hold you back. You can still live an active, full life. To help cope:

• Educate yourself and your friends and family about epilepsy so that they understand the condition.
• Try to ignore negative reactions from people. It helps to learn about epilepsy so that you know the facts as opposed to misconceptions about the disease. And try to keep your sense of humor.
• Live as independently as possible. Continue to work, if possible. If you cannot drive because of your seizures, investigate public transportation options near you. If you are not allowed to drive, you may want to consider moving to a city with good public transportation options.
• Find a doctor you like and with whom you feel comfortable.
• Try not to constantly worry about having a seizure.
• Find an epilepsy support group to meet people who understand what you are going through.

Let people you work and live with know the correct way to handle a seizure in case they are with you when you have one. You may offer them suggestions, such as:

• Carefully roll the person onto one side.
• Place something soft under his or her head.
• Loosen tight neckwear.
• Do not try to put your fingers or anything else in the person's mouth. No one has ever "swallowed" his or her tongue during a seizure: it is physically impossible.
• Do not try to restrain someone having a seizure.
• If the person is moving, clear away dangerous objects.
• Stay with the person until medical personnel arrive.
• Observe the person closely so that you can provide details on what happened.
• Time the seizures.
• Be calm during the seizures.

Once epilepsy is diagnosed, it is important to begin treatment as soon as possible. For about 70 percent of people diagnosed with epilepsy, seizures can be controlled with modern medicines and surgical techniques. Some drugs are more effective for specific types of seizures. An individual with seizures, particularly those that are not easily controlled, may want to see a neurologist specifically trained to treat epilepsy. In some children, special diets may help to control seizures when medications are either not effective or cause serious side effects.

Most people with epilepsy can become seizure-free by taking one anti-seizure medication, called anti-epileptic medications or anticonvulsants. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications. Your doctor will advise you about the appropriate time to stop taking medications.

More than half the children with epilepsy who are not experiencing epilepsy symptoms can eventually discontinue medications and live a seizure-free life. Many adults also can discontinue medications after 2 or more years without seizures.

Finding the right medication and dosage can be complex. There are several types of anti-epileptic medications that all work in different ways. Your doctor will consider your condition, frequency of seizures, your age and other factors when choosing which medication to prescribe. Your doctor will also review any other medications you may be taking, to ensure the anti-epileptic medications will not interact with them.

Common medications for epilepsy include:

• Carbamazepine (Carbatrol, Epitol, Equetro, Tegretol)
• Oxcarbazepine (Trileptal)
• Valproic acid (Depakote, Depakene)
• Topiramate (Topamax, Topiragen, Trokendi)
• Gabapentin (Neurontin)
• Phenytoin (Dilantin, Phenytek)
• Ethotoin (Peganone)
• Perampanel (Fycompa)
• Lamotrigine (Lamictal)
• Levetiracetam (Keppra, Keppra XR)

Surgery is most commonly done when tests show that your seizures originate in a small, well-defined area of your brain that does not interfere with vital functions such as speech, language, motor function, vision, or hearing. In surgery, your doctor removes the area of your brain that is causing the seizures.

If your seizures originate in a part of your brain that cannot be removed, your doctor may recommend a different type of surgery in which surgeons make several cuts in your brain. These cuts are designed to prevent seizures from spreading to other parts of your brain.

Although many people continue to need some medication to help prevent seizures after successful surgery, you may be able to take fewer drugs and reduce your dosages.

Other therapies may be considered for epilepsy:

• Vagus nerve stimulation. In vagus nerve stimulation, doctors implant a device called a vagus nerve stimulator underneath the skin of your chest, similar to a heart pacemaker. Wires from the stimulator are connected to the vagus nerve in your neck. The battery-powered device sends bursts of electrical energy through the vagus nerve and to your brain. It's not clear how this inhibits seizures, but the device can usually reduce seizures by 20 to 40 percent. Most people still need to take anti-epileptic medication, although some people may be able to lower their medication dose. You may experience side effects from vagus nerve stimulation, such as throat pain, hoarse voice, shortness of breath or coughing.
• Ketogenic diet. Some children with epilepsy have been able to reduce their seizures by following a strict diet that is high in fats and low in carbohydrates. In this diet, called a ketogenic diet, the body breaks down fats instead of carbohydrates for energy. After a few years, some children may be able to stop the ketogenic diet and remain seizure-free. Consult a doctor if you or your child is considering a ketogenic diet. It is important to make sure that your child does not become malnourished when following the diet.