Epilepsy: Symptoms, causes, diagnosis and treatment
About one in 100 people in the United States will experience an unprovoked seizure in their lifetime. However, a single seizure does not mean epilepsy exists.
Epilepsy is a disorder of electrical signals in the brain that causes recurrent seizures. The symptoms are different. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others have officially had a seizure.
About one in 100 people in the United States will experience an unprovoked seizure in their lifetime. However, a single seizure does not mean epilepsy is present. At least two unprovoked seizures are required for the diagnosis of epilepsy.
Even mild epilepsy may require treatment because it can be dangerous during activities such as driving or swimming. Treatment usually includes medication and sometimes surgery, often eliminating or reducing the frequency and intensity of seizures. Many children with epilepsy have even higher problems with age.
Because epilepsy is caused by abnormal brain cells, epilepsy can affect any brain process. A seizure can:
Uncontrollable muscle jerking, arm, and leg movements.
Loss of consciousness.
Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type from time to time, so the symptoms of seizures will be similar.
Doctors classify seizures as either partial or general, based on how abnormal brain activity begins. In some cases, seizures can begin locally and then become generalized.
When seizures occur from abnormal activity in only one part of the brain, they are called partial seizures. Seizures fall into two categories.
Simple partial seizures. The seizures do not lead to loss of consciousness. May alter emotions or change the way you look, smell, taste, or sound. It can also lead to involuntary twitching of a part of the body, like an arm or leg, and natural symptoms such as itching, dizziness, and flickering.
Complex partial seizures. Convulsions change consciousness, causing a loss of consciousness for a period of time. Complex partial seizures often cause involuntary staring and movements - such as rubbing hands, twitching, chewing, swallowing, or walking in circles.
Seizures that seem to involve the entire brain are called generalized epilepsy. Four types of epilepsy exist.
No seizures (also called petit mal). These seizures are characterized by vision and subtle body movements and may cause a brief loss of consciousness.
Myoclonic epilepsy. These seizures often appear as sudden jerks or twitching of the arms and legs.
Depressive epilepsy. Also known as a drop, these seizures cause a loss of normal muscle tone and sudden collapse or fall.
Grand mal (also called grand mal) seizures. The most intense of all seizure types, characterized by loss of consciousness, body stiffness and tremors, and loss of bladder control.
Seek medical advice if experiencing it for the first time. Also, seek medical help immediately if any of the following occur.
The attack lasted more than five minutes.
Breathing or awakening does not return after the cessation of the seizure.
The second wave followed immediately.
Was injured during a seizure.
Epilepsy has no known cause in about half of the people who have it. In the other half, the condition can be traced to many factors.
Genetic influence. Some types of epilepsy, classified by type in families, are likely to have a genetic influence. Researchers have linked several types of epilepsy to specific genes, estimating up to 500 genes may be tied to the condition. For some, genes are only part of the cause, which can make a person more sensitive to the environmental problem that triggers seizures.
Head injury. In a car accident or other trauma that can cause seizures.
Medical disorder. Events such as stroke or heart attack that lead to damage to the brain can also cause seizures. Stroke is responsible for up to half of epilepsy cases in people over the age of 65.
Neuropathy. It is a leading cause of epilepsy in the elderly.
Diseases such as meningitis, AIDS, and viral encephalitis can cause seizures.
Wounded before birth. The fetus is susceptible to brain damage due to infection when the mother's nutrition is poor or lack of oxygen. This can lead to cerebral palsy in children. About 20 percent of seizures in children are associated with cerebral palsy or other neurological abnormalities.
Developmental disorder. Epilepsy can be associated with other developmental disorders, such as autism and Down syndrome.
Several factors can increase the risk of epilepsy:
The age. The onset of epilepsy is most common during childhood and after age 65, but problems can occur at any age.
Sex. Men are slightly more likely to develop epilepsy than women.
Family history. If you have a family history of epilepsy, you may be at increased risk of developing the disorder.
Hurt. These injuries are responsible for many cases of epilepsy. The risk can be reduced by always wearing a seat belt when driving and wearing a helmet when skiing, biking, riding a motorcycle or engaging in other activities with a high risk of head injury.
Stroke and other vascular diseases. May lead to brain damage and may cause epilepsy. It can take several steps to reduce the risk of such diseases, including limiting alcohol intake and avoiding tobacco, eating a healthy diet, and exercising regularly.
Brain infection. Infections such as meningitis, which causes inflammation in the brain or spine, can increase the risk of epilepsy.
Prolonged convulsions in children. High fever in children can sometimes be associated with prolonged seizures and epilepsy later in life, especially those with a family history of epilepsy.
Having a seizure at certain times can lead to a dangerous situation for yourself or others.
Fall. If you fall during a seizure, you can injure your head or break a bone.
Drowning. If you have epilepsy, you are 15 times more likely to drown while swimming or bathing than other people.
Car accident. Seizures that occur or loss of consciousness can be dangerous if you drive or operate other equipment. Many places have restricted driving licenses related to seizure control.
Pregnancy complications. Seizures during pregnancy are dangerous for both mother and baby, and some antiepileptic drugs increase the risk of birth defects. If you have epilepsy and are considering becoming pregnant, talk to your doctor. Most women with epilepsy are able to get pregnant and give birth to a healthy baby. You will need to be carefully monitored throughout your pregnancy, and medications may need to be adjusted. Work with your doctor to plan a pregnancy.
Other life-threatening complications from epilepsy are uncommon.
Epilepsy condition. This condition occurs if you are in a state of continuous active epileptic seizures lasting more than five minutes, or have frequent recurrent seizures with no return of consciousness in between them. People with status epilepticus have an increased risk of permanent brain damage and death.
Sudden unexplained death in patients with epilepsy. People with uncontrolled epilepsy are also at increased risk of sudden and unexplained death. Overall, less than 1 in 1,000 people die suddenly from epilepsy, but it is more common in people whose seizures are not controlled by treatment. The risk of death is particularly high when overall seizures are frequent.
Testing and diagnosis
Your doctor can use a number of tests to diagnose epilepsy, ranging from neurological tests to imaging techniques such as MRI.
Neuroscience and behavior. Your doctor may test your mobility, behavior, and intellectual capacity to see how seizures affect them.
Blood tests. Your doctor may take a blood sample to check for signs of infection, lead poisoning, anemia, or diabetes that can cause seizures.
Your doctor may also recommend tests to detect abnormalities in the brain. These include:
Neurological examination. This group includes IQ tests, memory and speech assessments, which help doctors determine where seizures are coming from. This type of checkup is often performed before epilepsy surgery.
Electroencephalogram (EEG). This is the most common test to diagnose epilepsy. The EEG records the electrical activity of the brain through electrodes attached to the scalp. If epilepsy is present, there are changes in the pattern of brain waves, even in the absence of seizures. The doctor may watch on video while doing an EEG while awake or asleep in the hope of seeing what type of seizure is present. Sometimes the doctor will have to do something to induce a seizure during the test, such as asking for very little sleep the night before.
Computed tomography (CT). CT may be indicated for an initial episode because it is usually the available test. CT can reveal abnormalities in the brain that can cause seizures, including bleeding, tumors, and cysts.
Magnetic resonance imaging (MRI). MRI provides the same type of information as CT but is much more specific. An MRI uses radio waves and a strong magnetic field to create detailed images of the brain. MRI can reveal abnormalities of the brain that can cause seizures.
Functional MRI (fMRI). Changes in blood flow occur when specific parts of the brain are working. Doctors often use fMRI before surgery to determine the exact locations of vital functions, such as speech, so that surgeons don't injure those places during treatment.
Positron emission tomography (PET). PET uses a small amount of a low dose of radioactive material injected into a vein to help visualize areas of brain activity and detect abnormalities.
Emission computed tomography (SPECT). This type of test is used mainly if an MRI and an EEG are available without identifying the location in the brain where the seizures originated. SPECT uses small doses of radioactive material injected into a vein to create a detailed 3D map of blood flow activity in the brain during a seizure.
Treatments and medicine
Doctors usually start with treating epilepsy with medication. If that doesn't work, surgery or another type of treatment may be recommended.
Most people with epilepsy can improve by using a single antiepileptic drug. Others may reduce the frequency and intensity of seizures. More than half of children with epilepsy, may eventually stop taking their controller medication and live a temporary seizure-free life. Many adults can also stop taking the drug after two or more years without seizures.
Finding the type and dose of medication can be complicated. Your doctor will likely first prescribe a single medication at a relatively low dose and may increase the dose gradually until the seizures are well controlled. If you've tried two or more medications with no success, your doctor may recommend trying a combination of the two.
All antiepileptic drugs have some side effects. Mild side effects include:
Loss of bone density.
Loss of coordination.
Hard to say.
Serious but rare side effects include:
Suicidal thoughts and behavior.
Inflammation of certain organs, such as the pancreas.
To achieve the best possible control with medication:
Take the medicine exactly as prescribed.
Always call your doctor before switching to another medication or taking another prescription, prescription, or herbal medicine.
Never stop taking your medicine without talking to your doctor.
Notify your doctor right away if you notice new feelings or increased depression, suicidal thoughts, or unusual changes in mood or behavior.
Half of all people newly diagnosed with epilepsy will have success with the first medication. If anti-seizure medications do not provide satisfactory results, your doctor may recommend surgery or other treatment.
Surgery is most commonly performed when testing shows that the seizure originates in a small, identified area of the brain, without interfering with vital functions such as language, hearing, or speech. In these types of surgery, the doctor removes the area of the brain that is causing the seizures.
If the seizure originates in a part of the brain that cannot be removed, your doctor may recommend another type of surgery, where the surgeon makes a series of cuts in the brain. The cuts are designed to stop the seizure from spreading to other parts of the brain.
Although many people continue to need certain medications to help prevent seizures after successful surgery, less medication can be used and the dosage is reduced. In some cases, epilepsy surgery can cause complications such as permanently altering cognitive abilities. Talk to your surgeon about the experience, success rates, and complication rates with the procedures you're considering.
Stimulation of the vagus nerve. This therapy involves a vagus nerve stimulator implanted under the skin of the chest such as a pacemaker. The stimulator wire is wrapped around the vagus nerve in the neck. Battery-powered devices carry electrical energy to the brain via the vagus nerve. It's not clear how well it inhibits seizures, but the device can reduce seizures by 30 to 40 percent. Most people still need to take anti-seizure medication. Side effects of vagus nerve stimulation include hoarseness, sore throat, cough, shortness of breath, itching, and muscle pain.
Ketogenic diet. Some children with epilepsy can reduce their seizures by maintaining a strict fat and low carbohydrate diet. This diet, known as a ketogenic diet, causes the body to break down fats instead of carbohydrates into energy. Some children can stop the ketogenic diet after a few years and still not have a seizure.
Consult your doctor if you are considering a ketogenic diet. It is important to ensure that a child does not become malnourished while on this diet. Side effects of the ketogenic diet can include dehydration, constipation, slowed growth due to nutritional deficiencies, and a buildup of uric acid in the blood, which can cause kidney stones. These side effects are rare with proper diet and medical supervision.
Lifestyle and remedies
Understanding the condition can help with control.
Take medicine correctly. It should not be used when adjusting the dosage on your own. Instead, talk to your doctor if you feel something should be changed.
Get enough sleep. Insomnia is a powerful trigger of seizures. Be sure to get adequate sleep each night.
Wear a medical alert bracelet. This will help emergency personnel know how to treat correctly.
In addition, there are healthy living choices such as managing stress, limiting alcohol, and avoiding tobacco.
Coping and supporting
Uncontrolled seizures and their impact on life can fall at times when you feel overwhelmed or lead to depression. It is important not to limit seizures. It is still possible to live a socially active life. To help cope:
Educate yourself and your family about epilepsy.
Try to ignore the negative reactions, it helps to learn about epilepsy, knowing the facts as opposed to the misconceptions about this disease. And try to keep the spirit of humor.
Be as independent as possible. This means continuing to work, if possible. If unable to drive because of the seizure, investigate nearby public transportation options.
Find a doctor and with someone you feel comfortable with.
Try not to worry about having a seizure.
If the seizure is so severe that it's impossible to work outside the home, there are ways to feel productive and connected with people. These include:
Work from home by developing special skills, like computer programming.
Build or join interests and connect over the Internet with others who are interested in similar things.
Grow friends and contact others.
Work and live with the correct way to handle the attack. This includes:
Gently roll to one side.
Put something soft under his head.
Loosen the scarf.
Don't try to put your fingers or anything else in the person's mouth.
Don't try to limit seizures.
Do not try to wake or scold.
If moving, remove dangerous objects.
Stay with the person having the attack until paramedics arrive.
Observe closely to be able to provide details of what happened.
The duration of the seizures.
Stay calm and reassure others nearby.