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Resource Description: 
National Institute of Neurological Disorders and Stroke is a comprehensive resource for information about epilepsy. The primary National Institutes of Health organization for research on epilepsy.
Epilepsy Foundation offers a wide range of information and programs to help people with epilepsy and their families.
Episode number: 
203
Transcript: 
Epilepsy (transcript)

Epilepsy is not a disease. It is a relatively common neurological disorder, a physical condition that periodically produces brief disturbances in the normal electrical activity of the brain. The condition is characterized by sudden, brief seizures that may temporarily interfere with muscle control, movement, speech, vision, or awareness.

For someone experiencing a seizure, this sudden change in the brain's electrical activity may alter the way everything looks, or may make the person's body move involuntarily. Sometimes it may even cause a convulsion, a more severe series of uncontrolled stiffening or shaking. Seizures usually last from a few seconds to a few minutes, then gradually subside as brain cell activity returns to normal.


Causes

Anyone can develop epilepsy; it occurs in all ages, races and social classes. In many cases, doctors can't pinpoint exactly what causes epilepsy in a particular person, but they do know some of the things that can make a person more likely to develop epilepsy. These include:

  • Injury to the brain before, during or after birth
  • Malformation of the brain
  • Infections that damage the brain, such as meningitis and encephalitis
  • Toxic substances that affect the brain, such as lead or alcohol poisoning
  • Injury and lack of oxygen to the brain
  • Disturbances in blood circulation to the brain (stroke and other vascular problems)
  • Brain tumors

 

Unlike some other medical conditions, epilepsy has no identifiable or consistent "triggers" which can bring on a seizure. However, some environmental and internal factors that may make seizures more likely to occur in a susceptible person include:

 

  • Alcohol
  • Strong emotion
  • Intense exercise
  • Flashing lights or loud music
  • Illness or fever
  • Lack of sleep
  • Emotional stress
  • Menstrual period
  • Hormonal changes
  • Drug use, including some prescription medications
  • Missed medication
  • Poor nutrition
  • Extreme fatigue
  • Low blood sugar
Symptoms

Seizures are the only visible symptom of epilepsy. There are different kinds of seizures, and symptoms of each type can affect people differently. A medical exam is advised if one or more of the following symptoms occur:

 

  • A convulsion with or without a fever
  • Short periods of blackout or confused memory
  • Occasional "fainting spells" in which bladder or bowel control is lost, followed by extreme fatigue
  • Episodes of blank staring
  • Brief periods of unresponsiveness to questions or instructions
  • Sudden stiffening or falls for no apparent reason
  • Episodes of blinking or chewing at inappropriate times
  • Dazed behavior; being unable to talk or communicate for a short time
  • Repeated movements that look out of place or unnatural
  • Sudden fear, anger, or panic for no apparent reason
  • Muscle jerks of arms, legs or body
  • Odd changes in the way things look, sound, smell or feel

 

Diagnosis

Diagnosing epilepsy can be difficult. Your doctor will first try to determine whether you experienced a seizure and, if so, whether the seizure was due to a condition other than epilepsy.

 

A physical examination and detailed medical history often provide the best clues as to whether you have epilepsy and what type of epilepsy and seizures you have. Discussing what happens to you just before, during, and right after a seizure can help the doctor make a diagnosis.

 

The most useful test in support of a diagnosis of epilepsy is electroencephalography (EEG), which measures the electrical activity of the brain. Magnetic resonance imaging (MRI) and computed tomography (CT) scans may be used to evaluate the cause and location of a possible source of epilepsy within the brain.

 

Treatment

Medication can effectively control seizures in many people with epilepsy. Other treatments that help control seizures include surgery; a special diet, especially helpful in children (ketogenic diet); or a device that stimulates nerves (vagus nerve stimulator). A combination of these treatments may be tried when medication alone does not control seizures.  For those whose seizures do not respond to medication, surgery can be considered if the source of the seizures can be identified and if that area of the brain can be safely operated upon.



Quick Facts

  • Epilepsy can be caused by anything that interferes with electrochemical activity in the brain. In most cases, the cause is unknown.

  • About 2.5 million Americans have epilepsy and 200,000 more are diagnosed with the disorder every year.

  • Ten percent of the American population will experience a seizure in their lifetime.

  • Epilepsy is a disorder or syndrome, not a disease. It is not a mental illness or psychiatric problem.  Epilepsy is not infectious or contagious.

  • A single seizure does not necessarily mean you have epilepsy. Doctors give a diagnosis of epilepsy only after a person has had two or more seizures.

  • Epilepsy can affect people of all ages, intelligence levels, and from all racial and social backgrounds.

  • The major form of treatment is long-term drug therapy. Drugs are not a cure and can have side effects.

  • With the appropriate treatment, up to 70% of people with epilepsy could be seizure free.

  • Many children with epilepsy will outgrow it.

  • Most seizures end in seconds or a couple of minutes and are easily dealt with.

  • Epilepsy is most common in young children and older adults, though anyone can develop epilepsy at any stage of life.

 *Quick Facts have been reviewed by medical experts working with Second Opinion and are current as of September, 2005.

Ask Your Doctor

This list of questions is a good starting point for discussion with your doctor. However, it is not a comprehensive list.

 

  • What type(s) of seizure(s) do I have?
  • What treatment options are available for my particular condition?
  •  What should I do in the event of an emergency?
  • Is it important to get a certain amount of sleep?
  • Will other prescription or over-the-counter medicines affect my epilepsy medicine?
  • What are the side effects of my epilepsy medicine? Are alternative treatment options available?
  • What if I'm pregnant, or planning to become pregnant?
  • I'm taking (or considering taking) oral contraceptives (birth control pills). Will the pill affect my epilepsy medicine's ability to control my seizures? Will my epilepsy medicine affect birth control pills, making them less effective?
  • What should I do if I have another seizure?
  • Is it safe for me to drive? If not, when will it be safe to start driving again?
  • Is it safe for me to swim? Are there any other activities I should be cautious about participating in?
  • Is it safe for me to drink alcohol?

Key Point 1

Seizures are symptoms of abnormal brain activity.  They can be traumatic events and cause injury.  It's important to know the signs of a seizure, to get a proper diagnosis of your seizure even though that diagnosis unjustifiably carries some stigma.

 

Because there are many different types of seizure and symptoms, epilepsy can be a difficult condition to diagnose. It is important for a doctor to know what type of seizure a person has in order to determine the most suitable course of treatment.

 

Not all seizures are epileptic seizures.  In fact, epilepsy centers across the nation report that 30% of people referred to them have non-epileptic attacks -- events that look like seizures but are not caused by abnormal brain activity.

 

The kind of seizure a person has depends on where in the brain the seizure starts and where it spreads. The most common seizure types are classified as either partial or generalized seizures.

 

When seizures appear to result from abnormal activity in just one part of the brain, they're called partial seizures. When seizures seem to involve most or all of the brain, the seizures are called generalized. Both classifications are broken up further into smaller, more specific categories.

 

Partial seizure types: 

  • Simple partial seizures. These seizures begin from a small area in your brain and don't result in loss of consciousness or of awareness. They may cause uncontrolled shaking of an arm, leg, or other parts of your body. They may also alter your emotions, change the way things look, smell, feel, taste, or sound, or cause a disturbance in your speech.
  • Complex partial seizures. These seizures also begin from a small area of your brain. They alter awareness and usually cause memory loss (amnesia). Complex partial seizures can cause staring and unusual movements, such as repeated hand rubbing, lip smacking, posturing of your arm, vocalization or swallowing. After the seizure ends, you may be confused or sleep for a few minutes, and you may be unaware you had a seizure.
  • Secondary generalized seizures (partial seizures with secondary generalization). These seizures occur when simple or complex seizures spread to involve your entire brain. They may begin as a complex partial seizure with staring and unusual movements. The seizure then becomes more intense, leading to generalized convulsions characterized by stiffening and shaking of your extremities and loss of consciousness.

 

Generalized seizure types: 

  • Tonic-clonic (grand mal seizures). The most intense of all types of seizures, these are characterized by a loss of consciousness, body stiffening and shaking, and sometimes tongue biting or loss of bladder control. After the shaking subsides, a period of confusion or sleepiness usually sets in, lasting for a few minutes to a few hours.
  • Absence (petit mal seizures). These seizures are characterized by staring, subtle body movements, and brief lapses of awareness. They occur most often in children.  This type of seizure is usually brief. Typically no confusion or sleepiness occurs when the seizure is over.
  • Myoclonic seizures. These seizures usually appear as sudden jerks of your arms and legs. Myoclonic seizures may last only a short time, from less than a second for single jerks to a few seconds for repeated jerks.
  • Atonic seizures. Also known as drop attacks, these seizures cause you to suddenly collapse or fall down. After a few seconds, you regain consciousness and are able to stand and walk.
    

Key Point 2

A diagnosis of epilepsy has both personal and social consequences.  It is a common diagnosis and it is a misunderstood condition.

 

Epilepsy can be controlled in most people, but you will need to avoid triggers, consider whether to engage in high risk activities, and accept that society has placed certain restrictions upon people with the diagnosis.

 

Most people with epilepsy can control their seizures by taking antiepileptic drugs and are able to work and enjoy recreational and other activities much the same as those who are unaffected by the condition.  About a third of people with epilepsy may not be able to achieve complete seizure control. 

 

However, because the possibility of breakthrough seizures exists, there are some limitations that people with epilepsy must adhere to for the safety of themselves and others.

  

  • Driving. Most states require a person to be seizure-free for a specific amount of time before obtaining a regular driver's license. Additionally, some states have a mandatory physician reporting requirement under which doctors must inform the state when they treat people of driving age who have epilepsy.
  • Sports. It is permissible – and even advisable – for people with epilepsy to exercise and participate in sports, with proper precautions. Swimming, for example, should be supervised and preferably done in a pool, rather than the ocean, a river, or a lake. Sports such as scuba diving, rock climbing, hang gliding, and other high-risk activities should be avoided.
  • Employment. Many people with epilepsy can and do hold jobs. Also, the Americans With Disabilities Act, a federal law, prohibits discrimination against people with disabilities in the workplace, as well as in many other situations. However, you should avoid working at heights or near water, as well as jobs involving moving machinery or driving.
  • Drinking Alcohol. Anyone taking drugs that act on the brain, such as antiepileptic drugs, is likely to be more sensitive to the intoxicating effects of alcohol. The intoxicating effects of the alcohol will be increased. Also keep in mind that alcohol can increase the risk of side effects from antiepileptic drugs and in some people makes seizures more likely to happen.

General Issues

 

It makes good sense for anyone who has epilepsy to keep the following in mind:

  • Avoid things that might trigger your seizures if you can, but don't become obsessed by this.
  • Keep stress to a minimum, but bear in mind you can't avoid it altogether. Learn ways to cope with stress if it is a problem.
  • Eat regular meals and a healthy diet.
  • Lack of sleep is a common trigger of seizures, so try to avoid getting over-tired.
  • Make sure that you have enough medication, especially if you are going to be away from home.
  • Have a plan for dealing with seizures. If you live alone, it may help to arrange a call system with a friend or neighbor in case you get a warning sign of a seizure.
  • Keep a sense of perspective – no one's life can ever be entirely risk-free. Be sensible about what you do but don't let epilepsy rule your existence.
    

Key Point 3

The goal of epilepsy treatment is to stop the seizures and resultant injuries but at the same time give the person a quality of life worth living. The initiation, continuation, and cessation of treatment are based upon your risk of having another seizure.

 

 

Medications to prevent seizures are typically the first line of treatment for people who have epilepsy. These medications, called anticonvulsants or antiepileptic drugs (AEDs), do not cure epilepsy, but for many people they can prevent seizures and help you avoid injuries that can happen during seizures.

 

The type of treatment that your doctor prescribes will depend on several factors including the frequency and severity of your seizures, your age, the overall condition of your health, and your medical history. An accurate diagnosis of the type of epilepsy is also an important consideration in choosing the best treatment.

 

Finding the right medication and dosage can be complex. It might take more than one drug, or trying several different drugs until the right one (or combination) is found.

 

Take as Directed

AEDs work best when they are taken regularly as prescribed. The exact timing of doses is not crucial. However, it is important that the correct dose is taken around the same time or times each day, and that that they are evenly spaced apart. One missed dose on a rare occasion is unlikely to result in a seizure, but it's always best to take your medication as prescribed.

 

Side Effects

All medications have the possibility of causing side effects. Whether or not you experience side effects depends on your individual reaction to a particular medication. Side effects should always be reported to your doctor. Many times, fine-tuning the dosage of your medication will reduce or eliminate side effects. If side effects persist, your doctor may decide to switch you to a different medication.

 

No matter what side effects you experience, don't stop taking your medication without first talking to your doctor. If you suddenly stop taking your medicine, it could cause your seizures to come back, happen more often, or last for longer than they did before.

 

Interactions with Other Medications

Some antiepileptic drugs can affect how other kinds of medications work and vice versa, so be sure to tell your doctor about any other drugs you are taking.  It's also wise to check with your pharmacist before taking over-the-counter medications, which can also interact adversely with drugs you are taking for epilepsy.

 

Coming Off Your Medication

You may need to take antiepileptic drugs for a long period of time, sometimes many years. However, if you have no had a seizure for two or more years, there is a chance that you may be able to come off your medication. However, this should only be done on the advice of your doctor because there is a risk that stopping treatment can allow your seizures to occur again.

 

Medline Plus

Medline Description: 

Conduct an off-site search for Epilepsy information from MedlinePlus.  These up-to-date search results are based on search terms specific to Second Opinion Key Points.

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