Neurology

Conditions We Treat

Seizure Disorders and Epilepsy

Abnormal electrical activity in the brain can cause seizures. When a person has repeated seizures, this condition is called epilepsy.  Diagnosis and treatment of these disorders often requires consultation with a neurologist. Highland Hospital and the specialists at Highland Neurology are available to help if you or a family member suffer from seizures or epilepsy.

What Causes Seizures?

There are many different causes of seizures. According to some studies, between 7% and 10% of people will suffer a single isolated seizure at some time in their life. Evaluation of a first seizure requires a careful neurologic history and examination, often followed by other specialized tests. Often the cause of a seizure is never discovered, despite extensive testing. Even if that is the case, your neurologist will be able to work with you to figure out what the next step should be.

What is a Seizure?

Brain cells use electrical signals to communicate with each other.  These electrical signals are normally very carefully regulated. A seizure occurs when there is an abnormal electrical discharge of brain cells all at once. Almost all seizures stop in less than five minutes, and most in less than 2 minutes. Rarely, seizures can continue for many minutes or even hours (a serious medical emergency called status epilepticus). 

Symptoms of Seizures

There are many different kinds of seizures. The symptoms of a seizure depend on where in the brain the abnormal electrical signals occur. Since different parts of the brain perform different functions, seizure symptoms can be quite diverse. 

A convulsion is probably the most common symptom people associate with seizures. In a convulsion, the abnormal brain electrical activity spreads over the entire brain.  The patient loses consciousness, collapses, and has rhythmic jerking of arms and legs. They may bite their tongues or lose control of bowel or bladder. The patient is often sleepy and confused for some time after the convulsion stops. 

First Aid for a Convulsion

If you witness a convulsion, have someone call 9-1-1. Try and prevent the patient from hitting his or her head on any sharp objects nearby, such as corners of furniture. DO NOT place your finger (or anything else) in the person's mouth! The common fear that a patient may "swallow his or her tongue" is just an old wives' tale. The only thing you can accomplish by putting something in the patient’s mouth is injuring yourself, the patient, or both. After the convulsion stops, roll the patient on his or her side and wait for EMS to arrive.

Learn more on first aid for seizures.

Not all seizures come with convulsions

Sometimes a seizure is just a change in the patient’s awareness ("spacing out," for example). Those kinds of episodes can be accompanied by behavior that looks intentional but is not (such as lip smacking, picking at clothes, etc.). In some seizures, the patient's awareness may be completely normal but there are involuntary muscle movements, odd sensations, or sometimes even hallucinations. 

Specialized Testing in Evaluation of Seizures

Almost every patient who has had a seizure requires an imaging study of the brain. The most common imaging studies are:

Some patients require both types of scans. These tests look for some of the visible causes of seizures, but in most cases they are normal.

Patients evaluated for seizures usually require at least one electroencephalogram (EEG) or "brain wave test." This simple, painless test records the electrical activity of the brain. The procedure involves applying small metal discs called electrodes to the surface of the scalp using a dab of special gel. Wires from the electrodes feed into a computer that records the brain’s electrical activity. The length of the recording varies, but is usually 30-40 minutes. Applying and removing the electrodes takes longer, though, so the entire process is over an hour. During the actual recording, all the patient has to do is sit in a recliner and relax. It is helpful if you doze off during the recording, since abnormalities often show up during the transition between sleep and wakefulness. Your neurologist reads the EEG to look for clues in the brain’s activity that may help define the cause or type of seizure. 

A normal EEG does not rule out the possibility of epilepsy. In fact, since the EEG records only a 30-minute snapshot of the brain’s activity, many EEGs are normal. The sensitivity of the EEG—that is, the likelihood that the test will pick up abnormality—increases each time the test is run. Sometimes patients need a second or third EEG or more over the course of evaluation. 

Myths About EEG

For such a simple test, the EEG or "brain wave test" is surrounded by many myths! Here are a few.

Myth EEG can read a person's thoughts.
Truth

The EEG has little to do with what a person is thinking, and certainly cannot allow your doctor to "read your mind."

Myth EEG can be used as a lie detector.
Truth The EEG cannot be used to tell if a person is lying.
Myth A normal EEG means I do not have epilepsy.
Truth Many patients with epilepsy have a normal EEG between attacks.
Myth An abnormal EEG means I have epilepsy.
Truth Many people without seizures have mild abnormalities on EEG. Epilepsy is a clinical diagnosis, that is, made on the basis of history and examination. The EEG is just one piece of the puzzle. It does not replace careful medical evaluation.
Myth The EEG can be used to change my brain.
Truth The EEG has no effect on the brain. It is a one-way recording, like a tape recorder or camera.
Myth There is a risk of electrical shock or electrocution with the EEG machine.
Truth There is no risk of shock or electrocution. All electrical equipment at Highland Hospital is checked regularly by the Biomedical Engineering department to ensure patient safety.

Because many abnormalities tend to show up during the transition between sleep and wakefulness, your neurologist may ask you to have a "sleep deprived EEG." This means staying up as late as possible the night before the test so you are more likely to fall asleep during the EEG session the next morning. Ideally, you should get only 3 or 4 hours of sleep and should avoid caffeine for 24 hours before the EEG. You do not have to stay up all night, but just as late as you can so that you are tired during the test the next day. 

Treatment of Seizure Disorders

Not all seizures require treatment. The decision is made on a case-by-case basis after discussion with your neurologist. For example, a single seizure that occurs during hospitalization for a major illness might not require long-term treatment with medications. In such cases we often say that the seizure was provoked by some other medical problem. When the other medical problem is treated, the chance of the seizure recurring is usually low.

A wide variety of medications is available when treatment is required. Like all drugs, each of these medications has pros and cons. Choosing the right medication for you requires discussion with your neurologist. More information on medications is available from the Epilepsy Foundation.

Some common-sense lifestyle modifications can also reduce the risk of seizures in susceptible individuals. These steps include getting regular sleep, eating regular meals, avoiding excessive alcohol consumption, and generally maintaining a healthy lifestyle. 

Prognosis for Patients with Seizure Disorders

In the past, epilepsy was often a debilitating disorder that prevented patients from working or living normal lives. All that has changed. Today, with proper treatment, the vast majority of patients with seizure disorders live normal, productive lives. In fact, you may even know someone with epilepsy, but you don't know it because their condition is controlled with medication.  You can find out more information from your neurologist, or from the Epilepsy Foundation.

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Face

Ask the person to smile. Is the face lopsided?

Arm

Ask the person to raise arms. Does one arm drift down?

Speech

Ask the person to repeat a phrase. Does their speech sound strange? Can they do it without slurring words?

Time

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