Epilepsy and Seizures
Epilepsy is a neurological condition involving the brain that makes people more susceptible
to having recurrent, unprovoked seizures. It is one of the most common disorders of
the nervous system and affects people of all ages, races, and ethnic background. Almost
3 million Americans live with epilepsy.
Anything that interrupts the normal connections between nerve cells in the brain can
cause a seizure. This includes a high fever, low blood sugar, high blood sugar, alcohol
or drug withdrawal, or a brain concussion. Under these circumstances, anyone can have
one or more seizures. However, when a person has two or more unprovoked seizures,
he or she is considered to have epilepsy. There are many possible causes of epilepsy,
including an imbalance of nerve-signaling chemicals called neurotransmitters, tumors,
strokes, and brain damage from illness or injury, or some combination of these. In
the majority of cases, there may be no detectable cause for epilepsy.
What is a seizure?
The brain is the center that controls and regulates all voluntary and involuntary
responses in the body. It consists of nerve cells that communicate with each other
through electrical activity.
A seizure occurs when part(s) of the brain receives a burst of abnormal electrical
signals that temporarily interrupts normal electrical brain function.
The type of seizure depends on which part and how much of the brain is affected and
what happens during the seizure. The two broad categories of epileptic seizures are
generalized seizures (absence, atonic, tonic-clonic, myoclonic) and partial (simple
and complex) seizures. Within these categories, there are several different types
of seizures, including:
Focal or partial seizures. Focal seizures take place when abnormal electrical brain function occurs in one or
more areas of one side of the brain. Focal seizures may also be called partial seizures.
With focal seizures, particularly with complex focal seizures, a person may experience
an aura, or premonition, before the seizure occurs. The most common aura involves
feelings, such as deja vu, impending doom, fear, or euphoria. Visual changes, hearing
abnormalities, or changes in the sense of smell can also be auras. Two types of focal
Simple focal seizures. The person may have different symptoms depending on which area of the brain is involved.
If the abnormal electrical brain function is in the occipital lobe (the back part
of the brain that is involved with vision), sight may be altered, but muscles are
more commonly affected. The seizure activity is limited to an isolated muscle group,
such as the fingers, or to larger muscles in the arms and legs. Consciousness is not
lost in this type of seizure. The person may also experience sweating, nausea, or
Complex focal seizures. This type of seizure commonly occurs in the temporal lobe of the brain, the area of
the brain that controls emotion and memory function. Consciousness is usually lost
during these seizures. Losing consciousness may not mean that a person passes out--sometimes,
a person stops being aware of what's going on around him or her. The person may look
awake, but may have a variety of unusual behaviors. These behaviors may range from
gagging, lip smacking, running, screaming, crying, and/or laughing. When the person
regains consciousness, he or she may complain of being tired or sleepy after the seizure.
This is called the postictal period.
Generalized seizures. Generalized seizures involve both sides of the brain. There is loss of consciousness
and a postictal state after the seizure occurs. Types of generalized seizures include
Absence seizures (also called petit mal seizures). These seizures are characterized by a brief, altered state of consciousness and staring
episodes. Typically, the person's posture is maintained during the seizure. The mouth
or face may twitch or the eyes may blink rapidly. The seizure usually lasts no longer
than 30 seconds. When the seizure is over, the person may not recall what just occurred
and may go on with his or her activities, acting as though nothing happened. These
seizures may occur several times a day. This type of seizure is sometimes mistaken
for a learning problem or behavioral problem. Absence seizures almost always start
between ages 4 to 12 years.
Atonic (also called drop attacks). With atonic seizures, there is a sudden loss of muscle tone and the person may fall
from a standing position or suddenly drop his or her head. During the seizure, the
person is limp and unresponsive.
Generalized tonic-clonic seizures (GTC or also called grand mal seizures). The classic form of this kind of seizure, which may not occur in every case, is characterized
by five distinct phases. The body, arms, and legs will flex (contract), extend (straighten
out), and tremor (shake), followed by a clonic period (contraction and relaxation
of the muscles) and the postictal period. Not all of these phases may be seen in everyone with
this type of seizure. During the postictal period, the person may be sleepy, have
problems with vision or speech, and may have a bad headache, fatigue, or body aches.
Myoclonic seizures. This type of seizure refers to quick movements or sudden jerking of a group of muscles.
These seizures tend to occur in clusters, meaning that they may occur several times
a day, or for several days in a row.
Infantile spasms. This rare type of seizure disorder occurs in infants before six months of age. There
is a high occurrence rate of this seizure when the child is awakening, or when he
or she is trying to go to sleep. The infant usually has brief periods of movement
of the neck, trunk, or legs that lasts for a few seconds. Infants may have hundreds
of these seizures a day. This can be a serious problem, and can have long-term complications that
affect growth and development.
Febrile seizures. This type of seizure is associated with fever and is not epilepsy, although a fever
may trigger a seizure in a child who has epilepsy. These seizures are more commonly
seen in children between six months and five years of age, and there may be a family
history of this type of seizure. Febrile seizures that last less than 15 minutes are
called simple, and typically do not have long-term neurological effects. Seizures
lasting more than 15 minutes are called complex and there may be long-term neurological
changes in the child.
A person may experience one or many different types of seizures. While the exact cause
of the seizure may not be known, the more common seizures are caused by the following:
Other possible causes of seizures may include the following:
Use of illicit drugs
What are the symptoms of a seizure?
The person may have varying degrees of symptoms depending on the type of seizure.
The following are general symptoms of a seizure or warning signs of seizures. Symptoms
or warning signs may include:
Jerking movements of the arms and legs
Stiffening of the body
Loss of consciousness
Breathing problems or breathing stops
Loss of bowel or bladder control
Falling suddenly for no apparent reason, especially when associated with loss of consciousness
Not responding to noise or words for brief periods
Appearing confused or in a haze
Nodding the head rhythmically, when associated with loss of awareness or even loss
Periods of rapid eye blinking and staring
During the seizure, the person's lips may become bluish and breathing may not be normal.
The movements are often followed by a period of sleep or disorientation.
The symptoms of a seizure may resemble other problems or medical conditions. Always
consult your doctor for a diagnosis.
The full extent of the seizure may not be completely understood immediately after
onset of symptoms, but may be revealed with a comprehensive medical evaluation and
diagnostic testing. The diagnosis of a seizure is made with a physical examination
and diagnostic tests. During the examination, the doctor obtains a complete medical
history of the person and family and asks when the seizures occurred. Seizures may
be due to neurological problems and require further medical follow-up.
Diagnostic tests may include:
Electroencephalogram (EEG). A procedure that records the brain's continuous, electrical activity by means of electrodes
attached to the scalp.
Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies,
and a computer to produce detailed images of organs and structures within the body.
Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology
to produce horizontal, or axial, images (often called slices) of the body. A CT scan
shows detailed images of any part of the body, including the bones, muscles, fat,
and organs. CT scans are more detailed than general X-rays.
Lumbar puncture (spinal tap). A special needle is placed into the lower back, into the spinal canal. This is the
area around the spinal cord. The pressure in the spinal canal and brain can then be
measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for
testing to determine if there is an infection or other problems. CSF is the fluid
that bathes the brain and spinal cord.
Specific treatment for a seizure will be determined by your doctor based on:
Your age, overall health, and medical history
Type of the seizure
Frequency of the seizures
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the condition
Your opinion or preference
The goal of seizure management is to control, stop, or decrease the frequency of the
seizures without interfering with the normal activities of daily living (ADLs). The
major goals of seizure management include the following:
Proper identification of the type of seizure
Using medication specific to the type of seizure
Using the least amount of medication to achieve adequate control
Maintaining appropriate medication levels
Treatment may include:
Medications. There are many types of medications used to treat seizures and epilepsy. Medications
are selected based on the type of seizure, age of the patient, side effects, the cost
of the medication, and the adherence with the use of the medication.
Medications used at home are usually taken by mouth (as capsules, tablets, sprinkles,
or syrup), but some can be given rectally (into the person's rectum). If the person
is in the hospital with seizures, medication may be given by injection or intravenously
by vein (IV).
It is important to take your medication on time and as prescribed by your doctor.
Different people use up the medication in their body differently, so adjustments (schedule
and dosage) may need to be made for the most effective seizure control.
All medications can have side effects, although some people may not experience certain
side effects. Discuss your medication's possible side effects with your doctor.
While you are taking medications, different tests may be done to monitor the effectiveness
of the medication. These tests may include the following:
Blood work. Frequent blood draws testing is usually required to check the level of the medication
in the body. Based on this level, the doctor may increase or decrease the dose of
the medication to achieve the desired level. This level is called the therapeutic
level and is where the medication works most efficiently. Blood work may also be done
to monitor the effects of medications on body organs.
Urine tests. These tests are sometimes performed to see how the person's body is responding to
Electroencephalogram (EEG). An EEG is a procedure that records the brain's continuous, electrical activity by
means of electrodes attached to the scalp. This test is done to monitor how the medication
is helping the electrical problems in the brain.
Vagus nerve stimulation (VNS). Some people, whose seizures are not being well-controlled with seizure medications,
may benefit from a procedure called vagus nerve stimulation (VNS). VNS is currently most
commonly used for people over age 12 who have partial seizures that are not controlled
by other methods.VNS attempts to control seizures by sending small pulses of energy
to the brain from the vagus nerve, which is a large nerve in the neck. This is done
by surgically placing a small battery into the chest wall. Small wires are then attached
to the battery and placed under the skin and around the vagus nerve. The battery is
then programmed to send energy impulses every few minutes to the brain. When the person
feels a seizure coming on, he or she may activate the impulses by holding a small
magnet over the battery. In many cases, this will help to stop the seizure.There are
some side effects that may occur with the use of VNS. These may include, but are not
limited to, the following:
Surgery. Another treatment option for seizures is surgery. Surgery may be considered in a person
Has seizures that are unable to be controlled with medications.
Has seizures that always start in one area of the brain.
Has a seizure in a part of the brain that can be removed without disrupting important
behaviors such as speech, memory, or vision.
Surgery for epilepsy and seizures is very complicated and performed by a specialized
surgical team. The operation may remove the part of the brain where the seizures are
occurring, or, sometimes, the surgery helps to stop the spread of the bad electrical
currents through the brain.
A person may be awake during the surgery. The brain itself does not feel pain. With
the person awake and able to follow commands, the surgeons are better able to make
sure that important areas of the brain are not damaged.
Surgery is not an option for everyone with seizures. Discuss this treatment option
with your doctor for more information.
More information regarding the person with seizures or epilepsy
Make sure you or your child (if age appropriate) understand the type of seizure that
is occurring and the type of medication(s) that are needed.
Know the dose, time, and side effects of all medications.
Consult your doctor before taking other medications. Medications for seizures can
interact with many other medications, causing the medications to work improperly and/or
causing side effects.
Young women of childbearing age who are on seizure medications need to be informed
that seizure medications are harmful to a fetus, and the medication may also decrease
the effectiveness of oral contraceptives.
Check with your state to understand any laws about people with epilepsy or seizures
operating a motor vehicle.
If a person has good control over the seizures, only minimal restrictions need to
be placed on activities, in most cases.
Specific follow-up will be determined by your doctor.
Medications for seizures may not be needed for the person's entire life. Some people
may be taken off their medications if they have been seizure-free for one to two years.
This will be determined by your doctor.