Epilepsy

Epilepsy is a brain condition that causes a person to have seizures. It is one of the most common disorders of the nervous system. It affects people of all ages, races, and ethnic backgrounds.

The brain consists of nerve cells that communicate with each other through electrical activity. A seizure occurs when one or more parts of the brain has a burst of abnormal electrical signals that interrupt normal brain signals. Anything that interrupts the normal connections between nerve cells in the brain can cause a seizure. This includes a high fever, high or low blood sugar, alcohol or illegal drug withdrawal, or a brain concussion. But when a person has recurrent seizures not due to a temporary health problem, this is diagnosed as epilepsy.

There are different types of seizures. The type of seizure depends on which part and how much of the brain is affected and what happens during the seizure. The 2 main categories of epileptic seizures are focal (partial) seizure and generalized seizure. Focal seizures can spread to become generalized seizures.

Focal (or partial) seizures take place when abnormal electrical brain function occurs in one or more areas of one side of the brain. Before a focal seizure, you may have an aura or signs that a seizure is about to occur. Common auras involve feelings, such as deja vu, impending doom, fear, or euphoria. Or you may have visual changes, hearing abnormalities, or changes in your sense of smell. The 2 types of focal seizures are:

• Impairment of awareness (previously called complex partial seizure).

• No impairment of awareness (previously called simple partial seizure).

The symptoms depend on which area of the brain is affected. If the abnormal electrical brain function is in the part of the brain involved with vision (occipital lobe), your sight may be altered. More often, muscles are affected. The seizure activity is limited to an isolated muscle group. For example, it may only include the fingers, or larger muscles in the arms and legs. You may also experience sweating, nausea, or become pale.

You may just stop being aware of what's going on around you. You may look awake, but have a variety of unusual behaviors. These may range from gagging, lip smacking, running, screaming, crying, or laughing. You may be tired or sleepy after the seizure. This is called the postictal period.

A generalized seizure occurs in both sides of the brain. Types of generalized seizures include:

• Absence seizure. This seizure causes a brief loss of awareness and staring. You will likely maintain your posture. Your mouth or face may twitch or your eyes may blink rapidly. The seizure usually lasts no longer than 30 seconds. When the seizure is over, you may not recall what just occurred. You may go on with your activities as though nothing happened. These seizures may occur a few times a day or many times.

• Atonic seizure or drop attack. With an atonic seizure, you have a sudden loss of muscle tone and may fall from a standing position or suddenly drop your head. During the seizure, you will be limp and unresponsive.

• Tonic-clonic seizure. In this classic form of seizure, your body, arms, and legs will flex (contract), extend (straighten out), and tremor (shaking). This is followed by contraction and relaxation of the muscles (clonic period) and the postictal period. During the postictal period, you may be sleepy. You may have problems with vision or speech, and may have a bad headache, fatigue, or body aches. Not all of these phases occur in everyone with this type of seizure. 

• Myoclonic seizures. This type of seizure you will experience quick movements or sudden jerking of a group of muscles. These seizures tend to occur in clusters, which means that you may have them several times a day.

A seizure can be caused by many things. Anything that irritates the brain or causes nerve cells to have abnormal electrical activity can cause a seizure. These can include:

• An imbalance of nerve-signaling brain chemicals (neurotransmitters).

• Brain tumor.

• Stroke.

• Brain damage from birth, illness, prior brain surgery, or injury.

• Infection (meningitis, encephalitis).

• Hereditary epilepsy, when your genes cause you to have seizures.

• Health conditions that alter the normal electrical activity of the brain, such as:

  • Illegal drug use or some medicines.

  • Withdrawal of alcohol or medicines.

  • Abnormal glucose levels or levels of electrolytes in your blood (like sodium).

Epilepsy may be caused by a combination of these. In most cases, the cause of epilepsy can’t be found.

Your symptoms depend on the type of seizure. General symptoms or warning signs of a seizure can include: 

• Staring.

• Jerking movements of the arms and legs.

• Stiffening of the body.

• Loss of consciousness.

• Breathing problems or stopping breathing.

• 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 your head rhythmically, when associated with loss of awareness or loss of consciousness.

• Periods of rapid eye blinking and staring.

During the seizure, your lips may become tinted blue and your breathing may not be normal. After the seizure, you may be sleepy or confused.

The symptoms of a seizure may be like those of other health conditions. Make sure to talk with your healthcare provider for a diagnosis.

Your primary healthcare provider may be the first healthcare provider to evaluate you for epilepsy. He or she may then refer you to a specialist for further evaluation. Your evaluation will include a health history, physical and neurologic exams, and tests. An epilepsy diagnosis is typically made when someone has more than 1 seizure that occurs for no apparent reason (an unprovoked seizure).

Health history

This is the most important part of your evaluation. Your healthcare provider will ask you to describe your seizures. They may also want to talk with family or friends who have seen your seizures. In addition, your healthcare provider will ask about your risk factors, including:

• Being born before your due date (premature birth).

• Oxygen deprivation during birth.

• A family history of epilepsy.

• Past nervous system infection, such as meningitis.

• A previous head or brain injury.

• Past stroke or brain tumor.

• A history of febrile seizures (childhood seizures caused by high fever).

• Use of illegal drugs or alcohol.

• Certain genetic disorders.

• Alcohol abuse or withdrawal.

• Alzheimer’s disease.

• Gluten intolerance or celiac disease.

• Hydrocephalus or an abnormal buildup of fluid around the brain.

• Withdrawal of antiepileptic medicines, even when they are used for other conditions, such as gabapentin for pain.

Physical and neurologic exams

The physical exam checks your overall health. Your pulse, blood pressure, and temperature are taken. The neurologic exam checks certain functions of your brain. These include reflexes, balance, muscle strength, and coordination. Mental skills, like language and memory, and nerve function of the body are also checked.

Tests for epilepsy

After the exams are done, the healthcare provider may order some tests. Electroencephalogram (EEG) and MRI are the most common tests used to support a diagnosis of epilepsy.

• Blood tests - You may need blood tests to help rule out certain health problems or provide more information. They can also be done to check levels of medication in your body to help your healthcare provider make changes to the doses your receiving. You may also have blood tests to check the effects of medicines on your other organs.

• EEG - An EEG is a procedure that records the brain's electrical activity. This is done by attaching electrodes to your scalp. This test is done to see how medicine is helping the electrical problems in your brain.

EEG monitoring - This is when the EEG is hooked up for a prolonged time, This can be done with you at home or in the hospital. Sometimes, video is recorded at the same time to determine if the EEG explains the seizure.

The goal of treatment is to control, stop, or reduce how often seizures occur. Treatment is most often done with medicine. There are many types of medicines used to treat epilepsy. Your healthcare provider will need to identify the type of seizure you are having. Medicines are selected based on the type of seizure, age of the person, side effects, cost, and ease of use. Medicines used at home are usually taken by mouth as capsules, tablets, sprinkles, or syrup. If you are in the hospital with seizures, medicine may be given by injection or intravenously by vein (IV).

It is important to take your medicine on time and as prescribed by your healthcare provider. People’s bodies react to medicine differently so your schedule and dosage may need to be adjusted for the best seizure control. All medicines can have side effects. Talk with your healthcare provider about possible side effects. While you are taking medicine, you may need testing done to see how well the medicine is working.

Other treatments

If medicine doesn’t work well enough for you, your healthcare provider may advise other types of treatment.

Vagus nerve stimulator (VNS)

This treatment sends small pulses of energy to the brain from one of the vagus nerves. This is a pair of large nerves in the neck. If you have partial seizures that are not controlled well with medicine, VNS may be an option.

VNS 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 one of the vagus nerves. The battery is then programmed to send energy impulses every few minutes to the brain. When you feel a seizure coming on, you may activate the impulses by holding a small magnet over the battery. In many cases, this will help to stop the seizure. VNS can have side effects, such as hoarse voice, pain in the throat, or change in voice.

Surgery

Surgery may be done to remove the part of the brain where the seizures are occurring. Or the surgery helps to stop the spread of the bad electrical currents through the brain. Surgery may be an option if your seizures are hard to control and always begin in one part of the brain that doesn’t control speech, memory, or vision.

Surgery for epilepsy seizures is very complex. It is done by a specialized surgical team. At UC Health, we use the most advanced seizure detection devices like stereo-EEG, subdural, or depth electrodes to precisely map the seizures and normal functions of the brain. We also offer new treatments like Responsive Neurostimulation (RNS) and Deep Brain Stimulation (DBS) to help prevent seizures.

Most cases of epilepsy start in childhood. Many children who are diagnosed with epilepsy continue to have seizures into adulthood. Often, doctors can’t explain why a child has epilepsy. Certain factors, such as head injury, brain infection, stroke, or tumors can raise a child’s risk for getting epilepsy. Seizure disorders like epilepsy may run in families. More and more people are being diagnosed with genetic causes for epilepsy as genetic testing becomes more widely available. 

If you have epilepsy, you can manage your health. Make sure to:

• Take your medicine exactly as directed

• Get enough sleep, as lack of sleep can trigger a seizure

• Stay away from anything that may trigger a seizure

• Have tests as often as needed

• See your healthcare provider regularly

Call your healthcare provider if:

• Your symptoms get worse or do not get better

• You have side effects from medicine