Epilepsy

What is epilepsy?

According to the CDC, almost 3 million Americans live with epilepsy and nearly 200,000 people in the U.S. develop this condition each year. Also called seizure disorder, epilepsy is a neurological disorder that causes recurrent, unprovoked seizures due to abnormal electrical signals produced by damaged brain cells. These seizures can affect your movements, sensations, behavior, emotions, or consciousness. The symptoms of a seizure can vary widely, ranging from brief lapses of attention or jerking movements of limbs to severe and prolonged convulsions.

Epilepsy can be caused by a variety of factors, including genetic conditions, brain trauma, infections, stroke, and tumors, although in many cases the cause remains unknown. It is typically diagnosed through medical history assessment, neurological examination, and diagnostic tests such as an electroencephalogram (EEG), which records your brain’s electrical activity.

Treatment for epilepsy usually involves medication, which can control seizures in many people. Other treatment options include surgery to remove a specific area of the brain that is causing seizures, dietary changes such as the ketogenic diet, and neurostimulation therapies. Treatment will be based on the type of seizures, their frequency, and how they affect you.

What causes epilepsy?

Epileptic seizures can be caused by several factors, and often the exact cause is not known. However, some known risk factors and causes of epilepsy include:

  • Genetics: Some types of epilepsy are inherited, and certain genes can make it more likely that you develop epilepsy. Specific genetic abnormalities can also make you more sensitive to environmental triggers that can bring on a seizure.
  • Medical conditions: Conditions that cause damage to your brain’s structure, such as brain tumors, strokes, and traumatic brain injuries, can lead to epilepsy. Stroke is a leading cause of epilepsy in adults over the age of 35.
  • Infections: Certain infectious diseases such as meningitis, viral encephalitis, and AIDS can cause epilepsy.
  • Developmental disorders: Epilepsy can sometimes be associated with developmental disorders, such as autism and neurofibromatosis.
  • Prenatal injury: Brain damage in utero—due to infection, poor nutrition, metabolic imbalances, or oxygen deficiency—can result in epilepsy.
  • Head injuries: Traumatic head injuries from accidents or falls can trigger the onset of epilepsy.
  • Autoimmune diseases: Some autoimmune disorders may cause inflammation in the brain, which can lead to epilepsy.

Understanding the specific cause of epilepsy can often help guide the treatment options and action plans if you have a seizure disorder.

What are the common triggers for an epileptic seizure?

Identifying triggers can help manage seizures. Some common triggers include:

  • Missed medication
  • Not getting enough sleep or poor sleep quality
  • Infection
  • Stress
  • Hormone changes (puberty, menopause, menstruation)
  • Dehydration
  • Illicit drug or alcohol abuse
  • Low blood sugar
  • Flashing, flickering, or bright lights
  • Certain medications

Keeping track of when you have seizures—including the time of day, activities prior to the seizure, and how you were feeling—can help identify patterns. Share this information with your healthcare provider to develop an action plan that may reduce seizure frequency.

What are the symptoms of epilepsy?

Symptoms vary based on seizure type and can differ from person to person. Common seizure types and their symptoms include:

Generalized Seizures

These affect both sides of the brain. Symptoms can include:

  • Tonic-clonic seizures (Grand mal): Sudden loss of consciousness, body stiffening and shaking, loss of bladder control, tongue biting.
  • Absence seizures (Petit mal): Brief loss of awareness, staring into space, subtle body movements such as eye blinking or lip smacking.
  • Atonic seizures: Sudden loss of muscle control, causing collapse.
  • Clonic seizures: Repetitive, rhythmic jerking movements, often of the neck, face, and arms.
  • Myoclonic seizures: Sudden brief jerks or twitches of the arms and legs.
  • Febrile seizures: Triggered by fever, common in children 6 months to 5 years; not classified as epilepsy.

Focal Seizures (Partial Seizures)

These begin in one area of the brain. Symptoms can include:

  • With impaired awareness: Altered consciousness, staring spells, unresponsiveness, repetitive movements (hand rubbing, chewing, swallowing).
  • Without impaired awareness: Sudden jerking movements or sensory changes (tingling, dizziness, flashing lights).

Auras

Auras can precede focal seizures and act as a warning. They may involve:

  • A feeling in your stomach
  • Sudden fear or anxiety
  • A taste or smell sensation
  • Visual changes such as flashing lights or shapes
  • Dizziness or hallucinations

People with epilepsy are at risk for two life-threatening conditions:

  • Sudden unexpected death in epilepsy (SUDEP): A rare event accounting for less than 2% of deaths among those with epilepsy.
  • Tonic-clonic status epilepticus: A prolonged seizure lasting more than 30 minutes, requiring emergency treatment to prevent permanent injury or death.

How is epilepsy diagnosed?

Diagnosing epilepsy involves a combination of medical history, symptom assessment, and diagnostic tests. These may include:

  • Medical history and physical exam: Detailed review of seizure type, frequency, triggers, and family history.
  • Neurological exam: Tests of behavior, motor skills, and mental function to identify affected brain areas.
  • Electroencephalogram (EEG): Records brain electrical activity; abnormal patterns can confirm epilepsy and its type.
  • Imaging tests:
    • MRI: Detailed brain images to detect tumors, cysts, or injury.
    • CT scan: Alternative when MRI is not possible, reveals structural abnormalities.
    • PET: Locates seizure origins when MRI/CT are inconclusive.
    • SPECT: Similar to PET, maps blood flow to pinpoint seizure focus.
  • Neuropsychological tests: Assess memory, thinking, and language to understand seizure impact.
  • Blood tests: Identify infections, genetic conditions, or other causes of seizures.

How is epilepsy treated?

The goal of epilepsy treatment is to achieve seizure freedom with minimal side effects and enable a normal life. Treatment options include:

  • Medications: Anti-epileptic drugs (AEDs) control seizures in about 70% of patients. Choice depends on seizure type, age, and other factors.
  • Surgery: For medically refractory epilepsy, removal of the seizure focus is considered when it does not impair critical functions.
  • Dietary therapy: Ketogenic or modified Atkins diets can reduce seizures, especially in children unresponsive to medication.
  • Neurostimulation:
    • Vagus nerve stimulation (VNS): Implanted device sends pulses to the vagus nerve.
    • Responsive neurostimulation (RNS): Device in the skull monitors and interrupts seizure activity.
    • Deep brain stimulation (DBS): Electrodes in the brain deliver electrical pulses to reduce seizures.
  • Lifestyle and supportive measures: Stress management, sleep hygiene, avoiding triggers, medical alert bracelet, support groups.

Treatment plans are individualized by a neurologist and adjusted over time as needed.

Sources

  • Seizure first aid. Centers for Disease Control and Prevention. Accessed Apr. 30, 2024.
  • What is epilepsy? Epilepsy Foundation. Accessed Apr. 30, 2024.
  • Epilepsy and seizures. National Institute of Neurological Disorders and Stroke. Accessed Apr. 30, 2024.
  • Seizure disorders. Merck Manual Professional Version. Accessed Apr. 30, 2024.
  • Drug treatment of seizures. Merck Manual Professional Version. Accessed Apr. 30, 2024.
  • Epilepsy. American Academy of Neurology. Brain & Life. Accessed Apr. 30, 2024.