Epilepsy is a neurological condition involving the brain that makes people more susceptible to having 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.
When a person has two or more seizures, he or she is considered to have epilepsy. There are many possible causes of epilepsy, including tumors, strokes, and brain damage from illness or injury. In many cases, there may be no detectable cause for epilepsy.
The brain is the center that controls and regulates all voluntary and involuntary responses in the body. It consists of nerve cells that normally 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.
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 before the seizure occurs. An aura is a strange feeling, either consisting of visual changes, hearing abnormalities, or changes in the sense of smell. Two types of focal seizures include the following:
The seizures typically last less than one minute. The person may show different symptoms depending upon 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 person's muscles are typically 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 become pale.
This type of seizure commonly occurs in the temporal lobe of the brain, the area of the brain that controls emotion and memory function. This seizure usually lasts between one to two minutes. Consciousness is usually lost during these seizures and a variety of behaviors can occur. These behaviors may range from gagging, lip smacking, running, screaming, crying, and/or laughing. When the person regains consciousness, the person may complain of being tired or sleepy after the seizure. This is called the postictal period.
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 the following:
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 move or the eyes may blink. 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/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.
With atonic seizures, there is a sudden loss of muscle tone and the person may fall from a standing position or suddenly drop his/her head. During the seizure, the person is limp and unresponsive.
This seizure is characterized by five distinct phases that occur. 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. 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.
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.
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/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.
This type of seizure is associated with fever. 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 seizures. While the exact cause of the seizure may not be known, the more common seizures are caused by the following:
The person may have varying degrees of symptoms depending upon the type of seizure. The following are general symptoms of a seizure or warning signs of seizures. Symptoms or warning signs may include:
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 physician 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 physician 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.
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:
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 by injection or intravenous (IV) may be used.
It is important to take your medication on time and as prescribed by your physician. 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 side effects. Discuss your medication's side effects with your physician.
While you are taking medications, different tests may be done to monitor the effectiveness of the medication. These tests may include the following:
Frequent blood draws testing is usually required to check the level of the medication in the body. Based on this level, the physician 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.
These tests are performed to see how the person's body is responding to the medication.
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.
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 only used for persons over the age of 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/she may activate the impulses by holding a small magnet over the battery. In many cases, this will help to stop the seizure.
Another treatment option for seizures is surgery. Surgery may be considered in a person who:
Surgery for epilepsy and seizures is a very complicated surgery 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 physician for more information.
More information regarding the person with seizures or epilepsy: