Epilepsy

Epilepsy is a brain disorder involving repeated, spontaneous seizures of any type. Seizures ("fits," convulsions) are episodes of disturbed brain function that cause changes in attention or behavior. They are caused by abnormally excited electrical signals in the brain. Seizures happen when your brain cells, which communicate through electrical signals, send out abnormal signals. Having several seizures (recurrent seizures) is considered epilepsy. Seizures are not considered to be epilepsy if they occur only once or are correctable. Epilepsy can happen at any age, but it is most common in the elderly. Many children with epilepsy outgrow the condition. However, even mild seizures that happen more than once should be treated, because they could cause harm if they happen while you are driving, walking, or swimming, for example.

Adults & Epilepsy

You have epilepsy. People with epilepsy have seizures. A seizure is a sudden brief change in the electrical activity in your brain. It leads to brief unconsciousness and uncontrollable body movements. 

Below are some questions you may want to ask your doctor or nurse to help you take care of yourself if you have epilepsy. 

What safety measures do I need to take at home to prevent injuries when I have a seizure? 

Is it okay for me to drive? Where can I call to find more information about driving and epilepsy? 

What should I discuss with my boss at work about my epilepsy? 

Are there work activities that I should avoid? 
Will I need to rest during the day? 
Will I need to take medicines during the work day?
Are there any sports activities that I should not do? Do I need to wear a helmet for any type of activities? 

Do I need to wear a medical alert bracelet? 

Who else should know about my epilepsy? 
Is it ever okay for me to be alone?
What do I need to know about my seizure medicines? 

What medicines am I taking? What are the side effects? 
Can I take antibiotics or other medicines also? How about acetaminophen (Tylenol), vitamins, herbal remedies? Will birth control pills still work if I am taking medicines for my seizures? 
How should I store the seizure medicines? 
What happens if I miss one or more doses? 
Can I ever stop taking a seizure medicine if there are side effects?
How often do I need to see the doctor? When do I need blood tests? 

What are the signs that my epilepsy is becoming worse? 

What should others with me do when I am having a seizure? After the seizure is over, what should they do? When should they call the doctor? When should we call 911? 

Causes

Seizures ("fits," convulsions) are episodes of disturbed brain function that cause changes in attention or behavior. They are caused by abnormally excited electrical signals in the brain. 

Sometimes a seizure is related to a temporary condition, such as exposure to drugs, withdrawal from certain drugs, a high fever, or abnormal levels of sodium or glucose in the blood. If the seizure or seizures do not happen again once the underlying problem is corrected, the person does NOT have epilepsy. 

In other cases, permanent injury to or changes in brain tissue cause the brain to be abnormally excitable. In these cases, the seizures happen without an immediate cause. This is epilepsy. Epilepsy can affect people of any age. 

Epilepsy may be idiopathic, which means the cause cannot be identified. These seizures usually begin between ages 5 and 20, but they can happen at any age. People with this condition have no other neurological problems, but sometimes have a family history of seizures or epilepsy. 

Some other more common causes of epilepsy include:

  • Stroke or transient ischemic attack (TIA)
  • Illnesses that cause the brain to deteriorate
  • Dementia, such as Alzheimer's disease
  • Traumatic brain injury
  • Infections (including brain abscess, meningitis, encephalitis, neurosyphilis, and AIDS)
  • Problems that are present from before birth (congenital brain defects)
  • Injuries near the time of birth (in this case, seizures usually begin in infancy or early childhood)
  • Kidney failure or liver failure
  • Metabolic diseases that children may be born with (such as phenylketonuria)
  • Tumors or other structural brain lesions (such as hematomas or abnormal blood vessels)

Children & Epilepsy

Your child has epilepsy. People with epilepsy have seizures. A seizure is a sudden brief change in the electrical activity in your brain. It leads to brief unconsciousness and uncontrollable body movements. 

Below are some questions you may want to ask your doctor or nurse to help you take care of your child's epilepsy. 

What safety measures do I need to take at home to keep my child safe during a seizure? 

What should I discuss with my child's teachers about epilepsy? 

Will my child need to take medicines during the school day? 
Can my child participate in gym class and recess?
Are there any sports activities that my child should not do? Does my child need to wear a helmet for any type of activities? 

Does my child need to wear a medical alert bracelet? 

Who else should know about my child's epilepsy? 
Is it ever okay to leave my child alone?
What do we need to know about my child's seizure medicines? 

What medicines does my child take? What are the side effects? 
Can my child take antibiotics or other medicines also? How about acetaminophen (Tylenol), vitamins, or herbal remedies? 
How should I store the seizure medicines? 
What happens if my child misses one or more doses? 
Can my child ever stop taking a seizure medicine if there are side effects?
How often does my child need to see the doctor? When does my child need blood tests? 

Will I always be able to tell my child is having a seizure? 

What are the signs that my child's epilepsy is becoming worse? 

What should I do when my child is having a seizure? 

When should I call 911? 
After the seizure is over, what should I do? 
When should I call the doctor?

Prevention

Generally, there is no known way to prevent epilepsy. However, proper diet and sleep, and staying away from illegal drugs and alcohol, may decrease the likelihood of triggering seizures in people with epilepsy. 

Reduce the risk of head injury by wearing helmets during risky activities; this can help lessen the chance of developing epilepsy. 

Persons with uncontrolled seizures should not drive. Each state has a different law that determines which people with a history of seizures are allowed to drive. If you have uncontrolled seizures, you should also avoid activities where loss of awareness would cause great danger, such as climbing to high places, biking, and swimming alone. 

Treatment

If an underlying cause for recurrent seizures (such as infection) has been identified and treated, seizures may stop. Treatment may include surgery to remove a tumor, an abnormal or bleeding blood vessel, or other brain problems. 

Medication to prevent seizures, called anticonvulsants, may reduce the number of future seizures. These drugs are taken by mouth. 

The type of medicine you take depends on what type of seizures you are having. The dosage may need to be adjusted from time to time. 
Some seizure types respond well to one medication and may respond poorly (or even be made worse) by others. Some medications need to be monitored for side effects and blood levels. 
It is very important that you take your medication on time and at the correct dose. Most people taking these drugs need regular checkups and regular blood tests to make sure they are receiving the correct dosage. 
You should not stop taking or change medications without talking to your doctor first.
Some factors increase the risk for a seizure in a person with epilepsy. Talk with your doctor about:

  • Certain prescribed medications
  • Emotional stress
  • Illness, especially infection
  • Lack of sleep
  • Pregnancy
  • Skipping doses of epilepsy medications
  • Use of alcohol or other recreational drugs

Epilepsy that does not get better after two or three seizure drugs have been tried is called "medically refractory epilepsy." 

Some patients with this type of epilepsy may benefit from brain surgery to remove the abnormal brain cells that are causing the seizures. 
Others may be helped by a vagal nerve stimulator. This is a device that is implanted in the chest (similar to a heart pacemaker). This stimulator can help reduce the number of seizures, but rarely stops the seizures completely.
Sometimes, children are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet. A diet low in carbohydrates, such as the Atkins diet, may also be helpful in some adults. 

Persons with epilepsy should wear medical alert jewelry so that prompt medical treatment can be obtained if a seizure occurs. 

Signs & Symptoms

Seizures are classified in two main categories: 

Partial seizures -- involve a part of the brain. They can be: 

Simple partial seizures -- Symptoms may include involuntary twitching of the muscles or arms and legs; changes in vision; vertigo; and experiencing unusual tastes or smells. The person does not lose consciousness. 
Complex partial seizures -- Symptoms may be similar to those of partial seizures, but the person does lose awareness for a time. The persona may engage in repetitive behavior (like walking in a circle or rubbing their hands) or stare.

Generalized seizures -- involve much more or all of the brain. They can be: 

Absence seizures (petit mal) -- Symptoms may include staring and brief loss of consciousness. 
Myoclonic seizures -- Symptoms may include jerking or twitching of the limbs on both sides of the body. 
Tonic-clonic seizures (grand mal) -- Symptoms may include loss of consciousness, shaking or jerking of the body, and loss of bladder control. The person may have an aura or an unusual feeling before the seizure starts. These seizures can last from 5 - 20 minutes.

The severity of symptoms can vary greatly, from simple staring spells to loss of consciousness and violent convulsions. For most people with epilepsy, each seizure is similar to previous ones. The type of seizure a person has depends on a variety of things, such as the part of the brain affected and the underlying cause of the seizure. 

An aura consisting of a strange sensation (such as tingling, smelling an odor that isn't actually there, or emotional changes) occurs in some people prior to each seizure. 

Grand Mal

A generalized tonic-clonic seizure is a seizure involving the entire body. It is also called a grand mal seizure. Such seizures usually involve muscle rigidity, violent muscle contractions, and loss of consciousness. 

Generalized tonic-clonic seizures are the type of seizure that most people associate with the term "seizure," convulsion, or epilepsy. They may occur in people of any age, as a single episode, or as part of a repeated, chronic condition (epilepsy). 

Symptoms 
Many patients have an aura (a sensory warning sign) before the seizure. This can include vision, taste, smell, or sensory changes, hallucinations, or dizziness. 
 

The seizure itself involves:

  • Loss of consciousness or fainting, usually lasting between 30 seconds and 5 minutes
  • General muscle contraction and rigidity (tonic posture), usually lasting 15 - 20 seconds
  • Violent rhythmic muscle contraction and relaxation (clonic movement), usually lasting for 1 -2 minutes
  • Biting the cheek or tongue, clenched teeth or jaw
  • Incontinence (loss of urine or stool control)
  • Stopped breathing or difficulty breathing during seizure
  • Blue skin color
  • Almost all people lose consciousness, and most people have both tonic and clonic muscle activity.

After the seizure, the person usually has:

  • Normal breathing
  • Sleepiness that lasts for 1 hour or longer
  • Loss of memory (amnesia) regarding events surrounding the seizure episode
  • Headache
  • Drowsiness
  • Confusion, temporary and mild
  • Weakness of one side of the body for a few minutes to a few hours following seizure (This is called Todd's paralysis.)

Partial (focal) seizure

All seizures are caused by abnormal electrical disturbances in the brain. Partial (focal) seizures occur when this electrical activity remains in a limited area of the brain. The seizures may sometimes turn into generalized seizures, which affect the whole brain. This is called secondary generalization. 

Partial seizures can be further characterized as: 

Simple - not affecting awareness or memory 
Complex - affecting awareness or memory of events before, during, and immediately after the seizure, and affecting behavior

Symptoms 
Patients with focal seizures can have any of the symptoms below, depending on where in the brain the seizure starts. 

Patients with simple focal seizures do not lose consciousness and will be aware of and remember the events that occur at the time. 

Patients with complex partial seizures will have abnormal consciousness and may or may not remember any or all of the symptoms or events surrounding the seizure. Symptom such as the following may occur:

  • Abnormal muscle contraction
  • Muscle contraction/relaxation (clonic activity) -- common
  • Affects one side of the body (leg, part of the face, or other area)
  • Abnormal head movements
  • Forced turning of the head

Complex, repetitive movements (such as picking at clothes) -- these are called automatisms and include:

  • Abnormal mouth movements
  • Lip smacking
  • Behaviors that seem to be a habit
  • Chewing/swallowing without cause
  • Forced turning of the eyes
  • Abnormal sensations
  • Numbness, tingling, crawling sensation (like ants crawling on the skin)
  • May occur in only one part of the body, or may spread
  • May occur with or without motor symptoms
  • Hallucinations
  • Abdominal pain or discomfort
  • Nausea
  • Sweating
  • Flushed face
  • Dilated pupils
  • Rapid heart rate/pulse

Other symptoms:

  • Blackout spells -- periods of time lost from memory
  • Changes in vision
  • Sensation of deja vu
  • Changes in mood or emotion

Petit mal

A petit mal seizure is the term commonly given to a staring spell, most commonly called an "absence seizure." It is a brief (usually less than 15 seconds) disturbance of brain function due to abnormal electrical activity in the brain. 

Petit mal seizures occur most commonly in people under age 20, usually in children ages 6 to 12. They can occur as the only type of seizure but can also happen along with other types of seizures such as generalized tonic-clonic seizures (also called grand mal seizures), twitches or jerks (myoclonus), or sudden loss of muscle strength (atonic seizures).

Symptoms 
Most petit mal seizures last only a few seconds. Most commonly they involve staring episodes or "absence spells." 

The person may stop walking or talking in mid-sentence, and start again a few seconds later. The person usually does not fall. The person is usually wide awake and thinking clearly immediately after the seizure. 

"Spells" can be uncommon or occur up to hundreds of times in one day. They may occur for weeks to months before they are noticed, and may interfere with school function and learning. The seizures may sometimes be mistaken for a lack of attention or other misbehavior. Unexplained difficulties in school and learning difficulties may be the first indication of petit mal seizures. 

Symptoms of typical petit mal seizures may include:

  • Muscle activity changes
  • No movement
  • Hand fumbling (especially with longer spells)
  • Fluttering eyelids
  • Lip smacking (especially with longer spells)
  • Chewing (especially with longer spells)
  • Consciousness changes
  • Staring episodes (unintentional)
  • Lack of awareness of surroundings
  • Sudden halt in conscious activity (movement, talking, etc.)
  • May be provoked by hyperventilation or flashing lights, in some cases
  • Abrupt beginning of seizure
  • Each seizure lasts no more than a few seconds
  • Full recovery of consciousness, no confusion
  • No memory of seizure

Atypical petit mal seizures begin slower, last longer, and may have more noticeable muscle activity than typical petit mal seizures. There is usually no memory of the seizure. Symptoms may include:

  • Unintentional staring
  • Lack of awareness of surroundings
  • Sudden stop of conscious activity (movement, talking, etc.)
  • Hand fumbling
  • Fluttering eyelids
  • May be provoked by hyperventilation, in some cases
  • May have slower, gradual beginning of seizure
  • Each lasts only seconds to minutes
  • Recovery may be slower
  • May have short period of confusion or bizarre behavior
  • No memory of seizure
  • May change into a different type of seizure (such as a grand mal or atonic seizure)

Resources

The following organizations are good resources for information on epilepsy: 

  • American Epilepsy Society - www.aesnet.org 
  • Epilepsy Foundation of America (EFA) - www.efa.org

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