Epilepsy is a chronic central nervous system (neurological) disorder in which brain activity suddenly becomes abnormal, causing seizures or periods of unusual behavior, peculiar sensations, and sometimes a complete loss of awareness.
Important Note: Experiencing a single seizure does not mean you have epilepsy. Clinically, at least two unprovoked seizures occurring more than 24 hours apart are generally required for a formal epilepsy diagnosis.
While an epilepsy diagnosis can feel overwhelming, modern treatment with medications or specialized surgery can successfully control seizures for the vast majority of people. Additionally, some children with epilepsy may eventually outgrow the condition as their brains mature.
Symptoms & Types of Seizures
Because epilepsy is caused by abnormal electrical storms in the brain, seizures can affect virtually any process your brain coordinates. Symptoms vary wildly depending on the specific type of seizure you experience.
1. Focal Seizures (Partial Seizures)
These result from abnormal electrical activity in just one specific area of your brain.
- Focal Seizures Without Loss of Consciousness (Simple): You remain awake. It may alter your emotions or change how things look, smell, feel, or taste. It may also cause involuntary jerking of a body part, such as an arm or leg, and spontaneous sensory symptoms like tingling or dizziness.
- Focal Seizures With Impaired Awareness (Complex): These involve a change or loss of consciousness. You may stare blankly into space and not respond normally to your environment, or perform repetitive, purposeless movements like hand rubbing, chewing, swallowing, or walking in circles.
2. Generalized Seizures
These seizures involve abnormal electrical activity across all areas of the brain simultaneously.
- Absence Seizures (Petit Mal): Most common in children. They are characterized by staring into space and subtle, brief body movements like eye blinking or lip smacking. They usually last less than 10 seconds.
- Tonic Seizures: Cause severe muscle stiffening. These usually affect muscles in your back, arms, and legs and may cause you to fall to the ground.
- Atonic Seizures (Drop Seizures): Cause a sudden loss of muscle control, leading you to collapse suddenly or drop things.
- Clonic Seizures: Associated with repeated, rhythmic, jerking muscle movements. These usually affect the neck, face, and arms.
- Tonic-Clonic Seizures (Grand Mal): The most dramatic and recognizable type. They can cause an abrupt loss of consciousness, severe body stiffening and shaking, and sometimes a loss of bladder control or biting of the tongue.
Seek immediate medical help (Call 911) if you witness someone having a seizure and:
- The active seizure lasts more than 5 minutes.
- Normal breathing or consciousness doesn't return after the seizure stops.
- A second seizure follows immediately.
- The person has a high fever, is pregnant, or has diabetes.
- The person has visibly injured themselves during the seizure.
When to See a Doctor
If you experience a seizure for the very first time, you should seek immediate medical attention to determine the underlying cause. If you have already been diagnosed with epilepsy, contact your neurologist if you notice a sudden change in the frequency, severity, or type of your seizures, or if you begin experiencing new, intolerable side effects from your anti-seizure medications.
Causes
In about half of the people diagnosed with epilepsy, the condition has no identifiable cause (idiopathic). In the other half, the condition may be traced to various factors:
- Genetic Influence: Some types of epilepsy run in families, and researchers have linked some types to specific genes.
- Head Trauma: Car accidents, severe concussions, or traumatic brain injuries.
- Brain Conditions: Brain tumors or strokes. In fact, stroke is a leading cause of new-onset epilepsy in adults over age 35.
- Infectious Diseases: Infections such as meningitis, HIV, viral encephalitis, and some parasitic infections.
- Prenatal Injury: Before birth, babies are sensitive to brain damage caused by maternal infection, poor nutrition, or oxygen deficiencies.
- Developmental Disorders: Epilepsy can sometimes be associated with developmental disorders, such as autism spectrum disorder or neurofibromatosis.
Complications
Uncontrolled seizures can lead to circumstances that are dangerous to yourself or others:
- Physical Injury: Falling during a seizure can cause severe head injuries or broken bones. Seizing while bathing or swimming can lead to drowning.
- Car Accidents: Losing awareness or muscle control while operating a vehicle or heavy machinery.
- Pregnancy Risks: Seizures pose dangers to both mother and baby, and certain anti-epileptic medications increase the risk of birth defects.
- Status Epilepticus: A dangerous state of continuous seizure activity lasting more than 5 minutes. This is a medical emergency with a high risk of permanent brain damage or death.
- SUDEP: Sudden Unexpected Death in Epilepsy. While rare, people with frequent, poorly controlled tonic-clonic seizures are at a higher risk for this poorly understood complication.
Diagnosis
To accurately diagnose epilepsy and pinpoint the origin of the seizures, neurologists use several tests:
- Neurological Exam: Testing your behavior, motor abilities, and mental function to determine how the disorder is affecting you.
- EEG (Electroencephalogram): The most common test. Electrodes attached to the scalp record the electrical activity of your brain, looking for abnormal patterns even when you aren't actively having a seizure.
- Imaging (CT or MRI): Used to detect physical lesions, tumors, bleeding, or cysts in the brain that could be triggering the seizures.
- PET Scans: Used to visualize active areas of the brain and detect metabolic abnormalities.
Treatment
Epilepsy treatment generally begins with medication. If medications don't cure the condition, doctors may propose surgery or other therapies.
1. Medication
Most people with epilepsy can become seizure-free by taking a single anti-seizure medication (anti-epileptic). Finding the right medication and dosage can be a complex process of trial and error. Mild side effects include fatigue, dizziness, and weight changes. Severe but rare side effects include depression or liver inflammation. Never stop taking your medication abruptly, as this can trigger severe, non-stop seizures.
2. Surgery
If tests show that your seizures originate in a small, well-defined area of the brain that doesn't interfere with vital functions like speech, language, motor function, or vision, doctors may surgically remove that specific area to stop the seizures entirely.
3. Alternative Therapies
- Vagus Nerve Stimulation: A device implanted under the skin of the chest (similar to a pacemaker) sends regular, mild bursts of electrical energy to the vagus nerve in the neck, which has been shown to reduce seizure frequency by altering brain activity.
- Ketogenic Diet: A strict, medically supervised high-fat, ultra-low-carbohydrate diet has been shown to significantly reduce seizures, especially in children whose epilepsy does not respond well to medications.
Frequently Asked Questions (FAQs)
What should I do if I see someone having a seizure?
First, stay calm. Gently roll the person onto their side to help keep their airway clear and prevent choking. Place something soft under their head, loosen tight clothing around their neck, and remove any dangerous objects nearby. Never put anything into their mouth or try to hold them down. Time the seizure, and call 911 if it lasts longer than 5 minutes.
Can I still drive if I have been diagnosed with epilepsy?
Driving laws vary heavily by state and country. Generally, you must prove that you have been completely seizure-free for a specific period (often 6 months to a year) before you are legally allowed to drive again. Always discuss your driving restrictions honestly with your neurologist.
References
- Epilepsy Foundation
- Mayo Clinic - Epilepsy Symptoms and Causes
- World Health Organization (WHO) - Epilepsy Fact Sheet
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