A Mini-Guide to Epilepsy
Physical Health
Some people think of epilepsy as a condition that causes dramatic convulsions. While that can happen, there are many other ways epilepsy can affect people. If you or a loved one has been diagnosed with epilepsy, or if you just want to learn more about epilepsy, this mini guide will walk you through the basics of epilepsy.
What Is Epilepsy?
Epilepsy is a neurological (brain) disease that causes repeated seizures. You can also use the term seizure disorder to describe epilepsy.
A seizure is a burst of uncontrolled or abnormal electrical activity between neurons (brain cells) in the brain. Your neurons send and receive electrical signals from all over your body. When you have epilepsy, the electrical impulses between neurons can get disrupted. Instead of sending continuous electrical impulses, people with epilepsy can have a rhythmic electrical impulse pattern, causing bursts of electrical energy.
Types of Seizures
There are several different types of seizures. Physicians classify seizures by several factors, including:
- How a seizure begins (the onset)
- How aware a person is during a seizure
- Whether a person moves during the seizure (called motor symptoms)
There are two major types of seizures — generalized onset seizures and focal onset seizures.
Generalized Onset Seizures
Generalized onset seizures affect both sides of the brain at the same time. There are several types of generalized onset seizures.
Absence Seizures
An absence seizure (formerly known as a petit mal seizure) is a type of generalized seizure that causes a brief loss (absence) of awareness. It’s most commonly seen in children. Someone having an absence seizure may look like they’re staring off into space with a blank stare. They may or not also have minor muscle movements, such as eye blinking, lip-smacking, or hand movements. This type of seizure usually lasts a few seconds, but they can happen up to 100 times per day.
Atonic Seizures
The word atonic means without tone. Atonic seizures cause a loss of muscle tone, leading to suddenly weak muscles. During an atonic seizure, a person will lose muscle control in part of their body, usually for a few seconds. If it affects their legs, they may suddenly drop to the floor. That’s why this type of seizure is sometimes referred to as a drop seizure, or a drop attack.
Tonic Seizures
The word tonic means with tone. Tonic seizures cause increased muscle tone, leading to tense, stiff muscles. When the affected muscles stiffen, it can cause a sudden fall. Similar to atonic seizures, tonic seizures typical only last a few seconds. Some people can also lose awareness during a tonic seizure.
Clonic Seizures
The word clonus refers to repeated muscle jerking. During a clonic seizure, the muscles will rhythmically jerk, usually for a few seconds or minutes. This type of seizure most commonly affects the neck, face, and arms.
Myoclonic Seizures
A myoclonic seizure causes brief muscle jerking or twitching that lasts for a few seconds. This type of seizure most often affects the arms and legs.
Tonic-Clonic Seizures
Tonic-clonic seizures (formerly known as a grand mal seizure) combines stiff muscles (tonic) and repeated muscle jerking (clonic). During a tonic-clonic seizure, a person will suddenly lose consciousness, and have stiff muscles, shaking, and twitching. It usually lasts between one and five minutes. In some cases, the person having a seizure can bite their tongue or lose control of their bowels or bladder. This is the type of seizure many people think of when they hear the word seizure.
Focal Onset Seizures
Focal onset seizures begin in one area of the brain. In some cases, a focal seizure can spread to the other side of the brain to become a tonic-clonic seizure.
There are two types of focal onset seizures:
- Focal onset aware seizures — when a person is awake and aware during the seizure
- Focal onset impaired awareness seizures — when a person is confused or loses consciousness during the seizure
Focal Onset Seizure Symptoms
The symptoms of a focal onset seizure depend on what part of the brain is affected. For example, if a seizure occurs in the temporal lobe, it can affect a person’s emotions. Someone experiencing a temporal lobe seizure may suddenly feel an intense emotion, like fear or joy, or feel a sense of déjà vu. A focal onset seizure that occurs in the frontal lobe (the part of the brain that controls movement) can cause head movements, rocking, or bicycle pedaling movements in their legs.
An occipital lobe seizure can affect a person’s vision. If a seizure occurs in this part of the brain, a person can see things that aren’t there or temporarily lose their vision.
Focal Onset Seizure Warning Signs
Some people with focal onset seizures have an aura (warning signs) before the seizure begins. Common symptoms of a focal onset seizure aura include:
- Lip-smacking
- Losing muscle tone in the arms or legs
- Stiffness in body
- Numbness or tingling
- Jerky movements
- Screaming or yelling
- Repetitive movements
- A strange feeling in the stomach
- Feeling of déjà vu
- Unusual smell or taste
- Sudden intense feelings of joy or fear
- Seeing flashing lights
- Seeing something that isn’t there (called a hallucination)
Unknown Onset Seizures
If physicians don’t know when a seizure begins, it’s called an unknown onset seizure. You might be diagnosed with an unknown onset seizure if you had a seizure while you were alone and no one witnessed it.
With more information, an unknown onset seizure may be diagnosed as a generalized onset or focal onset seizure.
What Triggers a Seizure?
A seizure trigger is an event or something around you that causes a seizure to begin. Triggers are different for everyone. Some common seizure triggers include:
- Stress
- Feeling tired or not getting enough sleep
- Using alcohol or withdrawing from alcohol
- Using recreational drugs
- Hormonal changes
- Illness
- Flashing lights
- Skipping meals
- Vitamin or mineral deficiencies
- Being dehydrated
- Physical overexertion
- Certain medications
- Missing a dose of anti-seizure medication
If you have epilepsy, it’s important to track your seizures to try to figure out your personal seizure triggers. If you know your triggers, you can take steps to avoid them. A seizure diary can help. In your diary, take note of when the seizure happened, and what was going on right before it started. It might be how you felt, what you were doing, or what you ate or drank that day.
What Causes Epilepsy?
Up to 70% of people with epilepsy don’t know what caused it. Some of the known causes of epilepsy include:
- Genetics — some types of epilepsy are linked to specific genes that can run in families
- Head trauma — such as from a car accident or fall
- Brain tumors — seizures may be the first sign of a slow-growing brain tumor
- Blood vessel conditions in the brain — such as arteriovenous malformations or cavernous malformations
- Brain infections — such as meningitis, encephalitis, or a brain abscess
- Autoimmune disease — when the immune system mistakenly attacks part of the brain
- Injury before birth — brain damage can happen to babies in the womb due to an infection in the mother, poor nutrition, or not getting enough oxygen
- Metabolic disorders — some health conditions affect how the body
How Common Is Epilepsy?
Epilepsy isn’t a rare disorder. About 3.4 million people in the United States (U.S.) are living with epilepsy. Each year, 150,000 people are diagnosed with epilepsy.
People can develop epilepsy at any age. Many people think of epilepsy as a childhood condition. However, epilepsy develops almost as often in people over the age of 65 as it does in children. When older adults have seizures, it’s often a complication of another health conditions, like stroke or heart disease.
Other risk factors for epilepsy include:
How Is Epilepsy Diagnosed?
Epilepsy is diagnosed by a physician who specializes in diseases that affect the brain and nervous system, called a neurologist. Some neurologists specialize in treating people with epilepsy, known as epileptologists.
You’re considered to have epilepsy if you have two or more seizures not caused by another medical condition. Your physician may ask you or loved ones that witnessed your seizure about what happens during the seizure to determine what type of seizures you have.
Additional testing can help your physician learn more about the type and cause of your seizures. Getting an accurate diagnosis of the type and location of your seizures allows your physician to recommend the most effective treatment.
Physical Exam and Laboratory Tests
A physical exam and laboratory tests can help rule out other causes of seizures. Blood tests can check for signs of infection and other conditions that can cause seizures, such as low blood sugar. Genetic tests can check for inherited conditions that can cause seizures.
Neurological Exam
A neurological exam helps your physician learn about how well your brain and nervous system are working. Different tests help to assess your thinking, behaviors, movements, and senses.
Imaging Tests
Imaging tests create a picture of your brain and nervous system to help diagnose epilepsy. There are several types of brain imaging tests that can help diagnose epilepsy, including:
- Electroencephalogram (EEG) — a test that records electrical activity in your brain to find abnormal brain wave patterns
- Computerized tomography (CT) scan — a test that uses X-rays to create a detailed image of the brain to look for bleeding, tumors, or injuries that could be causing seizures
- Magnetic resonance imaging (MRI) scan — a test that uses magnets and radio waves to create an image of the brain to look for scarring and other brain abnormalities that may cause seizures
- Positron emission tomography (PET) scan — a test that measures blood flow and metabolic activity in the brain to help locate where seizures are occurring
How Is Epilepsy Treated?
The goal of epilepsy treatment is to have fewer seizures, or even no seizures. There are several available treatment options. We’ll review the most common treatments for epilepsy.
Antiseizure Medications
Antiseizure medications can help between 60% to 70% of people with epilepsy control their seizures. You may hear antiseizure medications called anti-epileptic drugs (AEDs) or anticonvulsants, but they all mean the same thing.
Some people will need to take antiseizure medication for the rest of their lives. Other people may be able to stop their medication after they remain seizure-free for two or more years. Many children diagnosed with epilepsy can eventually stop taking their antiseizure medications and go on to have a seizure-free life.
The type of antiseizure medication you take depends on the type of seizure you have, the condition causing epilepsy, other health conditions you have, and your age. There are more than 20 types of antiseizure medications available. Examples of antiseizure medications include:
- Brivaracetam (Briviact)
- Cannabidiol (Epidiolex)
- Carbamazepine (Tegretol)
- Cenobamate (Xcopri)
- Clobazam (Onfi)
- Clonazepam (Klonopin)
- Divalproex sodium (Depakote)
- Eslicarbazepine (Aptiom)
- Ethosuximide (Zarontin)
- Felbamate (Felbatol)
- Gabapentin (Neurontin)
- Lacosamide (Vimpat)
- Levetiracetam (Keppra)
- Oxcarbazepine (Trileptal)
- Perampanel (Fycompa)
- Pregabalin (Lyrica)
- Primidone (Mysoline)
- Rufinamide (Banzel)
- Stiripentol (Diacomit)
- Tiagabine (Gabitril)
- Topiramate (Topamax)
- Valproic acid (Depakene)
- Vigabatrin (Sabril)
- Zonisamide (Zonegran)
Surgery
If antiseizure medications don’t control seizures, your physician may recommend epilepsy surgery. During epilepsy surgery, a surgeon will remove the part of your brain causing seizures. You may be a candidate for epilepsy surgery if your seizures are localized to one small part of the brain and there is a small risk that surgery will affect your vital functions.
Ketogenic Diet
A ketogenic diet is a diet that’s high in fat and low in carbohydrates. When you eat a ketogenic diet, your body breaks down fat instead of carbohydrates to use for energy. This diet may help some people who still have seizures with other treatments.
Researchers don’t know why this diet helps epilepsy, but they think it may change how the brain uses energy and can reduce abnormal electrical activity that causes seizures.
Can You Die From Epilepsy?
Life-threatening complications of epilepsy are rare, but complications can occur. Status epilepticus is when you have continuous seizure activity for five minutes or more. When this happens, you’re at risk for permanent brain damage and death.
Sudden unexpected death in epilepsy (SUDEP) occurs in about 1% of people with epilepsy. It’s most common in people with frequent tonic-clonic seizures who don’t respond to treatment.
You may also endanger yourself if you have a seizure at the wrong place and time. For example, you could fall and break a bone or hit your head. If you have a seizure while driving, you may get in a car accident. Even everyday activities, like bathing or swimming can be dangerous for people with epilepsy.
