Health Library

What is epilepsy?

Epilepsy is a neurological condition involving the brain that makes people more susceptible
to having recurrent seizures. It is one of the most common disorders of the nervous
system and affects people of all ages, races, and ethnic background. Almost 2.2 million
Americans live with epilepsy.

Anything that interrupts the normal connections between nerve cells in the brain can
cause a seizure. This includes a high fever, low blood sugar, high blood sugar, alcohol
or drug withdrawal, or a brain concussion. Under these circumstances, anyone can have
one or more seizures. However, when a person has two or more seizures, he or she is
considered to have epilepsy. There are many possible causes of epilepsy, including
an imbalance of nerve-signaling chemicals called neurotransmitters, tumors, strokes,
and brain damage from illness or injury, or some combination of these. In the majority
of cases, there may be no cause that can be discovered for epilepsy.

What is a seizure?

The brain is the center that controls and regulates all voluntary and involuntary
responses in the body. It consists of nerve cells that communicate with each other
through electrical activity.

A seizure happens when part(s) of the brain receives a burst of abnormal electrical
signals that temporarily interrupt normal electrical brain function.

What are the different types of seizures?

The type of seizure depends on which part and how much of the brain is affected and
what happens during the seizure. The two broad categories of epileptic seizures are
generalized seizures (absence, atonic, tonic-clonic, myoclonic) and partial (simple
and complex) seizures. Within these categories, there are several different types
of seizures, including:

• Focal or partial seizures. Focal seizures take place when abnormal electrical brain function happens 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, or warning, before the seizure happens. The most common aura involves feelings,
  such as deja vu, impending doom, fear, or a feeling of great happiness or well-being.
  Visual changes, hearing abnormalities, or changes in the sense of smell can also be
  auras. Two types of focal seizures include:

  • Simple focal seizures. The person may have different symptoms depending on 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 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.

  • Complex focal seizures. This type of seizure commonly happens in the temporal lobe of the brain, the area
    of the brain that controls emotion and memory function. Consciousness is usually lost
    during these seizures. Losing consciousness may not mean that a person passes out.
    Sometimes, a person stops being aware of what’s going on around him or her. The person
    may look awake, but may have a variety of unusual behaviors. These behaviors may range
    from gagging, lip smacking, running, screaming, crying, and/or laughing. When the
    person regains consciousness, he or she may complain of being tired or sleepy after
    the seizure. This is called the postictal period.

• Generalized seizures. Generalized seizures involve both sides of the brain. There is loss of consciousness
  and a postictal state after the seizure happens. Types of generalized seizures include
  the following:

  • Absence seizures (also called petit mal seizures). 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 twitch or the eyes may blink rapidly. The seizure usually lasts no longer
    than 30 seconds. When the seizure is over, the person may not recall what just happened
    and may go on with his or her activities, acting as though nothing happened. These
    seizures may happen 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.

  • Atonic (also called drop attacks). With atonic seizures, there is a sudden loss of muscle tone and the person may fall
    from a standing position or suddenly drop his or her head. During the seizure, the
    person is limp and unresponsive.

  • Generalized tonic-clonic seizures (GTC or also called grand mal seizures). The classic form of this kind of seizure, which may not happen in every case, is characterized
    by 5 distinct phases. 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. Not all of these phases may be seen in everyone with
    this type of seizure. 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.

  • Myoclonic seizures. This type of seizure refers to quick movements or sudden jerking of a group of muscles.
    These seizures tend to happen in clusters, meaning that they may happen several times
    a day, or for several days in a row.

  • Infantile spasms. This rare type of seizure disorder happens in infants before six months of age. There
    is a high occurrence rate of this seizure when the child is awakening, or when he
    or 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 that
    affect growth and development.

  • Febrile seizures. This type of seizure is associated with fever and is not epilepsy, although a fever
    may trigger a seizure in a child who has epilepsy. These seizures are more commonly
    seen in children between three months and six years of age. Also, 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. Febrile seizures often happen while the child’s body temperature
    is rising, so often the child is not already known to have a fever. 

What causes a seizure?

A person may experience one or many different types of seizures. While the exact cause
of the seizure may not be known, the more common seizures are caused by the following:

• In newborns and infants:

  • Birth trauma

  • Congenital (present at birth) problems

  • Fever or infection

  • Metabolic or chemical imbalances in the body

• In children, adolescents, and adults:

  • Alcohol or drugs

  • Head trauma

  • Infection

  • Congenital conditions

  • Genetic factors

  • Progressive brain disease

  • Alzheimer disease

  • Tumors

  • Stroke

  • Unknown reasons

Other possible causes of seizures may include the following:

• Brain tumor

• Neurological problems

• Drug withdrawal

• Medicines

• Use of unlawful drugs

What are the symptoms of a seizure?

The person may have varying degrees of symptoms depending on the type of seizure.
The following are general symptoms of a seizure or warning signs of seizures. Symptoms
or warning signs may include:

• Staring

• Jerking movements of the arms and legs

• Stiffening of the body

• Loss of consciousness

• Breathing problems or breathing stops

• Loss of bowel or bladder control

• Falling suddenly for no apparent reason, especially when associated with loss of consciousness

• Not responding to noise or words for brief periods

• Appearing confused or in a haze

• Nodding the head rhythmically, when associated with loss of awareness or even loss
  of consciousness

• Periods of rapid eye blinking and staring

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 healthcare provider for a diagnosis.

How are seizures diagnosed?

The full extent of the seizure may not be completely understood immediately after
onset of symptoms. It may be revealed with a comprehensive medical evaluation and
diagnostic testing. The diagnosis of a seizure is made with a physical exam and diagnostic
tests. During the exam, the healthcare provider obtains a complete medical history
of the person and family and asks when the seizures happened. Seizures may be due
to neurological problems and require further medical follow-up.

Diagnostic tests may include:

• Blood tests

• Electroencephalogram (EEG). A procedure that records the brain’s continuous, electrical activity by means of electrodes
  attached to the scalp.

• Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies,
  and a computer to produce detailed images of organs and structures within the body.

• Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology
  to produce horizontal, or axial, images (often called slices) of the body. A CT scan
  shows detailed images of any part of the body, including the bones, muscles, fat,
  and organs. CT scans are more detailed than general X-rays.

• Lumbar puncture (spinal tap). A special needle is placed into the lower back, into the spinal canal. This is the
  area where the spinal cord and nerves travel to and from the brain. The pressure in
  the spinal canal and brain can then be measured. A small amount of cerebral spinal
  fluid (CSF) can be removed and sent for testing to determine if there is an infection
  or other problems. CSF is the fluid that bathes the brain and spinal cord.

Treatment of a seizure

Specific treatment for a seizure will be determined by your healthcare provider based
on:

• Your age, overall health, and medical history

• Type of the seizure

• Frequency of the seizures

• Your tolerance for specific medicines, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

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:

• Proper identification of the type of seizure

• Using medicine specific to the type of seizure

• Using the least amount of medicine to achieve adequate control

• Maintaining appropriate medicine levels

• Getting adequate rest, as seizures are more likely to happen when one is sleep-deprived

• Avoiding things that may trigger a seizure  

Treatment may include:

• Medicines. There are many types of medicines used to treat seizures and epilepsy. Medicines are
  selected based on the type of seizure, age of the patient, side effects, the cost
  of the medicine, and the adherence with the use of the medicine.

  Medicines 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, medicine may be given by injection or intravenously
  by vein (IV).

  It is important to take your medicine on time and as prescribed by your healthcare
  provider. Different people use up the medicine in their body differently, so adjustments
  (schedule and dosage) may need to be made for the most effective seizure control.

  All medicines can have side effects, although some people may not experience certain
  side effects. Discuss your medicine’s possible side effects with your healthcare provider.

  While you are taking medicines, different tests may be done to monitor the effectiveness
  of the medicine. These tests may include the following:

  • Blood work. Frequent blood draws testing is usually needed to check the level of the medicine
    in the body. Based on this level, the healthcare provider may increase or decrease
    the dose of the medicine to achieve the desired level. This level is called the therapeutic
    level and is where the medicine works most efficiently. Blood work may also be done
    to monitor the effects of medicines on body organs.

  • Urine tests. These tests are sometimes performed to see how the person’s body is responding to
    the medicine.

  • Electroencephalogram (EEG). 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 medicine
    is helping the electrical problems in the brain.

• Vagus nerve stimulation (VNS). Some people, whose seizures are not being well-controlled with seizure medicines,
  may benefit from a procedure called vagus nerve stimulation (VNS). VNS is currently most
  commonly used for people over age 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 or she may activate the impulses by holding a small magnet over the
  battery. In many cases, this will help to stop the seizure.
  There are some side effects that may happen with the use of VNS. These may include,
  but are not limited to, the following:

  • Hoarseness

  • Pain or discomfort in the throat

  • Change in voice

• Surgery. Another treatment option for seizures is surgery. Surgery may be considered in a person
  who:

  • Has seizures that are unable to be controlled with medicines.

  • Has seizures that always start in one area of the brain.

  • Has a seizure in a part of the brain that can be removed without disrupting important
    behaviors, such as speech, memory, or vision.

  Surgery for epilepsy and seizures is very complicated and performed by a specialized
  surgical team. The operation may remove the part of the brain where the seizures are
  happening, 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 a choice for everyone with seizures. Discuss this treatment choice
  with your healthcare provider for more information.

More information regarding the person with seizures or epilepsy

• Make sure you or your child (if age appropriate) understand the type of seizure that
  is happening and the type of medicine(s) that are needed.

• Know the dose, time, and side effects of all medicines.

• Consult your healthcare provider before taking other medicines. Medicines for seizures
  can interact with many other medicines, causing the medicines to work improperly and/or
  causing side effects.

• Young women of childbearing age who are on seizure medicines need to be informed that
  seizure medicines are harmful to a fetus, and the medicine may also decrease the effectiveness
  of oral contraceptives.

• Some vitamins, such as folic acid, can reduce the risks to the fetus from taking seizure
  medicines. Ask your healthcare provider if folic acid is recommended.  

• Check with your state to understand any laws about people with epilepsy or seizures
  operating a motor vehicle.

• If a person has good control over the seizures, only minimal restrictions need to
  be placed on activities, in most cases.

• Specific follow-up will be determined by your healthcare provider.

• Medicines for seizures may not be needed for the person’s entire life. Some people
  may be taken off their medicines if they have been seizure-free for one to two years.
  This will be determined by your healthcare provider.