Andrey Nailor, M.D.·Published 12 August 2004·6 min read
Key points
Epilepsy is a condition of the nervous system that causes recurrent, sudden, brief changes in the normal electrical activity of the brain.
The symptoms of epilepsy vary depending on how much of the brain is affected, and where the affected area is located.
Although your doctor may look for any of the symptoms described above, these seizure symptoms may not be present during your office visit.
Epilepsy can be a lifelong condition, but many people with a history of multiple seizures eventually will stop having seizures.
What Is It?
Epilepsy is a condition of the nervous system that causes recurrent, sudden, brief changes in the normal electrical activity of the brain. During one of these "epileptic" episodes, commonly called a seizure or convulsion, brain cells fire uncontrollably at up to four times their normal rate, temporarily affecting the way a person behaves, moves, thinks or feels. This pattern of abnormal firing may either involve the entire brain (primary generalized seizure) or begin in one brain area, called a focus, and affect only part of the brain (partial seizure). Having a single seizure does not mean that a person has epilepsy.
Many conditions can affect the brain and trigger epilepsy, including:
Brain injury, either before or after birth
Brain tumors
Infections, especially meningitis and encephalitis
Genetic conditions, including tuberous sclerosis
Structural abnormalities in the brain's blood vessels
Lead poisoning
However, in about 70 percent of people with epilepsy, the specific cause is unknown.
Epilepsy is the second most common neurological disease in the United States, affecting approximately 2 million Americans. Each year, 125,000 to 150,000 people are diagnosed with epilepsy in the United States, and up to 50 percent of these are children and adolescents. Epilepsy is also more common in people over age 65.
Symptoms
The symptoms of epilepsy vary depending on how much of the brain is affected, and where the affected area is located.
Primary generalized seizures (involve all areas of the brain):
Generalized tonic-clonic seizure (also called grand mal) — In this type of seizure, the person loses consciousness, falls to the ground, and temporarily stops breathing. All body muscles then contract (tense up) at once for a short period. This is soon followed by a series of shorter rhythmic contractions. Some people also lose bowel or bladder control (incontinence). The seizure episode may last for a few minutes, and is followed by a period of sleepiness (lethargy) and confusion, possibly accompanied by muscle soreness and headache.
Absence seizure (also called petit mal) — In this type of seizure, loss of consciousness is so brief that the person usually doesn't change position. For a few seconds, the person may have a blank stare, rapid blinking, chewing movements of the mouth, or a brief rhythmic movement of an extremity. This type of seizure usually begins in childhood or early adolescence.
Partial (focal) seizures (begin in a single area of the brain):
Written and revised by
Andrey Nailor, M.D.
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Simple partial seizure — In this type of seizure, the person remains awake and aware. Symptoms vary depending on the specific brain area involved, and can include jerking movements in one part of the body; an experience of abnormal smells or a distorted environment; nausea; or emotional symptoms, such as unexplained fear or rage.
Complex partial seizure — In this type of seizure, the person may seem to be aware, but is briefly unresponsive. There may be a blank stare, chewing or lip-smacking, repetitive movements of the hand, or unusual behaviors. After the seizure, the person has no memory of the episode.
Either type of partial seizure can progress to a generalized seizure as the electrical activity spreads from the seizure focus to involve the rest of the cerebral cortex.
Status epilepticus — This condition occurs when a person has a generalized seizure that lasts 20 to 30 minutes or more, or a series of seizures without fully regaining consciousness. This is a life-threatening medical emergency.
Diagnosis
Although your doctor may look for any of the symptoms described above, these seizure symptoms may not be present during your office visit. For this reason, it is important to ask anyone who witnessed your seizure to describe the event, and to write it down for your doctor. This description will provide important clues about the type of seizure you had, and will help to determine the appropriate treatment.
You doctor will diagnose epilepsy based on your history, a thorough physical and neurological examination, and the results of an electroencephalogram (EEG). In many cases, your doctor will order a Computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of the brain. Other types of brain scans also may be needed, such as positron emission tomography (PET), or single photon emission computed tomography (SPECT). To check whether your seizures are related to medical causes outside the brain, your doctor may order basic lab tests including blood tests, urinalysis, and an electrocardiogram (EKG).
Expected Duration
Epilepsy can be a lifelong condition, but many people with a history of multiple seizures eventually will stop having seizures. People who are younger when seizures start and people who have a normal neurological examination are more likely to become seizure-free at some point. For most people with epilepsy, the frequency and/or severity of seizures can be reduced with medication.
Prevention
Since the cause of most cases of epilepsy remains unknown, there is no way to prevent seizures. To help prevent epilepsy caused by head injury, you can:
Wear seat belts while driving.
Equip your car with air bags.
Wear an approved helmet while skating, riding a motorcycle, or bicycling.
Use protective headgear for sports.
For people with an active seizure disorder, it is also important to take precautions to minimize the risk of injury if a seizure should occur. For this reason, it is generally recommended that people with epilepsy do not operate a motor vehicle or other dangerous machinery for at least six months following the most recent seizure.
People with epilepsy may find it helpful to wear a medical identification bracelet or other form of identification that describes their condition. This will provide vital information about their epilepsy to emergency personnel in case of a seizure episode away from home.
People with epilepsy may find it helpful to wear a medical identification bracelet or other form of identification that describes their illness. This will provide vital information about their epilepsy to emergency personnel in case of a seizure episode away from home.
Treatment
In most cases, your doctor will begin treatment with one of the many available anti-epileptic medications. These medications include carbamazepine (Tegretol), clonazepam (Klonopin), ethosuximide (Zarontin), felbamate (Felbatol), gabapentin (Neurontin), lamotrigine (Lamictal), phenobarbital (Solfoton), phenytoin (Dilantin), primidone (Mysoline), topiramate (Topimax) and valproic acid (Depakene, Depakote). The type of medication used depends on the type of seizure being treated.
When medication fails to control a person's seizures, surgery may be considered. The decision to perform surgery depends on many factors, including the frequency and severity of seizures, the patient's risk of brain damage or bodily injury from frequent seizures, the effect on quality of life, the person's overall health, and the likelihood that surgery will control seizure episodes. Status epilepticus, a life-threatening medical emergency, is treated with intravenous medications, together with protective measures to keep the person's airway open and to prevent injury to the person's head and tongue.
When To Call A Professional
Call your doctor whenever you or anyone in your family experiences any of the seizure symptoms described above. Call for emergency help immediately if you suspect that someone with epilepsy has developed status epilepticus.
Prognosis
About 70 percent to 80 percent of people with epilepsy can control their seizures with medication, while the remaining 20 percent to 30 percent have "medically intractable epilepsy" that cannot be controlled. Medically intractable epilepsy responds poorly to anti-epileptic drugs, but in many cases, it can be treated with surgery.
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