What is epilepsy?
Epilepsy is a disorder of the brain. People who have epilepsy have electrical activity in the brain that is not normal, causing seizures. There are different types of seizures. In some cases, a seizure may cause jerking, uncontrolled movements, and loss of consciousness. In other cases, seizures cause only a period of confusion, a staring spell or muscle spasms. Epilepsy is also called a “seizure disorder”. A single seizure is not considered epilepsy. People who have epilepsy have repeated episodes of seizures. Epilepsy is not a mental illness, and it is not a sign of low intelligence. It is also not contagious. Seizures do not normally cause brain damage. Between seizures, a person with epilepsy is no different from anyone else.
What are the symptoms of epilepsy?
The primary symptom of epilepsy is seizures. A single seizure is not considered epilepsy. People who have epilepsy have repeated episodes of seizures.
There are many different types of seizures, and they each cause different symptoms. Some common types of seizures include the following:
Before a seizure begins, some people experience dizziness, emotional changes, or changes in vision (such as hallucinations), smell (smelling an odor that isn’t there), or touch (such as numbness or tingling). This is called an aura.
- Generalized tonic-clonic (grand mal) seizures: This type of seizure affects the whole brain. During the seizure, the muscles in the body become rigid (stiff), then shake and contract (called convulsions). The person having the seizure usually loses consciousness (faints). He or she may also clench the jaw, bite the tongue or cheek, or lose control of the bladder.
- Absence (or petit mal) seizures: This type of seizure affects the whole brain, and usually only lasts a few seconds. During the seizure, a person may have a staring spell, be unaware of his or her surroundings, suddenly stop talking or moving, or have small changes in muscle movements.
- Partial (focal) seizures: This type of seizure affects only one part of the brain. The symptoms may vary, depending on where in the brain the seizure starts. For example, a partial seizure may cause changes in emotions, or to the senses (for example, hallucinations, numbness, tingling, or other changes to vision, taste, smell, touch, or hearing). This type of seizure may also cause muscle contractions (for example, causing the person to move the head in an unusual way, or jerk an arm or a leg). Or, the seizure may cause staring spells, sometimes with unusual repetitive movements, such as moving the mouth or the lips, chewing or swallowing, or hand movements.
Causes & Risk Factors
What causes epilepsy?
Doctors don’t always know what causes epilepsy. Some things that may increase your risk for epilepsy include the following:
- Genetics: People with a parent or sibling who has epilepsy are at an increased risk for developing epilepsy.
- Head trauma: Serious head injuries can cause epilepsy, sometimes years after the injury.
- Infection: Infections such as meningitis, encephalitis, and AIDS can increase the risk of epilepsy.
- Medical conditions: Other medical conditions can increase the risk of epilepsy, such as Alzheimer’s disease, stroke, brain tumors, or problems with the blood vessels in the brain.
- Problems during pregnancy, birth, or early development: In some cases, infections during pregnancy, problems during birth, congenital brain defects (problems with the brain that are present at birth), or injury to an infant’s brain may cause epilepsy.
Diagnosis & Tests
How is epilepsy diagnosed?
To diagnose epilepsy, your doctor will review your medical history and perform a neurological exam. Your doctor may also recommend blood tests, and tests such as an electroencephalogram (EEG), computed tomography (CT) or magnetic resonance imaging (MRI). These tests allow your doctor to monitor your brain activity and examine your brain for problems such as bleeding or tumors.
How is epilepsy treated?
Epilepsy usually is treated with medicine. If medicine doesn’t help your seizures, your doctor may recommend surgery or other therapies. If your doctor knows what is causing your epilepsy, treating the cause may make the seizures stop.
What do I need to know about taking medicine for epilepsy?
Medicines that help prevent seizures are called anticonvulsants or antiepileptics. Your doctor will recommend a medicine based on the type of seizures you have, how often you have seizures, your age, and your general health. After you begin taking the medicine, your doctor will monitor you closely to determine whether the drug is working, to watch for side effects, and to make sure your dose is correct.
These medicines may cause side effects, including fatigue, dizziness, skin rash, or problems with your memory, coordination, or speech. Call your doctor right away if you experience depression, suicidal thoughts, or severe rash while taking your medicine.
To help your medicine work well, follow your doctor’s instructions for taking your medicine. Do not stop taking your medicine without talking to your doctor. Ask your doctor what to do if you miss a dose. Never take extra medicine, even if you think you’re about to have a seizure. Talk to your doctor before you start taking any new medicines, including vitamins or supplements.
You should avoid drinking alcohol if you have epilepsy. Alcohol can make it easier to have a seizure and can also affect the way your epilepsy medicine works in your body. Some medicines can also make it easier to have a seizure, so check with your doctor before starting to take any new medicines.
It may be possible for some people who have epilepsy to eventually stop taking medicine. However, this decision must be made by your doctor. Before you and your doctor can decide to stop the medicine, several questions should be considered. These include how quickly your seizures were controlled, how long you have been free of seizures, and if you have other illnesses that may affect your problem.
What about surgery and other therapies?
Surgery is most commonly done if it’s known that your seizures begin in a well-defined area of your brain that doesn’t interfere with important functions like speech, language, or hearing. In other cases of medicine-resistant seizures, your doctor may recommend a type of therapy called vagus nerve stimulation. This requires a small device be implanted under the skin on your chest. The device delivers electrical pulses to the vagus nerve in the neck. A kind of treatment for children with certain types of epilepsy that are difficult to control involves a strict diet that is high in fat and low in carbohydrates. This diet is known as a ketogenic diet. This diet should be prescribed and monitored by a physician. With all treatments, work with your doctor to determine the best treatment for you.
What should I do when someone has a seizure?
If you have epilepsy, you may want to share the following information with your family, friends and coworkers. If someone near you has a seizure, use the following general guidelines:
- Stay calm.
- Don’t move the person to another place.
- Don’t try to keep the person from moving or shaking.
- Don’t try to wake the person by shouting at or shaking them.
- Remove items that could cause injury if the person falls or bumps into them.
- Gently turn the person on his or her side so any fluid in the mouth can safely come out.
- Never try to force the person’s mouth open or put anything in it.
- Place something soft (such as a pillow) under his or her head.
- Most seizures aren’t life-threatening. You don’t need to call a doctor or an ambulance unless the person isn’t known to have epilepsy or unless the seizure lasts longer than 5 minutes.
- When the seizure is over, watch the person for signs of confusion. Allow the person to rest or sleep if he or she wishes.
What are the health risks associated with epilepsy?
Epilepsy can increase your risk of injury or other problems, including the following:
- Pregnancy complications: Uncontrolled seizures can affect the unborn baby. Epilepsy medicine may also affect the unborn baby. Decisions about taking medicine during pregnancy must be made by you and your doctor, after talking about the risks and the benefits.
- Injury: You can injure yourself during a seizure, or when a seizure causes you to fall, drown while swimming or bathing, or have a car accident. Laws about driving for people with epilepsy are different in each state. Ask your local epilepsy foundation about driving rules or ask your doctor.
- Emotional issues: People who have epilepsy are more likely to experience depression, mood disorders, and suicidal thoughts. Talk to your doctor if you think you might be depressed, or if you have thoughts about harming yourself.
- Sudden unexpected death in epilepsy (SUDEP): People who have epilepsy have a small risk of unexpected death, especially people who have frequent seizures that don’t respond to medicine. Doctors don’t know exactly why SUDEP occurs, but it is thought to be the result of breathing or heart problems.
Questions to Ask Your Doctor
- What causes epilepsy?
- What are symptoms other than seizures?
- What should I do while my child is having a seizure?
- What type of medicine is used to treat epilepsy?
- Are there side effects?
- I have epilepsy. Are my children at risk of having it too?
- Can you recommend a support group that helps people with epilepsy?
- Can epilepsy be prevented?
Epilepsy and Pregnancy
I have epilepsy. Are there risks to me if I become pregnant?
Women who have epilepsy and become pregnant have a higher risk for pregnancy-related complications than pregnant women who don’t have epilepsy. These complications include:
Pregnancy affects each woman who has epilepsy differently. Some women actually experience fewer seizures than normal while pregnant.
- Vaginal bleeding
- The possibility that your seizures may occur more often
- Preeclampsia (a condition during pregnancy that is a combination of high blood pressure and the presence of protein in the urine after 20 weeks of pregnancy)
- Separation of the placenta (the organ that provides nourishment for the baby during pregnancy) from the uterus (womb)
Are there risks to my baby?
More than 90% of women who have epilepsy deliver normal, healthy babies. But there are some risks. Babies of mothers who have epilepsy have a higher risk of the following:
- Being stillborn or being born premature
- Developing seizure disorders as they get older
- Delays in development and growth
- Bleeding problems in the baby after birth
- Birth defects caused by the medicine you take. However, it is important that you follow your doctor’s directions for taking your medicine. The risks of not taking your medicine are much higher for you and your baby. These include physical injury, developmental delay and even death from your seizures.
What can I do to help protect myself and my baby?
It’s very important that you take your antiseizure medicine just as your doctor tells you. If you haven’t had any seizures for 2 years or more, your doctor may want to slowly stop your seizure medicine before you become pregnant or while you are pregnant. However, you should not stop taking this medicine on your own.As with all pregnant women, it’s also very important for you to take prenatal vitamin supplements and folic acid, which can help prevent certain kinds of birth defects. Start taking these vitamins before you get pregnant to get the most benefit. Because your antiseizure medicine may change how your body absorbs folic acid, your doctor may recommend a type of prenatal vitamin with a higher dose of folic acid. Tell your doctor about any history of brain or spinal defects in your family (or in the family of the baby’s father). Eating a healthy diet, getting enough sleep and exercising regularly are other things you can do to have a safe and healthy pregnancy.
What can I expect when I’m pregnant?
During your pregnancy, you will see your doctor often. Your doctor will perform frequent blood tests to be sure that you’re getting enough antiseizure medicine. It’s very common for your doctor to change the dose of your medicine during your pregnancy. He or she may also want you to have several ultrasound exams (called sonograms) during your pregnancy. Your doctor may even want you to have an amniocentesis. In this procedure, a small amount of fluid is removed from your uterus. This fluid gives your doctor some information about the health of your unborn baby. These extra precautions are a way for your doctor to monitor your pregnancy and your unborn baby’s development.
When should I call my doctor?
Call your doctor if:
- You have a seizure that lasts longer than 5 minutes.
- You injured yourself during the seizure.
- The way you usually feel during and after having a seizure changes.
- It takes you longer than normal to recover after having a seizure.
- Your seizures become more severe or happen more frequently.
- A second seizure immediately occurs after the first.
- You are pregnant.
- You have diabetes.
- You have a sudden headache, numbness, or weakness in one side of your body, or problems with your vision or speech right before you have a seizure. These could be signs of a stroke.
Copyright © American Academy of Family Physicians
This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.