Epilepsy

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.”

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.

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:

• 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). They may also clench their jaw, bite their tongue or cheek, or lose control of their bladder.
• Absence (or petit mal) seizures: This type of seizure affects the whole brain and usually lasts only a few seconds. During the seizure, a person may have a staring spell, be unaware of their 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. These can include 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. These can include moving the mouth or the lips, chewing or swallowing, or hand movements.

Before a seizure begins, some people experience dizziness or emotional changes. They also may experience changes in vision (such as hallucinations), smell (smelling an odor that isn’t there), and touch (such as numbness or tingling). Feeling these things before a seizure is called an aura. Recognizing an aura is useful as a warning that you are about to have a seizure.

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)

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. These include 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.

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. They may also order 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.

Can epilepsy be prevented or avoided?

Doctors don’t always know what causes epilepsy. It seems to run in families. In that case, you may not be able to prevent it. But it also could be caused by a head trauma. If so, you might prevent epilepsy if you could prevent injuring your head.

Epilepsy treatment

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. They will also be watching for side effects, and to make sure your dose is correct.

Side effects may include 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 it. 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 performed 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 their 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 they wish.

Living with epilepsy

Never knowing when or where a seizure may occur can make you anxious. This anxiety can lead to depression. It could even trigger more seizures. To help combat this, talk to your doctor. They may prescribe medicine to help reduce anxiety or recommend therapy or a support group. You may need help finding a way to cope with your fear of having a seizure.

Epilepsy can also increase your risk of injury or other problems. Talk to your doctor about how to handle any relevant concerns, including:

• 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 doctor and your local epilepsy foundation about driving rules and restrictions.
• 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. 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?

Resources

Epilepsy Foundation: Understanding Epilepsy

National Institutes of Health, MedlinePlus: Epilepsy

National Institute of Neurological Disorders and Stroke: Epilepsy and Seizures