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Epilepsy

Epilepsy and seizures encompass a spectrum of brain disorders ranging from severe, life-threatening and disabling, to disorders that are much more benign. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions and behavior or sometimes convulsions, muscle spasms and loss of consciousness.

Epilepsy has many possible causes, and there are several types of seizures. Anything that disturbs the normal pattern of neuron activity – from illness to brain damage to abnormal brain development – can lead to seizures.

Epilepsy may develop because of an abnormality in brain wiring, an imbalance of nerve signaling chemicals called neurotransmitters, changes in important features of brain cells called channels or some combination of these and other factors. Having a single seizure as the result of a high fever (called febrile seizure) or head injury does not necessarily mean that you have epilepsy. Two or more seizures generally constitute a diagnosis of epilepsy.

Common causes of epilepsy include:

  • Stroke or transient ischemic attack
  • Dementia, such as Alzheimer’s disease
  • Traumatic brain injury
  • Infections, including brain abscesses, meningitis, encephalitis and AIDS
  • Congenital brain defects
  • Brain injury that occurs during birth
  • Metabolism disorders present at birth
  • Brain tumor
  • Abnormal vessels in the brain
  • Other illnesses that damage or destroy brain tissue
  • Use of certain medications, including antidepressants, tramadol, cocaine and amphetamines


Epilepsy seizures usually begin between ages 5 and 20, but they can occur at any age.


Common Symptoms

Symptoms vary from person to person. Some people may have simple staring spells, while others have violent shaking and loss of alertness. The type of seizure depends on the part of the brain affected and cause of epilepsy.Some people with epilepsy have a strange sensation (such as tingling, smelling an odor that isn't actually there or emotional changes) before each seizure. This is called an aura.

Absence (Petit Mal) Seizure

Petit mal seizures generally last only a few seconds. Most commonly they involve staring episodes or "absence spells." The episodes may:

  • Occur many times a day
  • Occur for weeks to months before being noticed
  • Interfere with school and learning
  • Be mistaken for lack of attention or other misbehavior


Unexplained difficulties in school and learning difficulties may be the first sign of absence. During the seizure, the person may:

  • Stop walking and start again a few seconds later
  • Stop talking in mid-sentence and start again a few seconds later


Immediately after the seizure, the individual is usually wide awake, thinking clearly and unaware of the seizure.

Specific symptoms of may include:

  • Changes in muscle activity (no movement, hand fumbling, fluttering eyelids, lip smacking, chewing)
  • Changes in alertness (staring episodes, lack of awareness of surroundings, a sudden halt in movement, talking or other activities)


Generalized Tonic-Clonic (Grand Mal) Seizure

Many patients with generalized tonic-clonic seizures have vision, taste, smell or sensory changes; hallucinations; or dizziness before the seizure. This is called an aura. Seizures usually involve muscle rigidity, followed by violent muscle contractions and loss of alertness.

Other symptoms that occur during the seizure include:

  • Biting the cheek or tongue
  • Clenched teeth or jaw
  • Incontinence
  • Stopped breathing or difficulty breathing
  • Blue skin color


Following the seizure, the person may have normal breathing, sleepiness that can last for an hour or longer, loss of memory about the events surrounding the seizure, headache, drowsiness, confusion and weakness on one side of the body for a few minutes to a few hours.

Partial (Focal) Seizures

Patients with focal seizures can have any of the symptoms below, depending on where in the brain the seizure starts. People who have simple focal seizures do not lose consciousness. They are aware of and remember the events that occur at the time. Patients with complex partial seizures may or may not remember any or all of the symptoms or events during the seizure.

  • Abnormal muscle contraction
  • Abnormal head movements, including forced turning of the head
  • Staring spells
  • Repetitive movements (picking at clothes, abnormal mouth movements, lip smacking, chewing or swallowing without cause)
  • Forced turning of the eyes
  • Numbness, tingling or a crawling sensation
  • Hallucinations
  • Nausea
  • Sweating and flushed face
  • Dilated pupils
  • Rapid heart rate/pulse
  • Blackout spells
  • Changes in vision
  • Sensation of déjà vu
  • Changes in mood or emotion



Diagnosis

Your doctor will perform a physical exam, which will include a detailed look at the brain and nervous system. An electroencephalogram (EEG) will be done to check the electrical activity in the brain. The test may reveal the area where the seizures are originating.

You may be asked to wear an EEG recorder for days or weeks while you go about daily life, or you may need to be hospitalized in our Epilepsy Monitoring Unit, where your brain activity will be monitored using video EEG.

Other diagnostic tests for epilepsy include:

  • CT scan of the brain
  • MRI of the brain
  • Memory and speech (Wada) testing
  • Neuropsychological testing
  • Do you have PET, SPECT and fMRI?


Treatment

Treatment for epilepsy may involve surgery or medication. If seizures are due to a tumor, abnormal blood vessels or bleeding in the brain, surgery to treat these disorders may stop the seizures.

Medication to prevent seizures, called anticonvulsants, may reduce the number of future seizures. The drugs are taken by mouth, and the type of medication depends on the type of seizures you have. Epilepsy that does not improve after two or three anti-seizure drugs have been tried is called "medically refractory epilepsy."

Surgery to remove the abnormal brain cells causing the seizures may be helpful for some patients, or surgery to place a vagus nerve stimulator (VNS) may be recommended. Similar to a heart pacemaker, a VNS can help reduce the number of seizures.

Sometimes, children are placed on a special diet to help prevent seizures, the most popular being the ketogenic diet. A diet low in carbohydrates, such as the Atkins diet, may also be helpful in some adults.

Lifestyle or medical changes can increase the risk for a seizure in a person with epilepsy. Talk with your doctor about:

  • New prescribed medications, vitamins or supplements
  • Emotional stress
  • Illness, especially infection
  • Lack of sleep
  • Use of alcohol or other recreational drugs



Source: National Institute of Neurological Disorders and Stroke


For More Information

Epilepsy Foundation

Stroke Aware
Neuroscience - In The News