Epilepsy and Seizures

Premier Health’s Barbara L. Phillips, MD, Clinical Neuroscience Institute, answers Frequently Asked Questions about Epilepsy and Seizures.

What is a seizure?

Dr. Barbara Phillips discusses what happens in the brain during and after a seizure. Click play to watch the video or read the transcript.

 

A seizure is an individual event that happens to someone when there is abnormal electrical activity in the brain. It usually lasts up to three minutes. After a seizure, a person is confused for a little while before returning to normal.

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What is epilepsy?

Dr. Barbara Phillips discusses the traits that mark the condition of epilepsy. Click play to watch the video or read the transcript.

 

Epilepsy is a condition in which people tend to have seizures. It is diagnosed after someone experiences two or more unprovoked seizures. Anyone can have a seizure caused by taking certain drugs or getting hit on the head or some other trauma. If you have a seizure without any provocation, then you may have a tendency toward having seizures.

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What's the difference between a seizure and a stroke?

Dr. Barbara Phillips discusses the differences between a seizure and a stroke. Click play to watch the video or read the transcript.  

 

A seizure is a temporary condition. A stroke is an anatomic problem in the brain where there is a lack of blood supply or sometimes bleeding in the brain. Once the seizure is over, the brain will gradually return to normal function.

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Who is affected by epilepsy?

Dr. Barbara Phillips discusses the two age groups in which epilepsy is most common. Click play to watch the video or read the transcript.

 

People who are affected by epilepsy tend to be in two major groups. There is a higher rate of developing epilepsy in childhood and in older adults over age 65. You can develop epilepsy at any age, but it is more likely to happen in those two age groups.

What are the symptoms of epileptic seizures?

Dr. Barbara Phillips discusses the signs and symptoms of epileptic seizures. Click play to watch the video or read the transcript.

 

Epileptic seizure symptoms vary depending on where in the brain the seizure starts. For example, temporal lobe epilepsy often causes seizures with altered consciousness. A person is confused and can have difficulty speaking. They might have a warning, such as an aura, deja vu or hallucinations. Sometimes, a person uses his or her hands unconsciously, like automatically picking up an object. These movements can progress to shaking and grand mal symptoms such as unconsciousness and convulsions, but this does not always happen.

What are the most common types of seizures?

Dr. Barbara Phillips discusses the different types of seizures. Click play to watch the video or read the transcript.

 

The most common type of seizure is the complex partial seizure. This is a seizure that begins in one part of the brain and then spreads to other regions of the brain. Other types of seizures are primary generalized seizures, which include absence epilepsy (blanking out for short periods of time) and myoclonic jerks – sudden involuntary muscle movements.

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Are seizures the only symptom of epilepsy?

Dr. Barbara Phillips discusses other epilepsy symptoms outside of seizures. Click play to watch the video or read the transcript.

 

Seizures are the hallmark of epilepsy. They are the symptom that defines the condition. This is a brain problem, obviously, with the seizures coming from the brain. There are other conditions and problems that epileptic patients tend to get. Memory problems are common. Depression is common. Long-term patients with severe seizures, who are not candidates for epilepsy surgery or other treatments, may experience cognitive changes and personality changes. Patients can also be injured during a seizure.

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What causes epilepsy?

Dr. Barbara Phillips discusses the causes of epilepsy. Click play to watch the video or read the transcript.

 

Epilepsy is caused by a variety of conditions. It can be genetic, and it runs in families. It's often caused by trauma or stroke, or anything that will affect or damage the brain, including head injuries and gunshot wounds. Men and women coming back from military service may have head injuries, and they are predisposed to seizures. Infections can also cause seizures.

What are the risk factors of epilepsy or seizures?

Dr. Barbara Phillips discusses the risks faced by people with epilepsy and seizures. Click play to watch the video or read the transcript.

 

Injuries are the most comment risk of seizures and epilepsy with recurrent seizures. People frequently fall and break bones. The intensity of the muscle contraction during a seizure can actually break the spinal column or cause vertebral collapse. You can also injure your brain. People fall during a seizure and have bleeding in the brain. If you have long-term seizures, you should get frequent brain imaging because, very rarely, people may develop tumors.

People with chronic epilepsy may also have memory problems and personality changes. They're at higher risk for depression and other psychiatric illnesses. There are also risks and side effects from medicines used to treat epilepsy.

How is epilepsy diagnosed?

Dr. Barbara Phillips discusses how epilepsy is diagnosed. Click play to watch the video or read the transcript.

 

Epilepsy is first diagnosed when you suspect it clinically. That means when you have two or more episodes that are unprovoked and sound like they might be seizures. After that, doctors use testing to look for causes that might be present, such as a magnetic resonance image (MRI) of the brain and an electroencephalogram (EEG) to check the brain’s electrical activity.

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What are some nonsurgical treatment options for epilepsy?

Dr. Barbara Phillips discusses nonsurgical treatments for epilepsy. Click play to watch the video or read the transcript.

 

The main treatment for epilepsy is medication. There are numerous medicines available today. About two-thirds of people with epilepsy now control their seizures with medicine. Other nonsurgical options include diet. A ketogenic diet is most often used in children, but modified diets can be used in adults and are sometimes effective.

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What are the most common surgical treatment options?

Dr. Barbara Phillips discusses the most common surgical treatments for epilepsy. Click play to watch the video or read the transcript.

 

There are two common surgical treatment options for epilepsy. The first is the vagal nerve stimulator. This procedure implants a pacemaker-like device in the chest. A wire is attached to a nerve in the neck. When the stimulator is turned on, it sends an electrical pulse on a regular basis to the nerve, which transmits the signal to the brain. This affects the ability of the brain to cause seizures. Over time, the vagal nerve stimulator can reduce the frequency of seizure activity.

The second common surgical treatment is epilepsy surgery per se. This procedure removes the part of the brain that's causing seizures. People with intractable seizures (seizures not controlled by medicine) are the best candidates for his surgery.

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When do doctors decide that epilepsy surgery is the best treatment option?

Dr. Barbara Phillips discusses how doctors decide if a patient will benefit from epilepsy surgery. Click play to watch the video or read the transcript.

 

A person with seizures that do not respond or cannot be controlled after trying a variety of different medicines is a candidate for epilepsy surgery. Most patients who need surgery have partial seizures, or seizures that begin in one part of the brain. To determine if surgery is a good option, doctors will perform more intense monitoring. This usually involves admitting patients to the hospital to monitor and record their seizure activity.

Evaluation may involve specialized MRI and other imaging tests, neuropsychological testing and sometimes an exam (called water testing) to see if memory can be supported by the part of the brain that will be left after surgery. Testing is also done to determine exactly where the seizures are coming from and whether there is a higher risk to memory or speech ability. We discuss that with the patient as we determine whether surgery is appropriate. Once all testing is complete, doctors decide if a patient will benefit from surgery.

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What other surgeries are used to treat epilepsy?

Dr. Barbara Phillips discusses the different kinds of surgical procedures used to treat epilepsy. Click play to watch the video or read the transcript.

 

The most common epilepsy surgery is temporal lobectomy. This removes all or part of the temporal lobe of the brain. Other surgeries involve taking out lesions, such as tumors, or abnormal blood vessel abnormalities such as tangles of abnormal blood vessels called arteriovenous malformations (AVMs) or benign tumors formed by blood vessels, called cavernous angiomas. These procedures are called lesionectomies because they involve the removal of an abnormal area of the brain.

Before a lesion can be removed, the doctor must make sure that it is not located near an area of the brain that would impact speech or motor function. Patients receive a pre-surgical work-up, including brain imaging and EEG studies, to ensure a lesionectomy can be performed safely.

If a lesion is the cause of a patient’s seizures, a neurosurgeon will remove the lesion and any surrounding areas of the brain from which the seizure may start.

A corpus callosotomy is a procedure that cuts the large fiber bundle that connects the two halves of the brain. This is usually done for children with extremely severe seizures that are very frequent and that cannot be treated by removing part of the brain. The goal is to disrupt the connections that cause severe seizures in order to protect the brain.

A functional hemispherectomy isolates one side of the brain by disconnecting all the connections. This surgery is only used in very rare circumstances in children with specific infections.

What are the risks and side effects of epilepsy surgery?

Dr. Barbara Phillips discusses the risks and side effects of epilepsy surgery. Click play to watch the video or read the transcript.

 

The risks of a temporal lobectomy include problems with memory and speech. Infection and stroke are also possible risks, but they occur less than 1 percent of the time. Most people report a small amount of trouble with memory or speech after surgery, but for the most part, they can speak.

If a patient experiences speech problems after epilepsy surgery, what therapies are available?

Dr. Barbara Phillips discusses therapy options for patients with speech and memory issues after epilepsy surgery. Click play to watch the video or read the transcript.

 

If someone is having difficulty with speech, such as the ability to find the right word or a little more trouble with memory, speech therapy will help. It takes a little while for the brain to recover and function properly again. Part of the brain was removed, and the brain has to adjust. Occupational therapy also will help. Medicines to prevent seizures will help. Finally, time will help. It usually takes several months before people feel like they're perfectly back to normal.

What specific side effects are caused by epilepsy medicines?

Dr. Barbara Phillips discusses the side effects caused by epilepsy medicines. Click play to watch the video or read the transcript.

 

Side effects from medications for epilepsy usually include feeling lethargic, dizzy and off balance. This is because the medicines affect the brain. Symptoms go away over time or patients get used to them.

Certain medicines have specific side effects. The liver breaks down older medicines like Depakote and Dilantin, so you need to monitor liver function. Newer medicines do not rely as much on liver function, but kidney function should be checked.

For women, the side effects of epilepsy medicines do include a higher risk of birth defects. We try to use the newer medicines with the least risks. Most patients do have healthy babies while taking epilepsy medicine. Your doctor will monitor you and your baby more closely. You will need to take extra vitamins and have more frequent follow-up visits during your pregnancy.

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What innovations in epilepsy treatment can we expect in the future?

Dr. Barbara Phillips discusses the innovations in epilepsy treatments. Click play to watch the video or read the transcript.

 

The newest epilepsy treatment is the response stimulation implant system. The procedure is only available in a few centers, but its use is growing. The treatment uses a device implanted directly in the brain. The device detects seizure activity and automatically stimulates the brain to stop the seizure.

New medicines are being tested. We have a lot of medicines today that weren't available even 10 years ago. There are more stimulus response systems being developed that are expected to be more targeted and with less side effects. Laser treatment is also being studied as an alternative to standard surgery.

What are things someone can do when they are near someone having seizure?

One in every 10 people has had a seizure, which makes seizures a common condition that you might one day witness in person, according to the Centers for Disease Control and PreventionOff Site Icon(CDC).

Knowing what to do if someone near you has a seizure is important so you can help care for them and get them the help they need. The CDC says you should take the following steps if you see someone having a seizure:

During the seizure:

  • Check for a medical bracelet or other emergency information
  • Ease the person to the floor
  • Gently turn the person onto one side to help them breathe
  • Keep yourself and other people around you calm
  • Loosen or remove anything from around the person’s neck, including ties, necklaces, or a tightly buttoned shirt, to help them breathe
  • Put a soft, flat object – such as a folded coat or towel – under the person’s head
  • Remove any sharp or hard things from around the person to prevent injury
  • Take the person’s glasses off

After the seizure:

  • Comfort the person and speak calmly to them
  • Help the person to a safe place
  • If you are not at the person’s home, call for transportation to get them home safely
  • Make sure the person is fully awake
  • Stay with the person until the seizure ends
  • Talk to the person to explain in simple terms what happened

When to call 911:

  • If a seizure lasts longer than five minutes
  • Several seizures happen in a row
  • If you are in doubt or the person’s condition

If the person has an established cause of seizures (like epilepsy) and the seizure is very typical, there is no need to call 911.

Talk to your doctor to learn more about what to do if someone around you has a seizure.

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Can it be difficult to find a seizure’s trigger?

Dr. Arshi Naz discusses difficulties in finding what triggers a seizure. Click play to watch the video or read the transcript.

 

Finding what triggered a seizure can be tricky.

Sleep deprivation can be one common trigger of seizures, Premier Physician Network (PPN) physicians say.

But other triggers, according to the Epilepsy FoundationOff Site Icon (EF), could also include:

  • Alcohol use
  • Caffeine
  • Drug use
  • Fevers
  • Flashing bright lights
  • Low blood sugar
  • Medication
  • Menstrual cycle
  • Not eating well
  • Stress
  • Time of day

Talk to your doctor for more details about difficulties in finding what triggers a seizure.

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How can a diary help you with your treatment of epilepsy?

Dr. Arshi Naz discusses how a diary can help you with your treatment of epilepsy. Click play to watch the video or read the transcript.

   

Keeping a diary can help you and your doctor find the best treatment and prevention options for managing your seizures and epilepsy, according to the Epilepsy FoundationOff Site Icon (EF). 

Your diary can also help you keep track of when to take medications, prescriptions refills, medical appointments, medical history, and much more.

Talk to your doctor for more information about how a diary can help with your treatment of epilepsy.

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What type of information can you record or track in an epilepsy diary?

Dr. Arshi Naz discusses information that can you record in an epilepsy diary. Click play to watch the video or read the transcript.

    

Your epilepsy diary should include more information than just when you’ve had seizures.

Epilepsy FoundationOff Site Icon (EF) shares some important details you should make sure to include in your seizure diary.

While some of the information might seem obvious, other information might not seem as important, but it can actually have a major effect on your likelihood of seizures.

Your diary information should include:

  • Frequency of seizures
  • Length of your seizure
  • Lifestyle changes
  • Medication changes over time
  • Medication side effects
  • Menstrual cycle, for women
  • Mood changes
  • Sleep pattern, including lack of sleep
  • Stress you feel
  • Type of seizure
  • When you have a seizure
  • When you miss a dose of any medication
  • Your current medication types and doses
  • Your medical history

Before working on your diary, talk with your physician to determine if there’s other important information he or she would like you to include.

For more information about what to record or track in an epilepsy diary, talk with your doctor.

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Are there pre-created epilepsy diaries available for you to use?

Dr. Arshi Naz discusses how to find a pre-created epilepsy diary. Click play to watch the video or read the transcript.

     

Technology can be a great tool to use when keeping an epilepsy diary.

Many options of epilepsy and seizure diaries are available online through sites such as the Epilepsy FoundationOff Site Icon (EF) and the American Epilepsy SocietyOff Site Icon (AES).

These online diaries and downloadable apps are helpful at tracking not only seizures, their length, and duration but also doctor’s appointments, medications, and other daily changes you want to track.

If online and epilepsy diaries aren’t your style, a pen and paper will work just as well. Just make sure to talk to your doctor about what you should include in your own epilepsy diary.

For more information about pre-created epilepsy diaries, talk with your doctor.

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Source: Barbara Phillips, MD, Clinical Neuroscience Institute; Arshi Naz, MD, Clinical Neuroscience Institute

Content Updated: May 1, 2018

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