Epilepsy is a long-term (chronic) disease that causes repeated seizures due to abnormal electrical signals produced by damaged brain cells. A burst of uncontrolled electrical activity within brain cells causes a seizure. Seizures can include changes to your awareness, muscle control (your muscles may twitch or jerk), sensations, emotions and behavior.
Epilepsy is also called a seizure disorder.
What are the signs and symptoms of epileptic seizures?
The main symptom of epilepsy is recurring seizures. Your symptoms, however, vary depending on the type of seizure you have.
Seizure signs and symptoms include:
Temporary loss of awareness or consciousness.
Uncontrolled muscle movements, muscle jerking, loss of muscle tone.
Blank stare or “staring into space” look.
Temporary confusion, slowed thinking, problems with talking and understanding.
Changes in hearing, vision, taste, smell, feelings of numbness or tingling.
Psychic symptoms, including fear, dread, anxiety or déjà vu.
Faster heart rate and/or breathing.
Most people with epilepsy tend to have the same type of seizure, so have similar symptoms with each seizure.
What causes epilepsy?
Most of the time (in up to 70% of cases), the cause of seizures is not known. Known causes include:
Genetics. Some types of epilepsy (like juvenile myoclonic epilepsy and childhood absence epilepsy) are more likely to run in families (inherited). Researchers believe that although there’s some evidence that specific genes are involved, the genes only increase the risk of epilepsy, and other factors may be involved. There are certain epilepsies that result from abnormalities that affect how brain cells can communicate with each other and can lead to abnormal brain signals and seizures.
Mesial temporal sclerosis. This is a scar that forms in the inner part of your temporal lobe (part of your brain near your ear) that can give rise to focal seizures.
Head injuries. Head injuries can result from vehicular accidents, falls or any blow to the head.
Brain infections. Infections can include brain abscess, meningitis, encephalitis and neurocysticercosis.
Immune disorders. Conditions that cause your immune system to attack brain cells (also called autoimmune diseases) can lead to epilepsy.
Developmental disorders. Birth abnormalities affecting the brain are a frequent cause of epilepsy, particularly in people whose seizures aren’t controlled with anti-seizure medications. Some birth abnormalities known to cause epilepsy include focal cortical dysplasia, polymicrogyria and tuberous sclerosis. There’s a wide range of other brain malformations known to cause epilepsy.
Metabolic disorders. People with a metabolic condition (how your body obtains energy for normal functions) can have epilepsy. Your healthcare provider can detect many of these disorders through genetic tests.
Treatments to control epilepsy include anti-seizure medications, special diets (usually in addition to anti-seizure medications) and surgery.
Anti-seizure medications
Anti-seizure medications can control seizures in about 60% to 70% of people with epilepsy. Anti-seizure medication treatment is individualized. The U.S. Food and Drug Administration (FDA) has approved more than 20 anti-seizure medications for treating epilepsy. Your healthcare provider may try one or more medications, doses of medications or a combination of medications to find what works best to control your seizures.
Choice of an anti-seizure medication depends on:
Seizure type.
Your prior response to anti-seizure medications.
Other medical conditions you have.
The potential for interaction with other medications you take.
Side effects of the anti-seizure drug (if any).
Your age
General health.
Cost.
Because some anti-seizure medications are linked to birth defects, let your healthcare provider know if you’re pregnant or planning to become pregnant.
If anti-seizure medications don’t control your seizures, your healthcare provider will discuss other treatment options, including special diets, medical devices or surgery.
Diet therapy
The ketogenic diet and the modified Atkins diet — diets high in fat, moderate in protein and low in carbohydrates — are the two most common diets sometimes recommended for people with epilepsy. Diets are mostly recommended for children where medication was not effective and who aren’t candidates for surgery. Low glycemic index diets may also reduce seizures in some people with epilepsy.
Surgery and devices
Your healthcare provider will consider surgery if anti-seizure medications don’t control your seizures, and if your seizures are severe and debilitating. Epilepsy surgery can be a safe and effective treatment option when more than two anti-seizure medication trials fail to control your seizures. It’s important to be evaluated at an epilepsy center to see if you’re a candidate for epilepsy surgery if anti-seizure medications don’t control your seizures.
Surgery options include surgical resection (removal of abnormal tissue), disconnection (cutting fiber bundles that connect areas of your brain), stereotactic radiosurgery (targeted destruction of abnormal brain tissue) or implantation of neuromodulation devices. These devices send electrical impulses to your brain to reduce seizures over time.
How is epilepsy diagnosed?
Technically, if you experience two or more seizures that weren’t caused by a known medical condition — for example, from alcohol withdrawal or low blood sugar — you’re considered to have epilepsy. Before making a diagnosis, your healthcare provider (or epilepsy specialist) will perform a physical exam, take your medical history and may order blood work (to rule out other causes). They may ask about your symptoms during the seizure and conduct other tests, as well.
Your healthcare provider will ask you or your family member (who’s witnessed your seizure) if you experienced any of the following during a seizure:
Muscle jerks.
Muscle stiffness.
Loss of bowel or bladder control (you peed or pooped during the seizure).
Change in breathing.
Skin color turned pale.
Had a blank stare.
Lost consciousness.
Had problems talking or understanding what was said to you.
What tests will be done to diagnose this condition?
Tests include:
Electroencephalography (EEG): This test measures the electrical activity in your brain. Certain abnormal electrical patterns are related to seizures.