Epilepsy

Answer 1

Definition

Epilepsy is a brain disorder involving repeated, spontaneous seizures of any type. Seizures ("fits," convulsions) are episodes of disturbed brain function that cause changes in attention or behavior. They are caused by abnormally excited electrical signals in the brain.

See also: Seizures

Alternative Names

Temporal lobe epilepsy; Seizure disorder

Causes, incidence, and risk factors

Seizures ("fits," convulsions) are episodes of disturbed brain function that cause changes in attention or behavior. They are caused by abnormally excited electrical signals in the brain.

Sometimes a seizure is related to a temporary condition, such as exposure to drugs, withdrawal from certain drugs, a high fever, or abnormal levels of sodium or glucose in the blood. If the seizure or seizures do not happen again once the underlying problem is corrected, the person does NOT have epilepsy.

In other cases, permanent injury to or changes in brain tissue cause the brain to be abnormally excitable. In these cases, the seizures happen without an immediate cause. This is epilepsy. Epilepsy can affect people of any age.

Epilepsy may be idiopathic, which means the cause cannot be identified. These seizures usually begin between ages 5 and 20, but they can happen at any age. People with this condition have no other neurological problems, but sometimes have a family history of seizures or epilepsy.

Some other more common causes of epilepsy include:

• Stroke or transient ischemic attack (TIA)
• Illnesses that cause the brain to deteriorate
• Dementia, such as Alzheimer's disease
• Traumatic brain injury
• Infections (including brain abscess, meningitis, encephalitis, neurosyphilis, and AIDS)
• Problems that are present from before birth (congenital brain defects)
• Injuries near the time of birth (in this case, seizures usually begin in infancy or early childhood)
• Kidney failureor liver failure
• Metabolic diseases that children may be born with (such as phenylketonuria)
• Tumors or other structural brain lesions (such as hematomas or abnormal blood vessels)

Symptoms

The severity of symptoms can vary greatly, from simple staring spells to loss of consciousness and violent convulsions. For most people with epilepsy, each seizure is similar to previous ones. The type of seizure a person has depends on a variety of things, such as the part of the brain affected and the underlying cause of the seizure.

An aura consisting of a strange sensation (such as tingling, smelling an odor that isn't actually there, or emotional changes) occurs in some people prior to each seizure.

For a detailed description of the symptoms associated with a specific type of seizure, see:

• Absence (petit mal) seizure
• Generalized tonic-clonic (grand mal) seizure
• Partial (focal) seizure

Signs and tests

A physical examination (including a detailed neurologic examination) may be normal, or it may show abnormal brain function related to specific areas of the brain.

People with epilepsy will often have abnormal electrical activity seen on an electroencephalograph (EEG). (An EEG is a reading of the electrical activity in the brain.) In some cases, the test may show the location in the brain where the seizures start. EEGs can often be normal after a seizure or between seizures, so it may be necessary to perform a longer test.

Various blood tests and other tests looking for temporary and reversible causes of seizures, may include:

• Blood chemistry
• Blood sugar
• CBC (complete blood count)
• CSF (cerebrospinal fluid) analysis
• Kidney function tests
• Liver function tests
• Tests for Infectious Diseases

Tests for the cause and location of the problem may include:

• EEG
• Head CT or MRI scan
• Lumbar puncture(spinal tap)

Treatment

For treatment of seizures, please see Seizures - first aid.

If an underlying cause for recurrent seizures (such as infection) has been identified and treated, seizures may stop. Treatment may include surgery to remove a tumor, an abnormal or bleeding blood vessel, or other brain problems.

Medication to prevent seizures, called anticonvulsants, may reduce the number of future seizures. These drugs are taken by mouth.

• The type of medicine you take depends on what type of seizures you are having. The dosage may need to be adjusted from time to time.
• Some seizure types respond well to one medication and may respond poorly (or even be made worse) by others. Some medications need to be monitored for side effects and blood levels.
• It is very important that you take your medication on time and at the correct dose. Most people taking these drugs need regular checkups and regular blood tests to make sure they are receiving the correct dosage.
• You should not stop taking or change medications without talking to your doctor first.

Some factors increase the risk for a seizure in a person with epilepsy. Talk with your doctor about:

• Certain prescribed medications
• Emotional stress
• Illness, especially infection
• Lack of sleep
• Pregnancy
• Skipping doses of epilepsy medications
• Use of alcohol or other recreational drugs

Epilepsy that does not get better after two or three seizure drugs have been tried is called "medically refractory epilepsy."

• Some patients with this type of epilepsy may benefit from brain surgery to remove the abnormal brain cells that are causing the seizures.
• Others may be helped by a vagal nerve stimulator. This is a device that is implanted in the chest (similar to a heart pacemaker). This stimulator can help reduce the number of seizures, but rarely stops the seizures completely.

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

Persons with epilepsy should wear medical alert jewelry so that prompt medical treatment can be obtained if a seizure occurs.

Support Groups

The stress caused by having seizures (or being a caretaker of someone with seizures) can often be helped by joining a support group. In these groups, members share common experiences and problems. See: Epilepsy - support group

In addition to groups that meet face-to-face, there are many discussion groups and bulletin boards on the internet where people with epilepsy can find support.

Expectations (prognosis)

Some people with certain types of seizures may be able to reduce or completely stop their seizure medicines after having no seizures for several years. Certain types of childhood epilepsy goes away or improves with age -- usually in the late teens or 20s.

For some people, epilepsy may be a lifelong condition. In these cases, the seizure drugs need to be continued.

Death or permanent brain damage from seizures is rare. However, seizures that last for a long time or two or more seizures that occur close together (status epilepticus) may cause permanent harm. Death or brain damage are most often caused by prolonged lack of breathing, which causes brain tissue to die from lack of oxygen. There are some cases of sudden, unexplained death in patients with epilepsy.

Serious injury can occur if a seizure occurs during driving or when operating dangerous equipment. For this reason, people with epilepsy whose seizures are not under good control should not do these activities.

People who have infrequent seizures may not have any severe restrictions on their lifestyle.

Complications

• Difficulty learning
• Inhaling fluid into the lungs, which can cause aspiration pneumonia
• Injury from falls, bumps, or self-inflicted bites during a seizure
• Injury from having a seizure while driving or operating machinery
• Many epilepsy medications cause birth defects -- women wishing to become pregnant should alert their doctor in advance in order to adjust medications
• Permanent brain damage (stroke or other damage)
• Prolonged seizures or numerous seizures without complete recovery between them (status epilepticus)
• Side effects of medications

Calling your health care provider

Call your local emergency number (such as 911) if this is the first time a person has had a seizure or if a seizure is occurring in someone without a medical ID bracelet (which has instructions explaining what to do).

In the case of someone who has had seizures before, call 911 for any of these emergency situations:

• This is a longer seizure than the person normally has, or an unusual number of seizures for the person
• Repeated seizures over a few minutes
• Repeated seizures where consciousness or normal behavior is not regained between them (status epilepticus)

Call your health care provider if any new symptoms occur, including possible side effects of medications (drowsiness, restlessness, confusion, sedation, or others), nausea/vomiting, rash, loss of hair, tremors or abnormal movements, or problems with coordination.

Prevention

Generally, there is no known way to prevent epilepsy. However, proper diet and sleep, and staying away from illegal drugs and alcohol, may decrease the likelihood of triggering seizures in people with epilepsy.

Reduce the risk of head injury by wearing helmets during risky activities; this can help lessen the chance of developing epilepsy.

Persons with uncontrolled seizures should not drive. Each state has a different law that determines which people with a history of seizures are allowed to drive. If you have uncontrolled seizures, you should also avoid activities where loss of awareness would cause great danger, such as climbing to high places, biking, and swimming alone.

References

Duvivier EH, Pollack Jr CV. Seizures. In: Marx, JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009: chap 100.

French JA, Pedley TA. Clinical practice. Initial management of epilepsy. N Engl J Med. 2008;359(2):166-76.

Kornblau DH, Conway Jr EE, Caplen SM. Neurologic Disorders. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, PA: Mosby Elsevier; 2009: chap 173.

Krumholz A, Wiebe S, Gronseth G, et al. Practice parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2007;69:1991-2007.

Schachter SC. Seizure disorders. Med Clin North Am. March 2009;93(2).

Trescher WH, Lesser RP. The Epilepsies. In: Bradley WG, Daroff RB, Fenichel GM, Jakovic J, eds. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa; Butterworth-Heinemann; 2008: chap 71.

Walker SP, Permezel M, Berkovic SF. The management of epilepsy in pregnancy. BJOG. 2009;116(6):758-67.

Answer 2

Definition

Epilepsy is a brain disorder in which a person has repeated seizures (convulsions) over time. Seizures are episodes of disturbed brain activity that cause changes in attention or behavior.

See also: Seizures

Alternative Names

Temporal lobe epilepsy; Seizure disorder

Causes, incidence, and risk factors

Epilepsy occurs when permanent changes in brain tissue cause the brain to be too excitable or jumpy. The brain sends out abnormal signals. This results in repeated, unpredictable seizures. (A single seizure that does not happen again is not epilepsy.)

Epilepsy may be due to a medical condition or injury that affects the brain, or the cause may be unknown (idiopathic).

Common causes of epilepsy include:

• Stroke or transient ischemic attack (TIA)
• Dementia, such as Alzheimer's disease
• Traumatic brain injury
• Infections, including brain abscess, meningitis, encephalitis, and AIDS
• Brain problems that are present at birth (congenital brain defect)
• Brain injury that occurs during or near bith
• Metabolism disorders that a child may be born with (such as phenylketonuria)
• Brain tumor
• Abnormal blood vessels in the brain
• Other illness that damage or destroy brain tissue

Epilepsy seizures usually begin between ages 5 and 20, but they can happen at any age. There may be a family history of seizures or epilepsy.

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.

Most of the time, the seizure is similar to the previous one. 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.

For a detailed description of the symptoms associated with a specific type of seizure, see:

• Absence (petit mal) seizure
• Generalized tonic-clonic (grand mal) seizure
• Partial (focal) seizure

Signs and tests

The doctor will perform a physical exam, which will include a detailed look at the brain and nervous system.

An EEG(electroencephalogram) will be done to check the electrical activity in the brain. People with epilepsy will often have abnormal electrical activity seen on this test. In some cases, the test may show the area in the brain where the seizures start. The brain may appear normal after a seizure or between seizures.

To diagnose epilepsy or plan for epilepsy surgery:

• You may need to wear an EEG recorder for days or weeks while you go about your everyday life.
• You may need to stay in a special hospital where brain activity can be be watched on video cameras. This is called video EEG.

Tests that may be done include:

• Blood chemistry
• Blood sugar
• CBC (complete blood count)
• Kidney function tests
• Liver function tests
• Lumbar puncture(spinal tap)
• Tests for infectious diseases

Head CT or MRI scan often done to find the cause and location of the problem in the brain.

Treatment

Treatment for epilepsy may involve surgery or medication.

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

Medication to prevent seizures, called anticonvulsants, may reduce the number of future seizures.

• These drugs are taken by mouth. Which type you are prescribed depends on the type of seizures you have.
• Your dosage may need to be changed from time to time. You may need regular blood tests to check for side effects.
• Always take your medication on time and as directed. Missing a dose can cause you to have a seizure. Never not stop taking or change medications without talking to your doctor first.
• Many epilepsy medications cause birth defects. Women wishing to become pregnant should tell the doctor in advance in order to adjust medications.

Epilepsy that does not get better 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.
• Surgery to place a vagus nerve stimulator (VNS) may be recommended. This device is similiar to a heart pacemaker. It can help reduce the number of seizures.

Sometimes, children are placed on a special diet to help prevent seizures. The most popular one is 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
• Pregnancy
• Skipping doses of epilepsy medications
• Use of alcohol or other recreational drugs

Other considerations:

• Persons with epilepsy should wear medical alert jewelry so that prompt medical treatment can be obtained if a seizure occurs.
• Persons with poorly controlled epilepsy should not drive. Each state has a different law about which people with a history of seizures are allowed to drive.
• Also avoid machinery or activities where loss of awareness would cause great danger, such as climbing to high places, biking, and swimming alone.

See also: Seizures - first aid.

Support Groups

The stress caused by having epilepsy (or being a caretaker of someone with epilepsy) can often be helped by joining a support group. In these groups, members share common experiences and problems.

See: Epilepsy - support group

Expectations (prognosis)

Some people with epilepsy may be able to reduce or even stop their anti-seizure medicines after having no seizures for several years. Certain types of childhood epilepsy go away or improve with age, usually in the late teens or 20s.

For many people, epilepsy is a lifelong condition. In these cases, the anti-seizure drugs need to be continued. There is a very low risk of sudden death with epilepsy. However, serious injury can occur if a seizure occurs during driving or when operating equipment.

Complications

• Difficulty learning
• Breathing in food or saliva into the lungs during a seizure, which can cause aspiration pneumonia
• Injury from falls, bumps, self-inflicted bites, driving or operating machinery during a seizure
• Permanent brain damage (stroke or other damage)
• Side effects of medications

Calling your health care provider

Call your local emergency number (such as 911) if:

• This is the first time a person has had a seizure
• A seizure occurs in someone who is not wearing a medical ID bracelet (which has instructions explaining what to do)

In the case of someone who has had seizures before, call 911 for any of these emergency situations:

• This is a longer seizure than the person normally has, or an unusual number of seizures for the person
• Repeated seizures over a few minutes
• Repeated seizures where consciousness or normal behavior is not regained between them (status epilepticus)

Call your health care provider if any new symptoms occur, including possible side effects of medications (drowsiness, restlessness, confusion, sedation, or others), nausea or vomiting, rash, loss of hair, tremors or abnormal movements, or problems with coordination.

Prevention

Generally, there is no known way to prevent epilepsy. However, proper diet and sleep, and staying away from illegal drugs and alcohol, may decrease the likelihood of triggering seizures in people with epilepsy.

Reduce the risk of head injury by wearing helmets during risky activities; this can help lessen the chance of developing epilepsy.

Persons with uncontrolled seizures should not drive. Each state has a different law that determines which people with a history of seizures are allowed to drive. If you have uncontrolled seizures, you should also avoid activities where loss of awareness would cause great danger, such as climbing to high places, biking, and swimming alone.

References

Duvivier EH, Pollack Jr CV. Seizures. In: Marx, JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2009: chap 100.

French JA, Pedley TA. Clinical practice. Initial management of epilepsy. N Engl J Med. 2008;359(2):166-76.

Kornblau DH, Conway Jr EE, Caplen SM. Neurologic Disorders. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, PA: Mosby Elsevier; 2009: chap 173.

Krumholz A, Wiebe S, Gronseth G, et al. Practice parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2007;69:1991-2007.

Schachter SC. Seizure disorders. Med Clin North Am. March 2009;93(2).

Trescher WH, Lesser RP. The Epilepsies. In: Bradley WG, Daroff RB, Fenichel GM, Jakovic J, eds. Neurology in Clinical Practice. 5th ed. Philadelphia, Pa; Butterworth-Heinemann; 2008: chap 71.

Walker SP, Permezel M, Berkovic SF. The management of epilepsy in pregnancy. BJOG. 2009;116(6):758-67.

C. L. Harden, J. Hopp, T. Y. Ting, et al. Practice Parameter update: Management issues for women with epilepsy --Focus on pregnancy (an evidence-based review). Neurology 2009;73;126

Reviewed By

Review Date: 03/28/2011

Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 3

Having a brain seizure can be a terrifying experience. If you have a seizure more than once, you may have epilepsy, a problem with electrical activity in your brain.

So, what causes epilepsy?

For most people, the brain sends electrical signals throughout the body efficiently, in a coordinated way. In epilepsy, however, the normal pattern of electrical activity becomes disturbed. This causes the brain to be too excitable, or jumpy, and it sends out abnormal signals. The result is repeated seizures that can happen at any time.

Epilepsy seizures usually begin between ages 5 and 20, but they can happen at any age. Common causes include Stroke, or a mini-stroke called transient ischemic attack; Dementia, or loss of brain function, such as Alzheimer's disease; Traumatic brain injury; Infections in the brain; Brain problems you are born with; or perhaps, a Brain tumor.

Some people with epilepsy may have simple staring spells, while others have violent, uncontrollable shaking and loss of consciousness. Before each seizure, some people may have strange sensations, such as tingling, smelling an odor that isn't really there, or emotional changes. This is called an aura.

Your doctor will perform a number of tests to find out if epilepsy is causing your seizures. One test, an electroencephalogram or EEG, checks your brain's electrical activity. Other tests can take detailed pictures of the part of your brain that is causing your seizures.

Your doctor will most likely start treating your epilepsy with medication. These medicines, called anticonvulsants, may reduce the number of seizures you have in the future. Sometimes, changing the diet of a child with epilepsy can help prevent seizures.

Your doctor will probably talk to you about making some changes in your life, such as reducing your stress, getting more sleep, and avoiding alcohol and recreational drugs.

Surgery to remove a brain tumor or abnormal blood vessels or brain cells may make the seizures stop. Another surgery can place a Vagus nerve stimulator in your brain. This device is like a pacemaker for your brain that limits the number of seizures you have.

For many people, epilepsy is a lifelong problem, and they'll always need to take anti-seizure medicines. There is a very low risk of sudden death with epilepsy. However, you, or someone else, can be seriously injured if you have a seizure while driving or operating equipment. If your seizures are uncontrolled, you should not drive.

Reviewed By

Review Date: 10/25/2011

Alan Greene, MD, Author and Practicing Pediatrician; also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.