What is Epilepsy?
Epilepsy is a neurological condition characterized by spontaneous, repeated seizures. Seizures occur when there are abnormal electrical impulses in the brain. A single seizure does not necessarily mean that a person will develop epilepsy.
Symptoms of Epilepsy
Seizures are the main symptom of epilepsy, but seizures don’t look and feel the same for everyone. There are more than 30 different types of epileptic seizures. The type of seizure you experience depends on where the seizure begins in your brain.
A partial seizure occurs when there are abnormal electrical impulses in only one area of the brain. General epileptic seizures occur when electrical impulses “storm” or spread through the brain.
Generally speaking, symptoms accompanying a seizure may include:
- Auras: These are symptoms that people experience at the beginning of a seizure (see below)
- Loss of consciousness or awareness
- Staring off into the distance, sometimes accompanied by repetitive actions like lip smacking
- Jerking, twitching, or other involuntary movements
- Stiffening or jerking of the body, arms, and legs
- Abrupt loss in muscle tone (“drop attacks”), which may lead to falls
Please see our seizure page for more details on different types of seizures.
Auras and Epileptic Seizures
Many people with epilepsy experience an aura, which tells them a seizure is coming. An aura can include a change in taste, vision, or hearing. An aura actually can be helpful to someone with epilepsy because it allows them to prepare themselves to prevent an injury.
Please seek the help of a licensed medical professional if you are concerned about your health, and call 911 if you are experiencing an emergency.
Treatments for Epilepsy
If you are diagnosed with epilepsy, your doctor will usually recommend treatment with one or more anti-epilepsy medications. About two-thirds of people with epilepsy have good control of their seizures with medication, and they have few or no side effects.
If you have epilepsy that is not well controlled with medication or if you experience side effects from medication, you might be eligible for other treatments. These treatments include epilepsy surgery, brain stimulation devices, vagal nerve stimulation, and the ketogenic diet. The goal of epilepsy treatment is to be completely seizure free.
Several anti-epilepsy medications have been approved in the U.S. Choosing your medication requires discussion with your epilepsy care team. It also involves careful monitoring over time to ensure that you are getting relief from your symptoms with minimal or no side effects.
Commonly used antiseizure medications include:
- Carbamazepine /Tegretol / Carbatrol / Tegretol XR:
- Clobazam / Onfi
- Gabapentin / Neurontin
- Lacosamide / Vimpat
- Lamotrigine / Lamictal / Lamictal XR
- Levetiracetam / Keppra / Keppra XR / Roweepra / Roweepra XR / Spritam
- Oxcarbazepine / Trileptal / Oxtellar XR
- Pregabalin / Lyrica
- Topiramate / Topamax / Trokendi XR / Qudexy
- Valproate / Depakote / Depakote ER / Depakene
- Zonisamide / Zonegran
- Brivaracetam / Briviact
Less commonly used antiseizure medications include:
- Acetazolamide / Diamox
- Cannabidiol / Epidiolex
- Cenobamate / Xcopri
- Clonazepam / Klonopin
- Clorazepate /Tranxene
- Eslicarbazepine / Aptiom
- Ethosuximide / Zarontin
- Felbamate /Felbatol
- Perampanel / Fycompa
- Phenobarbital / Mysoline
- Phenytoin / Dilantin / Phenytek
- Primidone / Mysoline
- Rufinamide / Banzel
- Stiripentol / Diacomit
- Tiagabine / Gabitril
- Vigabatin / Sabril
- Perampanel / Fycompa
If you have seizures that do not respond to medication therapy, you may want to seek specialty care from an epilepsy team. Other individuals who may want to consider specialty care include those who are pregnant or who have significant cognitive comorbidities, such as depression or anxiety.
A multidisciplinary epilepsy team may include:
- EEG Technologists
- Neuroscience Nurses
- Research Nurses
- Social Workers
You may be considered for epilepsy surgery if you meet the following criteria:
- Seizures are not controlled despite optimal medical management. For most people, this means a trial of at least two medications that are appropriate for the type of seizure, used in adequate doses.
- You experience intolerable side effects from the medications used to control seizures.
- A single “spot” or region in the brain can be identified as causing the seizures.
- The region causing the seizures can be removed safely without causing harm or loss of important functions such as speech or movement.
Decisions about whether to undergo surgery for epilepsy are different for everyone. No one recommendation fits every person. It’s also important to understand that epilepsy surgery is not always possible. Your evaluation may show that you are not a good candidate for surgery. For example, doctors seldom advise surgery for epilepsy when seizures arise from both sides of the brain.
Vagal Nerve Stimulation
This therapy involves implanting a pacemaker-like device under the skin of the chest and attaching it by a wire to the vagus nerve in the neck. The device sends mild pulses of electrical activity to the brain via the vagus nerve, which can help regulate abnormal electrical activity and prevent seizures.
The ketogenic diet (or other similar diets like the modified Atkins diet and the low glycemic index diet) can be used along with medications to help manage epilepsy in children and adolescents. The ketogenic diet is a high-fat, low-carbohydrate diet that creates a state of ketosis. In this state, the body uses fats for energy rather than carbohydrates. This diet is prescribed and monitored by a physician and dietitian.
How common is epilepsy?
Epilepsy is more common than many people realize. It is the fourth most common neurological problem in the United States, after migraine, stroke, and Alzheimer’s disease. One in 26 people will develop epilepsy, and approximately 3.4 million people in the United States are living with the disease.
Who gets epilepsy?
Epilepsy can develop in any person at any age. About half of people with epilepsy have a known cause. Identifiable causes of epilepsy are grouped into five categories:
- Genetic or inherited (sometimes with a history of epilepsy in other family members)
- Infectious (such as encephalitis or meningitis)
- Structural (history of an injury to the brain, such as a brain tumor or head trauma)
How is epilepsy diagnosed?
While a medical history and physical examination may indicate epilepsy, specialty diagnostic tests can provide a more complete diagnosis and inform treatment decisions.
Diagnostic tests for epilepsy include:
Computed tomography (CT) and magnetic resonance imaging (MRI) tests can be used to determine if there is a lesion responsible for the seizures.
Electroencephalography (EEG) records electrical activity in the brain. Epilepsy specialists use this data to look for abnormal patterns in brain waves, which can occur even if you are not having a seizure.
Magnetoencephalography (MEG) is the measurement of the magnetic field generated by the electrical activity of nerve cells in the brain. This functional brain mapping technique can help identify the location in the brain where your seizures originate.
People with epilepsy may experience cognitive challenges. Neuropsychological examinations can help explain difficulties with mental functions, such as memory, understanding or using language, and recognizing spatial patterns.
Neuropsychological evaluation often helps to identify the seizure focus. For example, patients with left temporal lobe epilepsy typically show a different pattern of results on neuropsychological testing than patients with right temporal lobe epilepsy.
Epilepsy Monitoring Unit
If you have epilepsy that is difficult to diagnose and/or treat, your doctor may recommend you be admitted to an inpatient epilepsy monitoring unit. This allows epilepsy specialists to perform an in-depth evaluation over an extended period.
While in the unit, you will be on a lower dose of anti-epileptic medications. Your brain wave patterns and physical activity will be monitored 24 hours a day using simultaneous EEG and audio/video monitoring. Your epilepsy team will then use the information collected to evaluate and diagnose your condition, create a treatment plan, and coordinate your care.