Frequently Asked Questions
about Epilepsy
1. What is epilepsy
and what are the symptoms?
Epilepsy is a chronic neurological disorder characterized
by recurrent unprovoked seizures. "Unprovoked"
means that there is no immediate cause for the
seizure, such as a fever, an infection of the
brain, or head trauma. Nearly 10% of people will
have a seizure during their lifetime; most of
these are "provoked" seizures during
an acute illness or condition. These people may
never go on to have another seizure, and therefore
do not have epilepsy.
Between seizures, most people with epilepsy are
completely normal. Seizures can occur at any time,
often without warning. In most people, seizures
are able to be controlled with treatment and may
go away entirely; in others, seizures continue
despite treatment and may last a lifetime.
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2.
What are seizures and how do they occur?
A "seizure" is a transient event caused
by abnormal excitability of all or part of the
brain. The principal cells of the brain, or "neurons",
use several different types of chemicals (called
neurotransmitters) to communicate with each other.
These chemical messages are translated into electrical
signals, which allow neurons in different parts
of the brain to work together and perform tasks:
to move your arm, read a book, or tell a story.
Normal balancing mechanisms ensure that these
signals travel in an orderly fashion. When the
brain is injured or when there is an abnormality
of the brain's neurotransmitters, normal brain
activity is interrupted and replaced by giant
waves of electrical impulses which flood the brain's
circuits. This abnormal electrical activity is
a "seizure".
Not all seizures "look" the same. What
you experience, or what others see during a seizure,
depends on the type of seizure. There are two
main types of seizures: generalized and
partial.
Generalized seizures involve the entire brain
immediately, causing loss or alteration of consciousness.
Generalized seizures include grand mal seizures,
during which a person falls down unconscious and
the body stiffens and jerks, and petit mal, or
absence, seizures, where there is momentary loss
of consciousness without abnormal body movements.
Partial or focal seizures begin in one part of
the brain. They cause varied symptoms, including
auras (unusual warning sensations such as sounds,
smells, or a funny feeling in the stomach), staring,
chewing, lip smacking, shaking or stiffening of
part of the body, wandering, or confusion. A partial
seizure may remain in one part of the brain or
spread to the rest of the brain. Most seizures
last only seconds or a few minutes, but may be
followed by sleep or confusion for several hours.
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3.
Is epilepsy genetic?
Some types of epilepsy run in families. If you
have generalized epilepsy, your first-degree relatives
(parents, siblings, and children) have about a
four-fold increased risk for epilepsy. First-degree
relatives of people with partial seizures have
twice the risk of developing epilepsy as the general
population. Although there is some increased risk,
it is important to remember that the overall risk
of epilepsy in other family members is still low.
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4.
Are there risk factors?
There are many different underlying causes of
epilepsy. In about half of patients, no exact
cause can be found despite thorough testing.
Some of the known causes include:
- Head trauma: Concussion (brief loss
of consciousness) is considered to be mild head
trauma, and increases the risk of epilepsy only
slightly. On the other hand, moderate or severe
head injury with prolonged loss of consciousness
or brain hemorrhage greatly increases the risk
of epilepsy.
- Infections of the brain, including
meningitis, encephalitis, and brain abscess
- Stroke: A brain infarct (caused by
lack of blood flow to part of the brain) or
hemorrhage increases the risk of epilepsy.
- Alcohol: Individuals who drink heavily
have a risk for seizures when they abruptly
stop drinking ("withdrawal" seizures),
and also have an increased risk of epilepsy.
- Brain tumors: Seizures may be the first
sign of a brain tumor. For this reason, brain
imaging is recommended for all patients who
have new seizures in adulthood. Rarely, a slow-growing
brain tumor may be found in people who have
had seizures for years.
- Degenerative brain diseases, such as
Alzheimer Disease, multiple sclerosis, and Parkinson
Disease
- Mental retardation and cerebral palsy
- Cortical dysplasia and migration disorders:
These are abnormalities in the way the brain
grows and develops. Some of the brain cells
do not migrate to their proper positions, resulting
in a "tangle" of neurons. These tangles
have abnormal electrical connections, and therefore
predispose to seizures.
- Genetic predisposition
- Age: The risk of seizures is highest
in young children and in the elderly.
- Febrile seizures during infancy increase
the risk for later development of epilepsy.
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5.
How is epilepsy treated?
My patients often ask, "How many seizures
is too many? Should I change my medications?"
The answers to these questions are different for
each patient. Optimal seizure control allows you
to lead a normal, active life. If you think that
you are having too many seizures, discuss this
with your doctor. Uncontrolled seizures can result
in limits on driving, loss of employment, deterioration
in school performance, and loss of self-esteem.
If your seizures are not under control within
a year after diagnosis, request referral to a
specialist in brain disorders or epilepsy.
The most common treatment for epilepsy is the
daily use of anticonvulsant, or antiepileptic,
drugs to prevent seizures. These medications act
on brain signaling to limit hyperexcitability.
While medications do not cure epilepsy, they allow
many people to live normal active lives free or
nearly free of seizures. Not all patients with
seizures require treatment with antiepileptic
drugs, and some patients need only one or two
years of drug therapy. Most patients with epilepsy,
however, will require one or more drugs for many
years. Overall, there is about a 60% chance of
good seizure control with a single drug, and about
75% with additional drugs.
There are nearly two dozen different medications
approved for the treatment of seizures. Certain
medications work best for certain types of seizures,
and your doctor will choose your first medication
based on the type of epilepsy you have. This may
not ultimately be the "best" drug for
you, and changes in your medications may be necessary
in order to find the best combination to prevent
seizures with the fewest possible side effects.
It is generally agreed that using a single medication
is best, when possible. Using two medications
may improve seizure control, but can also greatly
increase the chance of side effects.
Because antiepileptic drugs work by decreasing
brain "hyperactivity", it is not surprising
that many side effects are related to dulling
of normal brain "activity". Therefore,
nearly all the antiepileptic drugs can cause sleepiness,
difficulty with concentration and memory, blurred
vision, and trouble with balance in some patients.
The "newer" antiepileptic medications
(Neurontin, Lamictal, Topamax, Trileptal, Keppra,
Zonegran) may be better tolerated than older medications.
In general, no one drug has been proven to be
more effective than the others for treatment of
most seizures, and your doctor will often choose
a drug depending on its potential side effects
or how many times per day it needs to be taken.
As mentioned before, it may take some time to
find exactly the right combination of medications
for you. Because antiepileptic drugs work by preventing
seizures, it is important that you take them regularly.
If the level of medication in your blood is too
low, you may not be protected against a seizure.
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6.
Who is a candidate for surgery?
Some patients with seizures may be candidates
for brain surgery. Most patients are considered
for epilepsy surgery when trials of two or more
antiepileptic medications have failed to fully
control seizures. The most common type of surgery
removes the part of the brain that causes the
seizure. In order for a patient to be a surgical
candidate, we must be able to determine the exact
area where the seizure begins, and to make sure
that this area can be safely removed. Other types
of surgery "disconnect" parts of the
brain to prevent seizures from spreading.
In order to determine whether someone is a candidate
for surgery, several tests must be performed.
These include MRI (magnetic resonance imaging),
which gives a detailed picture of the brain, video-EEG
monitoring to see exactly where the seizures begin
in the brain, neuropsychological testing (tests
of memory and language), and usually a Wada test,
to ensure that the seizure focus can be safely
removed. The goal of the epilepsy surgical evaluation
is to determine the likelihood that a particular
patient will be helped by surgery, and what the
specific risks of the surgery will be. The patient
can then make a decision about whether or not
they want to consider surgery.
Another type of surgery, the vagus nerve stimulator,
involves electronic stimulation using a device
implanted in the chest and connected to the vagus
nerve in the neck. This procedure may significantly
improve seizures, but is less likely to result
in complete seizure.
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7.
Is there a cure for epilepsy?
In some patients, seizures resolve on their own,
and antiepileptic drugs can be stopped without
the seizures returning. In most patients, medications
suppress seizures, but the seizures may return
when the medications are stopped.
Epilepsy surgery is the only potential "cure"
for seizures. Depending on where the seizures
begin, epilepsy surgery can result in seizure
freedom in 40-90% of patients.
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8.
What type of follow-up care is necessary after
surgery?
Patients usually go home 4 to 5 days after epilepsy
surgery, and can return to most activities after
2-4 weeks. A period of recuperation (usually 2-3
months) is necessary before returning to work
or school. The patient will continue to follow
up with his neurologist and neurosurgeon. Sometimes
rehabilitation (physical therapy, occupational
therapy, or speech therapy) is needed.
The patient will continue to take antiepileptic
medications for several years, and the blood levels
of medications and other blood tests will be followed.
Neuropsychological testing is done one year after
surgery to see if there are any long-term effects
from the surgery.
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9.
Can the seizures reoccur?
Seizures can recur after successful epilepsy
surgery in about 20-30% of patients, with times
of recurrence ranging from 1 to more than 10 years.
Most commonly, seizures recur after antiepileptic
medications are stopped, and can be controlled
again if medications are restarted. Less often,
seizures recur even though the patient is still
taking medications.
To learn more about epilepsy, visit our Epilepsy
Health Information section.
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