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Epilepsy 

Introduction
Epilepsy is a disorder that is caused by a surge of abnormal nerve signals in the brain.  Repeated seizures are the main symptom of epilepsy.  In many cases, the cause of epilepsy is unknown.  Treatment for epilepsy involves medications, dietary changes, surgical procedures, or a combination of treatments to reduce and prevent seizures.  With treatment, some people can become seizure-free.

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Anatomy
Your brain regulates everything you think, do, and feel.  The brain is made of millions of nerve cells.  The nerve cells form tracts that carry messages in the form of electrical impulses.  The electrical impulses travel from one part of your brain to another and between your brain and body, controlling all of your functions.

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Causes
Epilepsy is a brain disorder that is characterized by repeated seizures.  A seizure is a brief abnormal over-firing of the nerves in a section of the brain or throughout the brain.  There are several different types of seizures.  In about 70% of cases, the cause of a seizure is unknown.  Stroke, traumatic brain injury, poisoning, infection, substance abuse, and metabolic problems, such as diabetes or kidney failure, are common causes of epilepsy.  Epilepsy can run in families and researchers suspect that an inherited gene may contribute to epilepsy in certain circumstances.  Epilepsy occurs in people of all ages, but most frequently develops in children under the age of 10 and older adults after the age 60. 

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Symptoms
Repeated seizures are the symptom of epilepsy.  There are different types and symptoms of seizures.  People with epilepsy may experience different types of seizures or the same type repeatedly.  Seizures may be triggered by stress, sensitivity to light, hormone changes, or changes in sleep patterns.  Some people experience an aura or strange sensations before a seizure. 
 
Seizures are usually brief.  They are a temporary condition, and normal functioning returns following the episode.  You should call emergency medical services (911) if a person is having difficulty breathing or sustains an injury.  You should call emergency medical services if seizures last longer than five minutes or if a second seizure immediately begins. Emergency medical treatment should be sought for people with diabetes or women that are pregnant.
 
Seizures are classified as partial (focal) or generalized.  Partial seizures involve just one part of the brain.  Generalized seizures involve the entire brain.  Types of seizures include:
 
Partial Seizures- Simple Partial (Focal) Seizures
Symptoms of simple partial seizures include changes in sensation, such as the way things look, smell, feel, taste, or sound.  Simple partial seizures do not cause a loss of consciousness.  You may feel nauseous, sweat and you may have dilated pupils, and flushed skin.
 
Partial Seizures- Complex Partial Seizures
Complex partial seizures cause a loss of consciousness, including a loss of awareness and the onset of automatic non-purposeful movements.  You may smack your lips, vocalize, swallow, or move your limbs.  You may experience changes in sensation, personality, emotions, alertness, smell, and taste.  You may feel nauseous, sweat and you may have dilated pupils, and flushed skin.  You may feel a sense of déjà vu.
 
Generalized Seizures- Petit Mal (Absence Seizures)
Petit mal seizures are a common seizure type among children and typically stop by age 20.  Petit mal seizures cause brief lapses of awareness.  A person may stare blankly and appear to be daydreaming. 
 
Generalized Seizures- Myoclonic Seizures
Myoclonic seizures are characterized by sudden leg and arm jerking, muscle twitches, or spasms.
 
Generalized Seizures- Atonic Seizures (Drop Attacks)
Atonic seizures occur suddenly.  They cause people to become limp and unexpectedly fall down or collapse.  Atonic seizures usually cause a loss of consciousness.
 
Generalized Seizures- Grand Mal (Tonic-Clonic) Seizures
Grand mal seizures are common in people with gliomas, a common type of brain tumor.  Grand mal seizures usually begin with sudden symptoms followed by loss of consciousness.  You may experience significant whole body muscle contractions, shallow breathing, and involuntary urination.  Upon regaining consciousness, you may feel confused, weak, and very tired.  Emergency medical services (911) should be called if a grand mal seizure begins again.

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Diagnosis
A doctor can diagnose epilepsy by reviewing your medical records and history of seizures.  You may not be able to recall the symptoms that you have during a seizure, but should tell your doctor what those around you have reported.  Your doctor will conduct a thorough neurological examination.  Blood, urine, or cerebral spinal fluid tests are used to identify possible temporary causes of seizures.  Your doctor may order tests to learn more about your brain structures and functioning.

Tests, such as computed tomography (CT) scans and magnetic resonance imaging (MRI) scans, are used to provide images of the brain.  The images can help identify tumors, strokes, or abnormalities in brain structure.  An electroencephalograph (EEG) records the electrical activity in the brain.  It is helpful for confirming seizure activity, determining the type of seizure, and identifying the part of the brain involved in the seizure.  For the test, electrode monitors are placed on your scalp.  Video recording may be used with EEG to allow your doctor to see your behavior during a seizure.

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Treatment
Treatment for epilepsy is aimed at reducing and preventing seizures.  In some cases, treatment of an underlying medical condition, such as an infection, can prevent seizures.  Epileptic seizures are commonly treated with medications, dietary changes, surgical procedures, or a combination of treatments. 

There are many types of antiepileptic drugs, and the kind that you receive depends on the type of seizures that you experience.  It is very important to follow the directions for taking your medication exactly.  You should not stop taking a medication without talking to your doctor first.  Under your doctor’s supervision, medication may be stopped after a period of seizure-free years.

A ketogenic diet may be used to treat recurrent seizures in children.  This is a diet low in carbohydrates and high in protein and fats.  The diet causes ketones to be released by the body, which reduces the incidence of seizures.  Medications and diets may be used in combination and a doctor carefully monitors both treatments.

Vagal nerve stimulation or brain surgery is used to treat epilepsy that does not respond to medication.  A vagus nerve stimulator is a device that is surgically placed in the chest.  Electrodes from the device are connected to the left vagus nerve, a nerve that travels to the brain.  The device generates regular electrical impulses to the nerve.  Vagus nerve stimulation has been shown to reduce the incidence of seizures and the amount of antiepileptic medication that a person needs to take.

A craniotomy is a surgery that removes a piece of the skull to allow access to the brain.  Brain surgery is used to remove the brain cells that send abnormal nerve signals and cause seizures.  Sophisticated technology, such as functional MRI (fMRI) and brain mapping, allow surgeons to determine functional centers in the brain to help plan surgery.  Further, gamma knife radiation has been found to be a nonsurgical alternative to treat epileptic seizures.  Gamma knife radiation uses high-energy beams to precisely destroy cells in a targeted area, while leaving surrounding tissues unaffected.  Because no incision is used, this procedure is associated with a quicker and easier recovery time than traditional surgery methods.
 
Epilepsy can be a lifelong condition and at times, cause emotional stress for people with the condition and their loved ones.  Epilepsy Support Groups can be a great place to find support and obtain educational information from people that understand what you are experiencing.  Ask your doctor for support group listings in your area.

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Prevention
People with epilepsy should wear Medic Alert bracelets or necklaces identifying their condition and the medications that they take.  This will help first responders provide prompt care in the event of an emergency. 

You may be able to prevent seizures by avoiding the triggers that cause it.  It can be helpful to manage stress, avoid alcohol and drugs, and get plenty of sleep.

You are at risk for accidental injury during a seizure episode.  Your doctor can help you determine activities that you may need to avoid, such as driving, climbing, and swimming.  You should instruct your friends, family, and coworkers regarding what they should do if you have a seizure.

If you witness someone having a seizure, call for medical help.  You should help the person lie down on his or her side, and clear away nearby objects.  Place a pillow or soft support under his or her head.  Check for a Medic Alert bracelet.  Stay with the person until medical help arrives so that you can provide details about the episode.

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Am I at Risk

A history of two or more seizures is necessary to meet the diagnostic criteria for epilepsy. 

Risk factors may increase your likelihood of developing epilepsy.  You should tell your doctor about your risk factors and discuss your concerns. 


Risk factors for epilepsy:
_____ Children under the age of 10 and adults over the age of 60
_____ Traumatic brain injury, brain tumor, hematoma, or stroke
_____ Metabolic disorders, including diabetes, kidney failure, uremia, electrolyte imbalance, nutritional deficiency, and phenylketonuria (PKU)
_____ Poisoning, such as lead poisoning
_____ Substance abuse, such as using and withdrawal from alcohol and illegal drugs
_____ Certain infections, including meningitis, viral encephalitis, lupus erythematosus, mumps, and measles
_____ Epilepsy appears to run in some families.  If your family members have epilepsy, your risk of developing the condition is increased.
_____ Developmental disorders that occurred during pregnancy, before a baby was born, increase the risk of epilepsy.

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Complications
Brain damage or sudden death is rare, but a possible complication from lack of breathing during seizures.  An increased risk of depression is associated with epilepsy.  People with epilepsy should check with their department of motor vehicles regarding driver’s license restrictions and seizures.  State policies differ and some states grant driver’s licenses after a period of seizure-free years.  Women that take antiepileptic medication should talk to their doctors before becoming pregnant.  Some medications can cause birth defects.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.