Understanding Epilepsy

Epilepsy is a neurological disorder that affects over three million people, nationwide. While some patients are born with epilepsy, others can develop it later in life for a variety of reasons. Having an understanding of what epilepsy is, how it is treated, and how to help those experiencing a seizure can prove useful for many.

Mariel Davila-Martinez, MD, a neurologist at Rochester Regional Health, provides information and advice regarding epilepsy and seizures.

What is Epilepsy?

Epilepsy is a chronic disorder causing recurrent, unprovoked seizures. Someone is diagnosed with epilepsy if they experience at least two seizures with no obvious triggers at least 24 hours apart.

“Generally, a diagnosis occurs after a patient experiences more than one seizure. However, patients who experience one seizure may be diagnosed with epilepsy if they have an abnormal brain scan, have an abnormal electroencephalogram or have other risk factors for epilepsy, such as seizures as a child or family history,” says Dr. Davila-Martinez.

What is a seizure?

A seizure is a surge of electrical impulses that cause brief changes in movement, behavior, feeling, or awareness. The electrical activity is a result of chemical changes in nerve cells that come from an imbalance of brain cell activity.

Seizures themselves are not a disease, rather a symptom of many different disorders that affect the brain. Some seizures are hardly noticeable, while others are completely disabling.

What are the symptoms of epilepsy?

Epilepsy can cause a range of symptoms. Sometimes, people with epilepsy experience focal onset seizures, sometimes called partial seizures, which are brief and don’t involve a loss of consciousness.

Focal onset seizure symptoms include:

• dizziness
• tingling and twitching of limbs
• changes to sense of taste, smell, sight, hearing, or touch
• sudden stiffness or falling

What are the different types of seizures?

There are several different types of seizures that differ in appearance, length, and symptoms. The three main classifications of seizures include:

1. Absence Seizure: These are often described as staring spells. The person will stop what they’re doing and stare into space for a few seconds, then go on as if nothing happened. This is commonly seen in epileptic children and usually starts between the ages of 4 and 12. A child can experience as many as 100 absence seizures in one day.
2. Generalized Tonic-Clonic Seizures: Formerly known as grand mal seizures, these are the most easily spotted. The person’s arms and legs stiffen, then begin to jerk. The jerking can last up to three minutes. After it stops, the person is usually very tired and confused.
3. Focal Onset Seizures: Also known as partial seizures, this type of seizure starts in one part of the brain. The person might make jerking motions or see things that aren’t actually there. Consciousness is not always lost but it can be. A person experiencing a focal onset seizure may wander, mumble, fumble with their clothes, and more.

What causes epilepsy?

Anything that disrupts the brain’s natural circuitry can cause epilepsy. In many cases, the exact cause is never determined. Some people inherit genetic factors that make epilepsy more likely to occur.

Risk factors can include:

• head trauma
• brain infection or disease
• brain conditions, like stroke or tumors
• developmental conditions
• AIDS
• lack of oxygen
• prenatal injury

“Most of the time the cause of epilepsy is unknown--what we call idiopathic epilepsy,” says Dr. Davila-Martinez.

How is epilepsy diagnosed?

When someone comes to the Rochester Regional Health Epilepsy Center with symptoms of epilepsy, our trained neurologists will first perform a thorough physical and neurological exam to learn more about the patient’s medical history and what happens before, during, and after the seizure. To determine the type of seizure, the cause of the seizures, and where the problem is located, further diagnostic testing may be needed.

Generally, a test called an electroencephalogram (EEG) is performed to confirm a diagnosis and get more information on the seizures. The test is a painless procedure that records electrical activity in the brain that will help guide treatment for the patient.

Often, doctors will conduct a brain scan, like a CT or an MRI, to help rule out some causes and form a treatment plan. They will look for bleeding, masses, or changes in the structure of the brain.

How are epilepsy patients treated?

There are a range of treatments for epilepsy, which focus on eliminating seizures or reducing the frequency and intensity of seizures. The neurologists at the Rochester Regional Health Epilepsy Center will develop a personalized treatment plan based on the patient’s careful diagnosis. Potential treatments include:

• Medication: Anti-seizure drugs, also called anti-epileptic medications, are the most common treatment. Around two-thirds of patients become seizure-free by taking prescribed medication. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications.

“Patients who do not respond after prescribing at least two anti-epileptic medications will likely be evaluated for other therapies,” explained Dr. Davila-Martinez.

• Ketogenic Diet: “For patients that do not respond to medication, or even in conjunction with medication, we sometimes recommend a ketogenic diet. This special high-fat, low-carbohydrate diet can help control seizures in some people with epilepsy.”

• Vagus Nerve Stimulation Therapy: VNS, or vagus nerve stimulation, is described as a pacemaker for the brain. A device is used to regulate electrical patterns in the brain by sending electrical pulses through a large nerve in the neck.

What safety measures do patients with epilepsy take?

Seizures come without warning. Because of this, some activities are dangerous and should be avoided. Losing consciousness while swimming or other extreme sports could be life-threatening.

“People with epilepsy should avoid things like managing heavy machinery, climbing ladders, bathing in a tub without supervision, and swimming.”

In many states, it is required to be seizure-free for a certain amount of time before driving a car.

“A patient must be seizure-free for a year before they can return to driving. Clinically, this time may be reduced to six months if the patient is well-controlled on medication,” says Dr. Davila-Martinez.

What should I do if I see someone having a seizure?

If you see someone having a seizure, here are a few ways you can help:

• Time how long it lasts. (You may be asked for this information later.)
• Clear the area of anything hard or sharp.
• Loosen anything around their neck that may affect their breathing.
• Turn them onto their side.
• Put something soft beneath their head.
• Do not place anything in their mouth.
• Call 911 if:
  
  • The seizure lasts over 5 minutes.
  • They are pregnant.
  • They are injured.
  • They have diabetes.

“Be sure to stay with them until the seizure stops, which usually takes about three to four minutes,” says Dr. Davila-Martinez.

Can people with epilepsy get pregnant?

It is safe for most women with epilepsy to get pregnant. Over 90% of babies born to mothers with epilepsy are healthy.

“If you’re planning to get pregnant, talk to your doctor to discuss medications. Some anti-seizure medications can be harmful during pregnancy and doses may need to be changed.”