Learn about epilepsy symptoms, possible causes of epilepsy and how epilepsy is treated, including surgical treatment options.
Epilepsy — also known as a seizure disorder — is a brain disorder that causes recurring seizures. There are many types of epilepsy. In some people, the cause can be identified. In others, the cause isn't known.
Epilepsy is common. It's estimated that 1 in 26 people develops the disorder, according to the Epilepsy Foundation. Epilepsy affects people of all genders, races, ethnic backgrounds and ages.
Seizure symptoms can vary widely. Some people may lose awareness during a seizure but others don't. Some people stare blankly for a few seconds during a seizure. Others may repeatedly twitch their arms or legs, movements known as convulsions or spasms.
Having a single seizure doesn't mean you have epilepsy. Epilepsy is diagnosed if you've had at least two unprovoked seizures at least 24 hours apart. Unprovoked seizures don't have a clear cause.
Treatment with medicines or sometimes surgery can control seizures for most people with epilepsy. Some people require lifelong treatment. For others, seizures eventually go away. Some children with epilepsy may outgrow the condition with age.
Seizure symptoms vary depending on the type of seizure. Because epilepsy is caused by certain activity in the brain, seizures can affect any brain process. Seizure symptoms may include:
Sometimes, people with epilepsy may have changes in their behavior. They also may have symptoms of psychosis.
Most people with epilepsy tend to have the same type of seizure each time. Symptoms are usually similar from episode to episode.
Some people with focal seizures experience warning signs in the moments before a seizure begins. These warning signs are known as aura. They might include a feeling in the stomach. Or they might include an emotion such as fear. Some people might feel deja vu. Aura also might be a taste or a smell. It might even be visual, such as a steady or flashing light, a color, or a shape. Some people may experience dizziness and loss of balance. Others may see things that aren't there, known as hallucinations.
Seizures are classified as either focal or generalized, based on how and where the brain activity causing the seizure begins.
When seizures appear to result from activity in just one area of the brain, they're called focal seizures. These seizures fall into two categories:
Symptoms of focal seizures may be confused with other neurological disorders, such as migraine, narcolepsy or mental illness. A thorough examination and testing are needed to distinguish epilepsy from other disorders.
Types of focal seizures include:
Seizures that appear to involve all areas of the brain are called generalized seizures. Generalized seizures include:
Seek immediate medical help if any of the following occurs:
If you experience a seizure for the first time, seek medical advice.
Epilepsy has no identifiable cause in about half the people with the condition. In the other half, the condition may be traced to various factors, including:
Genetic influence. Some types of epilepsy run in families. In these instances, it's likely that there's a genetic influence. Researchers have linked some types of epilepsy to specific genes. But some people have genetic epilepsy that isn't hereditary. Genetic changes can occur in a child without being passed down from a parent.
For most people, genes are only part of the cause of epilepsy. Certain genes may make a person more sensitive to environmental conditions that trigger seizures.
Certain factors may increase your risk of epilepsy:
Having a seizure at certain times can lead to circumstances that are dangerous to yourself or others.
Car accidents. A seizure that causes either loss of awareness or control can be dangerous if you're driving a car or operating other equipment.
Many states have driver's license restrictions related to a driver's ability to control seizures. In these states, there is a minimum amount of time that a driver must be seizure-free, ranging from months to years, before being allowed to drive.
Pregnancy complications. Seizures during pregnancy pose dangers to both mother and baby, and certain anti-epileptic medicines increase the risk of birth defects. If you have epilepsy and you're considering becoming pregnant, get medical help as you plan your pregnancy.
Most women with epilepsy can become pregnant and have healthy babies. You'll need to be carefully monitored throughout pregnancy, and medicines may need to be adjusted. It's very important that you work with your health care team to plan your pregnancy.
People with epilepsy are more likely to have psychological problems. Problems may be a result of dealing with the condition itself as well as medicine side effects. But even people with well-controlled epilepsy are at increased risk. Emotional health problems that may affect people with epilepsy include:
Other life-threatening complications of epilepsy are uncommon but may happen These include:
Sudden unexpected death in epilepsy (SUDEP). People with epilepsy also have a small risk of sudden unexpected death. The cause is unknown, but some research shows it may occur due to heart or respiratory conditions.
People with frequent tonic-clonic seizures or people whose seizures aren't controlled by medicines may be at higher risk of SUDEP. Overall, about 1% of people with epilepsy die of SUDEP. It's most common in those with severe epilepsy that doesn't respond to treatment.
To diagnose your condition, your health care provider will likely review your symptoms and medical history. You may have several tests to diagnose epilepsy and to detect the cause of seizures. Your evaluation may include:
Genetic testing. In some people with epilepsy, genetic testing may give more information about the condition and how to treat it. Genetic testing is most often performed in children but also may be helpful in some adults with epilepsy.
You also may have one or more brain imaging tests and scans that detect brain changes:
Electroencephalogram (EEG). This is the most common test used to diagnose epilepsy. In this test, electrodes are attached to your scalp with a paste-like substance or cap. The electrodes record the electrical activity of your brain.
If you have epilepsy, it's common to have changes in your typical pattern of brain waves. These changes occur even when you're not having a seizure. Your health care provider may monitor you on video during an EEG to detect and record any seizures you experience. This may be done while you're awake or asleep. Recording the seizures may help determine what kind of seizures you're having or rule out other conditions.
The test may be done in a health care provider's office or the hospital. If appropriate, you also may have an ambulatory EEG, which you wear at home while the EEG records seizure activity over the course of a few days.
You may get instructions to do something that can cause seizures, such as getting little sleep prior to the test.
Single-photon emission computerized tomography (SPECT). This type of test is used primarily if MRI and EEG didn't pinpoint the location in the brain where the seizures are originating.
A SPECT test uses a small amount of low-dose radioactive material that's injected into a vein to create a detailed, 3D map of the blood flow activity in the brain during seizures. Areas of higher than typical blood flow during a seizure may indicate places where seizures occur.
Another type of SPECT test called subtraction ictal SPECT coregistered to MRI (SISCOM) may provide even more-detailed results by overlapping the SPECT results with brain MRI results.
Along with your test results, a combination of analysis techniques may be used to help pinpoint where in the brain seizures start:
Accurate diagnosis of your seizure type and where seizures begin gives you the best chance for finding an effective treatment.
An EEG records the electrical activity of your brain via electrodes affixed to your scalp. EEG results show changes in brain activity that may be useful in diagnosing brain conditions, especially epilepsy and other seizure disorders.
Treatment can help people diagnosed with epilepsy have fewer seizures or even completely stop having seizures. Possible treatments include:
Most people with epilepsy can become seizure-free by taking one anti-seizure medicine, which is also called anti-epileptic medicine. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medicines.
Many children with epilepsy who aren't experiencing epilepsy symptoms can eventually discontinue medicines and live a seizure-free life. Many adults can discontinue medicines after two or more years without seizures. Your health care team can advise you about the appropriate time to stop taking medicines.
Finding the right medicine and dosage can be complex. Your provider may consider your condition, frequency of seizures, age and other factors when choosing which medicine to prescribe. Your provider also may review any other medicines you may be taking to ensure the anti-epileptic medicines won't interact with them.
You may first take a single medicine at a relatively low dosage and then increase the dosage gradually until your seizures are well controlled.
There are more than 20 different types of anti-seizure medicines available. The medicines that you take to treat your epilepsy depend on the type of seizures you have, as well as other factors such as your age and other health conditions.
These medicines may have some side effects. Mild side effects include:
More-severe but rare side effects include:
To achieve the best seizure control possible with medicine, follow these steps:
At least half the people newly diagnosed with epilepsy become seizure-free with their first medicine. If anti-seizure medicines don't provide good results, you may be able to have surgery or other therapies. You'll likely have regular follow-up appointments with your health care provider to evaluate your condition and medicines.
When medicines do not provide adequate control of seizures, epilepsy surgery may be an option. With epilepsy surgery, a surgeon removes the area of your brain that's causing seizures.
Surgery usually happens when tests show that:
For some types of epilepsy, minimally invasive approaches such as MRI-guided stereotactic laser ablation may provide effective treatment when an open procedure may be too risky. In these procedures, a thermal laser probe is directed at the specific area in the brain causing seizures to destroy that tissue in an effort to better control the seizures.
Although you may continue to need some medicine to help prevent seizures after successful surgery, you may be able to take fewer medicines and reduce your doses.
In a small number of people, surgery for epilepsy can cause complications such as permanently altering thinking abilities. Talk to your surgical team members about their experience, success rates and complication rates with the procedure you're considering.
Apart from medicines and surgery, these potential therapies offer an alternative for treating epilepsy:
Vagus nerve stimulation. Vagus nerve stimulation may be an option when medicines haven't worked well enough to control seizures and surgery isn't possible. In vagus nerve stimulation, a device called a vagus nerve stimulator is implanted underneath the skin of the chest, similar to a heart pacemaker. Wires from the stimulator are connected to the vagus nerve in the neck.
The battery-powered device sends bursts of electrical energy through the vagus nerve and to the brain. It's not clear how this inhibits seizures, but the device can usually reduce seizures by 20% to 40%.
Most people still need to take anti-epileptic medicine, although some people may be able to lower their medicine dose. Vagus nerve stimulation side effects may include throat pain, hoarse voice, shortness of breath or coughing.
Some children and adults with epilepsy have been able to reduce their seizures by following a strict diet that's high in fats and low in carbohydrates. This may be an option when medicines aren't helping to control epilepsy.
In this diet, called a ketogenic diet, the body breaks down fats instead of carbohydrates for energy. After a few years, some children may be able to stop the ketogenic diet — under close supervision of their health care providers — and remain seizure-free.
Experts don't fully know how a ketogenic diet works to reduce seizures. But researchers think that the diet creates chemical changes that suppress seizures. The diet also alters the actions of brain cells to reduce seizures.
Get medical advice if you or your child is considering a ketogenic diet. It's important to make sure that your child doesn't become malnourished when following the diet.
Side effects of a ketogenic diet may include dehydration, constipation, slowed growth because of nutritional deficiencies and a buildup of uric acid in the blood, which can cause kidney stones. These side effects are uncommon if the diet is properly and medically supervised.
Following a ketogenic diet can be a challenge. Low-glycemic index and modified Atkins diets offer less restrictive alternatives that may still provide some benefit for seizure control.
Researchers are studying many potential new treatments for epilepsy, including:
In vagus nerve stimulation, an implanted pulse generator and lead wire stimulate the vagus nerve, which leads to stabilization of electrical activity in the brain.
Understanding your condition can help you take better control of it:
In addition, make healthy life choices, such as managing stress, limiting alcoholic beverages and avoiding cigarettes.
Uncontrolled seizures and their effects on your life may at times feel overwhelming or lead to depression. It's important not to let epilepsy hold you back. You can still live an active, full life. To help cope:
If your seizures are so severe that you can't work outside your home, there are still ways to feel productive and connected to people. You may consider working from home.
Let people you work and live with know the correct way to handle a seizure in case they are with you when you have one. You may offer them suggestions, such as:
You're likely to start by seeing your primary care provider. However, when you call to set up an appointment, you may be referred immediately to a specialist. This specialist may be a doctor trained in brain and nervous system conditions, known as a neurologist, or a neurologist trained in epilepsy, known as an epileptologist.
Because appointments can be brief, and because there's often a lot to talk about, it's a good idea to be well prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect.
Keep a detailed seizure calendar. Each time a seizure occurs, write down the time, the type of seizure you experienced and how long it lasted. Also make note of any circumstances, such as missed medicines, sleep deprivation, increased stress, menstruation or other events that might trigger seizure activity.
Seek input from people who may observe your seizures, including family, friends and co-workers, so that you can record information you may not know.
Take a family member or friend along. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
Also, because you may not be aware of everything that happens when you're having a seizure, someone else who has seen your seizures may be able to answer questions during your appointment.
For epilepsy, some basic questions include:
In addition to the questions that you've prepared, don't hesitate to ask questions during your appointment at any time that you don't understand something.
Your health care provider is likely to ask you a number of questions, such as:
Certain conditions and activities can trigger seizures, so it may be helpful to:
Also, it's important to start keeping a log of your seizures before your appointment.