Epilepsy (EP’-uh-lep-see) is a neurological (meaning it has to do with your brain) disorder that causes seizures. There is no cure for epilepsy, but most people find relief from symptoms with medications, lifestyle changes or surgery. 

Epilepsy is fairly common — about 1 in 26 people develop symptoms of epilepsy, and it can affect people of all races, genders, ethnic backgrounds and ages. Medication often can control epilepsy symptoms. On average, 50% of patients become seizure-free with the first medicine. Of those who need to try a second medication, 25% become seizure-free. After two different medications don’t work, your doctor may speak with you about surgical options.

On average, it can take about 20 years from the time of diagnosis to being seen at a comprehensive epilepsy center. At Norton Neuroscience Institute Comprehensive Epilepsy Center, our goal is to see newly diagnosed patients within the week. If we find that patients need surgery for epilepsy, our goal is to schedule it within six months of that determination.

What Is Epilepsy?

Epilepsy is caused by abnormal electrical signals produced by damaged brain cells. While seizures might be the most well-known symptom of epilepsy, these bursts of uncontrolled electrical activity also can cause:

• Changes to your awareness
• Loss of muscle control, such as muscles twitching or jerking
• Unusual sensations in the body
• A change in emotions and behavior

Epilepsy is defined as two unprovoked seizures within 24 hours. Unprovoked means there is no obvious cause for the seizure, such as a head injury. While epilepsy is called a seizure disorder, not all seizures mean you have epilepsy. Seizures can have other causes, such as stroke or brain tumors.

First seizures, febrile seizures, nonepileptic events and eclampsia (a life-threatening condition that can occur during pregnancy) are examples of conditions involving seizures that may not be associated with epilepsy. Regardless of the type of seizure, it’s important to inform your doctor when you have a seizure.

If you have a seizure and have never had one before, it is important to see a health care professional. The Norton Neuroscience Institute First Seizure Clinic was established to provide a rapid and accurate diagnosis quickly after symptoms appear. Patients need a referral from an emergency room or primary care provider and will be seen within a week.

Norton Neuroscience Institute Is a Level 4 Epilepsy Center

The National Association of Epilepsy Centers has recognized Norton Neuroscience Institute as a level 4 epilepsy center. The designation means we provide the highest level of medical and surgical evaluation and treatment for patients with complex epilepsy. Our expertise includes:

• Evaluating the brain and how well it is working (complex, intensive neurodiagnostic monitoring)
• Extensive medical, neuropsychological and psychosocial treatment — that includes not only your physical health but your mental well-being
• Complete evaluation for epilepsy surgery, including evaluation for intracranial electrodes
• A broad range of surgical procedures for epilepsy

Exploring Different Types of Seizure

There are four types of seizure: focal, generalized, focal-generalized and unknown onset. What type you have depends on where in your brain the seizure activity begins and if it spreads to other parts of the brain.

Focal seizures appear to result from activity in just one area of the brain. There are  two different kinds of focal seizures:

• Focal seizures with awareness don’t cause a loss of consciousness. These seizures may alter emotions or change the way things look, smell, feel, taste or sound.
• Focal seizures with impaired awareness include a change in or loss of consciousness or awareness.

Generalized Seizures

Seizures that involve all areas of the brain are called generalized seizures. Generalized seizures include:

• Tonic seizure symptoms includestiff muscles and may affect consciousness. These seizures usually affect muscles in the back, arms and legs and may cause the person to fall to the ground.
• Atonic seizures, also known as drop seizures, cause a loss of muscle control. Since this most often affects the legs, it often causes the person to collapse suddenly or fall to the ground.
• Clonic seizures are associated with repeated or rhythmic jerking muscle movements. These seizures usually affect the neck, face and arms.
• Myoclonic seizures usually appear as sudden, brief jerks or twitches and usually affect the upper body, arms and legs.
• Tonic-clonic seizures are the most dramatic type of epileptic seizure, and probably are the type of seizure people most associate with epilepsy. They can cause an abrupt loss of consciousness and body stiffening, twitching and shaking. They sometimes cause loss of bladder control or biting of the tongue.

Focal-generalized seizures mean that the seizure starts in one part of the brain, but then spreads to affect both sides of the brain.

Unknown onset seizures: Sometimes, doctors may be sure you have epilepsy, but they don’t know whether the seizures are focal or generalized. This can happen if you were alone when you had seizures so no one can describe what happened before and during the seizure.

Diagnosis and Beyond

Our Comprehensive Epilepsy Center offers a full array of diagnostic tools and treatment options. If you have a seizure and have never had one before, you should see a health care provider as soon as possible. Your provider may refer you to the Norton Neuroscience Institute First Seizure Clinic. The First Seizure Clinic was established to provide a rapid and accurate diagnosis quickly after symptoms appear. Patients need a referral from an emergency room or primary care provider and will be seen within a week.

In order to create a treatment plan specifically for your symptoms and type of epilepsy, doctors will test you in many ways. It is important for your doctor to know what kind of epilepsy you have to know how to treat it.

The first step in diagnosis is for your health care provider to get a full medical history from you, including information about your seizure(s) and symptoms, as well as your dietary and lifestyle habits. You may have several tests to diagnose epilepsy and to detect the cause of seizures. Your evaluation may include:

• A neurological exam is used to tests your behavior, motor abilities, mental function and other abilities.
• Blood tests can detect signs of infections, genetic conditions or other conditions that may be associated with seizures.
• Genetic testing may give your provider more information about your condition and how to treat it.

You also may have one or more medical imaging tests and scans that detect brain changes and help doctors understand how your brain is working.

• Electroencephalogram (ee-leck-troh-en-SEFF’-uh-luh-gram) or EEG is the most common test used to diagnose epilepsy. In this test, electrodes are attached to your scalp to record the electrical activity of your brain.
• CT scan uses X-rays to record cross-sectional images of your brain. CT scans can see tumors, bleeding or cysts in the brain that might be causing epilepsy.
• MRI uses powerful magnets and radio waves to create a detailed picture of the brain. Like a CT scan, an MRI scan looks at the structure of the brain to detect what may be causing seizures. An MRI provides a more detailed look at the brain than a CT scan.
• Functional MRI or fMRI measures the changes in blood flow that occur when specific parts of the brain are working. This test may be used before surgery to identify the exact locations of critical functions, such as speech and movement, so that surgeons can avoid injuring those places while operating.
• Positron emission tomography or PET scans use a small amount of low-dose radioactive material that’s injected into a vein to help reveal activity or changes in the brain. Areas of the brain with low metabolism may indicate places where seizures occur.
• Single-photon emission computerized tomography, or SPECT, is used primarily if MRI and EEG testing couldn’t pinpoint the location in the brain where the seizures are starting.

Symptoms and Warning Signs of Epilepsy

Seizure symptoms vary from person to person and depend on the type of seizure. Epilepsy is caused by abnormal brain activity, so it can affect anything the brain does. Some people have reported experiencing some symptoms in the moments before a seizure begins. These warning signs are known as aura. Warning signs include:

• Temporary confusion
• A staring spell
• Stiff muscles
• Uncontrollable jerking movements of the arms and legs
• Loss of consciousness or awareness.
• Psychological symptoms such as fear, anxiety or déjà vu (the feeling you have been in a situation before)
• Behavior changes, such as irritability, anxiety and depression
• A feeling in the stomach, often described as a rising sensation
• A strange taste or a smell
• Visual sensations, such as a steady or flashing light, color, or shape
• Dizziness and loss of balance
• Seeing things that aren’t there, known as hallucinations (huh-LOO’-sin-ay-shun).

Not all seizures mean you have epilepsy. Some epilepsy symptoms may be confused with other neurological disorders, such as migraine, narcolepsy or mental illness. A neurologist (ner-OL’-oh-jist), which is a doctor specializing in brain conditions, will diagnose you after testing and examination.

Unveiling the Causes of Epilepsy

In half of the patients with epilepsy, it is idiopathic (id-ee-oh-PATH’-ick) which means there is no identifiable cause. For the other half of epilepsy patients, causes can vary.

• Genetics can cause some types of epilepsy to run in families. Sometimes, genetic likelihood of developing epilepsy and environmental triggers can lead to epilepsy. Genes usually are only partly responsible for epilepsy.  
• Head trauma as a result of a car accident or other major injury can cause epilepsy.
• Issues in the brain, such as tumors or the way blood vessels form in the brain, can cause epilepsy. In adults older than age 35, stroke is a leading cause of epilepsy.
• Infections including meningitis, HIV, viral encephalitis and some parasitic infections can cause epilepsy.
• Injury before birth can be a cause. Before they’re born, babies are sensitive to brain damage that could be caused by several factors. Causes might include an infection in the mother, poor nutrition or oxygen deficiencies. This brain damage can result in epilepsy or cerebral palsy.
• Developmental disorders can be a reason a person having epilepsy. People with autism are more likely to have epilepsy than are people without autism.

Risk Factors for Epilepsy

There are risk factors that can make it more likely for you to develop epilepsy. Those include:

• Age is a factor. While the onset of epilepsy is most common in children and older adults, the condition can occur at any age.
• Family history of epilepsy puts you at an increased risk of developing a seizure disorder.
• Head injuries sometimes can cause epilepsy. Reduce your risk by wearing a seat belt while riding in a car and by wearing a helmet while bicycling, skiing, riding a motorcycle or engaging in other activities with a high risk of head injury.
• Stroke and other vascular diseases can cause brain damage. Brain damage can trigger seizures and epilepsy. You can take a number of steps to reduce your risk of these diseases, including limiting your intake of alcohol and avoiding cigarettes, eating a healthy diet and exercising regularly.
• Dementia can increase the risk of epilepsy in older adults.
• Brain infections such as meningitis, which causes inflammation in the brain or spinal cord, can increase your risk.
• Seizures in childhood sometimes can be associated with epilepsy. Children who have seizures due to high fevers generally won’t develop epilepsy. The risk of epilepsy increases if a child has a long fever-associated seizure, another nervous system condition or a family history of epilepsy.

According to the World Health Organization, about 25% of epilepsy cases are preventable. Prevention measures include:

• Reducing and preventing head injury: Preventing falls, traffic accidents and sports injuries is the most effective way to prevent trauma-induced epilepsy.
• Good prenatal care can reduce new cases of epilepsy caused by birth injury.
• Using medication and other methods to lower the temperature in children with fevers can reduce the chance of febrile seizures.
• Prevent epilepsy associated with stroke through cardiovascular health: controlling high blood pressure, diabetes and obesity; avoiding tobacco and excessive alcohol use.

The Impact on Daily Life

Living with epilepsy means understanding your condition, including severity and frequency of seizures and what your seizure triggers may be. Many aspects of epilepsy can affect your day-to-day life, including driving ability, job status and financial status. While epilepsy does change your life, living a full life is a realistic goal for most people.

It is important to manage your seizures as soon as possible. Poorly controlled epilepsy can result in a number of complications and health risks, including:

• Physical injuries during a seizure
• Drowning, if the seizure occurs during a bath or swimming
• Depression and anxiety
• Worsening memory or other thinking skills

Some of the ways epilepsy impacts your daily life include:

• Work – How much the condition affects your work depends on the job and the severity of your symptoms. The Americans with Disabilities Act prohibits discrimination against anyone with a disability or medical condition such as epilepsy. Your workplace must make reasonable accommodations for you, such as time to take medications or providing a private area to rest after a seizure.
• Medication – If you have a prescription from your doctor for epilepsy medication, you must follow the prescriber’s orders very carefully. Epilepsy medicine is to be taken at the same time every day.
• Driving/transportation – This will depend on how well-controlled your seizures are. In most states, you can resume driving a motor vehicle after six months without a seizure. There are no restrictions on bicycles.
• Activity – Exercise is not usually a trigger for seizures and is generally beneficial to people with seizures. However, there are some activities that are more dangerous if you have epilepsy, including swimming, , rock climbing or even travelling on an airplane.
• Physical well-being – The period after a seizure is called the post-ictal (post-ICK’-tull) phase. You may feel tired, thirsty, sore or disoriented. If your seizures happen often, you may need to take more time out of your day to recover from seizures.
• Social and emotional well-being – An epilepsy diagnosis can feel overwhelming, for you and your friends and family. It is important to educate yourself and people around you about your epilepsy. Norton Neuroscience Institute Resource Centers can help with this.  

There are ways to manage seizures through medication and knowing what your individual seizure triggers are, which can include:

• Not taking your medicine as prescribed by your doctor
• Poor sleep quality
• Too much stress
• Alcohol or recreational drugs
• Flashing or flickering lights
• Hormonal shifts, such as those during a monthly period
• Skipping meals

Having a personalized treatment plan is key to managing life with epilepsy. Everyone’s symptoms are unique, and everyone responds to treatment differently. Your care team will tailor your plan to your needs.

Living With Epilepsy

While there is no cure for epilepsy, seizures can be managed for most people, either with medication, surgery or a combination of the two. We also know more about how epilepsy works and are developing new medicines and techniques to treat this condition so that more people can live seizure-free.

Read Justin’s story about life after epilepsy surgery.

Norton Neuroscience Institute Resource Centers offer a range of programs, services and information for people with neurological conditions. Thanks to funding from the Norton Healthcare Foundation, these resources are offered at no cost for patients and their families. Additionally, we have a series of educational videos on epilepsy.

If epilepsy is part of your life, talk to your health care provider, reach out to a supportive community and learn more about living with epilepsy.

Treatment for Epilepsy

The Norton Neuroscience Institute Comprehensive Epilepsy Center has board-certified physicians, leading-edge techniques and best-in-class diagnostic tools to help you become seizure-free. There are three main paths to life without seizures: medication, surgery and lifestyle changes. Since your epilepsy is unique to you, your treatment path may include any combination of these. In some cases, advanced epilepsy treatments may be necessary.

Medication

Medication for epilepsy is called anti-seizure medication or ASM. These used to be called anti-epileptic drugs. Your doctor will choose an ASM to begin with, but there is no one drug that works better for everyone. Medicine is prescribed based on:

• Side effects that should be avoided in your particular case
• Your health history
• Which type of seizure you have
• Whether you already have tried a different medication that did not work

Surgery

If your epilepsy is not well-controlled with only medication, you may be a candidate for surgery. This is known as medically refractory (re-FRACK’-tor-ee) epilepsy or drug-resistant epilepsy. Epilepsy surgery is done to stop seizures or limit their frequency and severity. Surgery can also decrease the risk of seizure-related deaths, the need for anti-seizure medications and the possible side effects of the medicines.

Epileptic seizures are caused by irregular activity in brain cells (neurons). The type of surgery needed depends on the location of the neurons that start the seizure and the age of the person having the surgery. 

Types of epilepsy surgery include:

• Resection of seizure focus: In the most common type of surgery for epilepsy, the surgeon removes the specific part of the brain causing seizures.
• Laser ablation: Using heat energy, the surgeon burns away the part of the brain causing seizures.
• Neuromodulation: A tiny implant monitors the part of the brain causing seizures and can deliver an electronic pulse to stop seizures before they happen.
• Vagus (VAY’-gus) nerve stimulation or VNS: Similar to neuromodulation, VNS uses a small implant to give an electrical pulse to the vagus nerve. This nerve controls the things your body does without you thinking about it such as breathing and sweating.

Lifestyle Interventions

While research continues to study how diet and other lifestyle choices affect seizures, there do appear to be some things you can do to reduce your chance of having a seizure including:

• Sleep: Regular good quality sleep is important and can affect your seizures. Poor sleep often can trigger seizures.
• Alcohol use: Binge drinking is more than four drinks in two hours for men or more than five drinks in two hours for women.
• Diet: The ketogenic diet (high fat, low carbohydrate) was developed as a way to manage symptoms of epilepsy in children. Dietary changes have not been studied enough to know how they affect adults with epilepsy. That said, most people in general do benefit from eating a diet rich in whole grains, fruits, vegetables and lean meats.
• Exercise: Regular physical activity is beneficial to everyone and is usually encouraged. You should be careful, however, if you have seizures. Use your judgment when it comes to activity and think of what might happen if you did have a seizure.

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