Epilepsy refers to any condition that causes or predisposes somebody to recurrent seizures. There are hundreds of different conditions that can predispose to someone having unprovoked recurrent seizures, and each of these conditions may be referred to as “epilepsy.”
A seizure is like an electrical storm in the brain. The brain misfires in a way that causes the brain to not function correctly. Anyone can have a seizure when it is provoked, but with epilepsy, the seizures come out of the blue. About 10% of the population will have a seizure at some point in their life but only about 1% of the population has epilepsy (recurrent unprovoked seizures).
There is a misconception that everyone who has epilepsy gets it from childhood – this is not true. Epilepsy is actually even more common in adults over the age of 65 than in children. While there is a spike in the occurrence of epilepsy in childhood and in younger ages, after about age 65, the incidence of epilepsy appears to be higher than in any other age group. This is likely due to people living longer and developing epilepsy as a result of a stroke, cancer, or brain trauma.
Seizures come in two major types. One type comes from a very specific area of the brain and those kinds of seizures are called focal or partial seizures. The other type of seizure comes from everywhere in the brain at once and those types of seizures are called generalized seizures. That also applies to epilepsy: There are generalized epilepsies and focal epilepsies or localization-related epilepsies.
There are three big triggers for seizures: stress, sleep deprivation, and alcohol use. Finding ways to reduce stress, getting a consistent good night’s sleep, and limiting alcohol use will help you prevent seizures from occurring if you have epilepsy.
In general, the main causes of epilepsy include major head trauma or stroke. Often, doctors cannot find the cause of seizures. The causes can differ among young people and older people. With young people, common causes include medications, drug use, and genetic predisposition. For older patients, in their 50s and 60s, the causes include strokes, brain tumors, and other neurodegenerative diseases like Alzheimer’s disease.
Yes. Hormones in women have a specific effect on epilepsy. Increased estrogen and decreased progesterone (which commonly happens when a woman has her period) can make seizures more frequent. It is a misconception that women with epilepsy can’t have children–they can–but they do have a higher rate of having children with birth defects, likely due to medication taken during pregnancy to reduce seizures.
The symptoms of epilepsy are recurrent unprovoked seizures.
If it is a first-time seizure or if you are uncomfortable helping the person with the seizure, call 911 immediately and get them to the hospital. However, if someone has been diagnosed with epilepsy, and they are familiar with their own seizures, they might not need to go to the hospital after every seizure. If the seizure is prolonged (longer than 5 minutes), you should call 911 immediately. If someone has back-to-back seizures or if there is any injury that needs medical attention, it is important to get the person to the hospital immediately.
The first thing you should do if someone is having a seizure is make sure the person is in a safe place. You should let them have their seizure and absolutely do not try to hold them down or stick anything in the person’s mouth. There is a common misconception that people who have seizures will choke on their tongues–this will not happen. You should time the seizure if you can and after the seizure, help them to their side in case they get nauseated and vomit, as they can actually choke on their vomit.
Someone who comes into the doctor’s office with seizures will likely have an MRI of the brain and an EEG, along with a thorough history taken from the physician. All of these factors can help the doctor diagnose epilepsy.
When confirming the diagnosis, there is a more definitive way to diagnose seizures, a video EEG. This test often takes place in an epilepsy monitoring unit. That test involves the patient being admitted to the hospital for a week. An EEG monitor is placed on their head to record brain activity during seizures. Under careful supervision, medications may be withdrawn. This is considered the gold standard for detecting seizures because by capturing a seizure on an EEG, we can see the electrical storm going on in the brain and track the changes as the seizure progresses. This gives us lots of information about what’s actually happening in the brain during a particular seizure.
In addition to taking a patient history, one test for epilepsy is an MRI of the brain to see structural abnormalities that would be associated with seizures. The MRI can detect types of strokes, brain tumors, and scar tissue that might contribute to seizures. Another test is an EEG, which is where electrodes are hooked up to the patient’s head in a dark room for 20-30 minutes so that the doctor can look at the brainwaves. The doctor is specifically looking for epileptiform discharges, which are waveforms or big spikes that can reveal if another seizure is likely. Even with these tests, epilepsy can be difficult to diagnose.
There are many options for epilepsy treatment. The mainstay of epilepsy treatment is the large number of anticonvulsant medications. If epilepsy medications or anticonvulsants don’t work, other options include brain surgery, dietary changes, or neuromodulation devices.
There are over 20 different medications for epilepsy and seizures. They are referred to as antiepileptic drugs or anticonvulsants. All of the medications seem to be roughly equally effective. It is really a matter of finding the right medication for the right person at the right dose.
Neuromodulation is surgery to help control seizures–not necessarily to stop them but to control them. The one that’s been around the longest is called the vagal nerve stimulator. This is a pacemaker device that’s implanted under the skin with a wire running underneath the skin to the neck to a nerve called the vagus nerve. This pacemaker sends an impulse to the vagus nerve and then, through a black-box mechanism, sends a signal up into the brain that helps control seizures. This therapy results with an average 50% reduction in seizure frequency. Another device called a neuropace device is actually implanted in the skull. An electrode is put into the place in the brain where the seizure is originating. The electrode can detect the onset of a seizure and zap the brain to prevent the seizure from occurring. With a neuropace device, the doctor has to be sure exactly which part of the brain the seizure is coming from before it can be implanted.
Yes. Epilepsy surgery involves removal of part of the brain. This is only useful if the doctor can identify exactly which part of the brain the seizures are coming from and remove it, so it is only for people with focal seizures.
For children, a ketogenic diet (very limited carbohydates) is recommended. This is very difficult for adults to stick to, so they usually use a modified Atkins Diet with limited carb intake.
There have been some anecdotal reports that say that marijuana helps people control seizures, but there have not been sufficient trials to prove it.
Epilepsy can have a big effect on a patient’s life. Epilepsy and driving is a state-specific issue. Each state has its own laws and own ways of approaching it, so be sure to check with your specific state. Other activities like swimming alone, working at heights, or working with heavy machinery can be dangerous.
Epilepsy can make finding jobs difficult. The rate of unemployment can be as high as 50% in epilepsy patients, and this is a huge issue because health insurance is critical for these patients to be able to get their medications and get the care that they need.
Most insurance companies cover epilepsy but each company will often have very specific medications that they would prefer to cover. Medicaid, for instance, will ask for something called a prior authorization, where even if the physician wants to try one medication, the insurance company will require the patient to try a few specific medications before paying for another medication.
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