What Is Epilepsy?

Epilepsy is a chronic neurological disorder in which the normal chemical and electrical activities between nerve cells in the brain, or neurons, become disturbed. This disturbance causes the neurons to fire abnormally, resulting in seizures.

Signs and Symptoms of Epilepsy

Seizures are the best-known symptom of epilepsy.

Symptoms of epileptic seizures vary widely depending on which type of the brain they involve, how much of the brain they impact, and the severity of the impact. Because of this, seizures can range from relatively benign events to life-threatening emergencies.

Generalized Seizures

• Absence Seizures Absence seizures may last only seconds and are sometimes confused with daydreaming, as the person is usually unresponsive during the seizure.
• Atonic Seizures These seizures cause normal resting muscle tension, or tone, to go limp. This can look like suddenly slumping over or dropping to the ground.
• Myoclonic Seizures These seizures are sudden body jolts or increases in muscle tone that make it seem as if the person has been jolted with electricity.
• Tonic Seizures In this kind of seizure, the person’s muscle tone suddenly stiffens, and they lose consciousness. They may also fall to the ground, but in a rigid manner, more like a tree trunk than a rag doll.
• Clonic Seizures This type of seizure causes a person’s muscles to spasm and jerk. The muscles in the elbows, legs, and neck flex and relax in rapid succession.
• Tonic-Clonic Seizures Previously known as grand mal seizures, these are the kind of convulsions people often associate with epilepsy. The person becomes rigid, then muscle jerking begins.

Focal Seizures

Focal seizures start in one part of the brain and stay in just one brain hemisphere. Because of this, symptoms aren’t often as extensive as generalized seizures. Focal symptoms tend to involve only one side of the body instead of both.

Many focal epilepsies have an “aura,” or warning symptoms of an upcoming seizure. The person experiencing the aura is conscious.

• Motor These symptoms often involve jerking movements of a foot, the face, an arm, or another part of the body.
• Sensory Sensory symptoms can affect hearing or sense of smell or may cause hallucinations.
• Autonomic These symptoms affect the part of the brain responsible for involuntary functions, causing changes in blood pressure, heart rate, or bowel or bladder function.
• Psychic When a focal seizure strikes parts of the brain related to emotions or memories, it can cause feelings of fear, anxiety, or déjà vu.

• Focal Aware Seizure During a focal aware seizure, the person is awake but frozen and unable to respond for a few seconds up to a couple of minutes. They will be able to recall the seizure afterward.
• Focal Impaired Awareness Seizure This kind of seizure causes a lack of awareness. The person may perform actions without realizing what they’re doing. They may seem like they are daydreaming but can’t be startled out of it.
• Focal to Tonic-Clonic Seizure Some seizures start as a focal impaired awareness seizure and progress to a generalized tonic-clonic seizure, affecting both sides of the brain.

Combined and Unknown Seizures

Types of Epilepsy

Some forms of epilepsy are defined by a set of symptoms that mark them as a “syndrome.” In other cases, we define types of epilepsy by which part of the brain it involves or affects.

Epilepsy Syndromes

Some of the most common epilepsy syndromes include these conditions:

• Childhood Absence Epilepsy (CAE) People with this epilepsy syndrome have staring spells that last 10 to 20 seconds and then end abruptly.

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  CAE often responds to medical treatment and typically disappears by adolescence.

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• Juvenile Absence Epilepsy (JAE) JAE seizures tend to last longer than CAE seizures and can also involve generalized tonic-clonic seizures, which affect movement. While it often responds to treatment, both the condition and treatment tend to be lifelong.

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• Juvenile Myoclonic Epilepsy (JME) People with JME can have absence seizures, myoclonic (muscle-jerking) seizures, and generalized tonic-clonic seizures. Kids can grow out of JME, but most will need to take medication throughout their lives.

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• Benign Childhood Epilepsy With Centrotemporal Spikes The most common epilepsy syndrome in children, this type of epilepsy involves facial twitching and numbness, and the seizures often occur at night. For most children, seizures cease by age 15.

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Epilepsies Based on Brain Region

Because different parts of the brain perform different functions, seizure activities in different areas can have distinct symptoms.

Here are some examples of epilepsy syndromes by brain regions affected:

• Temporal Lobe Epilepsy (TLE) TLE often has an aura of déjà vu, fear, an unusual smell or taste, or gastric rising, a sensation in your stomach similar to being on a rollercoaster. A TLE seizure can look like a staring spell or cause repetitive behaviors called automatisms.

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• Frontal Lobe Epilepsy Someone with frontal lobe epilepsy may have muscle weakness and abnormal movements, like twisting, waving the arms and legs, or grimacing during seizures, as well as psychosis, loss of awareness, personality changes, or different-than-usual behaviors. These seizures often occur during sleep.

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• Neocortical Epilepsy This type of epilepsy affects the neocortex, or the outer layer of the brain. Seizure symptoms can vary from unusual sensations to visual hallucinations, emotional changes, or convulsions.

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• Occipital Lobe Epilepsy This rare type of epilepsy involves recurring seizures originating in the part of the brain responsible for vision. Seizures tend to include visual changes, such as flashing lights, or even hallucinations.

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Causes and Risk Factors of Epilepsy

• Genetic The direct result of a known or presumed genetic difference.
• Structural Caused by changes to the structure of part of the brain that may be present at birth or come from a head injury, infection, tumors, or stroke.
• Metabolic When a documented metabolic condition leads to a higher risk of epilepsy.
• Immune When central nervous system inflammation leads to epilepsy, such as with some kinds of autoimmune encephalitis.
• Infectious When infections like human immunodeficiency virus, malaria, or tuberculosis lead to epilepsy.
• Unknown When none of the causes listed above contribute to the cause of epilepsy. Up to half of people with epilepsy don’t know their condition’s specific cause, even with a complete medical evaluation.

In some cases, combinations of these categories best describe the causes of seizures.

Epileptic Seizure Triggers

Epilepsy causes and triggers are different: While seizure triggers don’t cause epilepsy, they can lead to an epileptic seizure in someone who is already susceptible.

• Stress
• Sleep deprivation
• Dehydration or missing meals
• Flashing lights
• Consumption of or withdrawal from alcohol or drugs

How Is Epilepsy Diagnosed?

A variety of tests can help find evidence of and diagnose epilepsy, as well as rule out other possible seizure causes.

One of the main tools used for diagnosing epilepsy is the electroencephalogram, or EEG. An EEG records the brain’s electrical activity and can reveal the abnormal electrical brain activity that causes epilepsy.

Sometimes brain imaging using MRI or computed tomography (CT) can also identify structural brain abnormalities that may be causing seizures.

Treatment and Medication Options for Epilepsy

Antiseizure medication and anti-epileptic drugs are firstline treatments for epilepsy. Options including neurostimulation and surgery, as well as complementary therapies, can also help in some cases.

Medication

Most people with epilepsy can become seizure-free by taking an antiseizure medication. Some may need to take a combination of medications to control their seizures.

Your doctor will likely prescribe a single medication at a relatively low dose to start, increasing the dose gradually until your seizures are under control.

• brivaracetam
• clobazam
• clonazepam
• carbamazepine
• gabapentin
• lacosamide
• lamotrigine
• levetiracetam
• lorazepam
• oxcarbazapine
• topiramate
• valproic acid
• zonisamide

To help you find the right medication, your doctor may consider these factors:

• Your specific condition
• The frequency of your seizures
• Your age
• Co-occurring or pre-existing health conditions
• Other medications you’re currently taking

Surgery

More than half of people newly diagnosed with epilepsy will become seizure-free with their first medication. If anti-epileptic medications don’t work, your doctor may recommend surgery.

Surgery may help if brain scans reveal that your seizures originate in a small, well-defined area of your brain, and removing it won’t interfere with speech, language, motor function, vision, or hearing.

Neurostimulation

An alternative to surgery for some people with epilepsy is neurostimulation, which uses electrical pulses to stimulate the vagus nerve or other parts of the brain to stop or prevent seizures.

Types of nerve stimulation include the following:

• Vagus Nerve Stimulation A device called a vagus nerve stimulator sends pulses of electrical energy through the vagus nerve to your brain, reducing the number and severity of seizures.

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• Deep Brain Stimulation A neurosurgeon implants electrodes into a specific part of your brain, usually your thalamus. The electrodes are connected to a generator implanted in your chest or your skull, and they send electrical pulses to your brain to control seizures.

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• Responsive Neurostimulation An implantable, pacemaker-like device could help stop seizures by detecting them before they occur and delivering an electrical charge to the affected area of the brain to stop them.

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Complementary and Integrative Therapies

Some people with epilepsy also try alternative and complementary therapies alongside traditional treatments:

• Acupuncture A traditional Chinese treatment in which a practitioner inserts thin needles into your skin at various points around your body, acupuncture could reduce seizure frequency in some people.

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• Vitamin E Some studies have shown that people on anti-epileptic drugs who also take vitamin E supplements have fewer seizures and fewer signs of epilepsy on brain electroencephalograms.

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• Ketogenic Diet Evidence suggests the keto diet — a high-fat, low-carbohydrate approach — could help control seizures for some children with epilepsy, but it’s important to follow the diet under the guidance of a doctor.

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Lifestyle Changes and Prevention of Epilepsy and Seizures

Practice Good Hygiene to Prevent Infection

An infection called neurocysticercosis is a common cause of epilepsy globally, and it comes from ingesting tapeworm eggs. It’s most common in areas of Latin America, Asia, and Africa with poor sanitation, but fairly uncommon in the United States and Europe.

Protect Your Head and Brain From Injury

Another common cause of epilepsy is traumatic brain injury or head injuries. You can reduce your risk for head injuries by wearing a helmet when playing sports such as hockey or when riding a skateboard or bicycle, for example.

Wearing seatbelts while riding in the car and making sure to use child safety seats for babies and younger children can also help.

Reduce Cardiovascular Disease Risk Factors

Reducing your risk of heart attack and stroke can also help lower your risk of developing epilepsy later in life, as some epilepsies are caused by these health events. A heart healthy diet, regular exercise, and managing stress can help you maintain heart and blood vessel health.

Once you receive an epilepsy diagnosis, the best way to prevent seizures and reduce their frequency is to stick with the treatment prescribed by your doctor. If you feel your treatment isn’t working and seizures are affecting your quality of life, talk to your doctor about other options.

How Long Does Epilepsy Last?

How long you will experience epilepsy symptoms depends on the type of epilepsy you have and what’s causing it.

While medication helps some with epilepsy, it doesn’t have the same effect on everyone:

• Nearly half of people with epilepsy will be seizure-free after using the first seizure medication they try.

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• Another 14 percent of people may become seizure-free after trying a second or third medication.

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• About 30 to 40 percent of people with epilepsy have seizures that don’t respond to medication.

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Complications of Epilepsy

With early diagnosis and treatment, most people with epilepsy can go on to live long and healthy lives. But in rare cases or without treatment, it can cause complications — some of which are fatal.

Accidents

People with epilepsy are also at increased risk for accidents — burns, car accidents, drowning, falls — that occur during or immediately after a seizure.

Antiseizure Medication Side Effects

Sudden Unexpected Death in Epilepsy (SUDEP)

Status Epilepticus

Attention-Deficit/Hyperactivity Disorder (ADHD)

Migraine

Epilepsy, Stigma, and Mental Health

Some evidence suggests people with epilepsy experience higher rates of depression and anxiety than the general population.

Epilepsy can also be isolating, for children and adults. Friends, family, colleagues, and neighbors may not understand the condition or know how to respond when you have a seizure. Also, if those with epilepsy can’t drive, it can make accessing friends and family more difficult.

Disparities and Inequities in Epilepsy

Black American adults are slightly less likely to have epilepsy than white adults. Meanwhile, Hispanic American adults tend to experience slightly higher rates of epilepsy than either group.

Although there aren’t major racial disparities in the numbers of those living with epilepsy in the United States, research suggests there are differences in how racial and ethnic minorities are treated for the condition compared with their white counterparts.

This could be due to unconscious bias by healthcare workers or Black and Hispanic Americans being more likely to lack health insurance than their white counterparts, making such care more challenging to pay for.

The Takeaway

• Epilepsy is a condition that causes seizures, and its severity can vary from mild to life-threatening based on the type of epilepsy you have.
• Antiseizure medications are the standard treatment for epilepsy and allow many people with the condition to live seizure-free.
• While seizures can seem frightening and in some cases are dangerous to the person experiencing them, epilepsy is often very manageable with help from a healthcare professional.