Epilepsy Program

Epilepsy is a central nervous system (neurological) disorder in which brain activity becomes abnormal, causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness.Anyone can develop epilepsy. Epilepsy affects both males and females of all races, ethnic backgrounds and ages.

Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others repeatedly twitch their arms or legs. Having a single seizure doesn't mean you have epilepsy. At least two unprovoked seizures are generally required for an epilepsy diagnosis.

Treatment with medications or sometimes surgery can control seizures for the majority of people with epilepsy. Some people require lifelong treatment to control seizures, but for others, the seizures eventually go away. Some children with epilepsy may outgrow the condition with age.

Because epilepsy is caused by abnormal activity in the brain, seizures can affect any process your brain coordinates. Seizure signs and symptoms may include:

  • Temporary confusion
  • A staring spell
  • Uncontrollable jerking movements of the arms and legs
  • Loss of consciousness or awareness
  • Psychic symptoms such as fear, anxiety or deja vu

Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode.

Doctors generally classify seizures as either focal or generalized, based on how the abnormal brain activity begins.

When seizures appear to result from abnormal activity in just one area of your brain, they're called focal (partial) seizures. Focal seizures without loss of consciousness. Once called simple partial seizures, these seizures don't cause a loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste or sound. They may also result in involuntary jerking of a body part, such as an arm or leg, and spontaneous sensory symptoms such as tingling, dizziness and flashing lights.

Seizures that appear to involve all areas of the brain are called generalized seizures. Six types of generalized seizures exist.

  • Absence seizures.
  • Tonic seizures.
  • Atonic seizures.
  • Clonic seizures.
  • Myoclonic seizures
  • Tonic-clonic seizures.

Seek immediate medical help if any of the following occurs:

  • The seizure lasts more than five minutes.
  • Breathing or consciousness doesn't return after the seizure stops.
  • A second seizure follows immediately.
  • You've injured yourself during the seizure.
  • 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.
  • Head trauma.
  • Brain conditions.
  • Infectious diseases.
  • Prenatal injury.
  • Developmental disorders.

Having a seizure at certain times can lead to circumstances that are dangerous to yourself or others.

  • Falling.
  • Drowning.
  • 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.
  • Pregnancy complications.
  • Emotional health issues.

Other life-threatening complications of epilepsy are uncommon, but may happen, such as:

  • Status epilepticus. This condition occurs if you're in a state of continuous seizure activity lasting more than five minutes or if you have frequent recurrent seizures without regaining full consciousness in between them. People with status epilepticus have an increased risk of permanent brain damage and death.
  • 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 medications may be at higher risk of SUDEP. Overall, about 1 percent of people with epilepsy die of SUDEP.

To diagnose your condition, your doctor will review your symptoms and medical history. Your doctor may order several tests to diagnose epilepsy and determine the cause of seizures. Your evaluation may include:

  • A neurological exam.
  • Blood tests.

Your doctor may also suggest tests to detect brain abnormalities, such as:

  • 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.

The test may be done in a doctor'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.

Your doctor may give you instructions to do something that will cause seizures, such as getting little sleep prior to the test.

  • High-density EEG.
  • Computerized tomography (CT) scan.
  • Magnetic resonance imaging (MRI).
  • Functional MRI (fMRI).
  • Positron emission tomography (PET).
  • Single-photon emission computerized tomography (SPECT).
  • Neuropsychological tests.

Along with your test results, your doctor may use a combination of analysis techniques to help pinpoint where in the brain seizures start:

  • Statistical parametric mapping (SPM). SPM is a method of comparing areas of the brain that have increased metabolism during seizures to normal brains, which can give doctors an idea of where seizures begin.
  • Curry analysis. Curry analysis is a technique that takes EEG data and projects it onto an MRI of the brain to show doctors where seizures are occurring.
  • Magnetoencephalography (MEG). MEG measures the magnetic fields produced by brain activity to identify potential areas of seizure onset.

Treatment

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:

  • Medication
  • Surgery
  • Therapies

Apart from medications and surgery, these potential therapies offer an alternative for treating epilepsy:

  • Vagus nerve stimulation. In vagus nerve stimulation, doctors implant a device called a vagus nerve stimulator underneath the skin of your chest, similar to a heart pacemaker. Wires from the stimulator are connected to the vagus nerve in your neck.
  • Ketogenic diet. Some children with epilepsy have been able to reduce their seizures by following a strict diet that's high in fats and low in carbohydrates.
  • Deep brain stimulation. In deep brain stimulation, surgeons implant electrodes into a specific part of your brain, typically your thalamus. The electrodes are connected to a generator implanted in your chest or your skull that sends electrical pulses to your brain and may reduce your seizures.

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