Epilepsy

What Increases Your Risk

The risk for epilepsy increases if you have:

• Family history of epilepsy.
• Head injury (for example, a penetrating wound or skull fracture) with amnesia or loss of consciousness for more than 24 hours. The more severe the injury, the higher the risk.
• Stroke or conditions that affect the blood vessels (vascular system) in the brain.
• Brain tumor.
• Brain infection, such as encephalitis or meningitis.
• Lead poisoning.
• Problems with brain development that occurred before birth.
• Used illegal drugs, like cocaine.
• Fever seizures that last a long time (also known as febrile convulsions).
• Alzheimer's disease.

Epilepsy may develop even though you do not have any risk factors. This is especially true of many forms of childhood epilepsy.

Symptoms

The main symptom of epilepsy is repeated seizures that happen without warning. Without treatment, seizures may continue and become worse and happen more often over time.

There are different kinds of seizures. You may have only one type of seizure. Some people have more than one type. Depending on what kind of seizure you have:

• Your senses may not work right. For example, you may notice strange smells or sounds.
• You may lose control of your muscles.
• You may fall down, and your body may twitch or jerk.
• You may stare off into space.
• You may faint (lose consciousness).

Not everyone who has seizures has epilepsy. Sometimes seizures happen because of an injury, an illness, or another problem. In these cases, the seizures stop when that problem improves or goes away.

Types of epilepsy and their symptoms

There are many types of epilepsy. All types cause seizures. Some specific types are:

• Benign focal childhood epilepsy. It causes muscles all over the body to stiffen and jerk. These symptoms usually occur at night.
• Childhood and juvenile absence epilepsy. It causes staring into space, eye fluttering, and slight muscle jerks.
• Infantile spasms (West syndrome). It causes muscle spasms that affect a child's head, torso, and limbs. Spasms usually start before a child is 1 year old.
• Juvenile myoclonic epilepsy. It causes jerking in the shoulders or arms.
• Lennox-Gastaut syndrome. It causes frequent seizures and several different types of seizures. It can lead to falls during a seizure, which can cause an injury.
• Temporal lobe epilepsy (the most common type of epilepsy in adults). It causes smacking of the lips or rubbing the hands together, emotional or thought disturbances, and hearing, smelling, or tasting things that aren't there (hallucinations of sounds, smells, or tastes).

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What Happens

Epilepsy does not always follow a course that you can predict. It can start at any age. And it may get worse over time or it may get better.

Though not common, epilepsy that begins in a certain area of the brain may over time affect another part of the brain. Some types of childhood epilepsy go away after the child reaches the teen years. Other types may continue for life. Epilepsy that started after a head injury may go away after several years or may last the rest of your life.

Focal epileptic seizures

Epilepsy that causes focal seizures is sometimes called focal epilepsy, because the seizures start at a specific focus or location within the brain. In people with this type of disorder, the electrical charges that cause seizures begin in a specific area in the brain, although more of the brain may become affected during the seizure.

Epilepsy that causes focal seizures is the most common type of epilepsy in adults.

Generalized epileptic seizures

Epilepsy that causes generalized seizures is more common in children than in adults. Focal seizures start in a specific, often damaged area in the brain. But generalized seizures can't be traced to a specific location or focus. The abnormal electrical activity that causes the seizures begins over the entire surface of the brain. And these seizures tend to affect the entire body.

Sometimes the cause of this type of seizure is not known. In some cases, it may be caused by another condition like an infection or head injury. It is most often treated with medicine. But surgery may help in some cases.

Complications of seizures

Epileptic seizures themselves usually cause no harm. The danger lies in where you are or what you are doing when the seizure occurs. For example, there is a risk of head injury, broken bones, and other injuries when you fall during a seizure.

Some seizures may place brief but severe stress on the body. This can cause problems with the muscles, lungs, or heart. Choking or an abnormal heartbeat may cause sudden death, though this is rare. Seizures that aren't treated and become more severe or frequent may lead to these problems.

More serious problems related to epilepsy are not common but may include:

• Status epilepticus. This prolonged seizure can result in brain damage or death.
• Sudden unexpected death in epilepsy (SUDEP). There is a small risk of this for people with epilepsy. The risk may be higher in people who often have tonic-clonic seizures or uncontrolled seizures.

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When to Call a Doctor

Call 911 or other emergency services immediately if:

• The person having a seizure stops breathing for longer than 30 seconds. After calling 911 or other emergency services, begin rescue breathing.
• The seizure lasts longer than 5 minutes. (The person may have entered a life-threatening state of prolonged seizure called status epilepticus.)
• More than one seizure occurs within 24 hours.
• The person having a seizure does not respond normally within 1 hour after the seizure or has any of the following symptoms:
  • Reduced awareness and wakefulness or is not fully awake
  • Confusion
  • Nausea or vomiting
  • Dizziness
  • Inability to walk or stand
  • Fever
• A seizure occurs after the person complains of a sudden, severe headache.
• A seizure occurs with signs of a stroke, such as trouble speaking or understanding speech, loss of vision, and inability to move part or all of one side of the body.
• A seizure follows a head injury.
• Someone who is pregnant or who recently had a baby has a seizure. This could be a sign of eclampsia.
• A person with diabetes has a seizure. Low blood sugar (hypoglycemia) or very high blood sugar (hyperglycemia) can cause seizures in a person who has diabetes.
• A seizure occurs after a person eats poison or breathes fumes.

Call your doctor now if you have a seizure for the first time.

If you have been diagnosed with epilepsy, call your doctor if:

• Your seizures become more frequent or more severe.
• A serious illness seems to be changing the normal pattern, frequency, length, or other features of your seizures.
• The normal pattern or features of your seizures change. For example, you have never lost consciousness during a seizure before, but now you do. Or you have never fallen down during a seizure, but now you do.
• You are taking antiepileptic medicine and the side effects seem more severe than expected. When you begin taking a medicine, talk to your doctor about what side effects you can expect. Find out what problems might mean that your medicine levels are too high (drug toxicity). You may start having seizures more often if your medicine levels are too low.
• You are pregnant or thinking about becoming pregnant.

Watchful waiting

Watchful waiting is okay if you have already been diagnosed with epilepsy and you have a seizure. But call your doctor right away if you have a second seizure within a short period of time or if your seizures have become more frequent or more severe. Your doctor may need to change the amount of medicine you take or try a different medicine.

Check your symptoms

Exams and Tests

It can be hard to diagnose epilepsy. A physical exam and your detailed medical history often give the best clues as to whether you have epilepsy and what type of epilepsy and seizures you have.

If you think that you've had a seizure, your doctor will first try to figure out if it was a seizure or something else with similar symptoms. For example, a muscle tic or a migraine headache may look or feel like a kind of seizure.

Your doctor will ask lots of questions to find out what happened to you just before, during, and right after a seizure. Your doctor will also check you and do some tests, such as an electroencephalogram (EEG). This information can help your doctor decide what kind of seizures you have and if you have epilepsy.

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Treatment Overview

You can take medicines to control and reduce seizures. You and your doctor will need to find the right combination, schedule, and dose of medicine. After you find a medicine that works for you, take it exactly as prescribed.

If medicine alone doesn't control your seizures, your doctor may recommend other treatments. They include:

• Surgery to remove tissue in the brain or the area of brain tissue where seizures start.
• A special diet in which you eat more fat and less carbohydrate.
• A vagus nerve stimulator. This device sends weak signals to the vagus nerve in your neck and to your brain to help control seizures.
• A responsive neurostimulation system. This device senses when a seizure may be starting. It sends a weak signal to prevent the seizure.
• Deep brain stimulation (DBS). This device sends signals to change the activity in an area of the brain involved in seizures.

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Self-Care

To help control your seizures, follow your treatment plan. If you take medicine to control seizures, take it exactly as prescribed.

The medicine works best if you take the right amount on the schedule your doctor sets up. Following this schedule keeps the right level of medicine in your body. Even missing just a few doses can allow seizures to happen.

You might be on a special ketogenic diet. If so, follow the diet carefully.

As you follow your treatment plan, also try to figure out and avoid things that may make you more likely to have a seizure. These may include:

• Not getting enough sleep.
• Using drugs or alcohol.
• Being stressed.
• Skipping meals.

If you keep having seizures despite treatment, keep a record of them. Note the date, time of day, and any details about the seizure that you can remember. Your doctor can use this information to plan or adjust your medicine or other treatment. The record can also help your doctor find out what kinds of seizures you are having.

If you have epilepsy:

• Be sure that any doctor who treats you knows that you have epilepsy. And let the doctor know what medicines you take, if any.
• Wear a medical ID bracelet. If you have a seizure or accident that leaves you unconscious or unable to speak for yourself, the bracelet will let those who are treating you know that you have epilepsy. It will also list any medicines you take to control your seizures. That way, you won't be given any medicines that will react badly with those already in your body.
• Ask your doctor if it's safe for you to do things like drive or swim.
• Create a seizure first-aid plan with your friends and family. The plan will help them know how to help you. The kind of plan you need can depend on the kind of seizures you have. Your doctor can tell you more about this.

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Medicines

There are many medicines used to treat epilepsy. These are called antiepileptics. You may also hear them called anticonvulsants or antiseizure medicines. But they don't all treat the same types of seizures. So the first step is for your doctor to figure out the types of seizures you have.

It may take time and careful, controlled adjustments by you and your doctor to find the combination, schedule, and dose of medicine to best manage your epilepsy. The goal is to prevent seizures while causing the fewest side effects.

Some antiepileptics are used alone. And some are used only along with other medicines.

Reducing or stopping epilepsy medicine safely

If you haven't had a seizure in several years, you may ask your doctor if you can slowly stop or reduce your medicine. You and your doctor will need to weigh the benefits of stopping treatment against the risk that your seizures may return.

You have a lower risk of having a seizure after you stop medicine if:

• You haven't had a seizure in 2 years or more.
• You have only one type of seizure. (An exception is myoclonic seizures, which usually require lifelong treatment.)
• Your epilepsy started when you were a child or teen.
• You had only a few seizures before starting treatment.
• Your seizures were easy to control with initial drug therapy using only one medicine.
• Your electroencephalogram (EEG) is consistently normal.
• Brain scans (MRI or CT scan) don't show any problems.
• You have a type of epilepsy that tends to go away (remit), such as benign focal childhood epilepsy.

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Special Diets for Epilepsy

When the body burns (metabolizes) fat, it creates substances called ketones. The ketogenic diet tries to force the body to use more fat for energy instead of sugar (glucose) by increasing fat and restricting carbohydrates. The ketogenic diet can be used to prevent seizures in an adult or a child who has any type of epilepsy. It is not yet clear how or why the ketogenic diet prevents or reduces seizures.

One version of the ketogenic diet provides 4 grams of fat for every 1 gram of protein and carbohydrate together. People on a ketogenic diet have to eat mostly fatty foods, such as butter, cream, and peanut butter. Foods such as bread, pasta, fruits, and vegetables have to be severely limited. And the person's total calories are also restricted. At every meal, the food has to be measured carefully so that the right amounts of each food are given. Even a slight departure from the diet can cancel its effect.

If you are thinking about the ketogenic diet, keep in mind:

• For the diet to prevent seizures, your child has to follow it exactly. The amounts and types of foods eaten have to be measured precisely. And preparing meals can take a lot of time.
• The diet does not work for some children, no matter how closely they follow it.

The ketogenic diet is very strict and can be hard for some people and families to follow. Other special diets for epilepsy that are less strict may also be tried.

The medium chain triglyceride (MCT) diet.

People on this diet take an oil supplement instead of relying on food for the fat in the diet. This can make the diet easier, because less total fat is needed from food and the person can eat more protein and carbohydrates.

The modified Atkins diet.

The Atkins diet is known as a high-protein, low-carbohydrate diet. The modified Atkins diet for people with epilepsy is similar to the ketogenic diet but allows for a little more flexibility in protein, fluid, and calorie amounts.

The low glycemic index diet.

This is the least restrictive special diet for epilepsy. It does not restrict fluids or protein and people do not need to be so strict about calories or the amount of fat they eat. People on this diet still eat much more fat than in a typical diet, but carbohydrates are not as limited.