A seizure occurs when the normal function of the nervous system is disrupted by abnormal electrical discharge within the brain. This can manifest in many different ways, from abrupt loss of consciousness and violent abnormal movements to confusion and altered mental status or brief spells of staring and lack of awareness of the environment.
Seizures are not uncommon—in fact, one in 10 persons will have at least one seizure during their lifetime. There are many reasons that a person may have a seizure. A seizure can be “provoked” by a wide variety of abnormal physical conditions, including excess intake or withdrawal from medications, alterations in the normal levels of electrolytes and/or metabolic byproducts in the blood, exposure to toxins, high fevers and abrupt withdrawal from alcohol.
Epilepsy is a condition characterized by a tendency to recurrent seizures and affects approximately 1 percent of the U.S. population. Epilepsy can be acquired, most commonly after a stroke, brain tumor, traumatic brain injury or brain infection. Alternatively, it can represent a primary neurological disorder, resulting from abnormalities of brain function at the molecular or structural level. There is also a possibility of a genetic predisposition toward epilepsy.
Management of patients who have had a seizure begins with an evaluation to determine the cause of the seizure—typically labs, an MRI of the brain and an EEG. In some cases, prolonged monitoring is necessary either on an ambulatory basis or in an epilepsy monitoring unit.
Treatment options include monitoring, medications, surgery and neuropsychiatric evaluations and counseling. However, while medication is the mainstay of therapy for most patients with epilepsy, no two patients are the same and the choice of specific medication requires careful analysis and monitoring. Martha Jefferson’s Seizure Disorder/Epilepsy Clinic provides patients with the individualized care and monitoring that they need.
Seizures are a symptom of epilepsy, but having a single seizure does not necessarily mean a person has epilepsy. High fever, severe head injury, lack of oxygen — a number of factors can affect the brain enough to cause a single seizure. Epilepsy, on the other hand, is an underlying condition that affects the delicate systems that govern how electrical energy behaves in the brain, making it susceptible to recurring seizures.
Seizures can manifest in many different ways. Some involve a loss of consciousness, others do not. Commonly, seizures are classified as either partial seizures and generalized seizures.
Partial or Focal Seizures
Focal seizures, also called partial seizures, occur in just one part of the brain.
In a simple focal seizure, the person will remain conscious but experience unusual feelings or sensations that can take many forms. The person may experience sudden and unexplainable feelings of joy, anger, sadness or nausea. He or she also may hear, smell, taste, see or feel things that are not real.
In a complex focal seizure, the person has a change in consciousness. His or her consciousness may be altered, producing a dreamlike experience. People having a complex focal seizure may display strange, repetitious behaviors such as blinks, twitches, mouth movements or even walking in a circle.
Generalized seizures are a result of abnormal neuronal activity on both sides of the brain. These seizures may cause loss of consciousness, falls or massive muscle spasms.
There are several categories of generalized seizures. Some start with a stiffening of the limbs and then a jerking of the limbs and face. Some are more mild and can be mistaken for daydreaming and staring spells. Others may cause someone to drop to the ground.
Not all seizures can be easily defined as either focal or generalized. Some people have seizures that begin as focal seizures but then spread to the entire brain. Other people may have both types of seizures but with no clear pattern.
The management of epilepsy begins with a comprehensive evaluation to clarify the cause, type and frequency of seizures. This enables the neurologist to tailor a treatment regiment for maximum efficacy. In some cases, evaluation is necessary to rule out other possible causes for spells which may resemble epilepsy symptoms
For an epilepsy diagnosis, our specialists will conduct a physical exam and compile an extensive medical history. Patients should provide as many specifics about the nature of their seizures as possible. (It helps to bring a family member who has witnessed your seizures to the initial intake interview to describe your seizures to the neurologist.)
One diagnostic tool for epilepsy diagnosis is an EEG (electroencephalogram), which detects the brain's electrical impulses, creating patterns to help the physician determine the nature of the problem and how best to treat a disorder. To conduct the EEG, electrodes are applied to the scalp to measure the activity.
Tests for Epilepsy Diagnosis
- Imaging methods
CT (computerized tomography) or MRI (magnetic resonance imaging) scans may be used to search for any growths, scars or other physical conditions in the brain that may be causing the seizures. In a few research centers, positron emission tomography (PET) imaging is used to identify areas of the brain which are producing seizures.
- EEG monitoring
As many as 25 percent of adults who have seizures may have completely normal EEGs. This is because the brain's seizure activity pattern can come and go and is not always apparent during routine EEG tests. In some cases, physicians may choose to record a seizure on video as it is happening to get the best information they can about their patient.
The “backpack” EEG allows doctors to see what actually happens before, during and after a seizure. The test's purpose is to determine where in the brain seizures begin. It can be conducted in a few hours, but in some cases may take five to seven days, depending on how frequently your seizures occur and how many seizures need to be recorded.
Several factors determine whether doctors will treat epilepsy or wait to take action. These categories depend on age, whether the patient drives, EEG results, other neurological impairments and a history of seizures.
Epilepsy treatment can take many approaches:
- Vagus Nerve Stimulation
- Complementary Therapies
The most common epilepsy treatment is antiepileptic drugs. Antiepileptic drugs successfully prevent seizures in the majority of people who take them regularly and as prescribed. The type of epilepsy determines which medications will work best. It is also important to develop a "seizure calendar" to keep track of the number of seizures experienced and when they occur.
Periodically, your doctor will order blood tests done to find out how much medicine is in your blood. Your doctor will inform you of the best time of day to have these tests done and will call you with the results to allow you to make any needed adjustments.
Vagus nerve stimulation
Another option for treatment involves using a Vagus Nerve Stimulator (VNS). It is currently approved for use in adults and children over the age of 12 who have partial seizures that resist control by other methods.
The stimulator delivers energy by a flat, round battery, about the size of a silver dollar, which is surgically implanted in the chest wall. Thin wires (electrodes) are threaded under the skin and wound around the vagus nerve in the neck. The battery is programmed to send a few seconds of electrical energy to the vagus nerve every few minutes.
If a patient feels a seizure coming on, he or she can activate the electrical discharge by passing a small magnet over the battery. In some people, this has the effect of stopping the seizure.
Patients usually cannot stop taking epilepsy medication even with the stimulator, but they often experience fewer seizures and they may be able to reduce the dose of their medication. Side effects of the vagus nerve stimulator are generally mild but may include hoarseness, ear pain, a sore throat or nausea. Adjusting the amount of stimulation can usually eliminate most side effects, although the hoarseness typically persists.
Unfortunately, some people continue to have seizures regularly despite taking medication. For them, surgery may be helpful.
The type of surgery you will need depends upon several factors, including:
- The type of seizures you have
- Where in the brain these seizures begin
- What functions the affected area of the brain controls
These questions are answered during evaluation and testing at the Martha Jefferson Neuroscience Center. Recommendations including the risks, benefits and successful outcomes of surgery, are presented to the patient and family members.
For more information about the types of surgeries used to treat epilepsy, see the National Institutes of Neurological Disorders
and Stroke or the Epilepsy Foundation
Some people say they feel better, or have fewer seizures, when they use remedies, such as folk medicines, herbs and megavitamin therapy. If the treating physician has no objection, and these therapies do not contain harmful substances or involve any dangerous practices – and regular medication is continued, they could be beneficial.
Sometimes, a physician may prescribe a non-traditional supplemental therapy when a patient has developed a seizure-related metabolic disorder. Stopping standard medication or a prescribed diet in favor of an unproved remedy, however, presents definite risks and is not advisable.