Epilepsy

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Introductio n
Epilepsy is a disorder that disrupts the transmission of electrical signals inside the brain. Although you may assume that epilepsy always causes episodes of uncontrolled movements and loss of consciousness, the condition is actually quite variable. Symptom episodes known as seizures are often subtle, causing strange sensations, emotions and behavior. Some people with epilepsy simply stare blankly for a few seconds when having a seizure, while others have full fledged

Introductio n
About one in !"" people in the #nited States has e$perienced an unprovoked seizure at some point in life. %owever, a solitary seizure doesn&t mean you have epilepsy. 'any people for e$ample, children with high fevers e$perience one seizure and then never have another one. (ut after you&ve had two seizures, the chance that you&ll have additional seizures increases dramatically. At least two unprovoked seizures are required for a diagnosis of epilepsy.

Introductio n
)he onset of epilepsy is most common during childhood and after age *+, but the condition can occur at any age. )reatments may leave you free of seizures, or at least reduce their frequency and intensity. 'any children with epilepsy even outgrow the condition with age

 (ecause epilepsy is caused by abnormal activity in brain cells, seizures can affect any process your brain coordinates. A seizure can produce temporary confusion, complete loss of consciousness, a staring spell, or uncontrollable ,erking movements of the arms and legs. Symptoms vary depending on the type of seizure. -n most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be very similar from episode to episode. (ut some people have many different types of seizures, with different

Signs & Symptoms

Signs & Symptoms .octors classify seizures as either partial or generalized, based on how the abnormal brain activity begins. /hen seizures appear to result from abnormal activity in ,ust one part of the brain, they&re called partial or focal seizures. Seizures that seem to involve all of the brain are called generalized seizures. -n some cases, seizures can begin in one part of the brain and then spread throughout the rest of the

Partial Seizures
Simple partial seizures. )hese seizures don&t result in loss of consciousness. )hey may alter emotions or change the way things look, smell, feel, taste or sound. Complex partial seizures. )hese seizures alter consciousness, causing you to lose awareness for a period of time. 0omple$ partial seizures often result in staring and nonpurposeful movements such as hand rubbing, lip smacking, arm positioning, vocalization or swallowing.

Generalized Seizures
Absence seizures (petit mal). )hese seizures are characterized by staring, subtle body movement and brief lapses of awareness. Myoclonic seizures. )hese seizures usually appear as sudden ,erks of your arms and legs. Atonic seizures. Also known as drop attacks, these seizures cause you to suddenly collapse or fall down. Tonic-clonic seizures (grand mal). )he most intense of all types of seizures, these are characterized by a loss of

Causes
Several types of epilepsy have been linked to defective genes that regulate how brain cells communicate with each other, but only a few rare types of the disorder are known to arise from specific gene defects. 1therwise, it appears that abnormalities in any of several hundred genes may play a role in the development of epilepsy. Although some forms of epilepsy tend to run in families, genetic inheritance plays only a partial role in causing epilepsy perhaps by making a person more susceptible to environmental factors that cause seizures. -n many cases, the onset of epilepsy can be traced to an accident, disease or medical trauma such as a stroke that in,ures your brain or deprives it of o$ygen. -n rare

Risk Factors
If you have a family history of epilepsy, you may be at increased risk of developing a seizure disorder. Head injuries are responsible for many cases of epilepsy. You can reduce your risk by al ays earing a seat belt hile riding in a car and by earing a helmet hile bicycling, skiing, riding a motorcycle, or engaging in other activities ith a high risk of head injury. !troke and other vascular diseases can lead to brain damage that may trigger epilepsy. You can take a number of steps to reduce your risk of these diseases, including limiting your intake of alcohol, follo ing a healthy diet, managing your eight, e"ercising regularly and avoiding cigarettes. #ther epilepsy risk factors include brain infections, such as meningitis, and prolonged seizures in childhood due to high fevers.

When to seek medical advice

Seek medical help i any o the ollo!ing occur" )he seizure lasts more than five minutes. 2ecovery from your seizure is slow. A second seizure follows immediately. 3ou&re pregnant or have diabetes. 3our seizures change in frequency and severity. )here&s a change in the way you feel during and after the seizures.

When to seek medical advice

3our seizure is preceded by a sudden, severe headache or other symptoms or signs of stroke including weakness or numbness on one side of your body, vision loss, confusion, and coordination or speech problems. -f you see someone having a seizure, call for medical help immediately and then follow these tips4 5ently roll the person onto one side and put something soft under his or her head. 6oosen tight neckwear.

When to seek medical advice

.on&t try to restrain someone having a seizure, and don&t attempt to rouse the person by shouting at or shaking him or her. -f the person is moving, clear away dangerous ob,ects. 6ook for a medical alert bracelet. )he bracelet should state who to contact in an emergency and what medications the person uses. Stay with the person until medical personnel arrive. -f possible, observe the person closely so that you can provide details on what happened.

Screening & #iagnosis

Electroencephalogram (EE ) Computerized tomography (CT) Magnetic resonance imaging (M!") #ositron emission tomography (#ET)

Single-photon emission computerized tom

Electroencephalogram (EE )
An EE5 records the electrical activity of your brain via electrodes affi$ed to your scalp. 7eople with epilepsy often have changes in their normal pattern of brain waves, even when they&re not having a seizure. )o prepare for an EE5, avoid elaborate hair styling, metallic hair spray or greasy hair dressing. 2efrain from caffeine for si$ hours before the test. )he procedure itself is painless and usually lasts about 8" minutes. %owever, it can take as long as an hour to place the electrodes on your scalp.

Electroencephalogram (EE )
-n some cases, your doctor may recommend video EE5 monitoring. )his can be helpful because it allows your doctor to compare second by second the behaviors that occur during a seizure with your EE5 pattern from e$actly that same time. )his helps your doctor pinpoint e$actly where your seizures originate, which aids treatment decisions. 9ideo EE5s are e$pensive because you usually must stay at the testing facility for several days. )he EE5 electrodes stay attached for that entire time, and you are videotaped continuously.

Computerized tomography $C%&

#sing special : ray equipment, 0) machines obtain images from many different angles and ,oin them together to show cross sectional images of your brain and skull. 0) scans can reveal abnormalities in brain structure, including tumors, cysts, strokes or tangled blood vessels. )his helps your doctor rule out other potential causes of your seizures.

Computerized tomography $C%&

)o prepare for a 0) scan of your head, you should remove such things as earrings, eyeglasses, dentures and hairpins. 3ou may need to have an intravenous ;-9< line inserted if your test requires the in,ection of a contrast material which makes abnormalities easier to see. .uring the test, you will lie on a table that slides into the 0) machine. .epending on the number of images needed, the scan can take between two and =" minutes. )he procedure is painless.

'agnetic resonance imaging $'RI&

An '2- machine uses radio waves and a strong magnetic field to produce detailed images of your brain. 6ike 0) scans, '2-s can reveal brain abnormalities that could be causing your seizures. .ental fillings and braces may distort the images, so be sure to tell the technician about them before the test begins. .uring the test, you will lie on a padded table that slides into the '2- machine. 3our head will be immobilized in a brace, to improve precision. )he test is painless, but some people e$perience an uncomfortable feeling similar to claustrophobia inside the '2- machine&s close quarters. -f you think you may have a problem

'agnetic resonance imaging $'RI&

A special type of '2- called functional '2;f'2-< can measure the small metabolic changes that occur when a part of your brain is working. An f'2- can record which areas of your brain are working when you perform certain tasks, such as rubbing a block of sandpaper or answering simple questions. .octors know the general areas of the brain responsible for such tasks as thought, speech, movement and sensation, but the precise locations vary by individual. An f'2- can identify the locations of these critical functions so that your doctor can determine if epilepsy surgery would be a safe option for

Positron emission tomography $PE%&

7E) scans use in,ected radioactive material to help visualize active areas of the brain. )he radioactive material is tagged in a way that makes it attracted to glucose. (ecause the brain uses glucose for energy, the parts that are working harder will be brighter on a 7E) image. After the radioactive material is in,ected, it will take between 8" and >" minutes for the substance to accumulate in your brain tissue. .uring this waiting period, you will be asked to rest quietly and not talk or move around much. )he actual scan takes 8" to ?+ minutes. )he amount of radioactive material used in the test is very small, and its glucose binding activity in the brain lasts only a short period of time.

Single-photon emission computerized tomography (S#ECT)

)his type of test is used primarily in people being evaluated for epilepsy surgery when the area of seizure onset is unclear on '2-s or EE5s. S7E0) imaging requires two scans one during a seizure and one =? hours later. 2adioactive material is in,ected for both scans and then the two results are compared. )he area of the brain with the greatest activity during the seizure can be superimposed onto the person&s '2-, to show surgeons e$actly what portion of the

Complications
-f you fall during a seizure, you may sustain a head in,ury. .rowning is a very real risk if you have a seizure while swimming or bathing. A seizure that causes either loss of awareness or control can be dangerous if you&re driving a car or operating other equipment. .rugs used to control seizures also can cause drowsiness, which may affect your driving ability. 'any states have

Complications
Seizures during pregnancy pose dangers to both mother and baby, and certain anti epileptic medications increase the risk of birth defects. -f you have epilepsy and you&re considering becoming pregnant, talk to your doctor. 'ost women with epilepsy can become pregnant and have a healthy baby, but many need to ad,ust their medications and be carefully monitored throughout pregnancy. -t is very important to work with your doctor and to plan your

Complications
6ife threatening complications from epilepsy are uncommon, but do occur. 7eople who have severe, prolonged or continuous seizures ;status epilepticus< are at increased risk of permanent brain damage and death. 7eople with epilepsy, particularly people with poorly controlled epilepsy, also have a small risk of a condition called sudden une$plained death in epilepsy ;S#.E7<. 3our risk of S#.E7 increases if you4 $ (egan having seizures at an early age $ %ave frequent seizures that involve more than one area of your brain

%reatment (nti)epileptic drugs Surgery *agus nerve stimulation +etogenic diet

(nti)epileptic drugs
'ost people with epilepsy can become seizure free by using a single anti epileptic drug. 1thers can decrease the frequency and intensity of their seizures with medication. 'ore than half the children with medication controlled epilepsy can eventually stop medications and live a seizure free life. 'any adults also can discontinue medication after two or more years without seizures.

(nti)epileptic drugs
@inding the right medication and dosage can be comple$. 3our doctor likely will first prescribe a single drug at a relatively low dosage, and may increase the dosage gradually until your seizures are well controlled. -f you&ve tried two or more single drug regimens without success, your doctor may recommend trying a combination of two drugs. All anti seizure medications have some side effects, which may include mild fatigue, dizziness and weight gain. 'ore severe side effects include depression, skin rashes, loss

(nti)epileptic drugs
)o achieve the best seizure control possible, take medications e$actly as prescribed. Always call your doctor before switching to a generic version of your medication or taking other prescription medications, over the counter drugs or herbal remedies. And never stop taking your medication without talking to your doctor. -f anti epileptic medications don&t provide satisfactory results, your doctor may suggest other treatment options such as surgery, vagus nerve stimulation or a ketogenic diet.

Surgery
Surgery is most commonly done when tests show that your seizures originate in a small, well defined area in the temporal lobes or the frontal lobes of your brain. Surgery is rarely an option if you have seizures that start in several areas of the brain or if you have seizures originating from a region of the brain that

Surgery
.uring the procedure, your surgeon makes an incision in your scalp and removes a piece of the skull bone. %e or she then cuts into or removes the area of the brain that&s causing the seizures. Although many people continue to need some medication to help prevent seizures after surgery, you may be able to take fewer drugs and reduce your dosages. -n some cases, surgery for epilepsy can cause complications such as permanently altering your cognitive abilities. )alk to your surgeon about his or her e$perience, success rates

*agus nerve stimulation

A device called a vagus nerve stimulator is implanted into your chest under the collarbone. /ires from the stimulator are wrapped around the vagus nerve in your neck. )he vagus nerve connects your brain to your heart, lungs and gastrointestinal tract. )he device turns on and off according to an ad,ustable program. -t&s not clear how brain stimulation via the vagus nerve inhibits seizures, but the device reduces seizures by about =" percent to ?" percent on average. 'ost people still need to take anti epileptic

+etogenic #iet
Some children with epilepsy have been helped by adopting a rigid diet that&s high in fat and protein and low in carbohydrates. )he goal of the diet is to get the body to produce ketones, which cause the body to use fat instead of glucose for energy. )he e$act way in which the ketogenic diet works is unclear.

Sel )care
#nderstanding your condition can help you control it. (e sure to take your medication correctly. .on&t take it upon yourself to ad,ust your dosage levels. -nstead, talk to your doctor if you feel something should be changed.

Sel )care
-t&s also important to keep a detailed seizure record. )his record can help your doctor better understand your condition and direct your treatment. Each time a seizure occurs, write down the time, the type of seizure it was and how long it lasted. Also make note of any unusual circumstances, such as changes in medication, increased stress or other events that might trigger seizure activity. Seek input from people who may observe your seizures including family, friends and co workers so that you can record information you may not know.

Sel )care
As with many chronic conditions, maintaining your overall health is an important step in controlling epilepsy. Sleep deprivation is a powerful trigger of seizures. (e sure to get adequate rest every night, and make a conscious effort to eat a balanced diet, e$ercise and manage stress effectively. E$cessive alcohol consumption may trigger seizures. -f you have difficulty avoiding alcohol and cigarettes, ask your doctor for help. /ear a medical bracelet to help emergency personnel. )he bracelet should state who to contact in an