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Epilepsy
Overview
Epilepsy is a seizure disorder. It affects about 1 out of 200 people. It’s caused by abnormal electrical activity in the brain. People with this condition may have:
- Recurrent convulsions. Some people call them fits, spells, or attacks.
- Unusual sensations, limb movement, or unusual behavior.
- Loss of consciousness (awareness) or gaps in memory or sense of time.
A single seizure doesn’t mean you have epilepsy. Epilepsy is defined as a tendency to have recurrent (ongoing) seizures.
About 65 percent of new cases have no obvious cause. Of the rest, epilepsy may be inherited or caused by:
- Strokes
- Brain tumors
- Traumas
- Infections
- Congenital abnormalities
Like many chronic conditions, epilepsy can be managed. There are few activity restrictions if the seizures are controlled by medications.
Symptoms
Epilepsy is caused by abnormal electrical activity in the brain. Symptoms will depend on the area of the brain that’s affected.
Symptoms can include:
- Confusion
- Staring
- Uncontrollable limb or body movements
- Loss of consciousness or awareness
- Fear, anxiety, or déjà vu (feeling that you’ve experienced something before)
- Generalized convulsion
Types
Seizures are classified as either focal (one area) or generalized depending on the area of the brain that’s involved. Symptoms can be similar for both types.
Most seizures are over within a minute and cause no permanent damage. However, injuries can occur under certain circumstances, and the symptoms are often frightening.
Generalized seizures
Seizures that appear to involve all areas of the brain are called generalized seizures. Many types of generalized seizures exist, including the following.
Absence seizures
These used to be known as “petit mal seizures.” They may occur in clusters, and often in school-age children. A child may:
- Stare into space.
- Make subtle body movements such as eye blinking or lip smacking.
- Lose awareness for a short period.
Tonic seizures
These cause stiffening muscles. Tonic seizures usually affect muscles in the trunk, arms, and legs. They may cause falls.
Atonic seizures
These are also known as drop seizures or drop attacks. They cause a loss of muscle control. This may cause a person to collapse suddenly.
Clonic seizures
These cause jerking muscle movements. The movements are repeated or rhythmic. They usually affect the neck, face, and arms.
Myoclonic seizures
These are sudden brief jerks or twitches of the arms and legs.
Tonic-clonic seizures
These used to be known as “grand mal seizures.” They are often dramatic and can result in injury. They can cause:
- Abrupt loss of consciousness
- Body stiffening and shaking
- Jaw clenching
- Loss of bladder control
- Tongue biting
Focal seizures
Some seizures result from abnormal brain activity in one area of brain. These are called focal (partial) seizures. There are 2 categories.
Focal seizures without loss of consciousness
These used to be called simple partial seizures or focal aware seizures. They may:
- Alter emotions.
- Change the way things look, smell, feel, taste, or sound.
- Cause involuntary jerking of a body part, such as an arm or leg.
- Cause sensory symptoms such as tingling and dizziness. Some people see flashing lights.
Focal seizures with impaired awareness
These used to be called complex partial seizures. They may cause:
- Change, or loss, of consciousness or awareness
- Staring
- Not responding to stimuli
- Repetitive movements such as hand rubbing, chewing, or swallowing
- Walking in circles
Diagnosis
Epileptic seizures
A thorough exam and testing are needed to distinguish epilepsy from other disorders. We’ll ask you about your medical and family history, and symptoms that occurred during and after the seizures. If a family member or friend witnessed your seizures, ask if they’ll come with you to your appointment. They can help describe the seizures.
This information will help us rule out other conditions. For example, fainting can also cause a loss of consciousness. People usually recover quickly after fainting, often within seconds.
Symptoms of seizures can be confused with other neurological disorders, such as:
- Migraine
- Narcolepsy
- Mental illness
Nonepileptic seizures
Some people have seizures that aren’t epileptic. These seizures aren’t caused by abnormal electrical discharges in the brain. Nonepileptic events can occasionally be caused by stressful psychological experiences (psychogenic).
Psychogenic nonepileptic seizures may result from:
- Sexual or physical abuse. This may be recent or in the past, such as during childhood.
- Stressful events, such as divorce or death of a loved one.
We diagnose nonepileptic seizures by:
- Asking observers to describe them.
- Observing your seizures. Simultaneous EEG (electroencephalogram) and video monitoring of the seizures can be helpful.
Evaluations by mental health professionals may help diagnose and guide treatments.
Tests
We may recommend further tests, including:
- EEG to assess brain electrical activity.
- Computerized tomography (CT) scan or magnetic resonance imaging (MRI) to look for structural abnormalities in the brain.
- Blood tests. These can help us identify an electrolyte or other metabolic abnormality.
Medications
Epilepsy is a chronic (ongoing) condition that may require taking medication for an extended period of time, or for life. There are many anticonvulsant and antiseizure medications. These are often referred to as antiepileptic drugs or antiseizure medications. Finding the right medication and dose for you can take time, and taking antiseizure medications should be supervised by your doctor.
Medications suppress seizures for most people. However, some people continue to have seizures despite medication.
Other Treatments
About 1 out of 3 people with epilepsy have seizures that can’t be treated with medication. This is called drug-resistant epilepsy or medically refractory epilepsy. If you’ve tried more than 2 antiseizure medications that haven’t been effective, your doctor will talk to you about other treatments.
Ablation surgery
Ablation surgery to remove (laser ablate) the part of the brain where the seizures are located, may be an option for some people who have drug-resistant seizures. It’s usually most appropriate for seizures that begin in one specific area of the brain.
Evaluation and specialized testing are required before deciding if surgery is the best treatment.
Neurostimulators
Neurostimulators may be used to reduce seizure frequency and severity. Different types of neurostimulators target different areas of the brain. Devices include:
- Vagus nerve stimulator (VNS)
- Responsive neurostimulator system (RNS)
- Deep brain stimulator (DBS)
First Aid During a Seizure
Tell friends and family about your seizures. Ask them to review the following first aid advice in case they're with you during a seizure.
- Stay calm.
- Move objects that could hurt the person out of the way, such as sharp and heavy items.
- Don't attempt to restrain the person or prevent their arms and legs from moving.
- Monitor how long the seizure lasts.
- Loosen clothing, especially anything around the neck. Loosen ties and scarves.
- Protect the head with something soft. Place a jacket, pillow, or other soft, flat item underneath it.
- Never put your hands near the mouth, and never force any objects (such as teeth-guard) into the mouth. You don’t need to protect the person’s tongue.
- Make sure someone stays with the person until the seizure ends.
- Turn the person gently onto their side once the seizure has stopped. This keeps the airway open and avoids risk of choking on their own saliva.
- Allow the person to regain consciousness at their own pace. Be there to reassure and comfort them.
Living With Your Condition
Check before you drive
We’re required to report lapses of consciousness to the Department of Public Health in California. This information is shared with the Department of Motor Vehicles (DMV).
The DMV will decide:
- If you may continue to drive.
- When your driving privileges may be reinstated. This is based on information obtained from you and your physicians.
If you stop or change seizure medications, you may need to stop driving or take precautions until an observational period has passed.
Get enough sleep
Lack of sleep may trigger seizures. Make sure you get at least 8 hours of sleep a night. If you have epilepsy, it's particularly important to follow a regular sleep schedule.
Keep a seizure log
Keep a record of your seizures. This helps us understand their frequency and pattern so we can make appropriate treatment decisions.
Be sure to include the:
- Date and time of day of each seizure.
- Description of the seizure (you’ll need help from a witness, if available).
- Length of time the seizure lasted.
Note any other observations, such as:
- What you were doing when the seizure occurred.
- Any stress you were under.
- Recent changes to your medication.
- Energy level (tired or sleepy).
Additional References
Disclaimer
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.