Epilepsy

Epilepsy is a disorder of the nervous system that produces sudden, intense bursts of electrical activity in the brain. These bursts cause seizures, which may briefly affect muscle control, movement, speech, vision and awareness. People with this condition have repeated seizures, usually without warning and for no clear reason. If epilepsy is not treated, seizures may occur throughout a person’s life and, in some cases, become more severe and more frequent over time.

The Epilepsy Program in the Cedars-Sinai Department of Neurology offers extensive experience and leading-edge knowledge in treating patients with epilepsy.

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Symptoms

There are many types of epilepsy, which cause two types of epileptic seizures: partial or generalized.

Partial (or focal) seizures begin in a specific area in the brain and may affect only one part or side of the body, depending on the location of the brain affected.

Some symptoms of partial seizures include:

  • Jerky or rhythmic movements
  • Sensations such as tingling, dizziness, feeling full in the stomach
  • Repetitive motions
  • Staring
  • Confusion
  • Changes in emotions
  • Altered senses

Generalized seizures occur over the entire surface of the brain and may affect all areas of the body.

Some symptoms of generalized seizures include:

  • Convulsions
  • Crying out or making a noise
  • Stiffening
  • Jerky, rhythmic or twitching motions
  • Falling down
  • Loss of consciousness
  • Not breathing
  • Confusion after returning to consciousness
  • Loss of bladder control
  • Biting the tongue


Causes and Risk Factors

In most cases, there is no known cause of epilepsy. However, several factors may be at play in the onset of the condition, such as serious head injury, stroke, brain tumor, brain infection (meningitis or encephalitis), Alzheimer's disease, loss of oxygen at birth and hardening of the brain's arteries.

Children are more likely than adults to develop the disorder from an unknown cause. A family history of epilepsy may sometimes be a factor, although experts are not sure how the disease is passed from parent to child.

Not all seizures are epileptic; they may be caused by injury, illness or other medical conditions. In these cases, seizures end when the condition improves or is resolved.

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Diagnosis

Although it can be difficult, making an accurate epilepsy diagnosis is vital in planning the correct treatment to control seizures. The doctor needs to determine whether the event that brought the patient to seek medical care was actually a seizure and, if so, what type of seizure and whether it was caused by epilepsy.

A detailed medical history often provides the best clues about seizures and may help rule out non-epilepsy conditions that might have caused them. In addition to providing a detailed medical history, patients will undergo a neurological examination and be asked to recount what happens just before, during and right after they experience seizure.

Routine lab tests may be performed to rule out other medical conditions that might be causing the seizures. A complete blood count (CBC) will provide the doctor with information regarding infection, abnormal electrolyte levels (such as magnesium, potassium and calcium), kidney or liver malfunction or genetic conditions. A lumbar puncture (spinal tap) can rule out infections, such as spinal meningitis and encephalitis. A toxicology screening can show poisons, illegal drugs or other toxins.

The most useful test in confirming epilepsy is an electroencephalogram (EEG), which records electrical activity in the brain and can record abnormal spikes or waves in electrical activity patterns. Different types of epilepsy can be identified with these patterns.

Video EEG monitoring can be performed to record seizures on a digital video recording, which allows the doctor to see what happens just before, during and right after a seizure. The video records what the body is doing, and the EEG records the electrical activity occurring in the brain. Such monitoring may be used prior to surgery, or when repeated EEG tests have not provided enough clues as to the type of seizure, or to diagnose whether seizures could have a psychological origin.

Magnetic resonance imaging (MRI) and computed tomography (CT) scans may be used to evaluate the cause and pinpoint the location within the brain. The scans can reveal scar tissue, tumors or structural problems in the brain.

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Treatments

For most people with epilepsy, proper treatment can reduce or prevent seizures, and, in some cases, allow patients to remain free of seizures for the rest of their lives.

Partial and generalized seizures often are treated differently. The type, frequency and severity of seizures, along with the patient’s age, overall health and medical history, will be factors in determining treatment.

Medications such as anti-seizure (or anti-epileptic) drugs can be highly effective. It may take a few tries to get the right drug and dosage, and the doctor will monitor for side effects to find the best solution.

In cases where medication cannot control seizures, surgery may be an option.

A vagus nerve stimulator (VNS) is sometimes implanted and used along with anti-epileptic medication to reduce seizures. The VNS is a device placed under the skin of the chest that sends electrical energy through the vagus nerve in the neck to the brain.

Certain types of epilepsy may be controlled with a ketogenic diet. This is a high-fat, low-carbohydrate diet used most often for children who have not responded to medications.

Status epilepticus is a prolonged seizure or cluster of seizures that requires emergency treatment whether or not the individual has epilepsy. A seizure or cluster of seizures that goes on for more than 20 to 30 minutes during which the person does not wake up can cause brain damage. Treatment with antiepileptic medications needs to be started immediately for any seizure lasting more than five minutes. Medication used to end the seizure usually is given through an IV so that it takes effect more quickly.

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