Epilepsy (Seizure Disorder)

Overview

Epilepsy is a neurologic disorder which affects your nervous system. If you have more than one seizure not caused by a known medical condition, such as alcohol withdrawal or extremely low blood sugar, you’re considered to have epilepsy.

Seizures are the primary symptom of epilepsy. A seizure is a sudden surge of disruptive electrical activity in the brain that usually affects how a person feels or acts for a brief amount of time. Some epileptic seizures can be mild and hardly noticed, while others can be completely disabling. Experiencing a seizure while driving or swimming can be very dangerous.

Intractable epilepsy, also called drug-resistant, uncontrolled, or refractory epilepsy, is when recurrent seizures cannot be fully controlled by medications. This happens in approximately one-third of cases, and often negatively impacts the affected individual’s quality of life.

There are many types of seizures, which include:

  • Tonic-clonic or convulsive seizures (formerly known as grand mal)
  • Absence seizures (formerly known as petit mal)
  • Atonic seizures
  • Clonic seizures
  • Tonic seizures
  • Myoclonic seizures

Causes

Seizures can be caused by brain injury, stroke or may be hereditary. However, in the majority of cases, the cause of epilepsy is unknown. Because of America’s aging population, an increasing percentage of cases of epilepsy are due to strokes, brain tumors and Alzheimer’s in the elderly.

Idiopathic seizures can be due to genetic tendencies which can be inherited from one or both parents.

The greatest risk of any seizure is injury due to loss of consciousness, particularly in the event of driving or performing an activity, such as swimming. 

Symptoms

The symptoms of epilepsy vary greatly. Because of disruption to normal brain activity, seizures can affect many different processes controlled by the brain. Symptoms may include:

  • Blank gaze, staring into space
  • Confusion, temporary loss of time
  • Uncontrolled, erratic muscle spasms, jerking of the upper body, arms, and legs
  • Loss of consciousness or awareness
  • Irregular behaviors or confusing emotions

Diagnosis and testing

At the Comprehensive Epilepsy Center, our extensive diagnostic methods are designed to determine the nature, type, and severity of your condition. These include:

  • Clinical history and physical examination - An epileptologist (a neurologist with special training in epilepsy) gets a clear description of the events, as well as past medical, family and social history. An examination will be performed to assess cognitive, motor and sensory function.
  • CT scan - Radiation and computer technology create images of the brain. This test is often used when seizures first begin and may be useful in detecting underlying, unrelated problems such as bleeding, tumors, infections or problems with the skull.
  • Magnetic resonance imaging (MRI) - When looking for brain abnormalities that can’t be found with a CT scan, our epileptologist use one of the most advanced MRI units available to develop a highly detailed picture of the brain.
  • Electroencephalogram (EEG) - An EEG records electrical activity from the brain. The EEG shows patterns of normal or abnormal brain electrical activity. EEG may help the physician to understand the part of the brain where seizures originate, the specific areas of abnormal brain tissue, the risk of further seizures and whether seizures may be occurring that the individual may or may not be aware of.
  • Positron emission tomography (PET) - The PET procedure injects a small amount of radioactive sugar into a person to allow a radiation-detecting camera to record brain images. The pictures from Positron Emission Tomography show how and where the brain uses energy. Epilepsy can cause changes in the way the brain uses sugar, and a PET scan can help pinpoint a seizure focus.
  • Single photon emission computed tomography (SPECT) - The SPECT procedure measures blood flow in the brain. An ictal SPECT scan is a study performed on people with very frequent or predictable epilepsy seizures. “Ictal” means that the scan is performed during a seizure. This test is performed by injecting a radioactive substance immediately after a seizure begins. After the substance travels to the area of the brain where seizures originate, a special camera detects its location in the brain and produces a corresponding image.
  • Magneto-encephalography (MEG) - MEG is a test that records brain activity by evaluating magnetic fields generated by the brain, and may be an adjunctive test to EEG. MEG is usually used in only certain cases.
  • Neuropsychological evaluation — A neuro psychologist conducts a number of tests to understand how well a person performs in different cognitive functions, such as memory, language, and attention.
  • Intracarotid sodium amobarbital test (Wada test) — Sometimes a Wada test is necessary prior to brain surgery. This test is performed by injecting a drug via a catheter to temporarily put one side of the brain to sleep in order to test the function of the other side that is still awake. This allows a neuropsychologist, working with a neuroradiologist, to test functions of the right and left sides of the brain individually. The Wada test can determine how each side of the brain performs important brain functions like language and memory. This test also helps to determine the safety of undergoing epilepsy brain surgery.
  • Intracranial EEG - In special circumstances, where appropriate for individuals with epilepsy that is highly resistant to medications, inpatient intracranial EEG monitoring may be done to pinpoint the location where seizures begin. For this type of EEG, small electrodes are placed under the skull by a neurosurgeon. The electrodes may be used to both record electrical signals from the brain and stimulate the brain to map necessary brain function. Performing intracranial EEG requires a dedicated center with a highly specialized team of neurosurgeons, neurologists, nurses, technicians, and staff.
  • Video electroencephalogram (video EEG) - Video EEG is a key diagnostic test that records brain waves while a person is videotaped for a period of time. Video EEG is also helpful in monitoring the effects of anticonvulsant medications, and in evaluating for subclinical or subtle events of concern for epilepsy seizures. This painless exam involves placing electrodes on the head with gauze and a special cream, which will harden after application to help prevent the electrodes from falling off. A device will then continuously record patients' brain wave activity from the electrodes and behavior on video.

Video EEG results can help the epileptologist:

  • Classify the event type
  • Confirm the diagnosis of epilepsy
  • Identify the type of epilepsy the person may have
  • localize the seizure-related activity
  • Design a treatment plan

The video EEG study usually takes between one to seven days but depends on the specific goals of the admission and the individual’s circumstance. The epileptologist will determine, based on the patient’s goals, when it is most appropriate to be discharged.

Treatment

If you have epilepsy, there are a number of medication options for you to consider. It’s important to work closely with your health care providers to develop the best treatment for you. The physicians and nurses at the Comprehensive Epilepsy Center will assist you in making the decisions involved in epilepsy medications and treatments.

We offer a variety of medical and surgical treatment options to control and prevent your seizures. If surgery is recommended, our multidisciplinary team provides the most innovative surgical treatments, including:

  • Stereoelectroencephalography (SEEG)
  • Laser ablation
  • Combined stereoelectroencephalography (SEEG) and laser ablation
  • Vagus nerve stimulation (VNS)
  • Disconnection surgery
  • Gamma Knife®

We perform between 50 and 100 epilepsy surgeries each year, and 90 percent of our patients are either seizure-free or have reduced seizures one year after surgery.

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