Epilepsy (convulsive and non-convulsive)
What is epilepsy?
Epilepsy is a neurological disorder diagnosed when a person has recurring seizures due to an overstimulation or disruption of nerve cell activity in the brain.
Our integrated and multidisciplinary team of specialty-trained epilepsy neurologists, neurosurgeons, neuropsychologists, nurses and nurse practitioners, pharmacists, social workers and technical staff all work together to provide you with personalized care. Our mission is to provide you with seizure freedom so you can enjoy the most active, productive and fulfilling life. The standard treatment for epileptic seizures is medication, but if a patient does not respond to medicine, we can perform innovative surgical treatment options to control and prevent seizures.
The primary symptom of epilepsy is seizures, 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, as well as dangerous depending on the activity you’re doing when it occurs.
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
Seizures can be caused by brain injury, stroke or may be hereditary. However, in the majority of cases, the cause of epilepsy is unknown.
Side effects of medications
Each anti-epilepsy medication affects each person differently. The occurrence of side effects depends on the dose, type of medication and length of treatment. Side effects are more common with higher doses, but tend to become less severe over time as the body adjusts. Some common side effects include:
- Dizziness or unsteadiness
- Blurred vision
- Upset stomach
- Memory and thinking problems
- Weight gain
Types of epilepsy
Seizures involve the entire body and are involuntary. They include a sudden onset of violent, rapid contraction and relaxation of body muscles, shaking, loss of consciousness, difficulty breathing, loss of bowel/bladder control and confusion. They usually last a few minutes.
People with this disorder do not experience a loss of consciousness with violent muscle spasms typically associated with epilepsy, but have seizures that can be nearly undetectable. A facial twitch often occurs along with what appears as absent-mindedness, a lack of attention, and/or a blank stare. These seizures will present without warning or post-episodic symptoms and will last only a few seconds.
How is it diagnosed?
Our extensive diagnostic methods are designed to determine the nature, type and severity of your condition, and include:
- Clinical history and physical examination—An epileptologist (a neurologist with special training in epilepsy) gets a clear description of the events (epilepsy seizures), 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 creates images of the brain. This test is often used when seizures first begin and may be useful in detecting underlying non-epilepsy problems such as bleeding, tumor, infection or problems with the skull.
- Magnetic resonance imaging (MRI)—When looking for brain abnormalities that can’t be found with a CT scan, our epileptologists 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 images 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; it may be an adjunctive test to EEG. MEG is used only in certain cases.
- Neuropsychological evaluation—A neuropsychologist 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—When 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 in order to map necessary brain function. Performing intracranial EEG requires a dedicated center with a highly specialized team of neurosurgeons, neurologists, nurses and technicians.
- 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. A device will then continuously record patients' brain wave activity from the electrodes and behavior on video. 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. Video EEG results can help the epileptologist:
- Classify the event type
- Confirm the diagnosis of epilepsy
- Identify the type of epilepsy syndrome the person may have
- Localize the seizure-related activity
- Design a treatment plan
The standard treatment for epileptic seizures is medication, prescribed by a neurologist. The choice of drugs used to treat epilepsy is most often based on factors like tolerance of the side effects, other illnesses, and the medication's delivery method. In general, medications control seizures in about 70 percent of people.
If a patient does not respond to medicine, we may explore a number of innovative surgical treatment options to control and prevent seizures, including:
- Laser ablation, where doctors insert a laser catheter in the brain and ablate the seizure (used in cases of a small seizure focus).
- Vagus nerve stimulation (VNS) is designed to prevent seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nerve. These pulses are supplied by a pacemaker-like
- device that’s placed under the skin on the chest wall and a wire runs from it to the vagus nerve in the neck.
- Corpus callosotomy, where doctors cut the corpus callosum, or the band of tissue that connects and transmits messages from one side of the brain to the other.
- Resective epilepsy surgery, where the abnormal portion of the brain is removed.
- Hemispherectomy, where the damaged half of the brain is removed (common in a disease process called Sturge-Weber).
- Gamma Knife radiosurgery (GKS) allows precise and complete destruction of chosen target structures containing healthy and/or pathological cells, without causing significant radiation damage to adjacent tissues.
We carefully consider the potential risks and benefits of epilepsy surgery for each patient’s unique case. 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.