Epilepsy & Seizures

Epilepsy, which is also referred to as a seizure disorder, is characterized by repeated, spontaneous seizures of any type. A seizure is a brief episode of disturbed brain function caused by abnormally excited electrical signals in your brain that may result in changes in attention or behavior.

Epilepsy
Epilepsy can affect people at any age and is normally the result of permanent injury to or changes in the brain which cause the brain to be abnormally excitable. Epileptic seizures often occur without any apparent cause (trigger).

Epilepsy may be idiopathic, which means the underlying brain tissue defect cannot be identified or located. These seizures usually begin between ages 5 and 20, but they can happen at any age. Some people with this condition have no other neurological problems, but the family may have a history of seizures or epilepsy.

Epilepsy has many common causes, often initiated by other problems:

• Stroke or transient ischemic attack (TIA)
• Illnesses that cause damage to the brain 
• Dementia, such as Alzheimer's disease
• Traumatic brain injury (also called TBI)
• Infections (including brain abscess, HIV/AIDS when it affects the brain, meningitis, encephalitis or neurosyphilis)
• Problems that are present from before birth (congenital brain defects)
• Injuries near the time of birth (also called perinatal complications; in this case, seizures usually begin in infancy or early childhood)
• Kidney (also called renal) failure or liver (also called hepatic) failure
• Metabolic diseases that children are born with, (such as phenylketonuria)
• Tumors or other structural brain lesions, such as hematomas (local accumulation of blood, often clotted) or abnormal blood vessels

 Epilepsy may lead to other difficulties:

• Difficulty learning
• Inhaling fluid into the lungs (also called aspiration)  which can cause pneumonia (infection of the lung)
• Injury from falls or bumps
• Self-inflicted bites during a seizure that may become infected
• Injury to self or others from a seizure while driving or operating machinery
• Birth defects due to epilepsy medication (women wishing to become pregnant should alert their doctor in advance to avoid medications associated with birth defects, that is, teratogenic medications)
• Side effects of medications

Seizures
Seizures (often called convulsions) can have many causes and vary widely in how the person having the seizure experiences them and how they appear to bystanders. Seizures range from changes in consciousness (your doctor may say petit mal or absence seizures) to loss of consciousness (your doctor may say grand mal or tonic-clonic seizures). Temporal lobe (also called psychomotor) seizures may result in coordinated body movements without apparent purpose with various levels of consciousness or recall by the person having the seizure.

Having a seizure does not always indicate you have epilepsy. Sometimes a seizure is related to a temporary condition such as exposure to drugs, withdrawal from certain medications, a high fever or abnormal levels of sodium or glucose in the blood. Once the underlying problem is identified and corrected and if you do not experience another seizure, you do not have epilepsy. 

Death or permanent brain damage from seizures is rare. However, seizures that last for a long time, or two or more seizures that occur close together (known as status epilepticus), may cause permanent harm. Death or brain damage is most often caused by prolonged lack of breathing which causes brain tissue to die from lack of oxygen.  

Symptoms of Epilepsy
The frequency and severity of symptoms in a person with epilepsy can vary widely, ranging from simple staring spells (momentary loss of awareness of surroundings) to loss of consciousness and violent convulsions, sometimes called fits. For most people with epilepsy, each seizure is similar to their previous one. The type of seizure a person has depends on a variety of things, such as the part of the brain affected and the underlying cause of the seizure.

An aura consisting of a strange sensation, such as tingling, smelling an odor that is not actually there or emotional changes, occurs in some people prior to each seizure.

The risk for a seizure in someone with epilepsy may be increased by a variety of factors:

• Certain prescribed medications
• Emotional stress
• Illness, especially infection
• Lack of sleep
• Pregnancy
• Skipping doses of epilepsy medications
• Use of alcohol or other recreational drugs

Diagnosis for Epilepsy
At Houston Methodist, our doctors will conduct an examination that includes a thorough look at your complete medical history, a physical examination, detailed neurological examination and blood tests to diagnose epilepsy. We will also perform an electroencephalogram (EEG) to see if there is any abnormal electrical activity in the brain. In some cases, an EEG may show where the seizures started in the brain. Because EEGs can often be normal in between seizures, it may be necessary to perform additional tests or monitoring.

Additional tests, such as head CT (computerized tomography) or MRI (magnetic resonance imaging) scans and lumbar puncture (also called spinal tap) may be done to determine the cause and location of the problem.

To rule out temporary and reversible causes of a seizure other than epilepsy, certain tests may be performed:

• Blood chemistry
• Blood sugar
• CBC (complete blood count)
• CSF (cerebrospinal fluid) analysis
• Kidney (renal) function tests
• Liver (hepatic) function tests
• Tests for infectious diseases

Treatment Options for Epilepsy and Seizures
The treatment for seizures depends on the underlying cause; once identified and treated, the seizures may stop. Treatment with medication is usually the first option, but you may need to consider surgery as an option to remove a tumor or an abnormal or bleeding blood vessel.

Medication
Medications for epilepsy (often called anticonvulsants) are drugs, taken by mouth, to help reduce the number of future seizures.

• The type of medicine you take depends on what type of seizures you are having.
• The dosage may need to be adjusted from time to time, so you will need to be monitored for side effects and blood levels.
• Some types of seizure respond well to one medication, but less so to another one, so you may need to try several medications.
• Some epilepsy medications may even worsen your condition temporarily.
• It is very important to take your medication on time and at the correct dose. Most people taking these drugs need regular checkups and regular blood tests to make sure they are receiving the correct medication at the correct dosage.
• You should not stop taking or change medications without first talking to your doctor.

Diet
Some children are placed on a special diet to help prevent seizures — the most popular being the ketogenic diet (high in fats, low in carbohydrates and protein). For adults, diet low in carbohydrates, such as the Atkins diet, may be helpful.

Surgery
Epilepsy that does not improve after two or three seizure drugs have been tried is called "medically refractory epilepsy." There are other options in addition to medications. Patients with difficult-to-treat or drug-resistant epilepsy may benefit from brain surgery to remove the abnormal brain cells that are causing the seizures. 

Recovery and Rehabilitation
People who have infrequent seizures may or may not have any severe restrictions on their lifestyle. With certain types of seizures, medications may be reduced or completely stopped after several years have passed without having any seizures. Certain types of childhood epilepsy go away or improve with age — usually in the late teens or 20s.

For some people, epilepsy may be a lifelong condition. In these cases, the seizure drugs need to be continued indefinitely.

Persons with epilepsy should wear medical alert jewelry (for example, a medical ID bracelet) so that prompt medical treatment can be obtained if a seizure occurs.

Generally, there is no way to prevent epilepsy, but there are lifestyle changes that can help decrease the likelihood of triggering seizures or minimize its impact on your life.

• Get enough sleep.
• Eat a healthy diet.
• Avoid illegal drugs and alcohol.
• Wear a helmet to reduce risk of head injury during risky activities.
• Do not drive or operate dangerous equipment — each state has laws to determine whether people with a history of seizures are allowed to drive. 
• Avoid activities where loss of awareness would cause great danger, such as climbing to high places, biking and swimming alone.