Epilepsy is a common disorder that causes seizures, but most people who suffer from it can be treated with medications. Trial and error is often needed to find the proper drugs and dosage, according to Dr. P. Jay Foreman, director of the Epilepsy Center at the Sandra and Malcolm Berman Brain & Spine Institute at LifeBridge Health's Sinai Hospital. He explains the condition.
What is epilepsy and how common is it?
A seizure is uncontrolled abnormal electrical activity in the brain that may produce a physical convulsion, minor physical signs, thought disturbances or a combination of symptoms.
Epilepsy, also known as "seizure disorder," is defined as a tendency to have recurring unprovoked seizures. It is usually diagnosed after a person has had at least two seizures that were not caused by a known medical condition.
Epilepsy is the fourth most common neurologic condition, after migraine, stroke and dementia. In the United States, it affects approximately 2.5 million people.
Are all seizures epilepsy and how is the disease diagnosed?
Not everything that looks like a seizure is a seizure, and not every seizure is an epileptic seizure. In fact, a first-time seizure is usually triggered by an ongoing medical condition. These seizures are not considered to be epilepsy; rather, a consequence of that underlying condition.
Epilepsy has numerous causes, including genetic predisposition, in utero brain injury (e.g., lack of oxygen), infection or illness that affects the developing fetal brain, traumatic injuries, central nervous system infections (e.g., meningitis or encephalitis), strokes, and progressive neurodegenerative conditions (e.g., Alzheimer's disease). Other factors can include sleep deprivation, alcohol intake or withdrawal, dehydration, malnutrition, systemic infection, fever, trauma, hyperventilation and flashing lights.
Epilepsy is primarily a diagnosis of clinical suspicion based on the history and description of the seizures, a patient's epilepsy risk factors, a detailed family history, neurologic exams and brain imaging studies (e.g., CT, MRI, PET scan). An electroencephalogram is the primary tool that allows physicians to look for patterns of abnormal brain electrical activity.
What happens to a person during a seizure physically and in their brain?
Seizures happen when a group of nerve cells in the brain produces abnormal signals that may briefly alter a person's consciousness, movements or actions. Where the seizure occurs in the brain may dictate the changes in behavior. Seizures that originate in the front of the brain in regions that control muscle movement may result in recurrent jerks on the opposite side of the body. Seizures that affect the parts of the brain that control attention and awareness may result in staring and confusion.
Generally, a patient with epilepsy will show the same repetitive behavior pattern with each seizure, although behaviors may vary greatly among patients. Common behaviors include staring, confusion, inability to speak or respond, and shaking of extremities. Immediately after seizures, patients are often confused, have difficulty speaking, are tired, weak and may sleep for minutes or hours.
Why aren't everyone's seizures controllable with medicine?
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This question has no simple answer. Studies suggest that between 50 percent and 70 percent of patients with epilepsy can be controlled (no seizures) with a single medication. However it may take several trials of various medications and doses to find a dose that controls seizures without disabling side effects.
Another 10 percent of patients may achieve control with multiple medications. Many patients choose to tolerate mild to moderate medication side effects in order to be seizure free. Other noninvasive treatments include the modified Atkins diet, the ketogenic diet and hormonal manipulation.
When is surgery considered, what does it entail and how effective are the options?
Unfortunately, approximately 20 percent of patients cannot be helped with medications, and they continue to have seizures. When medicine and other attempts to control seizures are not effective, surgery and implantable devices may be options.
Among the available procedures are laser ablation (surgical removal of the brain region where the seizures originate), placement of various neurostimulators and deep-brain stimulation. All of these procedures require extensive pre-surgical evaluations to ensure that they are appropriate for each individual's needs.