What a Neurologist Wants You to Know About Epilepsy

By Loren DeVito, PhD

According to the Centers for Disease Control and Prevention (CDC), about 3.4 million Americans have epilepsy. This number includes both adults and children, as the disorder can affect patients very early in life.

Even if you have first-hand experience with epilepsy, you may still have questions about seizures, how the condition is diagnosed and the ways it can be treated. We spoke to Lee Dresser, MD, a neurologist at Saint Francis Healthcare in Wilmington, Delaware, about epilepsy—and what you can do to help someone with a seizure disorder.

Epilepsy is the fourth most common neurological condition, and includes a wide range of seizure disorders that can affect people at different ages. Seizures happen when the electrical activity in your brain is disrupted. Since cells in the brain communicate using electrical and chemical messages, this disruption can cause your awareness and behavior to change; you may experience unusual movements, as well. Seizures may last a few seconds or up to a few minutes.

Seizures can cause a variety of symptoms. For example, during a tonic-clonic seizure—also called a grand mal seizure—patients can have convulsions and shake, and may temporarily lose consciousness. During other types of seizures, people may “space out” instead of showing physical signs, like involuntary movements.

Seizures can be classified into two main types—focal (or partial) or generalized. Their symptoms and the impact on the brain and body may differ.

During a focal seizure, one area of the brain is affected. There are three different kinds:

• Simple: the person remains awake and aware
• Complex: the person's awareness is impaired
• Secondary: a simple or partial seizure that progresses to a general seizure

“Focal seizures can be associated with impaired consciousness or preserved consciousness,” says Dr. Dresser. That means you may be aware you're having a seizure, you may be confused or you may black out. Focal seizures have a wide array of symptoms; you can experience unusual smells or tastes, have a strange feeling in your stomach or feel tingling or twitching in your arms or legs.

During a general seizure, both sides of the brain are affected. There are several different types, including absence, tonic, atonic, clonic, myoclonic and tonic-clonic seizures. “Most generalized seizures are associated with either loss of consciousness or impaired consciousness,” says Dresser. Symptoms vary; during a general seizure, you may lose control of your bowel or bladder, experience difficulty breathing, have stiff or twitching muscles or flutter your eyes.

Several different medical conditions can cause epilepsy, including a prior stroke, brain tumor or infection, or loss of oxygen to the brain. Epilepsy may also result from a head injury, a genetic disorder or other neurological disease. In rare cases, epilepsy may be caused by over-activation of certain autoimmune diseases.

“A lot of times, those autoimmune-type epilepsies are really resistant to medications but, if treated with medicines that suppress the immune system, the seizures can come under control,” said Dresser.

However, in many cases, there is no known cause of seizure disorders. Patients with an unknown cause of the disease have what is called idiopathic epilepsy.

Not all seizures are associated with epilepsy—in fact, having a high fever or low blood sugar can trigger a seizure event, as can stress or lack of sleep in people who are predisposed to having seizures. So, how then is an epilepsy diagnosis made?

“It can be challenging [to diagnose epilepsy]," Dresser says. "You really have to rely heavily on what the patient can tell you or, a lot of times, what bystanders can tell you happened to the person: what the symptoms were, what they experienced, what people saw and what happened after the seizure.”

Neurologists use many different tools to determine where a person is experiencing seizures due to epilepsy. In addition to using computerized tomography (CT) or magnetic resonance imaging (MRI) to take pictures of the brain, they also use an electroencephalogram (EEG) to check electrical activity. Patients with seizures disorders will most likely have disrupted brain activity that can be detected on an EEG.

Research suggests those with epilepsy have brains that are physically different from those without the disease. For a 2018 study published in the journal Brain, authors analyzed brain MRIs of 2,149 people with epilepsy from all over the world. They found patients frequently had reduced thickness and volume of gray matter in key areas. More research is needed, but understanding these variations could be crucial to future treatment of the disorder.

“The mainstay of treatment for epilepsy is medications,” says Dresser. "Roughly 70 percent of patients can have their seizures completely controlled with medicine."

In cases where medications can't control seizures, patients may have surgery to remove the part of the brain where the seizures originate. This type of procedure is only performed on a small minority of patients. The ketogenic diet, which is very high in fat and low in carbohydrates, may be effective for those who don't respond to medication or choose to have surgery—particularly children. It can be hard to follow, however.

There are many treatments and interventions in development that can help people whose seizures do not respond to medication, as well. “[Researchers] are looking at electrical stimulators of the brain, a surgical implanted device, that can actually sense when the seizure is occurring,” says Dresser. "[They can] trigger an electrical stimulus to the brain and try to terminate the seizure quite quickly."

If you witness your loved one having a seizure event, it’s important to follow these steps:

• If this is the first time the person has had experienced a seizure, call 9-1-1, or if the person quickly regains consciousness, take him or her to the emergency room right away.
• If the person is having a tonic-clonic (grand mal) seizure, place them on the ground in a safe environment and remove any sharp or dangerous objects in the area.
• Make sure the person is not in a position where he or she can hurt themselves or anyone else in the area.
• Do not place anything at all in his or her mouth.

For more information on how to help manage a seizure event—including additional reasons to seek medical help—the CDC and Epilepsy Foundation are good resources.

While it may be difficult to witness a seizure event, by following these steps, you can make sure you that your loved one stays safe and gets the medical treatment he or she needs as soon as possible.