When Seizures Indicate Epilepsy
Over a lifetime, one in 26 people will be diagnosed with epilepsy, the fourth most common neurological disease. Although seizures and epilepsy are closely related, having a seizure does not automatically mean you have epilepsy. Here are answers to five common questions about seizures and epilepsy.
1. What is a seizure?
Seizures happen when a temporary change in brain activity disrupts regular processing. That may sound pretty straightforward, but seizures are tremendously complex neurological events with numerous possible causes.
“Seizures can be difficult to identify because they generally last just a few seconds to a few minutes,” says Elizabeth Gerard, MD, an epileptologist at Northwestern Medicine Comprehensive Epilepsy Center. “Some seizures are so subtle that they may not be recognized by a casual observer, and patients may be unaware of their own seizures.”
Despite the difficulty in diagnosis, the Centers for Disease Control and Prevention (CDC) estimates that 3.8 percent of Americans (12.4 million people) will experience recurring seizures at some point in their lifetime, and approximately 1.2 percent (3.4 million people) have “active epilepsy.” This means they have a diagnosed seizure disorder for which they are taking medication or that has resulted in a seizure within the last 12 months.
2. What are the different types of seizures?
There are 29 different types of seizures, according to the International League Against Epilepsy, the world’s leading panel of seizure experts. These seizure types fall into two basic categories — focal seizures and generalized seizures — depending on where in the brain the seizures start.
A focal seizure, also known as a partial seizure, is a disturbance in a specific part of the brain. Approximately 60 percent of seizures fall into this category, so they are more common than generalized seizures, particularly in adults. In contrast, generalized seizures impact the entire brain. More than 30 percent of seizures are considered generalized.
There are 31 syndromes and disorders of epilepsy. The type of epilepsy syndrome you have is determined by the type of seizures you have, how old you were when you started having seizures, the part of the brain involved and genetic information. Diagnosing the epilepsy syndrome helps physicians determine what medication or treatment would be beneficial for you.
3. When do I seek medical attention?
If you or a loved one experiences symptoms such as staring spells, temporary alteration of consciousness, brief unusual sensations or brief but sudden onset involuntary moments or shaking, schedule an appointment with a physician. If a loved one has a seizure, it is important to know how to react.
Seek immediate medical attention if:
- It is the person’s first seizure.
- The seizure lasts longer than five minutes.
- The individual appears to be choking or having trouble breathing.
- Injury occurs.
- There appears to be a series of seizures without full recovery between them.
4. If someone has a seizure, does that mean they have epilepsy?
Not necessarily. Epilepsy is a specific diagnosis, which may be given after a person has experienced two or more seizures at some point in their life, according to the CDC. Epilepsy can also be diagnosed after a single seizure if medical evaluation indicates that a patient is at increased risk for seizures, such as the discovery of abnormalities on MRI or EEG. If you have had a seizure, it is important to work with your physician to identify which tests are needed and to evaluate your risk for further seizures and to help decide if should take a medication to prevent further seizures.
The number of people diagnosed with epilepsy is increasing and is now at an all-time high in the U.S. This is attributed to the growing population and increased willingness to report having the condition.
5. How can you manage epilepsy?
The majority of patients with epilepsy will have their seizures resolve with appropriately selected anti-seizure medications. There are a number of medication options for patients who have epilepsy. In addition to medication, lifestyle modifications can reduce your risk of seizures. These include:
- Getting adequate sleep. Fatigue is the second-most common trigger of seizures. When your sleep suffers, your brain is more susceptible to misfiring, causing seizures.
- Avoiding alcohol and drugs. Alcohol use can be a trigger for seizures in many patients with epilepsy. Even a drink or two can provoke seizures in someone who is prone to epilepsy.
- Minimizing emotional stress. Although there is not definitive proof stress causes seizures, those who maintain healthy stress levels believed it reduced their risk.
- Exercising frequently. Regular exercise provides a host of benefits, from prompting sleep to reducing stress, which can reduce your risk of seizures. However, in rare cases, exercise can actually cause seizures, so you should consult your physician before starting a new routine.
Two out of three patients with seizures can be well controlled with medications. There is a large selection which allows the individual to select an anti-seizure medication so they not only have good control, but no side effects or impact to their quality of life.
Despite appropriate medications and lifestyle changes, one in three patients with epilepsy will continue to have seizures. Surgical procedures may be an option for patients with refractory epilepsy. Minimally invasive procedures may be an option for some patients, allowing them to avoid major surgery. Surgery options include:
- Removal of tissue from the brain where seizures originate
- Laser ablation to destroy tissue without requiring open surgery
Prior to surgery, patients typically require one or more inpatient evaluations to identify the area of the brain tissue responsible for the seizures. Stereo EEG is an advanced and minimally invasive technique sometimes used to precisely locate the origin of seizures.
Neurostimulation also offers benefit for many patients with difficult to control epilepsy. These options include:
If you have epilepsy, medical advances can help you live a healthy, normal life. For more answers to your questions, visit the Comprehensive Epilepsy Center, anchored by Northwestern Memorial Hospital, which is ranked in the top 10 nationally for neurology and neurosurgery by U.S. News & World Report.
– Elizabeth E. Gerard, MD, Northwestern Medical Group, Comprehensive Epilepsy Center
– Stephan U. Schuele, MD, Northwestern Medical Group, Clinical Neurophysiology