Epilepsy is a brain disorder that causes repeated seizures. The brain's cells (neurons) communicate with one another with electrical signals. A seizure occurs when these signals become excessive and uncontrolled, resulting in strange sensations and behaviors, and sometimes convulsions and loss of consciousness. Only when a person has had at least two unprovoked seizures is epilepsy diagnosed.
Epilepsy cannot be cured, but it can be controlled easily in many cases. For many people with epilepsy, activity is restricted, for example, driving, swimming and sailing, which can affect independence. In Georgia, a person with epilepsy may obtain a driver's license after six months without a seizure.
In the United States, about 3 million people have epilepsy, and roughly 200,000 new cases are diagnosed annually.
Causes and Prevention
In most cases, the specific cause of epilepsy is not identifiable. However, it is helpful to try to identify a cause, because often the best treatment will be one specific to a cause.
Causes of epilepsy include in newborns:
- Physical brain defects
- Oxygen loss during birth
- Abnormal blood chemistry
- Metabolic errors
- Brain hemorrhage
- Mother's drug use
- Brain tumor (rare)
In children and adults:
- Genetic conditions, like Down syndrome
- Family history
- Brain disease (rare)
- Head trauma
In the elderly:
- Alzheimer's disease
Seizures may be triggered by lack of sleep, alcohol consumption, smoking, stress, or the hormonal changes of the menstrual cycle. Sleep deprivation is a very common trigger, so people with epilepsy should get enough sleep and try to stay on a regular sleep schedule. For some people, flashing or flickering light can trigger a seizure. More recent data suggests that obstructive sleep apnea (OSA) may cause nocturnal (night) seizures.
If you have had seizures, your WellStar neurologist will take your medical history, with particular attention to characteristics of the seizures and what was happening before they began. He/she will also conduct a physical examination, especially of your nervous system, and may order tests of blood and other bodily fluids.
There are other disorders that can cause seizures; to distinguish between them and epilepsy often requires an extensive observation and testing.
One of these tests is an electroencephalogram (EEG), in which small electrodes are taped around your head to pick up your brain's electrical signals. During a seizure, these signals may show patterns that indicate epilepsy. Your neurologist may try to induce a seizure with a flashing light.
Imaging of the brain through computerized tomography (CT) or magnetic resonance imagery (MRI) may be used to try to identify physical brain conditions that are causing the seizures.
Although there is no cure for epilepsy, seizures can be controlled in most people with epilepsy through medication, vagus nerve stimulation (VNS), surgery, and diet.
Unless the EEG is clearly abnormal, there will generally not be any treatment for a single seizure. Although anti-epileptic drugs' side-effects are generally mild, they include liver damage and potentially fatal rashes and blood disorders. They can also interfere with other medications. Finding the best medication and dosage to control your epilepsy may be a lengthy process.
When medications fail to control seizures, vagus nerve stimulation (VNS) may prevent them by sending regular pulses of electricity to the brain through the vagus nerve, a large nerve in the neck. A small battery is implanted in the chest, and wires a run under the skin and around the vagus nerve, where they can induce a small electric current. When you feel the beginnings of a seizure, you can activate the device with a magnet, often stopping the seizure.
In patients whose epilepsy does not respond to drugs or VNS, and whose epilepsy originates only in a part of the brain that can be removed without damaging important functions, surgery may also be an option. This surgery is very well planned, and may be preceded by implantation of electrodes to locate exactly the source of seizures.
A ketogenic (high-fat and low-carbohydrate) diet may help prevent epileptic seizures. The diet must be developed very carefully and individually, and must be adhered to strictly; this is not something to be tried at home.