Having or witnessing a seizure can be frightening. But clinicians have made remarkable advances in diagnosing the causes and preventing future seizures with medications and surgery.
“Seizures often seem scarier to bystanders than to patients,” said Dr. Thomas Holmes, a Wellstar neurologist. “Most patients don’t even remember them.”
Epilepsy is more common than many realize—about 1 in 26 people will be diagnosed in their lifetime. On WSB’s The Weekly Check-Up, Dr. Holmes explained how epilepsy is diagnosed, why not all seizures mean epilepsy and what treatments are available.
As director of neurodiagnostics at Wellstar, Dr. Holmes helped Wellstar Kennestone Regional Medical Center earn Level 3 Adult Epilepsy Center accreditation, recognizing its advanced care for patients with hard-to-treat seizures.
Diagnosing epilepsy
According to Dr. Holmes, a seizure happens when there's an “abnormal firing of neurons in the brain.” This electrical disturbance can cause a range of symptoms—some more visible than others. A person having a seizure may briefly lose consciousness, and other signs can include:
- Trouble breathing or temporarily stopping breathing
- Sudden falls without warning
- Jerking movements or a sudden loss of muscle control
- Loss of bladder or bowel control
- Not responding to sounds or voices for a few moments
- Staring spells, sometimes with rapid blinking
It’s important to know that not all seizures are caused by epilepsy. Other conditions like stroke, brain injuries, infections or tumors can also trigger them. That’s why gathering details from someone who witnessed the seizure—like a family member—can be helpful for doctors trying to make an accurate diagnosis.
When someone experiences a seizure, the first step is usually brain imaging. An MRI is often ordered to look for structural causes, and an EEG, which records the brain’s electrical activity, can help detect abnormal patterns. In some cases, patients may be asked to wear a portable EEG at home for several days to capture activity that doesn’t happen regularly. Both MRIs and EEGs are safe and painless.
For more advanced monitoring, Wellstar offers inpatient epilepsy monitoring units (EMUs) at Wellstar Kennestone, Wellstar MCG Health and Wellstar North Fulton Medical Centers. These specialized units provide around-the-clock observation and are among the few in Georgia offering this level of epilepsy care.
Medications and surgery for seizures and epilepsy
For most people with epilepsy, medication is the first and most effective treatment option. How long someone needs to stay on medication depends on several factors, including what’s causing the seizures and what clinicians find during ongoing monitoring.
Sometimes a seizure is triggered by a specific event, like a head injury. In those cases, Dr. Holmes explained, long-term medication may not be necessary. But if tests reveal a structural issue in the brain—like an area of damage—it usually means a higher risk of future seizures and longer-term treatment is often recommended.
“You don’t necessarily need to be on medication for life, even if you have epilepsy,” said Dr. Holmes. Patients are regularly monitored, treatment plans are highly personalized and care plans are revisited to ensure the best outcomes possible.
“If someone has been seizure-free for two to three years, has a normal EEG and no visible brain lesion, we’ll often discuss tapering off medication if the patient is open to it,” he said.
Some people may struggle with seizure control despite medication. About 10% of patients don’t respond well to drugs—but there are additional treatments available.
Wellstar’s EMUs can help determine where in the brain seizures are starting. In some cases, surgery to remove a small area of brain tissue can significantly reduce or even stop seizures. According to Dr. Holmes, this approach is successful in nearly 70% of cases.
Other advanced options include laser surgery or a responsive neurostimulation—when a small device is implanted in the brain to detect abnormal activity and deliver a pulse to stop a seizure before it starts.
Looking ahead, Dr. Holmes is optimistic. “There are going to be many options that are not drug-related,” he said. “Less invasive procedures are on the rise, and we’re learning more about the genetic causes of epilepsy—especially in children. Research and clinical trials may even lead us to gene therapies in the near future.”
Epilepsy care is evolving rapidly, and for many patients, that means more control, fewer side effects, and real hope for the future.
Epilepsy and Seizures Program at Wellstar
Our Epilepsy and Seizures Program is one of only a few such programs in Georgia. It provides comprehensive care to help children and adults manage seizures. The program also offers a streamlined pathway to determine if a patient is a candidate for advanced treatments, including minimally invasive surgery and deep brain stimulation.
Wellstar Children's Hospital of Georgia and Wellstar MCG Health in Augusta are Level 4 Comprehensive Epilepsy Centers, the highest designation by the National Association of Epilepsy Centers. Wellstar Kennestone is a Level 3 Adult Epilepsy Center.
Learn more about the Epilepsy and Seizures Program and Wellstar providers.
