Seizures and epilepsy
Education Content:
ADULTS WITH NEW ONSET SEIZURES
WHAT IS A SEIZURE?
A seizure can be thought of like an electrical storm in the brain. The sudden abnormal electrical activity can interfere with the normal function of the brain and cause different symptoms. The symptoms one experiences during a seizure depends on what part of their brain is affected by the seizure and may include staring, confusion, jerking movements, or shaking. If the whole brain is involved, then the seizure will cause a loss in consciousness.
What causes seizures?
Seizures can be provoked as a single event in an otherwise normal adult or can be caused by epilepsy. “Epilepsy” is a persistent underlying tendency of the brain to have seizures. If a person has had just one seizure, then it is most likely provoked by something, rather than due to epilepsy.
What is epilepsy?
Epilepsy is a disorder in which seizures occur spontaneously because of an underlying tendency for the brain to have seizures. It is diagnosed as “epilepsy” when two or more unprovoked seizures occur at least 24 hours apart.
What causes epilepsy?
About half of the time, the cause of epilepsy cannot be identified because the cause is microscopic or affects the brain in a way that cannot be detected by normal tests. However, commonly identified causes are head injury, birth-related injury, stroke or other causes of scars on the brain, abnormal brain development, and brain tumors.
Are there spells that look like seizures?
Sometimes fainting spells, strokes and even migraine headaches and panic attacks can look like seizures.
Are there different types of seizures?
Yes, there are different types. Common types of seizures are:
§ Simple partial seizures: Isolated twitching, numbness, sweating, dizziness, nausea/vomiting, disturbances to hearing, vision, smell or taste. No loss of consciousness occurs, and the person remains aware of his/her environment.
§ Complex partial seizures: Staring, motionless, picking at clothes, smacking lips, swallowing repeatedly or wandering around. The person is not aware of his or her surroundings and is not fully responsive.
§ Atonic seizures: “Drop attacks” or sudden, rapid fall to ground with rapid recovery.
§ Myoclonic seizures: Brief forceful jerks which can affect the whole body or just part of it.
§ Absence seizures: May appear to be daydreaming or “spacing out.” They are momentarily unresponsive and unaware of what is happening around them.
§ Tonic seizures: Stiffening of the entire body or just part of the body.
§ Tonic-Clonic Seizures: Sudden loss of consciousness with body stiffening followed by continuous jerking movements. A blue tinge around the mouth is likely but lack of oxygen is rare. Loss of bladder and/or bowel control may occur.
How long does a seizure last?
Depending on the type of seizure, it can last anywhere from a few seconds to a few minutes. For example, a generalized tonic-clonic seizure can last up to a few minutes, while absence seizures usually only last a few seconds.
Will my epilepsy get worse or progress?
Each person is different and whether their seizures get worse or better over time is highly variable. While it depends on the cause of the seizures, most epilepsies do not progress.
How is epilepsy treated?
The main treatment for epilepsy is to take antiepileptic drugs (AEDs) each day to suppress the tendency of the brain to have seizures. Taking medications only when seizures occur is not usually effective because their occurrence cannot be predicted for most people. If seizures do not respond to medications then implantable devices or brain surgery may be considered.
Will I have to take medications for the rest of my life?
This depends on the cause of the seizures. Some epilepsies go away, especially if they start in childhood. Some epilepsies are present throughout life, but are easily treated with medications.
Can I have children?
Epilepsy does not generally prevent someone from having children. Some special precautions should be taken before pregnancy, so it is important that pregnancy be planned in advance.
Will my epilepsy affect my children?
This depends heavily on the cause of the epilepsy. A few epilepsies are inherited from one generation to another. Discuss this with your doctor if you are concerned about it.
What should I tell people to do if they witness me having a seizure?
If someone witnesses you having a seizure, he or she should stay calm, move objects that you could hit during the seizure away from you, turn you gently onto one side to help keep your airway safe. They should not put anything in your mouth, including their hand, pills, food or drink. If the seizure does not stop after 3-4 minutes then they should prepare to administer a rescue medication and to call the rescue squad. If you awaken and return to normal, then there is no need to call the rescue squad or take you to a hospital. Please also review the section of “First Aid for Seizures (Adults)” on this website.
EPILEPSY SURGEry evaluation (phase 1)
WHEN IS EPILEPSY SURGERY CONSIDERED?
Your doctor usually begins to consider epilepsy surgery when three or more antiepileptic
drugs (AEDs) have not controlled your seizure activity.
WHAT KIND OF EPILEPSY SURGERY IS MOST FREQUENTLY PERFORMED?
Temporal lobectomy is the most frequent type of surgery performed for seizures. Temporal lobectomies are usually performed on patients who have complex partial seizures or secondarily generalized seizures. “Extra temporal” surgery means removing a part of the brain outside of the temporal lobe.
WHAT ARE SOME STATITISTICS ABOUT PATIENTS WHO GO THROUGH WITH A TEMPORAL LOBECTOMY?
§ Patients who have temporal lobectomies have a 70% chance of being essentially seizure free.
§ Patients who have extratemporal surgery have a 50% chance of being essentially seizure free.
§ If you experience one year of seizure-freedom after surgery, you may be able to decrease the number of AEDs you take
§ Some people (about 50%) are able to stop taking their AEDs completely after surgery.
WHAT ARE THE RISKS ASSOCIATED WITH EPILEPSY SURGERY
With any surgery there are risks that the physician will discuss with you if is determined that you are a candidate for surgery. The list of risks may include the following:
§ Less than 1% of patients have a serious unexpected complication (like stroke or death).
§ About 15% of patients have a temporary or mild complication
§ Examples of temporary complications are headaches or depression for 6 months after surgery.
§ Examples of mild permanent complications include mild memory difficulties or a change in peripheral vision.
WHAT ARE SOME QUESTIONS TO CONSIDER BEFORE TALKING TO MY DOCTOR ABOUT EPILEPSY SURGERY
§ What are my goals for surgery?
§ What is my risk for injury with seizures?
§ How do seizures affect my quality of life?
§ How do I think my life would be different if my seizures were controlled?
WHAT KIND OF TESTS MAY BE DONE TO DETERMINE WHETHER I AM A CANDIDATE FOR SURGERY OR NOT?
There are several different tests that your doctor may order as part of the epilepsy surgery work-up. Most of these tests are done to determine what kind of seizures you have and to find the seizure focus:
1. MRI (magnetic resonance imaging): Provides a visual image of your brain, is a painless procedure during which you will lie flat on a narrow table inside the opening of a large magnet. You will need to lie still while the scan is completed. You will hear loud humming/whirring sounds.
2. Routine EEG: An EEG, or electroencephalogram, is a recording of electrical brain wave activity from leads and wires placed on the scalp. A routine EEG, in between your seizure activity, may give your doctor clues about the type of seizures you have and where the seizure focus is.
3. Video/EEG Intensive Monitoring: You will be continuously monitored with video and EEG in the hospital. The purpose of the admission is to capture your typical seizures and correlate them with your brain waves. The doctors may try to provoke your events by decreasing your antiepileptic drugs (AEDs).
4. Neuropsychological Testing: Neuropsychological testing conducted as part of a Phase I epilepsy evaluation typically measures general intellect, reasoning and/or problem solving skills, multi-tasking, attention and concentration, learning and memory, language skills, and sensory and motor skills. These tests can help locate your seizure focus because sometimes the area where the seizure starts doesn’t work as well as the rest of the brain. Everyone has areas of the brain that are stronger or weaker than others, but in people with epilepsy, the weaker area often corresponds with the seizure focus.
5. SPECT Scans: SPECT is an abbreviation for single photon emission computed tomography. It is similar to a CT scan (which is an abbreviation for “computed tomography”). SPECT measures blood flow in your brain. During a seizure, the blood flow increases in the area of the brain where the seizure begins. In between seizures the blood flow can be less than normal at the site where the seizure begins. Therefore, the blood flow measured by SPECT can assist in determining where your seizures begin.
6. PET Scan: Similar to A SPECT scan, but a PET scan measures brain sugar metabolism or activity rather than blood flow. This test also requires a radioactive tracer. Between seizures the seizure focus usually uses less blood sugar than the rest of the brain, indicated by decreased radioactivity in that area. PET scans are only performed in between seizures, not during seizure activity, because the radioactive tracer only lasts a few minutes and it would not be possible to wait for a seizure to occur. To prepare, you have to be NPO (nothing by mouth), including no caffeine, no sugar, and no chewing gum for four hours before the injection of the tracer. After the injection, you need to sit quietly for an hour.
7. Wada Test (also known as an intracarotid sodium amobarbital test): The Wada test is a procedure done to determine which side of your brain controls language function and to measure memory function of each side of the brain separately. To prepare for the test, you will be seen in the Epilepsy Clinic for a clinic visit and blood work one day and then have the Wada test the next day. On the day of your Wada test, you will come to the EEG laboratory in the main hospital to have EEG electrodes placed on your scalp in the early morning and typically be done with the test by noon. However, you will be required to lay flat for between 3-6 hours after the test. Most likely, you will be able to go home in the evening.
ONCE ALL THESE TESTS ARE DONE, WHO DETERMINES IF I AM A CANDIDATE FOR EPILEPSY SURGERY?
All of your test results are reviewed by the Epilepsy Surgery Committee, which is a committee consisting of epileptologists (neurologists who specialize in epilepsy), neuropsychologists, and neurosurgeons. The committee helps your primary epileptologist determine whether or not you are a candidate for epilepsy surgery.
Phase 1: Presurgical Evaluation
Types Of Surgery
§ Temporal lobectomy is the most frequent type of surgery performed for seizures.
§ Surgery is usually done for complex partial seizures or secondarily generalized seizures.
§ “Extra temporal” surgery removes a part of the brain outside of the temporal lobe.
When To Consider Surgery
§ When three or more anti-seizure medications have not controlled your seizure activity.
§ Your seizure type is complex partial or secondarily generalized.
§ Your seizure focus (where your seizures start) can be localized.
§ The area (focus) can be safely removed.
Benefits Versus Risks Of Surgery
§ Benefits
- Patients who have temporal lobectomies have a 70% chance of being essentially seizure free.
- Patients who have extratemporal surgery have a 50% chance of being essentially seizure free.
- In most surgeries, it is better to have surgery at a younger age.
- May be able to decrease the number of medications you take after one to two years.
- Some people (about 50%) are able to discontinue anti-seizure medication completely.
§ Risks
- With any surgery there are risks that the physician will discuss with you if you are a candidate for surgery.
- Less than 1% of patients have a serious unexpected complication (like stroke or death).
- About 15% of patients have a temporary or mild complication
§ Examples of temporary complications are headaches or depression for 6 months after surgery.
§ Examples of mild permanent complications include mild memory difficulties or a change in peripheral vision
Questions To Consider
§ What are your goals for surgery?
§ What are your risks for injury with seizures?
§ How do your seizures affect your quality of life?
§ How do you think your life would be different if your seizures were controlled?
Tests Prior To Surgery
§ In general, testing is done to clarify your type of seizure and to localize the “seizure focus”, where they start in your brain. No one test alone gives enough information for surgical treatment; therefore, several tests are conducted.
MRI (magnetic resonance imaging)
§ Provides a visual image of your brain.
- It is a painless procedure.
- You will lay flat on a narrow table inside the opening of a large magnet. You will need to lie still while the scan is completed. You will hear loud humming/whirring sounds.
Routine EEG
§ An EEG records the electrical activity of the brain. A routine EEG, in between your seizure activity, gives clues to the type of seizure and location.
§ This is usually performed at the beginning of your hospitalization.
Video/EEG Intensive Monitoring
§ Your electrical brain activity, along with a video recording of your seizure activity can usually provide a definitive diagnosis of your seizure type.
§ It usually localizes the seizure focus.
§ It is important to record your brain waves before, during and after a seizure.
§ The video picture makes the interpretation of your EEG more accurate.
Neuropsychological Testing
§ This is a battery of tests that look at different areas of the brain; including memory, IQ, motor and speech tests.