Epilepsy Health Article

Symptoms

The severity of symptoms can vary greatly, from simple staring spells to loss of consciousness and violent convulsions. For most people with epilepsy, each seizure is similar to previous ones. The type of seizure a person has depends on a variety of things, such as the part of the brain affected and the underlying cause of the seizure.

An aura consisting of a strange sensation (such as tingling, smelling an odor that isn't actually there, or emotional changes) occurs in some people prior to each seizure.

For a detailed description of the symptoms associated with a specific type of seizure, see:

• Absence (petit mal) seizure
• Generalized tonic-clonic (grand mal) seizure
• Partial (focal) seizure

Signs and tests

A physical examination (including a detailed neurologic examination) may be normal, or it may show abnormal brain function related to specific areas of the brain.

Persons with epilepsy will often have abnormal electrical activity seen on an electroencephalograph (EEG). (An EEG is a reading of the electrical activity in the brain.) In some cases, the test may show where in the brain the seizures start. EEGs can often be normal in between seizures, so it may be necessary to perform a longer test.

Various blood tests and other tests to rule out temporary and reversible causes of seizures, may include:

• Blood chemistry
• Blood sugar
• CBC (complete blood count)
• CSF (cerebrospinal fluid) analysis
• Kidney function tests
• Liver function tests
• Tests for infectious diseases

Tests for the cause and location of the problem may include:

• EEG
• Head CT or MRI scan
• Lumbar puncture (spinal tap)

Treatment

For treatment of seizures, please see Seizures - first aid.

If an underlying cause for recurrent seizures (such as infection) has been identified and treated, seizures may stop. Treatment may include surgery to remove a tumor, an abnormal or bleeding blood vessel, or other brain problems.

Medication to prevent seizures, called anti-convulsants, may reduce the number of future seizures. These drugs are taken by mouth.

• The type of medicine you take depends on what type of seizures you are having. The dosage may need to be adjusted from time to time.
• Some seizure types respond well to one medication and may respond poorly (or even be made worse) by others. Some medications need to be monitored for side effects and blood levels.
• It is very important that you take your medication on time and at the correct dose. Most people taking these drugs need regular checkups and regular blood tests to make sure they are receiving the correct dosage.
• You should not stop taking or change medications without talking to your doctor first.

Some factors increase the risk for a seizure in a person with epilepsy. Talk with your doctor about:

• Certain prescribed medications
• Emotional stress
• Illness, especially infection
• Lack of sleep
• Pregnancy
• Skipping doses of epilepsy medications
• Use of alcohol or other recreational drugs

Epilepsy that does not get better after two or three seizure drugs have been tried is called "medically refractory epilepsy."

• Some patients with this type of epilepsy may benefit from brain surgery to remove the abnormal brain cells that are causing the seizures.
• Others may be helped by a vagal nerve stimulator. This is a device that is implanted in the chest (similar to a heart pacemaker). This stimulator can help reduce the number of seizures, but rarely stops the seizures completely.

Sometimes, children are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet. A diet low in carbohydrates, such as the Atkins diet, may also be helpful in some adults.

Persons with epilepsy should wear medical alert jewelry so that prompt medical treatment can be obtained if a seizure occurs.