Epilepsy Health Article

Signs and tests

The diagnosis of epilepsy and seizure disorders requires a history of recurrent seizures of any type. A physical examination (including a detailed neuromuscular examination) may be normal, or it may show abnormal brain function related to specific areas of the brain.

An electroencephalograph (EEG), a reading of the electrical activity in the brain, may confirm the presence of various types of seizures. It may, in some cases, indicate the location of the lesion causing the seizure. EEGs can often be normal in between seizures, so it may be necessary to do prolonged EEG monitoring.

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

• CBC
• Blood chemistry
• Blood glucose
• Liver function tests
• Kidney function tests
• Tests for infectious diseases
• CSF (cerebrospinal fluid) analysis

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

• 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 repair a tumors or brain lesions.

Anti-convulsants taken by mouth may reduce the number of future seizures. How well medicine works depends on each individual's response to the drug. The type of medicine used depends on seizure type, and 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.

Epilepsy that does not respond to the use of several medications is called refractory epilepsy. Certain people 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 with a vagal nerve stimulator, which is implanted in the chest. This stimulator can help reduce the number of seizures.

Sometimes, children are placed on a special diet to help prevent seizures. The most one is the ketogenic diet.

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

Support Groups

The stress caused by having seizures (or being a caretaker of someone with seizures) can often be helped by joining a support group. In these groups, members share common experiences and problems. See epilepsy - support group.

Expectations (prognosis)

Epilepsy may be a chronic, lifelong condition. In some cases, the need for medications may be reduced or eliminated over time. Certain types of childhood epilepsy resolve or improve with age. A seizure-free period of 4 years may indicate that reduction or elimination of medications is possible.

Death or permanent brain damage from seizures is rare, but can occur if the seizure is prolonged or 2 or more seizures occur close together (status epilepticus). Death or brain damage are most often caused by prolonged lack of breathing and resultant death of brain tissue from lack of oxygen. There are some cases of sudden, unexplained death in patients with epilepsy.

Serious injury can occur if a seizure occurs during driving or when operating dangerous equipment, so these activities may be restricted for people with poorly controlled seizure disorders.

Infrequent seizures may not severely restrict the person's lifestyle. Work, school, and recreation do not necessarily need to be restricted.

Complications

• Prolonged seizures or numerous seizures without complete recovery between them (status epilepticus)
• Injury from falls, bumps, or self-inflicted bites
• Injury from having a seizure while driving or operating machinery
• Inhaling fluid into the lungs and subsequent aspiration pneumonia
• Permanent brain damage (stroke or other damage)
• Difficulty with learning
• Side effects of medications
• Many anti-epileptic medications cause birth defects -- women wishing to become pregnant should alert their doctor in advance in order to adjust medications