Epilepsy is a chronic disorder of the brain that causes a tendency to have recurrent seizures. Two or more seizures must occur before a person can receive the diagnosis of epilepsy, also known as a seizure disorder. Seizures occur when there’s a sudden change in the normal way your brain cells communicate through electrical signals. During a seizure, some brain cells send abnormal signals, which stop other cells from working properly. This abnormality may cause temporary changes in sensation, behavior, movement or consciousness.
The onset of epilepsy is most common during childhood and after age 65, but the condition can occur at any age. Treatments may be able to leave you free of seizures, or at least reduce their frequency and intensity.
Signs and symptoms of epilepsy
Because abnormal brain cell activity causes seizures, having a seizure can result in the sudden occurrence of any activity that’s coordinated by your brain. This can include slight temporary confusion, complete loss of consciousness, a staring spell, muscle spasms, or uncontrollable, jerking movements of the arms and legs. Seizures originating in your brain’s temporal lobe can be associated with a sense of deja vu, anxiety and panic, or simply an uneasy sensation in your stomach, which can be followed by loss of consciousness.
Signs and symptoms may vary depending on the type of seizure. Most people with epilepsy experience the same type of seizure, with similar symptoms, each time they have a seizure, but others may experience a wide range of types and symptoms.
Doctors classify seizures as either partial or generalized, based on how the abnormal brain activity begins. When seizures appear to result from abnormal activity in just one part of the brain, they’re called partial seizures. When seizures seem to involve most or all of the brain, the seizures are called generalized.
What can cause epilepsy?
The onset of epilepsy can often be traced to an accident, disease or medical trauma —such as a stroke — that injures your brain or deprives it of oxygen, often causing a small scar in your brain. In rare occasions, epilepsy may be caused by a tumor in your brain. However, in many cases there’s no identifiable cause for the disease.
Epilepsy isn’t a mental disease, although mental health can influence the control of seizures in epilepsy. Epilepsy doesn’t cause psychiatric problems or mental retardation, but people with epilepsy may also be afflicted with those conditions.
Are there any risk factors?
Research suggests that genetic abnormalities contribute significantly to epilepsy. If you have a family history of the disease, you may be at increased risk.
Head injuries are responsible for many cases of epilepsy. You can reduce your risk by always wearing a seat belt while riding in a car and by wearing a helmet while bicycling, skiing, riding a motorcycle, or engaging in other activities with a high risk of head injury.
Stroke and other diseases that affect your vascular system can lead to brain damage that may trigger epilepsy. You can take a number of steps to reduce your risk of these diseases, including limiting your intake of alcohol, following a healthy diet, managing your weight, exercising regularly and avoiding cigarettes.
Diagnosis of epilepsy
Because the possible causes of seizures are many, doctors may need to ask detailed questions and perform several tests to diagnose epilepsy, including:
- Medical history. Descriptions of your past seizures — from yourself or others who have observed your seizures — may help your doctor identify the type and cause of your problem. Your physician may also need to know about your current and past medical conditions and how they’ve been treated.
- Physical and neurologic examination. A neurologic examination may include testing your reflexes, muscle tone and strength, the function of your senses, and your gait, posture, coordination and balance. Your doctor may also ask questions to test your thinking, judgment and memory.
- Blood tests. Your doctor may want to take samples of your blood to be tested for chemical imbalances that may be the cause of your seizures.
- Electroencephalogram (EEG). This procedure records the electrical activity of your brain. An EEG helps determine what type of seizures or epilepsy you have and from which part of the brain seizures may start. During the procedure, which takes about a half-hour, you lie down. Between 16 and 30 small electrodes may be attached to your scalp with paste or an elastic cap. You remain still during the test, but at times you may be asked to breathe deeply and steadily for several minutes or to stare at a patterned board. At times a light may be flashed in your eyes. These actions are intended to stimulate your brain in ways that might be seen on the EEG. The electrodes pick up the electrical impulses from your brain and send them to the EEG machine, which records your brain waves on a moving sheet of paper or digitally on a computer screen.
- Computerized tomography (CT). A CT scan produces detailed cross-sectional images of your brain. The images may reveal abnormalities in brain structure, including tumors, cysts, strokes or tangled blood vessels.
- Magnetic resonance imaging (MRI). An MRI scan uses a powerful magnetic field and radio waves to produce images of your brain. Like CT scans, MRI images may reveal abnormalities in brain structure.
Medications for the treatment of epilepsy
Finding the right medication and dosage can be complex. It might take more than one drug, or trying several different drugs until the right one is found. Medications available for the treatment of seizures include:
All of these medications have some side effects, which may include mild fatigue, dizziness and weight gain. More severe side effects include depression, skin rashes, loss of coordination, speech problems and extreme fatigue. Discuss any of these side effects with your doctor as soon as possible. Many people with epilepsy use these medications for years without significant problems. Ask your doctor to explain these issues to you when you receive the prescription.
To achieve the best seizure control possible, take medications exactly as prescribed. Some seizure medications increase the risk of birth defects, so if you’re a woman with epilepsy tell your doctor if you’re considering becoming pregnant.
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