Vital signs: what causes epilepsy and what treatments are available? | Health

About 3.4 million Americans – including about 470,000 children – have epilepsy, according to the US Centers for Disease Control and Prevention. People with epilepsy have spontaneous seizures, which feel like an electrical storm in the brain.

Causes of epilepsy include brain damage, infections, tumors, and strokes. And although it has long been suspected that genetics contribute to epilepsy, until recently we were often unable to identify specific genetic disorders. Most often, the genetic changes that cause epilepsy affect how brain cells work or communicate, causing abnormal electricity in the brain. While some genetic epilepsies run in families or are hereditary, many are spontaneous or “de novo” changes occurring in families without any relatives with epilepsy. For some patients, we can identify a specific genetic cause via a test (usually blood or saliva).

The most common type of seizure caused by epilepsy is a full-body convulsion with stiffness, tremors, loss of consciousness, and breathing changes. Other types of seizures can include unresponsiveness, sensory changes such as a strange smell or taste. While people can have more than one type of seizure, most people tend to have the same type of seizure each time.

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Primary care physicians often refer children with these or similar symptoms to a neurologist to determine if a seizure has occurred. After taking a detailed history and doing a physical exam, the neurologist may give a patient brain imaging or an electrocephalogram (EEG), which examines electrical brain waves. In children and adults who continue to have seizures despite treatment with two anticonvulsant drugs, they should be evaluated by an epileptologist, a neurologist with additional training in epilepsy, at a comprehensive epilepsy center.

Medications are the first choice of treatment for epilepsy. More than 30 drugs are used to treat seizures, but the choice of which drug to try first is individualized for each patient.

My treatment goal is to stop the seizures without medication side effects. Although many people respond well to their first or second medication, a third of people with epilepsy continue to have seizures. In these patients, we consider alternative treatments such as medically supervised dietary changes (ketogenic diet or modified Atkins diet) or devices such as vagus nerve stimulators that send electrical impulses to the brain to prevent seizures. For some patients, epilepsy surgery is an option that can safely cure their seizures.

Some of the medications we use for seizures have been around for many years, but fortunately new medications and treatment options are coming out all the time.

At UVa Health, we are certified as a Level 4 center – the highest level of care – by the National Association of Epilepsy Centers, providing high quality care for children and adults. Our comprehensive care team includes neurologists and epileptologists, nurse coordinators, EEG technologists, neuropsychologists, dietitian, neuroradiologists and neurosurgeons. At UVa, I am fortunate to have phenomenal colleagues in developmental pediatrics, genetics, behavioral health, and psychiatry whom I often call on to help me care for my patients.

For more information about epilepsy care at UVa Health, visit uvahealth.com/services/epilepsy.

Dr. Erika Axeen is a neurologist at UVa Health and UVa Children’s and specializes in the assessment and management of seizures and epilepsy in children.

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