All people with epilepsy have seizures, but not all people who have had a seizure have epilepsy.
The disease, which affects 3.5 million children and adults in the United States, is a brain disorder characterized by recurrent seizures. Many patients live in constant fear that their neighbor will arrive, that they might pass out and lose control of their body.
With the right treatment, most people can control epilepsy, and it starts with understanding and diagnosing it. Just because you’ve had a seizure doesn’t mean you have epilepsy.
Is it epilepsy?
“If a person has two or more unprovoked seizures, separated by more than 24 hours, they are considered epileptic,” said Dr. Jayant Acharya, neurologist and director of the Comprehensive Epilepsy Center at Penn State Health Milton S. Hershey Medical Center . .
But that’s not the only way crises occur. Sometimes they can be caused – the result of severe sleep deprivation, hypoglycemia, drug or alcohol withdrawal, or – especially seen in young children – a high fever. “If a seizure only happens in these settings, we wouldn’t call it epilepsy,” Acharya said.
When a patient sees a doctor with a suspected seizure, doctors will first try to determine if it was a seizure or something else, such as syncope (fainting) or a transient ischemic attack, also called mini-stroke.
The medical team collects a detailed history to help guide the diagnosis. Often, however, patients are not able to provide much information about the event itself.
“Maybe they came to me because they passed out and someone told them it looked like they were having a seizure,” Acharya said. “We really want to hear the witness directly. “
During what is called a grand mal seizure, abnormal electrical activity occurs throughout the brain, causing unconsciousness and violent muscle contractions. In a focal seizure, the abnormal electrical activity is limited to certain areas of the brain. Sometimes a patient loses consciousness. Symptoms – which can be subtle – include tremors of a limb, unusual movements of the head or eyes, tingling, abdominal pain, rapid heartbeat, repetitive movements such as lip smacking, dilated pupils, vision changes or hallucinations or fainting.
How do they test for epilepsy?
After taking the patient’s medical and family history, the doctor will often order clinical tests, starting with an electroencephalogram (EEG). This simple, non-invasive procedure measures electrical activity in the brain using small electrodes attached to the scalp.
“We are looking for interictal epileptiform discharges, which will show up as a peak or a sharp wave on the EEG,” Acharya said. “It shows that part of the brain has undergone physiological changes that predispose to seizures.”
About half of people with epilepsy will have a normal EEG. Doctors may order more complex tests, including an outpatient EEG – when the patient is sent home for two to three days with the electrodes hanging from their scalp – or video EEG monitoring. The latter involves a patient spending five days in the hospital while the medical team takes more aggressive measures to provoke a seizure in a safe and controlled setting.
Some epilepsies are idiopathic, which means the cause is either genetic or unknown, Acharya said. “Then there’s symptomatic epilepsy, which can be caused by a brain deformity, or some type of brain injury or scarring, or a brain tumor,” he said. Magnetic resonance imaging or positron emission tomography can help identify an underlying cause or location of epilepsy.
Treatment usually begins with oral medication. If that doesn’t work, doctors can try a different drug or a combination. “Almost 60% of our patients are successful with mono or combination drug therapies,” said Acharya.
However, a third of people with epilepsy fail to control their seizures with medication alone.
“In our Level IV epilepsy center at Penn State Health, we often see patients with drug-resistant epilepsy,” Acharya said. “They failed several drug therapies and were referred to us to look at other options.”
These options include surgical resections, during which abnormal brain tissue is removed. This is only possible for patients with focal epilepsy affecting a “non-eloquent part of the brain,” Acharya said. “We will not touch areas like the main motor area, the speech center, or the visual cortex.” The medical team will use a variety of tests to assess whether removing the epileptic region of the brain is likely to cause major neurological complications.
Thermal laser ablation, a new surgical option, uses heat to destroy small areas of abnormal brain tissue. With surgery or removal, patients have a 65-70% chance of completely freeing themselves from seizures, Acharya said.
Patients with drug-resistant epilepsy who are not candidates for surgery may find relief from their seizures through neurostimulation devices.
Diet can play an important role in controlling seizures. The ketogenic diet was developed for epilepsy decades ago, Acharya said. Originally designed with 90% fat and 10% protein and carbohydrate, the restrictive diet controlled by a doctor can reduce seizures by 50% in some people, but it takes at least three months of strict adherence for it to be. ‘he works.
“People have come up with changes to make it easier to stay,” Acharya said. “One is a modified Atkins diet that allows for more protein and more carbohydrates.”
Epilepsy is considered a disease that lasts a lifetime. But some patients may eventually have their diagnosis resolved.
“If someone who is on medication goes a few years without having a seizure, we will start weaning them off their medication,” Acharya said. “Many continue to do well, without any crisis being reported. After 10 years without seizure, including at least five without medication, their epilepsy is considered cured or resolved.
Even if a patient never fully recovers from epilepsy, by controlling their seizures and managing their epilepsy, they can enjoy a high quality of life, Acharya said.
The Medical minute is a weekly health article produced by Penn State Health. The articles showcase the expertise of faculty, physicians and staff and are designed to deliver relevant and timely health information of interest to a broad audience.