Frequently Asked Questions
Epilepsy is a neurological condition that affects approximately 2 million people in America. Electrical signals are constantly sent throughout the brain; when there is an abnormal surge of electric activity, a seizure results. Chronic seizures are the classic indicator of epilepsy, and there's a wide range of seizure symptoms-such as staring episodes, rapid blinking, convulsions, and loss of consciousness. Not all seizures are caused by epilepsy.
About 30 percent of all cases of epilepsy can be traced to factors such as head injury, infection, conditions such as cerebral palsy, and prenatal damage to the brain. But for the remaining 70 percent, a cause cannot be found. One general explanation is that an imbalance of neurotransmitters - special chemicals in the brain - can cause epilepsy to develop. One category of neurotransmitter that has been specifically identified is gamma-aminobutyric acid, or GABA, and medicines have been developed to balance levels of this chemical. A few types of epilepsy have been traced to a defect in a specific gene, but most of the time, the condition is not inherited.
Epilepsy can affect people of all ages, races, and genders. However, about one-third of all new cases are diagnosed in children. People over age 65 also have a higher tendency toward epilepsy.
In addition to medical history and physical exam, doctors have several tools that aid in the diagnosis of epilepsy. The electroencephalogram, or EEG, records electrical impulses from the brain through electrodes that are placed on a patient's head. This non-invasive test can be done on an outpatient basis, or when a more detailed study is needed, continuous video EEG monitoring may be ordered. Another tool, Magnetic Resonance Imaging (MRI), uses a magnetic field to capture an image. By scanning at different angles, it can provide a 3-dimensional image of the brain. Functional MRI takes images in "real time" sequence and faster than traditional MRI. This technique often is used before surgery to create a map of the brain, indicating where language, motor, and sensory areas are located.
Another imaging device, Single Photon Emission Computed Tomography, or SPECT, measures a low-dose radioactive material as it circulates through the brain. SPECT, which is available at University Hospital, can track cerebral blood flow and detect alternations in brain metabolism between and during seizures. This information can be useful in locating the seizure focus - the place within the brain that a seizure originates. A patient usually also undergoes a complete cognitive evaluation, which includes neuropsychologic and speech localization testing.
Not necessarily. Epilepsy is characterized by recurrent seizures, and there are many causes of seizure other than epilepsy, such as narcolepsy, high fever, and cardiac arrhythmia. Any seizure, however, is cause for a visit to a doctor for examination and further diagnostic tests if necessary.
Seizure "triggers" vary from person to person. Some common triggers include lack of sleep, alcohol, flashing lights ("photosensitive epilepsy"), and certain noises. When a patient is able to identify what brings on a seizure, he or she can avoid that thing or situation.
Many people have heard the terms "grand mal" and "petit mal" seizures. However, a new identification system, The International Classification of Epilepsy Seizures, that more precisely defines specific types of epilepsy is now used. The two broad categories, partial and generalized, refer to whether the seizure originates in one part of the brain or the entire brain. Tonic-clonic seizures, formerly grand mal, are characterized by convulsions; generalized absence seizures, which were known as petit mal, involve very brief lapses in consciousness and typically affect children. During complex-partial seizures, or temporal lobe epilepsy, the person appears dazed and exhibits involuntary behavior known as "automatisms," such as random walking or mumbling.
Medicines known as antiepileptic drugs (AEDs),or anticonvulsants, help control seizures for about 80 percent of people with epilepsy. A patient might take more than one kind of AED; over time, if seizure frequency and severity subside, a doctor may permit a patient to stop taking the medicine. Some newer AEDs are available that minimize the unwanted side effects - namely drowsiness - common to the older drugs. When drug therapy is ineffective, surgery, vagal nerve stimulation, or a special diet, all of which are described below, may be recommended.
The high-fat, low-carbohydrate Ketogenic Diet is carefully designed to help a patient's body make large amounts of ketones, which are produced when fats are processed in the liver. The diet helps reduce the number of seizures in some patients, although precisely why this beneficial effect occurs is not known. Most often, the diet is used with children whose epilepsy does not respond to medication.
The diet consists of three categories of food: unrestricted, fatty, and restricted. Unrestricted foods include vegetables, such as broccoli, carrots, lettuce, and spinach; artificial sweeteners; and unsweetened fruit. The fatty foods include bacon, hot dogs, potato chips, nuts, cream, eggs, mayonnaise, and butter. Restricted foods include candy and items containing sugar. A dietitian provides the patient and family with a foods list that must be strictly followed. A vitamin supplement is necessary to ensure that adequate nutritional needs are met.
The body has two vagus nerves, one that travels up the left side of the neck and one on the right. The left nerve relays information to areas of the brain that are believed to produce seizures. When this nerve is stimulated by a low level of electrical current, some people find that their seizures are less frequent or less severe.
A small, battery-operated device called a vagal nerve stimulator can be surgically placed in a person's body. It can be programmed to deliver stimulation at regular intervals, or it can be activated with a magnet when a patient experiences an aura.
For most people with epilepsy, their seizures are well controlled by antiepileptic drugs. But for those with intractable epilepsy, surgery may be an option. The surgery is specific to the type of epilepsy the patient has. Temporal and extratemporal cortical resection removes the brain tissue containing the epileptic focus. The Center uses Functional Image-Guided Surgery to create a precise "road map" of the brain and enables the neurosurgeon to avoid healthy tissue. Two other procedures-corpus callosotomy, which severs the neural connections between the brain's two hemispheres, and hemispherectomy, where one half of the brain is removed-are performed primarily on children with severe epilepsy.
While the pregnancies of women with epilepsy are high risk, the vast majority - 90 percent - result in the birth of a healthy baby. A well-planned pregnancy with early prenatal care (even prior to conception) is important, as certain AEDs are associated with a higher incidence of birth defects . Medication is usually continued to control seizures, but at lower doses or reduced from multiple AEDs to one, if possible. About one-third of women with epilepsy experience an increase in seizure activity during pregnancy. This can be due to lack of sleep (also a trigger for seizures in people who are not expecting); changes in how the woman's body metabolizes the AED; failure to take the AED as directed; or a decline in blood levels. While brief seizures generally do not harm the fetus, those that are prolonged may adversely affect the fetus or the mother. While the risks of these birth defects are small, the most common found in children born to mothers with epilepsy are spina bifida, cleft lip and palate, and congenital heart disease. It is recommended that women take the supplement folic acid (even before conception) to help protect against neural tube defects. There is no way to predict whether a parent's genetic tendency for epilepsy will be passed down to a child. While possible, the risk is considered small-a 3 percent to 4 percent chance.
Some antiepileptic drugs, such as Tegreal and Dilantin, can reduce the effectiveness of hormonally based contraceptives, i.e., the Pill, implanted protection, and hormone injections. In essence, these AEDs quicken the breakdown of birth control hormones, reducing the latter's effectiveness. That is why it is recommended that a second form of birth control ("barrier" protection such as a diaphragm or condom) be used along with hormonal contraception. Or, a woman may choose to avoid hormonally based contraceptives altogether and opt for a diaphragm. When the woman's family is complete or if she and her partner decide not to have children, tubal ligation or sterilization are permanent birth control options.
That depends on the child, but in general, most are of normal intelligence and will do well in school. It's important for the parent or caregiver to communicate with the child's teacher and school nurse about what type of seizures he or she has, what the seizures are like, what medication the child is taking, and the possible side effects of the medication. If the teacher is uninformed, an absence seizure may be characterized as day dreaming, for example, or inattentiveness brought on by an AED may be attributed to other factors. The teacher can also be a key ally in educating classmates about a child's epilepsy. Still, learning problems are more common in children with epilepsy; any damage to the brain associated with epilepsy can possibly also affect cognitive skills. The school's child study team of educators, psychologists, and social workers can evaluate the child and, if needed, develop a plan to address any deficiencies.
Most states require a person to be seizure-free for a specific amount of time before obtaining a regular driver's license. New Jersey law calls for a one-year, seizure-free period: Applications to drive are reviewed by a special unit within the Division of Motor Vehicles. Additionally, New Jersey has a mandatory physician reporting requirement under which doctors must inform the state when they treat people over 16 years of age who have epilepsy.