Seizures & Epilepsy

Seizure disorder is a general term used to describe any condition in which seizures may be a symptom and it is often used in place of the term ''epilepsy.''

Epilepsy and seizures occur as a result of abnormal electrical activity in the brain. Brain cells communicate by sending electrical signals in an orderly pattern. In epilepsy, these electrical signals become abnormal, giving rise to an "electrical storm" that produces seizures. These storms may be within a specific part of the brain or be generalized, depending on the type of epilepsy.

Not all people who appear to have seizures have epilepsy.

• Epilepsy is identified by seizures, abnormal movements or behavior due to unusual electrical activity in the brain.
• Non-epileptic seizures are caused by some known and reversible medical conditions like psychological issues, stress, alcohol withdrawal or extremely low blood sugar.

Seizure symptoms can vary widely. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others repeatedly twitch their arms or legs. No matter which part of the body is affected, the brain is the source of the symptoms.

The location of that event, how it spreads, how much of the brain is affected, and how long it lasts are factors that determine the type of seizure and its impact on the individual.

Many people with epilepsy have more than one type of seizure and may have other symptoms of neurological problems as well.

One seizure is important enough to warrant an appointment with the neurology team at Semmes Murphey Clinic.

The seizures in epilepsy may be related to a brain injury or a family tendency, but often the cause is completely unknown.

Anyone can develop epilepsy as it affects males and females of all races, ethnic backgrounds, and ages.

It is a relatively common condition, affecting 0.5% to 1% of the population. In the United States, about 2.5 million people have epilepsy and about 9% of Americans will have at least one seizure in their lifetimes.

Patients with epilepsy may experience more than one seizure type. This is because seizures are only symptoms. Therefore, it is essential that your neurologist diagnose your type of epilepsy, not just the type(s) of seizure you are having.

Researchers have linked some types of epilepsy to specific genes, but for most people, genes are only part of the cause of epilepsy. Certain genes may make a person more sensitive to environmental conditions that trigger seizures.

Epilepsy can be triggered by:

• Head trauma from a car accident or other serious injury
• Brain conditions such as brain tumors or strokes (Stroke is a leading cause of epilepsy in adults older than age 35.)
• Infectious diseases such as meningitis, AIDS and viral encephalitis
• Developmental disorders such as autism and neurofibromatosis

Because epilepsy is caused by abnormal activity in the brain, seizures can affect any variety of the processes the brain coordinates.

Seizure signs and symptoms may include:

• Temporary confusion
• Staring
• Uncontrollable jerking movements of the arms and legs
• Loss of consciousness or awareness
• Stiffening of muscles, typically in the back, arms and legs
• Loss of muscle control
• Sudden collapsing or falling down
• Psychic symptoms such as fear, anxiety or deja vu

In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode.

Of course, the most identified symptom is most dramatic type of epileptic seizure. Often called grand mal seizures, these can cause an abrupt loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control or biting your tongue.

Doctors generally classify seizures as either focal or generalized, based on how the abnormal brain activity begins.

Focal seizures

When seizures appear to result from abnormal activity in just one area of your brain, they're called focal (partial) seizures. These seizures fall into two categories:

• Focal seizures with impaired awareness.
  • These seizures involve a change or loss of consciousness or awareness. During a complex partial seizure, you may stare into space and not respond normally to your environment or perform repetitive movements, such as hand rubbing, chewing, swallowing or walking in circles.
• Symptoms of focal seizures may be confused with other neurological disorders, such as migraine, narcolepsy or mental illness.

• Focal seizures without loss of consciousness.
  • These seizures do not cause a loss of consciousness.
• They may alter emotions or change the way things look, smell, feel, taste or sound.
• They may also result in involuntary jerking of a body part, such as an arm or leg, and spontaneous sensory symptoms such as tingling, dizziness and flashing lights.

All of these detailed differences call for a thorough examination and testing by the neurology team at Semmes Murphey Clinic.

It is important to seek medical advice if you or a loved one experiences a seizure for the first time.

But seek immediate medical help if the seizure:

• Lasts more than five minutes,
• Is immediately followed by a second seizure,
• Is accompanied by a high fever or heat exhaustion,
• Causes an injury,
• Occurs in a pregnant woman or someone with diabetes, or
• Breathing or consciousness doesn't return after the seizure stops.

While some people require lifelong treatment to control seizures, for others, the seizures may eventually go away. Also, some children with epilepsy may outgrow the condition with age.

But there is still good news for people with epilepsy or seizure disorders. There are a variety of medications and surgery options that can control seizures for the majority of people with epilepsy.

Controlling seizures begins with a proper and specific diagnosis. Determining the exact type of seizure or epilepsy is like putting together puzzle pieces to best explain the event.

To do this, the neurology team will need information about the event, medical history, blood tests, EEG tests, and perhaps brain imaging tests such as CT and MRI scans.

Semmes Murphey’s world-renowned epilepsy teams include neurologists, neurosurgeons, imaging specialists (radiologists), mental health specialists (neuropsychologists) and other professionals who work together to properly diagnose our patients and provide exactly the care they need.

Semmes Murphey clinicians use advanced technology, including MRI, electroencephalography, computerized tomography, magnetic resonance imaging, positron emission tomography, inpatient video-EEG epilepsy monitoring and other tests to accurately diagnose the seizure(s).

But the description of the event is very important. The doctor will want to hear not only a description of the seizure itself, but also the story of the events leading up to it and the after-effects that followed it.

Often it is important to bring along a family member or someone else who saw the seizure and can tell the doctor what happened, since the person who had the spell may have been unconscious.

Questions your doctor may ask include:

• What was the setting?
• Did the episode occur shortly after standing?
• Was there a warning?
• Exactly what happened during the episode?
• How long did it last?
• Could the episode have been provoked by sleep deprivation, excessive use of alcohol or drugs, or some other factor?
• Was the person tired or confused after the episode?
• Has there been more than one episode? If so, were they all alike?
• Has the person seen a doctor before about this kind of event?
• If so, what tests were done?
• Was any medication prescribed? What effect did it have?

When medications have failed to control seizures then surgery may be an option.

Semmes Murphey has a comprehensive team of neurosurgeons, neurologists, neuropsychologists, and radiologists who can determine if you are a surgical candidate.

Surgery entails either removal of the problem areas in the brain with traditional surgery or laser ablation, deep stimulation of electrical circuits in the brain, and peripheral nerve stimulation of the vagus nerve.