What to Know About Epilepsy Treatment and Symptoms This Epilepsy Awareness Month

November is Epilepsy Awareness Month, and with epilepsy affecting nearly 1.2 percent of the population at some point, it’s important to understand the potential causes, symptoms, and epilepsy treatment options.

Epilepsy is one of the most common neurological conditions in the world. Most people are diagnosed before the age of 20, but around 30 percent will be diagnosed after age 50. Nearly all who are diagnosed retain the condition for life.

Witnessing an epileptic seizure can be very disconcerting and even a little frightening. Unfortunately, this has led to a significant amount of stigma, including the idea that patients with epilepsy are delicate or should somehow be avoided.

The truth is that epilepsy is neither contagious nor dangerous to anyone but the patient themselves. Even though watching someone have a seizure can be scary, what the patient needs most is patience and understanding.

In honor of Epilepsy Awareness Month, we want to help you get to know this complex yet common condition. Whether you have epilepsy yourself, or you just know someone who does, a little education can always help.

What Is Epilepsy?

Epilepsy is an umbrella term referring to a small number of central nervous system disorders that temporarily interfere with normal brain functioning. This leads to:

• Seizures
• Convulsions
• Many other serious symptoms

In a normal, healthy brain, rhythmic electric pulses facilitate communication between neuron bundles, which send messages back and forth to control your body. In epilepsy, these signals misfire, stopping the flow of information. Neurons stop sending information or send confused messages, leading to significantly abnormal brain activity in whichever area of the brain the seizure occurs.

Think of your brain like a highway with stop lights and intersections; you and your vehicle are the messages between neurons. Lights and signs tell you where to drive and which paths to follow to get where you want to go. Without them, you might drive down the wrong path or even get into an accident with another vehicle. That’s exactly what happens during an epileptic seizure.

4 Types of Epilepsy

There are four distinct types of epilepsy recognized in America by experts. Each addresses a slightly different set of symptoms and/or refers to seizures that occur within a specific area, or areas, of the brain.

1. Generalized epilepsy:

Involves faulty electrical signals affecting both sides of the brain.

• Patients often suffer from “generalized motor seizures” (sometimes referred to as “grand mal seizures”) with extreme jerking and uncontrollable movements.
• They may also lose awareness or consciousness.

2. Focal epilepsy:

Involves seizures that originate on only one side of the brain (sometimes referred to as “partial seizures”).

• Patients may or may not lose awareness, and uncontrollable movements tend to be present, yet much less pronounced.
• A small number of focal epilepsy patients experience no uncontrollable movements or loss of consciousness at all. Instead, seizures manifest as sudden and intense changes in the way they think or feel; this is a focal non-motor seizure.

3. Generalized and focal epilepsy:

This type of epilepsy occurs when someone has a mixture of seizures from both sides and only one side of the brain.

• Seizures may occur together at the same time or completely independently of one another. This type of epilepsy can be one of the most severe.

4. Unknown if generalized or focal epilepsy:

This label simply signifies that doctors aren’t yet sure exactly what type of epilepsy someone has.

• This may be due to the fact that test results have been inconclusive.
• Or, it may be a result of the fact that no one has witnessed the seizures except the patient, limiting the amount of knowledge available about the presentation.
• A small number of patients keep this diagnosis for life because their seizures present in a way that doesn’t easily fit other categories.

Other Common Symptoms

The symptoms of epilepsy can be a product of many different variables, as mentioned above. There are even subtle differences patient-to-patient; for example, one person might hallucinate, while another smells burning toast just before a seizure comes on. Another still might suddenly feel intense panic or fear, yet remain entirely aware and present in the moment.

Researchers know these differences are probably related to individual differences in brain structure. However, we don’t yet know enough about the brain and how it works to be able to definitively predict every subtle symptom.

Still, the vast majority of patients do experience one or more of the following “core symptoms” on a semi-regular or regular basis:

• Confusion and/or disorientation
• Severe, uncontrollable muscle spasms
• Uncontrollable movements (twitching, convulsions)
• Loss of consciousness or awareness
• Fear, anxiety, or panic attacks before a seizure
• Strange, unexplainable symptoms (seeing flashing lights)

We also mentioned further up that the location of the seizure can have a significant impact on how a patient experiences it.

1. Misfires located in the dominant temporal lobe, for example, are often associated with vocal symptoms (like shouting) because this area of the brain is responsible for handling speech.
2. Seizures that occur within the occipital lobe, on the other hand, typically manifest with symptoms related to sight instead. This is one reason why identifying the right symptoms is an important facet of making the correct diagnosis.

Are Seizures Always Caused By Epilepsy?

Not at all. In fact, the second most common cause of seizures is high fever (called febrile seizures), especially in children under the age of two. “High” can be somewhat relative; one child may experience febrile seizures with a temperature of just 102 F, while another may not seize until their fever reaches 105 F. However, risk increases exponentially for every degree above 101 F.

Certain drugs may also trigger seizures in a small number of patients, including:

• Tramadol
• Tapentadol
• Reserpine
• Theophylline
• Bupropion
• Cocaine
• Benzodiazepines
• Alcohol

In some cases, it is the drug itself that makes having a seizure more likely (known as “lowering the seizure threshold”). In others, withdrawing from the drug leads to an imbalance of certain brain chemicals that triggers an “electrical storm” in the brain.

Other health issues may also trigger seizures, such as:

• Strokes
• Heart attacks
• Diabetes
• Brain tumors
• Problems with the adrenal or thyroid glands
• Viral infections

In almost all cases, treating the originating illness resolves seizure activity completely. This isn’t the case in epilepsy because the problem originates within the brain itself.

Why is it important to make this distinction? While epilepsy can certainly cause seizures, not every seizure is because of epilepsy. Outside forces must be ruled out in order to make an exact diagnosis, and more importantly, find the right treatment.

If someone is diagnosed with epilepsy, it can be treated. We’ll tell you a bit about those epilepsy treatment options next.

Epilepsy Treatment Options

Epilepsy treatment depends on the patient, the type of seizure experienced, and even the patient’s age.

• Patients who have grand mal seizures, for example, often require aggressive drug therapy or even surgery to bring them under control.
• People who experience partial seizures with minor uncontrollable moments may need nothing more than simple monitoring unless their condition declines.

In most cases, doctors who make a positive diagnosis of epilepsy will at least initiate some kind of epilepsy treatment drug.

• Maintenance medications, like Tegretol, Dilantin, Trileptal, and Zarontin are most effective when taken every single day.
• Short-acting sedatives and anti-epileptic drugs (AEDs) like Ativan, Klonopin, and phenobarbital are mostly beneficial in halting seizures in progress instead.

Surgery is generally a last-line epilepsy treatment option. It involves removing a small piece of the skull over the area of the brain responsible for the seizure itself. Surgeons then identify and remove the smallest amount of tissue possible to prevent seizures from happening in the future. Results are not guaranteed; and there are significant risks. Still, it is an effective option for many when nothing else works.

Conclusion: Answers to Common Questions