Seizure & epilepsy disorders

The first step in diagnosing epilepsy usually involves a discussion with your physician. They will listen carefully to a description of symptoms and take a detailed medical history. Central to diagnosing epilepsy is determining if there is a precise area of the brain that produces the seizure.

Your doctor may recommend one of several sophisticated tests:

Electroencephalogram (EEG): This test monitors brain wave activity during seizure and nonseizure periods.

MRI: This imaging test combines a powerful magnetic field, radio waves and a computer to create highly detailed images of the brain and other organs or body structures and their functions. MRI is the most sensitive imaging technology for the brain, making it a very helpful tool for fine-tuning an epilepsy diagnosis.

CT scan: This is a noninvasive test that uses special X-ray equipment that captures many cross-sectional views of an organ or area being examined. A computer then combines the many slices to create a two-dimensional view of the organ, tissue or blood vessel for examination. CT scans offer much more detail than traditional X-rays.

Positron emission tomography (PET) scan: This is a type of nuclear medicine imaging that uses a tiny amount of radioactive material to help provide detailed images of internal body organs and structures. Because the PET scan can show body functions including brain activity, it can be a helpful tool for evaluating seizures and other brain disorders.

Treatment of epilepsy is determined by the type and severity of diagnosis. In some cases (for example, specific types of pediatric epilepsy that children will outgrow) no treatment is given. The most common treatments for epilepsy are medications, surgery and vagal nerve stimulation. If you are diagnosed with epilepsy, your care team will develop a treatment plan tailored to your needs.

• Medications: Medication can be particularly effective in reducing the frequency and severity of seizures, while surgery may be an option for adults or children with a clearly defined focal point responsible for triggering seizures. It’s a successful way to treat seizures in seven out of 10 people. If one medication doesn’t stop your seizures, your doctor can try a variety of others.
• Vagal nerve stimulation: Seizures may also be treated using vagal nerve stimulation, a state-of-the-art treatment that has shown to be successful with patients whose epilepsy does not respond to medication. It helps prevent seizures by sending mild electrical pulses to the brain via the vagus nerve. The doctor implants a small device under the skin on the chest wall, with a wire that runs from the device to the vagus nerve located in the neck. With this treatment, the doctor implants a small device under the skin in the left chest area. A vagal nerve stimulator is sometimes called a pacemaker for the brain because it is programmed to send electric energy at regularly paced intervals to prevent seizures.
• Surgical resection: In some cases, surgery is an option for stopping epileptic seizures. Finding the exact site of abnormal electrical activity is essential before surgical treatment can be considered. Abnormalities located in the temporal lobe of the brain can be treated most successfully with surgery. The surgeon removes brain tissue from the area of the brain where seizures occur, which usually contains a tumor, brain injury or malformation.

Seizure symptoms can vary significantly, and recognizing a seizure can be difficult when symptoms are mild. Some seizures involve jerky bodily movements, whereas others may look like the person is daydreaming. Doctors can identify a specific cause for seizures in some cases, but if not, the seizures are known as unprovoked seizures.

Here are some signs someone may be having a seizure:

• Staring into space
• Rolling back of eyes
• Unusual repetitive movements such as blinking or head nodding
• Nausea or headaches
• Confusion, sleepiness or weakness
• Feeling “electricity,” tingling, pins-and-needles sensations or numbness in parts of the body
• Sudden feelings of fear or anger
• Out-of-body sensations
• Distortions in sense of sight, taste or smell
• Falling
• Involuntary jerking of arms, legs or body
• Loss of consciousness or lack of awareness
• Losing control of urine or stool

Most seizures only last a few minutes or less. If you believe someone is having a seizure, and it lasts more than a few minutes, seek medical help immediately. A single seizure or a series of multiple epileptic seizures that last more than five minutes without recovery between is called status epilepticus.

Status epilepticus is a medical emergency that can cause permanent brain damage or death and requires immediate care. Call for help right away if you think someone is experiencing status epilepticus.