Epilepsy: Causes, Symptoms & Treatment

Epilepsy is a chronic neurological disorder characterized by recurrent, unprovoked seizures. A seizure occurs when there is a sudden burst of abnormal electrical activity in the brain, temporarily disrupting normal brain function. Epilepsy is diagnosed when a person has had two or more unprovoked seizures occurring more than 24 hours apart, or after a single seizure with a high risk of recurrence.

Epilepsy affects approximately 50 million people worldwide and 3.4 million in the United States, making it one of the most common neurological conditions.

Focal (partial) seizures -- start in one area of the brain:

• Focal aware seizures (simple partial): Person remains conscious but may experience unusual sensations, movements, or emotions
• Focal impaired awareness seizures (complex partial): Consciousness is altered; person may stare, make repetitive movements (lip smacking, hand rubbing)
• Focal to bilateral tonic-clonic: Starts focal and spreads to involve both sides of the brain

Generalized seizures -- involve both sides of the brain from the start:

• Absence seizures (petit mal): Brief staring spells lasting 5-30 seconds, common in children
• Tonic-clonic seizures (grand mal): Loss of consciousness, stiffening (tonic phase), then rhythmic jerking (clonic phase)
• Myoclonic seizures: Sudden, brief muscle jerks
• Atonic seizures (drop attacks): Sudden loss of muscle tone causing falls
• Tonic seizures: Sudden stiffening of muscles

• Genetic factors: Many epilepsies have a genetic component
• Structural brain abnormalities: Tumors, stroke, traumatic brain injury, brain malformations
• Infections: Meningitis, encephalitis, brain abscess, neurocysticercosis
• Developmental conditions: Autism, neurofibromatosis, tuberous sclerosis
• Prenatal injury: Oxygen deprivation, maternal infections
• Unknown: In about 50% of cases, no identifiable cause is found

• Electroencephalogram (EEG): Records brain electrical activity; may show epileptiform patterns
• MRI of the brain: Identifies structural causes (tumors, malformations, scars)
• Video-EEG monitoring: Continuous monitoring to capture seizures and correlate with EEG
• Blood tests: To rule out metabolic causes
• Neuropsychological testing: Assesses cognitive function and helps localize seizure focus

Antiseizure medications (ASMs) -- first-line treatment:

• Approximately 70% of patients achieve seizure control with appropriate medication
• Common ASMs: levetiracetam, lamotrigine, carbamazepine, valproic acid, oxcarbazepine, lacosamide
• Choice depends on seizure type, side effects, age, sex, and other medications
• Treatment is typically started with a single medication (monotherapy) at a low dose and gradually increased

Surgery (for drug-resistant epilepsy):

• Resective surgery: Removal of the seizure focus (most effective when a single focus is identified)
• Temporal lobectomy achieves seizure freedom in 60-80% of suitable candidates
• Laser interstitial thermal therapy (LITT): Minimally invasive option

Other therapies:

• Vagus nerve stimulation (VNS): Implanted device that sends electrical pulses to the brain via the vagus nerve
• Responsive neurostimulation (RNS): Detects abnormal activity and delivers targeted stimulation
• Ketogenic diet: High-fat, low-carbohydrate diet especially effective in children

• Take medications consistently at the same times each day
• Get adequate sleep (sleep deprivation is a common seizure trigger)
• Avoid excessive alcohol
• Manage stress
• Wear a medical alert bracelet
• Discuss driving regulations with your doctor (varies by state/country)
• Women should discuss contraception and pregnancy planning with their neurologist, as some ASMs can affect hormonal contraception and carry teratogenic risks

See a doctor after any seizure. Seek emergency care for seizures lasting more than 5 minutes, repeated seizures without recovery between them (status epilepticus), seizures with difficulty breathing, or seizures resulting in injury.