How is epilepsy diagnosed?

Each year in the United States, approximately 150,000 people seek medical attention after experiencing their first seizure. Forty to 50 percent of first-time episodes will develop into recurrent seizures; many of those patients will be diagnosed with epilepsy. The team begins with sophisticated outpatient or inpatient diagnostic procedures, including continuous video-EEG monitoring in our epilepsy monitoring unit, to detect seizures in real-time. 

What are the different types of seizures?

The different types of seizures can be classified into two main categories: generalized seizures and focal seizures.

Generalized seizures involve both sides of the brain and can cause a loss of consciousness. Some types of generalized seizures include:

1. Absence seizures typically last only a few seconds and involve staring into space.
2. Tonic-clonic seizures involve muscle stiffness (tonic phase) followed by muscle jerks (clonic phase) and loss of consciousness.
3. Myoclonic seizures cause sudden, brief muscle jerks.
4. Atonic seizures cause a sudden loss of muscle tone, which can lead to falls.

Focal seizures, also known as partial seizures, only affect one part of the brain. There are two types of focal seizures:

1. Focal aware seizures do not involve a loss of consciousness and may cause sensory or emotional changes.
2. Focal impaired awareness seizures involve a loss of consciousness and can cause confusion or staring spells.

What are some common triggers for seizures?

• Lack of sleep or poor sleep quality
• Stress or anxiety
• Hormonal changes, such as during menstruation or menopause
• Flickering lights or patterns (known as photosensitivity)
• Certain medications or drug interactions
• Alcohol or drug use
• Illness or fever
• Dehydration or low blood sugar
• Skipping meals or fasting
• Overexertion or exhaustion

What are non-epilepsy causes of seizures?

• Fever or infection, particularly in young children
• Head injury or trauma
• Stroke or other brain injury
• Brain tumor or cyst
• Drug or alcohol withdrawal
• Metabolic imbalances, such as low blood sugar or electrolyte abnormalities
• Toxins or poisoning
• Hyperventilation or breath-holding spells
• Migraines or other neurological conditions
• Genetic disorders affecting the brain or nervous system

What are the symptoms of seizures?

• Uncontrolled movements: This can include jerking movements of the arms or legs, stiffening of the body, or repetitive movements such as lip smacking.
• Changes in consciousness: This can range from staring blankly to losing consciousness.
• Sensory changes: This can include hallucinations, changes in vision or hearing, or a feeling of tingling or numbness.
• Emotional changes: Some people may experience intense emotions such as fear, anxiety, or déjà vu.
• Physical symptoms: Some people may experience physical symptoms such as headache, fatigue, or difficulty speaking.

What are the after-effects of a seizure?

After a seizure, a person may experience a range of physical, cognitive, and emotional effects. The specific after-effects can vary depending on the individual, the type of seizure, and the severity of the seizure. Here are some common after-effects of a seizure:

• Confusion or disorientation
• Fatigue or sleepiness
• Muscle soreness or weakness
• Headache or migraine
• Memory loss or difficulty with memory recall
• Difficulty speaking or finding words
• Mood changes, such as irritability or depression
• Anxiety or fear
• Nausea or vomiting
• Incontinence or loss of bowel or bladder control

These after-effects are usually temporary and resolve within a few hours or days. However, it's important to seek medical attention if the after-effects are severe or if they persist for an extended period of time. Your doctor can help you manage and prevent future seizures, as well as provide support and resources for managing the after-effects of seizures.

What are the different types of epilepsy?

• Idiopathic generalized epilepsy (IGE): This type of epilepsy is thought to be caused by genetic factors and involves generalized seizures.
• Juvenile myoclonic epilepsy (JME): JME typically begins in adolescence and involves myoclonic seizures, as well as other types of seizures.
• Temporal lobe epilepsy (TLE): TLE is the most common type of focal epilepsy and involves seizures that originate in the temporal lobe of the brain.
• Frontal lobe epilepsy (FLE): FLE involves seizures that originate in the frontal lobe of the brain and can cause a wide range of symptoms.
• Lennox-Gastaut syndrome (LGS): LGS is a rare and severe form of epilepsy that typically begins in childhood and involves multiple seizure types.
• Dravet syndrome: Dravet syndrome is a rare genetic disorder that typically begins in infancy and involves multiple seizure types.
• Absence epilepsy: This type of epilepsy involves brief, non-convulsive seizures that can cause staring spells and brief loss of consciousness.

Can you tell if you're about to have a seizure if you have epilepsy?

If you have epilepsy, you may be able to recognize warning signs that you're about to have a seizure. These warning signs are known as auras and can vary from person to person. Some common auras include:

• Visual changes: This can include flashing lights or blurry vision.
• Sensory changes: This can include a feeling of tingling or numbness in a specific part of the body.
• Emotional changes: Some people may experience intense emotions such as fear or anxiety.
• Physical symptoms: Some people may experience physical symptoms such as dizziness or nausea.

How do you diagnose epilepsy?

Here are the steps commonly taken to diagnose epilepsy:

• Medical history: Your doctor will ask you questions about your symptoms, such as the frequency, duration, and type of seizures you have experienced. They will also ask about your medical history, including any previous head injuries, infections, or other medical conditions that could be related to epilepsy.
• Physical examination: Your doctor will perform a physical exam to look for any physical signs of seizures, such as muscle spasms, and to rule out other conditions that could be causing your symptoms.
• Neurological examination: Your doctor may also perform a neurological exam to evaluate your reflexes, muscle strength, coordination, and sensory function. They may also test your memory and other cognitive functions.
• Diagnostic tests: Your doctor may order one or more diagnostic tests to help diagnose epilepsy. These tests may include:
  • Electroencephalogram (EEG): A test that records the electrical activity of your brain to detect abnormal brain activity that may be related to seizures.
  • Magnetic resonance imaging (MRI): A test that uses magnetic fields and radio waves to create detailed images of your brain to look for any structural abnormalities.
  • Blood tests: A test that checks for any underlying medical conditions or infections that may be causing your symptoms.

It's important to work closely with your doctor, like a St. Luke's Health neurologist, to get an accurate diagnosis of epilepsy. Treatment options and management strategies may vary depending on the type and severity of epilepsy, so an accurate diagnosis is critical to effective treatment.

What are things you shouldn't do after an epilepsy diagnosis?

After an epilepsy diagnosis, there are some things you should avoid doing to manage your condition effectively. Here are some things you should not do:

• Ignore your seizures: Seizures can be unpredictable and dangerous. It's important to track your seizures and follow your doctor's recommendations for treatment and management.
• Stop taking your medication: Even if you haven't had a seizure in a while, it's important to continue taking your medication as prescribed by your doctor. Suddenly stopping your medication can increase your risk of having a seizure.
• Drive without medical clearance: Depending on the severity and frequency of your seizures, you may not be able to drive for a certain period of time. It's important to follow your doctor's recommendations and only drive with medical clearance.
• Drink alcohol excessively: Alcohol can interact with some epilepsy medications and increase your risk of having a seizure. It's important to talk to your doctor about safe alcohol consumption with your medication.
• Neglect your mental health: Epilepsy can have a significant impact on your mental health. It's important to prioritize self-care and seek help if you are experiencing anxiety, depression, or other mental health issues.
• Isolate yourself: Epilepsy can be isolating, but it's important to stay connected to your loved ones and seek support from epilepsy support groups or organizations.

What are the different treatment options for epilepsy?

There are several treatment options for epilepsy, and the best option for you will depend on the type and severity of your seizures. Here are some common treatment options:

1. Medication: Antiepileptic medications can be effective in preventing seizures for many people with epilepsy. There are many different types of medications, and your doctor will work with you to find the medication that is most effective and has the fewest side effects for you.
2. Surgery: In some cases, surgery may be an option to remove the part of the brain causing seizures. This is typically only considered for people who have seizures that are not controlled with medication.
3. Vagus nerve stimulation: This is a type of therapy that involves implanting a device under the skin of your chest that sends electrical impulses to the brain through the vagus nerve in the neck. This can help reduce the frequency and severity of seizures for some people.
4. Ketogenic diet: This is a high-fat, low-carbohydrate diet that has been shown to reduce seizures in some people with epilepsy, particularly children.
5. Responsive neurostimulation: This is a new type of therapy that involves implanting a device into the brain that can detect when a seizure is starting and deliver electrical stimulation to stop the seizure before it occurs.

It's important to work with your doctor to determine the best treatment plan for you based on your individual needs and circumstances.

NeuroPace® RNS® System

The NeuroPace® RNS® System is a responsive neurostimulation device used to treat partial onset seizures through the detection of abnormal brain activity. Implanted into the brain, the device detects indicators of a seizure and emits small electrical stimulations to normalize brain activity and prevent the seizure from occurring. Having participated in the NeuroPace clinical trial that advanced the standard of care for patients with epilepsy and partial onset seizures, Baylor St. Luke’s Medical Center is also the most experienced hospital system in the Houston area with this technology. When other treatments aren’t an option, NeuroPace offers another source of hope.

Additional epilepsy treatments we offer:

• Anterior Temporal Lobectomy
• Awake Craniotomy
• Extratemporal Resections
• Vagus Nerve Stimulation (VNS) Therapy
• Hemispherectomy
• Multilobar Resections
• Laser Interstitial Thermal Therapy (LITT)
• Stereotactic Radiosurgery (Cyberknife and Gamma Knife)
  

The Centers for Disease Control, the American Academy of Neurology, and the American Epilepsy Society recommend patients with intractable epilepsy seek treatment at a comprehensive epilepsy center.

The NAEC-designated Level IV Baylor Comprehensive Epilepsy Center at Baylor St. Luke’s Medical Center is an integral part of neurophysiology services within the Neuroscience Institute and offers innovative and comprehensive care to patients with epilepsy.

How do you help someone with a seizure?

If you witness someone having a seizure, it's important to stay calm and take the following steps to help:

• Protect the person from injury: If possible, move the person away from any sharp or hard objects. Place something soft under their head and remove any glasses or other items that could cause injury.
• Time the seizure: Note the time the seizure begins and ends. If the seizure lasts longer than 5 minutes, call for emergency medical help.
• Do not restrain the person: Do not try to hold the person down or stop their movements. This can cause injury to both you and the person having the seizure.
• Turn the person onto their side: This can help prevent choking if the person vomits or has saliva in their mouth.
• Do not put anything in the person's mouth: Contrary to popular belief, it is not necessary to put anything in the person's mouth during a seizure. This can actually cause injury to the person.
• Stay with the person until the seizure is over: Reassure the person and stay with them until they are fully alert and oriented.
• Seek medical attention if necessary: If the person has never had a seizure before, if the seizure lasts longer than 5 minutes, or if the person is injured during the seizure, seek medical attention immediately.

Remember, each person with epilepsy may have different needs during and after a seizure, so it's important to ask the person what you can do to help them.

If I have epilepsy, what do I need to tell people and who do I need to tell?

If you have epilepsy, it's important to tell the people around you so they can be aware of your condition and know how to help you in case you have a seizure. Here are some things you may need to tell people:

• What epilepsy is: Explain to people what epilepsy is and what it means for you. This can help reduce any misconceptions or fears they may have about your condition.
• What to do in case of a seizure: Let people know what to do if you have a seizure, including how to keep you safe and who to contact for medical help if necessary.
• Triggers: Let people know if you have any specific triggers that can cause a seizure, such as flashing lights or stress.
• Medications: Tell people about any medications you take for epilepsy and how to administer them in case you have a seizure.
• Emergency contact information: Provide people with emergency contact information in case they need to reach someone for help.

It's also important to consider who you need to tell about your epilepsy, such as your family, friends, coworkers, and school or university staff. Remember that having epilepsy does not define you, and with the right support and management, you can live a full and fulfilling life.

Can you outgrow epilepsy?

In some cases, people may outgrow epilepsy, but it depends on the type of epilepsy and the underlying cause of the seizures.

Some types of epilepsy, such as childhood absence epilepsy, may resolve on their own as a person reaches adulthood. Other types of epilepsy may be caused by an underlying condition, such as a brain injury or tumor, that can be treated or resolved with surgery, medication, or other therapies.

However, for many people with epilepsy, the condition is a lifelong condition that requires ongoing management and treatment. It's important to work closely with your doctor to develop a treatment plan that is effective for you and to regularly monitor your seizures and adjust your treatment as needed. With the right management and support, it's possible to live a full and fulfilling life with epilepsy.