Epilepsy Causes and Treatment Options
This article describes types of epileptic seizures, signs and symptoms of epilepsy, and tests for diagnosing the condition. It also explores treatment options and the outlook for people with epilepsy.
According to the International League Against Epilepsy, the definition of epilepsy is:
- one epileptic seizure with a second one more than 24 hours later
- one epileptic seizure and a greater-than-60% chance of a second one
- an epilepsy syndrome diagnosis
An epileptic seizure is an unprovoked seizure — that is, one not provoked by such temporary causes as fever, substance overdose, or low blood sugar. Excessive and synchronous electrical activity in the brain can result in an epileptic seizure.
The progression of epilepsy depends on the underlying cause, which could be a brain injury, surgery, disease, genetics, or a developmental defect.
In some cases, epilepsy may resolve spontaneously. Certain medications can help control seizures, allowing you to lead a less disrupted life. Treatment goals for epilepsy include controlling seizure activity, reducing drug side effects, and preserving quality of life.
The types of seizures you have define the type of epilepsy you have. There are several types of seizures and many types of epilepsy. The condition can also be one aspect of a more complex syndrome, such as an inherited syndrome.
Types of seizures
There are three types of epileptic seizures:
- Generalized onset seizures: These affect both sides of the brain.
- Focal onset seizures: This refers to the area of the brain where the seizures start. There are two types of focal onset seizures:
- Focal onset aware seizure: You are awake and aware of your surroundings during the seizure.
- Focal onset impaired awareness: You experience confusion or diminished awareness with the seizure.
- Unknown onset seizures: You do not know when the seizure starts, nor does anyone witness it.
Types of epilepsy
The symptoms and types of seizures you experience define the type of epilepsy you have, according to the National Institute of Neurological Disorders and Stroke (NINDS).
Some types of epilepsy include:
- Absence epilepsy: A person with this form of epilepsy has generalized onset seizures, which may involve jerking movements and a brief loss of consciousness. They may occur up to 100 times per day.
- Frontal lobe epilepsy: A person with this form of epilepsy has focal onset seizures that map to the movement control area of the brain. These seizures, which include both aware and impaired types, usually involve uncontrollable movements and can leave the person with muscle weakness. The seizures may cluster.
- Temporal lobe epilepsy: A person with this common epilepsy syndrome experiences focal onset impaired awareness seizures. They may also experience nausea and emotions such as fear.
- Neocortical epilepsy: A person with this type of epilepsy experiences generalized onset or focal onset seizures from the outer layer of the brain. Several symptoms are possible, including hallucinations, unusual emotions, and contractions or convulsions.
The symptoms that define epilepsy are:
- recurrent seizures with moments of mental absence
- changes in consciousness
- changes in sensation
- muscular contractions
Seizures may be very mild or very severe and can last from a few seconds to several minutes. It is possible to have many seizures in succession or to have them only occasionally.
Common symptoms of epilepsy
A person with epilepsy may experience symptoms daily or just once in a while. At times, any of these symptoms can be severe:
- unusual sensations
- changes in mood, personality, or behavior
- changes in responsiveness
- confusion or a loss of consciousness for even a brief moment
- muscle twitching, spasms, or seizures
- muscle weakness
When to call 911
- a duration of longer than 5 minutes
- breathing difficulties after the seizure stops
- a loss of consciousness after the seizure stops
- another seizure before regaining consciousness
- seizure in a body of water
Epilepsy can result from any type of damage to the brain. In some cases, the cause is not known. Epilepsy can be related to development, a brain injury, a brain infection, surgery, or medication side effects.
Epileptic seizure causes include:
- brain defects present since birth
- a brain infection
- a brain injury
- brain tumors
- kidney or liver failure
- some metabolic conditions, such as phenylketonuria, which refers to an inability to break down the amino acid phenylalanine
- a stroke
- certain genetic syndromes
People with epilepsy may identify certain triggers of their seizures. There is not necessarily a scientific basis for these triggers, as some may occur by chance.
Common triggers include:
- difficulty sleeping
- specific times during the day or night
- alcohol or substance use
- the menstrual cycle or hormonal changes
- specific medication use
- missed medications
Some people with epilepsy also may experience reflex epilepsy, wherein seizures occur in direct response to a specific trigger, such as:
- flashing lights
- certain noises
Risk factors for epilepsy include:
- a family history of epilepsy
- a brain infection
- recent brain surgery
- a recent head injury
Reducing your risk of epilepsy
You may be able to lower your risk of epilepsy by:
- taking care to avoid traumatic brain injuries, such as by wearing your seat belt in the car and wearing a helmet when cycling, rock climbing, or doing other high risk activities
- maintaining a healthy lifestyle to reduce your risk of heart disease and stroke
- getting recommended immunizations to reduce your risk of infections that could involve the brain
- following your doctor’s recommendations for a healthy pregnancy, as complications during pregnancy and childbirth could lead to epilepsy
Who gets epilepsy?
Although someone can develop epilepsy at any age, it is more prevalent in young children and older adults, according to the Epilepsy Foundation.
Children between the ages of birth to 1 year see the most new cases of epilepsy. Although new cases taper off in children around the age of 10 years and remain that way for many years, new cases flare up again in people ages 55 years and older. New cases in older adults are often attributable to brain tumors, strokes, or Alzheimer’s disease.
As part of your epilepsy treatment plan, it is important to follow a well-balanced diet. According to the Epilepsy Foundation, there is some evidence to suggest that the ketogenic diet, modified Atkins diet, and low glycemic index (GI) diet may be beneficial for people who have epileptic seizures.
Common themes in these diets include:
- removing foods with simple sugars that have a high GI score
- including whole, natural foods, as these are minimally processed foods that contain no more than three ingredients
- limiting alcohol intake
Ask your healthcare professional for guidance before making any significant changes to your diet.
Your full medical history and the results of a neurological exam and other tests will help your doctor make a diagnosis. They will ask you or a companion who is familiar with your symptoms some questions, including:
- Where were you and what were you doing when the episode started?
- Did you experience any confusion during the episode?
- How long did the episode last?
- Did you have any warning signs?
- What happened during the episode?
- Was there more than one episode? If so, how many were there?
- How frequent are the episodes?
Tests to help diagnose epilepsy include:
- electroencephalogram (EEG)
- blood tests
- MRI or CT scans
- a lumbar puncture, or spinal tap
- sleep tests
Although medications are the mainstay of therapy for epilepsy, your treatment plan may include several options with the goal of controlling or reducing your number of seizures.
Current research for epilepsy includes the development of better drug therapy and electrical stimulation techniques to control and prevent seizures.
Treatments can include:
- making changes to your diet to prevent seizures associated with certain types of epilepsy, especially in children
- trying deep brain stimulation, which can interfere with abnormal electrical activity
- undergoing vagus nerve stimulation to prevent seizures by sending pulses of electricity to the brain via the vagus nerve
- taking medications to control abnormal electrical activity in the brain and prevent muscle spasms
- undergoing epilepsy surgery to remove the epileptic focus, which is the part of the brain where the abnormal electrical activity starts
- seeking counseling to help you cope with the difficulties of epilepsy
Some complementary treatments may help some people in their efforts to deal with epilepsy. These treatments, which are also known as alternative therapies, are used in conjunction with traditional medical treatments. They are not meant to substitute for traditional medical care.
Be sure to notify your doctor if you are using nutritional supplements or nonprescription remedies, as they may interact with the prescribed medical therapy.
Complementary treatments may include:
- massage therapy
- nutritional dietary supplements
Complications of untreated or poorly controlled epilepsy can be serious. Following the treatment plan that you and your healthcare professional design specifically for you can help reduce the chance of complications.
Complications of epilepsy can include:
- absenteeism from work or school
- behavioral or emotional problems
- brain damage
- injury during a seizure
- a loss of independence
- memory loss
- aspiration of food or liquid into the lungs
- status epilepticus, which is a medical emergency
- withdrawal or depression
How a person fares with epilepsy varies considerably. Factors that affect the outlook include the cause (if known), EEG findings, the number of seizures, and how the condition responds to antiepileptic medications.
Most people have a good outlook with considerable seizure control. The outlook is not as good for people with seizures that do not respond to medication early on or seizures that are part of a more complex epilepsy syndrome.
For your individual outlook following a diagnosis of epilepsy, talk with your doctor.
November is National Epilepsy Awareness Month. It is an important opportunity to educate others about epilepsy so that those who experience seizures can get help right away. Increasing awareness can also provide emotional support for people with epilepsy.
You can participate in local events, help spread the word on social media, and help raise money to fund epilepsy research and support.
Epilepsy is a brain condition wherein excessive, synchronized electrical impulses result in seizures.
There are many treatment options available for epilepsy, but it may take time to figure out the most effective combination of medications. The outlook is good for most people.
Several organizations dedicate research efforts to understanding epilepsy and its treatments.