This post was written by Eric Kimmel, MD, PPG — Neurology.
It’s estimated that about 3.4 million people in the United States have active epilepsy, and that about 1 in 26 people will develop epilepsy at some point in their lifetime. That’s why it’s important to understand the condition, including treatment and management options, and when to seek medical care for yourself or someone else.
What is epilepsy?
Epilepsy is a brain disorder that causes recurring, unprovoked seizures. A person may be diagnosed with epilepsy if they have two unprovoked seizures or one unprovoked seizure with a high risk of more. Not all seizures are the result of epilepsy. For example, some people may have seizures due to their blood glucose being too low or their sodium being off. The word "epilepsy" simply means "seizure disorder." It does not tell us anything about the cause of a person's seizures or their severity.
What are the common presentations of an epileptic seizure?
Seizures themselves can have different appearances or physical manifestations, depending on which parts of the brain are being affected during the event. This can include temporary confusion, episodes of staring blankly, uncontrollable jerking movements or twitching, loss of consciousness or awareness, psychological symptoms like fear or anxiety, intense feelings of euphoria or unconsciously performing actions.
What happens in a seizure may look different from one person to another. However, seizures are usually stereotypic, which means the same things or behaviors tend to occur in a person each time they have a seizure. The seizure behavior may be inappropriate for the time and place, but it is unlikely to cause harm to anyone.
Are there any risk factors or trends for epilepsy?
Seizures may relate to a brain injury or a family trait, but often the cause is completely unknown. Risk factors for epilepsy include febrile seizures as an infant/child, family history, history of meningitis/encephalitis, traumatic brain injuries, CNS malignancy, history of stroke or other structural brain lesions.
How does epilepsy typically present and at what age?
Anyone can develop epilepsy at any age. In fact, seizures start for the first time in people over age 65 almost as often as they do in children. The most common ages to develop epilepsy are very young children and geriatric patients. Seizures in the elderly are often the after-effect of other health problems such as a stroke or brain tumor.
If someone has a seizure, is this a clear indicator of epilepsy?
People who have recurrent, unprovoked seizures meet the diagnosis of epilepsy. However, people can have seizures that are due to a provoking cause such as low blood glucose, sodium levels being off, alcohol withdrawal, etc.
Some people have events that can appear from the outside to look a lot like epilepsy but may be due to underlying stress or anxiety, such as shaking or convulsing that is not actually related to an epileptic seizure. Other people have conditions that make them prone to fainting and convulsing, but this is not considered a seizure.
How is the condition diagnosed?
A diagnosis of epilepsy is generally made by a neurologist after taking a careful history and examination of the patient. If others have witnessed an epileptic event or taken a video of an epileptic event, reviewing this information with the provider can be helpful in making a diagnosis.
Certain tests can also be performed to provide more information, such as an MRI of the brain to look for structural changes as well as an EEG, which is a recording of the brain’s electrical activity that can sometimes show abnormal discharges and give us a clue that a patient may be at risk for seizures and which part of the brain the seizures may be coming from.
What treatment options are available?
There are many different medications available to treat epilepsy, as well as surgical options and neuromodulation that is used to alter nerve activity to help with seizures. Although many people can receive treatment for their epilepsy, treatments do not work for all patients.
Some patients with refractory epilepsy may benefit from a strict ketogenic diet. In general, staying well-hydrated, trying to avoid getting sick, sleeping well and managing stress are all lifestyle modifications that can help reduce seizures (or reduce the risk of breakthrough seizures). Although beneficial, these measures should not replace anti-seizure medications.
When should someone seek medical attention?
If someone without a history of seizures or epilepsy has a seizure, they should be evaluated for epilepsy.
Patients with epilepsy should also seek medical attention if they have a prolonged seizure lasting more than five minutes or have a cluster of seizures in the same day without returning to normal in-between their seizures.
What should someone do if they witness an epileptic seizure?
If you are with someone who appears to be having an epileptic seizure, it’s important to remember this saying: STAY. SAFE. SIDE.
- STAY. Stay with the person and start timing the seizure. Stay with them until they are awake and alert after the seizure.
- SAFE. Keep the person safe. Do not put anything in their mouth and do not restrain them.
- SIDE. If they are not awake and aware, turn the person on their side.
Call 911 if the person has:
- A seizure that lasts longer than five minutes
- Repeated seizures
- Difficulty breathing
- A seizure in water
- A seizure while injured, sick or pregnant
- A seizure for the first time
If the person does not return to their usual state or is asking for medical help, call 911.
Is epilepsy fatal?
While it doesn’t happen frequently, epilepsy is a very serious condition that can lead to death. The most common cause of death is sudden unexpected death in epilepsy (SUDEP). While there is a lot we still don’t know about SUDEP, experts estimate that 1 out of every 1,000 people with epilepsy die from SUDEP each year.
People can also die from prolonged seizures, with 1.9% of deaths in people with epilepsy due to this type of seizure emergency. This is one of the reasons why it is important to try to get seizures under the best control possible.
If you have questions or concerns about epilepsy, reach out to your healthcare provider for more information.