Understanding Epilepsy. What it is and What to do.

Epilepsy is a brain disorder characterized by repeated, unprovoked seizures. The seizures are caused by abnormal, excessive electrical discharges in a group of neurons, or nerve cells in the brain.

A seizure can present as a sudden but temporary change in behavior (fear, anxiety), uncontrollable muscle movement (convulsions or sudden paralysis), loss of consciousness, or brief period of confusion and staring into space. Epilepsy is diagnosed if there are at least two unprovoked seizures at least 24 hours apart.¹

Epilepsy is indiscriminate. It can affect anyone, at any age, gender or ethnic background. The CDC estimates that approximately 3.4 million Americans suffer from epilepsy.²

“Living with epilepsy can be a high-wire act, but there is no need to live in fear of the next seizure. With proper treatment, a healthy lifestyle, and an understanding of potential triggers, most epilepsy sufferers learn to live normal, fulfilling lives. It’s key to get a proper diagnosis early and follow your physician’s medical directives.”

Dr. Eric Nagele, DO

Clinical Neurophysiologist
Cooper and Inspira Neuroscience

What are the Symptoms of Epilepsy?

The trademark indicator of epilepsy is seizures. Not all seizures are the same, nor does a single occurrence of a seizure automatically equate to having epilepsy.

Epileptic seizures breakdown into one of three categories. Each may have a different cause and require a different set of diagnostic tests to further confirm a prognosis, as well as treatment strategies for longer term management.³

• Focal Onset Seizures: Focal seizures start in one area or group of cells, on one side of the brain. The word “focal” is used to signify where in the brain the seizures start from.
• Generalized Onset Seizures: These seizures originate from groups of neurons (or cells) that are on both sides of the brain, that are affected at the same time.
• Unknown Onset Seizures: As the first word in the term suggests, seizures that are reported but not directly witnessed due to happening either at night or because the person lives alone — are identified in this category. However, as more information is learned or captured, it’s possible that seizures of this sort may be reclassified as being either focal or generalized seizures.

Understanding where a seizure begins in the brain, the individual’s level of awareness during the seizure, and what (if any) type of muscle movement of the limbs occurred is critical information that should be shared and collected by a healthcare team to diagnose and begin treatment.

What Causes Epilepsy?

Epilepsy can be caused by many different and underlying conditions that affect the brain, which result in seizure-like symptoms. Diagnosing the specific root cause of an individual case is complex, and not always possible to determine or assign a conclusive reason to. Less than half of the people who have been diagnosed with epilepsy know the exact root cause.⁴

Researchers have identified six causes that contribute to the onset of epilepsy. Being able to connect epilepsy symptoms to underlying reasons for occurring, allows doctors to assess a patient’s future prognosis and provide a better path of treatment.⁵

• Structural: Abnormalities on the brain seen through diagnostics tests such as MRI’s, are classified as Structural. The abnormalities may be the result of genetics, inherited or not, through head trauma or events such as stroke.
• Genetic: It’s estimated that hundreds of genes could play a role in what develops as epilepsy. In some cases, genes may be inherited or passed down through one’s DNA at birth. In other cases where there is no known family history, the causal genes may be the result of spontaneous gene mutation.⁶
• Infectious: There are several acquired infections that can cause epilepsy by either directly impacting cells in the brain, swelling in the brain, or seizures. Examples of noted viruses which trigger epileptic symptoms: Cerebral malaria, Encephalitis, HIV, Meningitis, Tuberculosis, Zika Virus.
• Metabolic: A metabolic disorder⁷ occurs when the process by which the body makes energy is disrupted or performs abnormally. In some cases, the abnormality affects the brain and increases the occurrence of epilepsy, which often has an underlying genetic origin. Identifying a metabolic cause is important to how the condition is treated.
• Immune: The body’s immune system is the frontline defense to protecting it against viruses, infections, or foreign bodies. When there’s a rare occurrence that the immune system reads that the body is the foreign object and starts attacking itself, that is referred as an autoimmune response. If that then triggers seizure, then the cause of epilepsy is categorized as Immune based.
• Unknown: As the term implies, any epilepsies where medical professionals cannot diagnose the underlying cause to be attributable to any of the 5 previous mentioned categories, it’s considered to be Unknown.

How is Epilepsy Diagnosed?

Diagnosing epilepsy involves a thorough medical evaluation, including a detailed patient history and various tests. Here are the primary steps involved⁸:

• Medical History: The doctor will begin by collecting as much information as possible on any previous illnesses, conditions, and known family history of epilepsy. They’ll ask for situational details of the seizures — before, during and after.
• Neurological Examination: This includes testing reflexes, muscle tone, sensory function, and overall brain function.
• Neuropsychological Tests: Epilepsy can affect cognitive thinking and memory functions. A neuropsychologist can run tests that assess how the brain performs with thinking, attention and problem-solving skills.
• Blood Tests: Blood tests can help rule out other conditions that might be causing seizures, such as infections or metabolic disorders.
• Genetic Tests: Using a blood or salvia sample, a DNA analysis to look for genetic variants know to be associated with epilepsy or epileptic syndromes.⁹
• Electroencephalogram (EEG): This is the most crucial test for diagnosing epilepsy. It records electrical activity in the brain and can identify unusual patterns that may indicate a seizure disorder.
• Imaging Tests: MRI (Magnetic Resonance Imaging) can detect structural abnormalities in the brain that might be causing seizures. CT scans (Computed Tomography) are done to quickly assess if there are any brain injuries or bleeding in the brain that could be a trigger to seizures.

How is Epilepsy Treated?

Treatment for epilepsy is multifaceted and will be tailored to the patient’s specific needs. The primary treatment options include⁹:

• Medications: To manage symptoms finding an Anti-Epileptic Drug (AED) to control seizures is the most common first step of treatment. AEDs help control seizures in about 70% of people with epilepsy.
• Surgery: For persistent uncontrolled seizures where at AEDs or therapies have failed to control the frequency of seizures, surgery may become an option for further treatment.
• Seizure Devices: Acting by sending small electric currents to the nervous system, seizure devices can change how the affected brain cells act and help them return to their normal state. This process is called neuromodulation.
• Therapies:
  • Dietary: A special diet can help control seizures in some people. The most often prescribed that have shown to help are: Ketogenic diet, a modified Atkins diet, low glycemic diet, and medium-chain triglyceride (MCT) diet.
  • Seizure Rescue: Medicines that when administered, quickly get into the bloodstream to start working on the effected brain cells and are used only as needed to stop a seizure. They do not replace emergency care or the need to take daily medication, if prescribed.

Where to Go For Epilepsy Care and Treatment?

Epilepsy is a complex condition, but with the right knowledge and support, it is manageable. Cooper and Inspira Neuroscience offers one of the most comprehensive epilepsy programs in New Jersey. Our multidisciplinary care teams combine expertise with advanced technologies to diagnose and treat a broad spectrum of neurological conditions.

The Cooper and Inspira Epilepsy Center is accredited by the National Association of Epilepsy Centers (NAEC)¹⁰ as a level 4 epilepsy center. As a level 4 center, it provides the most complex, intensive neurodiagnostic monitoring, as well as advanced medical, neuropsychological, and psychosocial treatments. The Epilepsy Center offers a complete evaluation for epilepsy surgery, including intracranial electrodes and a broad range of surgical procedures for epilepsy.

Understanding epilepsy is the first step towards providing effective care and support for those affected. You are not alone in this journey. Whether you are a parent, caregiver, or concerned adult, the right information and support can make all the difference.

Learn More.

References

1. Center for Disease Control. Recognizing a Seizure https://www.cdc.gov/epilepsy/first-aid-for-seizures/index.html#cdc_generic_section_2-recognizing-a-seizure[↩]
2. Center for Disease Control. Epilepsy Basics. Overview, Epilepsy is Common, https://www.cdc.gov/epilepsy/about/?CDC_AAref_Val=https://www.cdc.gov/epilepsy/about/fast-facts.htm[↩]
3. Epilepsy Foundation. Understanding Epilepsy, Types of Seizures, https://www.epilepsy.com/what-is-epilepsy/seizure-types – How-Are-Seizures-Classified-Now?[↩]
4. National Institute of Neurological Disorders and Stroke. Epilepsy and Seizures https://www.ninds.nih.gov/health-information/disorders/epilepsy-and-seizures[↩]
5. National Library of Medicine. Classification and Diagnosis of Epilepsy. Abstract https://pubmed.ncbi.nlm.nih.gov/39899094/[↩]
6. National Library of Medicine. Epilepsy Benchmark Area 1: Understanding the Causes of the Epilepsies https://pmc.ncbi.nlm.nih.gov/articles/PMC7031801/[↩]
7. Cure Epilepsy. Understanding Epilepsy, Epilepsy Basics. The Causes of Epilepsy are Broken Into Six Subgroups https://www.cureepilepsy.org/understanding-epilepsy/epilepsy-basics/what-causes-epilepsy/[↩]
8. Cure Epilepsy. Understanding Epilepsy, Diagnosing Epilepsy. Diagnostic Tests for Epilepsy https://www.cureepilepsy.org/understanding-epilepsy/diagnosing-epilepsy/how-is-epilepsy-diagnosed/[↩]
9. Epilepsy Foundation. Treatment. https://www.epilepsy.com/treatment[↩][↩]
10. National Association of Epilepsy Centers https://naec-epilepsy.org/about[↩]