Epilepsy

Epilepsy is a neurological condition that causes unprovoked, recurrent seizures. A seizure is a sudden rush of abnormal electrical activity in your brain. Doctors diagnose epilepsy when you have two or more seizures with no other identifiable cause.

Causes #

• Traumatic brain injury or other head trauma

• Brain scarring after a brain injury (post-traumatic epilepsy)

• Serious illness or very high fever

• Stroke, which causes about half of epilepsy cases in older adults when there’s no identifiable cause, according to the CDC

• Lack of oxygen to the brain

• Brain tumor or cyst

• Dementia, including Alzheimer’s disease

• Maternal use of some drugs, prenatal injury, brain malformation, or lack of oxygen at birth

• Infectious conditions like HIV and AIDS and meningitis

• Genetic or developmental disorders or neurological diseases

Symptoms #

• Staring straight ahead, repetitive swallowing, and lapsing into complete immobility for a few seconds characterize absence (petit mal) seizures, which can recur many times in a day.

• Tonic/clonic (grand mal) seizures, which usually last several minutes, typically begin with a loss of consciousness and a fall, followed by rigidity, then jerking motions and incontinence of urine. After the seizure ends, there is usually a period of confusion and deep sleep.

• Repetitive lip smacking, aimless fiddling movements, and a sense of detachment from surroundings may indicate temporal lobe seizures. They may be preceded by a vague feeling of abdominal discomfort, visual/sensory hallucination, and distorted perceptions such as deja-vu (a feeling of familiarity or having seen something before).

• Motor or Jacksonian seizures start with localized rhythmic twitching of muscles in a hand, a foot, or the face, which may spread to the whole body. Such seizures are often followed by a period of weakness or paralysis.

Diagnosis #

Electroencephalogram (EEG) #

This is the most common test. Your doctor places sensors on your scalp that record electrical activity in your brain. If they see changes in your normal brain wave pattern, that’s a symptom. Many people with epilepsy have abnormal EEGs.

You can have this test while you’re asleep or awake. The doctor may watch you on video to record how your body reacts during a seizure. This usually requires an overnight stay or two at the hospital.

Computerized tomography (CT) scan #

It uses X-rays to create images of your brain. This can help your doctor rule out other seizure causes, like tumors, bleeding, and cysts.

Blood tests #

They also help discount other reasons for seizures, like genetic conditions or infections.

Magnetic resonance imaging (MRI) #

It lets your doctor see the structure of your brain. It may show damaged tissue that leads to seizures. For the test, you’ll lie on a table inside the MRI machine, which is like a tunnel. The scanner takes pictures of the inside of your head.

Functional MRI (fMRI) #

This type of MRI shows which part of your brain uses more oxygen when you speak, move, or do certain tasks. That helps your doctor avoid those areas if they need to operate on your brain.

Magnetic resonance spectroscopy (MRS) #

Like the MRI, an MRS creates an image. It helps the doctor compare how different parts of your brain work. Unlike the MRI, it doesn’t show your entire brain at once. It focuses only on the parts of the brain your doctor wants to study more.

Positron emission tomography (PET scan) #

For this test, the doctor injects a radioactive material into a vein in your arm. It then collects in your brain. This helps check for damage by showing which parts of your brain use more or less glucose. The PET scan helps your doctor see changes in your brain chemistry and find problems.

Single-photon emission computerized tomography (SPECT) #

This two-part test helps your doctor figure out where seizures start in your brain. As with the PET scan, the doctor injects a small amount of radioactive material into a vein to show blood flow. They’ll repeat the test when you aren’t having a seizure and compare the difference between the scans.

Neuropsychological tests #

The doctor will test your speech, thinking, and memory skills to see if those areas of your brain have been affected by seizures.

Treatment #

Nerve Stimulation #

There are two kinds of nerve stimulation:

Vagus nerve stimulation #

This nerve runs from your chest and abdomen, through your neck, and up to the lower part of your brain. It controls things that are automatic in your body, like your heartbeat.

Your doctor will put a small device called a vagus nerve stimulator under the skin of your chest, and connect it to the nerve.

The device sends small bursts of electricity through the nerve to your brain. You’ll probably still have to take medication. This device can be adjusted by a neurologist at your appointments in order to find the settings that work for you. It does not work for everyone.

Responsive neurostimulation #

This treatment involves surgically implanting a small gadget called a neurostimulator. Your doctor puts it under your skull bone. It looks for patterns in your brain activity that can lead to a seizure. When the neurostimulator sees one of these patterns, it sends out a little pulse to interrupt it. Not every person is able to have this device, it is based on the type of epilepsy

Surgery #

There are two main kinds:

Resective surgery #

The surgeon will remove the part of your brain that causes the seizures. This surgery is most often done when the part of the brain causing the seizures is very small, has very good boundaries, and doesn’t control things like your speech, movement, sight, or hearing.

Disconnective surgery #

Instead of removing part of your brain, the surgeon will cut the paths between the nerves in your brain that are involved in your seizures.