Epilepsy 101

Experts answer 7 frequently asked questions about epilepsy.

By Heather Hatfield
WebMD the Magazine - Feature
Reviewed by Louise Chang, MD

More than 2 million people in the United States have some form of epilepsy, a group of
related disorders marked by recurrent seizures. WebMD asked epilepsy experts your most
frequently asked questions.
How do people develop epilepsy?

In most cases -- about seven in 10 people -- the cause of epilepsy is unknown. In other
cases, epilepsy can have a symptomatic cause, such as birth injuries, head injuries, and
infectious diseases including meningitis and encephalitis. It can also be caused by genetic
conditions and stroke.
"Whatever the cause, epilepsy causes too many nerve cells to fire in the brain at the same
time," says Donald Olson, MD, director of the Epilepsy Program at Lucile Packard Children's
Hospital at Stanford University Medical Center. "Depending on which part of the brain the
cells are firing in, the symptoms could vary from a strange feeling, to one side of the body
jerking, to a whole-body convulsion."
How is epilepsy diagnosed?

A doctor will start by taking a medical history, followed by a physical and neurological
examination of muscle strength, reflexes, eyesight, hearing, and ability to detect various
sensations. Other tests include an electroencephalogram (EEG) test, which measures
electrical impulses in the brain; imaging studies of the brain, often with magnetic resonance
imaging (MRI); and blood tests to measure red and white blood cell counts, blood sugar,
blood calcium and electrolyte levels; and to evaluate liver and kidney function.
What are the types of seizures?

Seizures are divided into two broad categories: partial and generalized.
Partial seizures affect only a specific part of the brain and are further grouped into two types:
In simple partial seizures, a person may have jerking movement and abnormal sensations,
such as extreme emotion or changes in taste, depending on what part of the brain the seizure
affects. In complex partial seizures, a person loses awareness and may have unconscious
movements such as lip smacking and fidgeting. Partial seizures that spread and become
generalized are called partial seizures secondarily generalized.
Generalized seizures affect the entire brain from the beginning of the seizure and are broken
down into several types: In generalized tonic-clonic seizures, the entire body stiffens and jerks
and a person loses consciousness. This is also known as a grand mal seizure. Myoclonic
seizures are lightning jerks of the muscle, usually on both sides of the body. In absence
seizures, a person loses awareness and has a blank stare, as if he or she is looking through
you. This is also known as a petit mal seizure. Atonic seizures cause the body to lose muscle
tone with no warning and fall over.
What do I do if my friend has a seizure?

"It's the generalized tonic-clonic seizure that requires the most action," says Jacqueline
French, MD, a professor of neurology at New York University Comprehensive Epilepsy
Center and a fellow with the American Academy of Neurology.
First, gently bring the person to the ground and put something under the head so he or she
doesn't hit the floor, French explains. Then turn the person over on the left side -- a better
position for easier breathing and improved circulation. Turn him or her head slightly down so
saliva won't go into the lungs -- and absolutely do not put anything in the person's mouth. The
seizure should end in one or two minutes, maybe even less.
When the person regains consciousness, he or she will be confused, so stay with the
person until he or she is back to the person's normal self. It's a good idea for those with
epilepsy to wear a medical bracelet. If he or she has a seizure and no one is around, the
bracelet will tell others what's happening so they can respond appropriately.
Can a seizure be life-threatening?

Yes, but very rarely. "Status epilepticus is when a seizure lasts longer than a few minutes,
which can lead to brain injury and even death," says French. So, if a seizure hits the three-
minute mark, call 911 immediately.
Looking at seizures in another way, they can be life-threatening, especially for children who
are not well supervised in certain situations. For instance, never leave a child who has had a
seizure alone in the bathtub, explains Olson.
How is epilepsy treated?

The most common way to treat epilepsy is with medication. Specific drugs are prescribed
depending on the type of epilepsy or seizure a person has. When medication doesn't work,
surgery is another treatment option. In some cases, a surgeon can remove the area of the
brain producing seizures or can interrupt the nerve pathways that signal seizures. For
children, a very strict meal plan called theketogenic diet may reduce seizures.
If a patient doesn't respond to medication and surgery is not an option, vagus nerve
stimulation can help prevent seizures. It works through a battery implant in the chest that
delivers small pulses of electrical energy into the brain via the vagus nerve in the neck. The
downside: It doesn't work for everyone, and it is not approved by the FDA for kids younger
than age 12.
Any new treatments on the horizon?

"We have a lot of hope that some of the brain-stimulation technologies currently in
development will bear fruit," says Olson. The goal of brain stimulation is to detect and
interrupt seizures before they begin, through an implanted device in the brain. New
medications are also in clinical trials, such as nasal sprays with antiseizure drugs that could
be used immediately when a seizure starts to help stop its progression.

Originally published in the March/April 2008 issue of WebMD the Magazine