Penn Medicine Neuroscience Center: Epilepsy Center
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Frequently Asked Questions about Epilepsy

1. What is epilepsy and what are the symptoms?

Epilepsy is a chronic neurological disorder characterized by recurrent unprovoked seizures. "Unprovoked" means that there is no immediate cause for the seizure, such as a fever, an infection of the brain, or head trauma. Nearly 10% of people will have a seizure during their lifetime; most of these are "provoked" seizures during an acute illness or condition. These people may never go on to have another seizure, and therefore do not have epilepsy.

Between seizures, most people with epilepsy are completely normal. Seizures can occur at any time, often without warning. In most people, seizures are able to be controlled with treatment and may go away entirely; in others, seizures continue despite treatment and may last a lifetime.

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2. What are seizures and how do they occur?

A "seizure" is a transient event caused by abnormal excitability of all or part of the brain. The principal cells of the brain, or "neurons", use several different types of chemicals (called neurotransmitters) to communicate with each other. These chemical messages are translated into electrical signals, which allow neurons in different parts of the brain to work together and perform tasks: to move your arm, read a book, or tell a story. Normal balancing mechanisms ensure that these signals travel in an orderly fashion. When the brain is injured or when there is an abnormality of the brain's neurotransmitters, normal brain activity is interrupted and replaced by giant waves of electrical impulses which flood the brain's circuits. This abnormal electrical activity is a "seizure".

Not all seizures "look" the same. What you experience, or what others see during a seizure, depends on the type of seizure. There are two main types of seizures: generalized and partial.

Generalized seizures involve the entire brain immediately, causing loss or alteration of consciousness. Generalized seizures include grand mal seizures, during which a person falls down unconscious and the body stiffens and jerks, and petit mal, or absence, seizures, where there is momentary loss of consciousness without abnormal body movements.

Partial or focal seizures begin in one part of the brain. They cause varied symptoms, including auras (unusual warning sensations such as sounds, smells, or a funny feeling in the stomach), staring, chewing, lip smacking, shaking or stiffening of part of the body, wandering, or confusion. A partial seizure may remain in one part of the brain or spread to the rest of the brain. Most seizures last only seconds or a few minutes, but may be followed by sleep or confusion for several hours.

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3. Is epilepsy genetic?

Some types of epilepsy run in families. If you have generalized epilepsy, your first-degree relatives (parents, siblings, and children) have about a four-fold increased risk for epilepsy. First-degree relatives of people with partial seizures have twice the risk of developing epilepsy as the general population. Although there is some increased risk, it is important to remember that the overall risk of epilepsy in other family members is still low.

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4. Are there risk factors?

There are many different underlying causes of epilepsy. In about half of patients, no exact cause can be found despite thorough testing.
Some of the known causes include:

  • Head trauma: Concussion (brief loss of consciousness) is considered to be mild head trauma, and increases the risk of epilepsy only slightly. On the other hand, moderate or severe head injury with prolonged loss of consciousness or brain hemorrhage greatly increases the risk of epilepsy.
  • Infections of the brain, including meningitis, encephalitis, and brain abscess
  • Stroke: A brain infarct (caused by lack of blood flow to part of the brain) or hemorrhage increases the risk of epilepsy.
  • Alcohol: Individuals who drink heavily have a risk for seizures when they abruptly stop drinking ("withdrawal" seizures), and also have an increased risk of epilepsy.
  • Brain tumors: Seizures may be the first sign of a brain tumor. For this reason, brain imaging is recommended for all patients who have new seizures in adulthood. Rarely, a slow-growing brain tumor may be found in people who have had seizures for years.
  • Degenerative brain diseases, such as Alzheimer Disease, multiple sclerosis, and Parkinson Disease
  • Mental retardation and cerebral palsy
  • Cortical dysplasia and migration disorders: These are abnormalities in the way the brain grows and develops. Some of the brain cells do not migrate to their proper positions, resulting in a "tangle" of neurons. These tangles have abnormal electrical connections, and therefore predispose to seizures.
  • Genetic predisposition
  • Age: The risk of seizures is highest in young children and in the elderly.
  • Febrile seizures during infancy increase the risk for later development of epilepsy.

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5. How is epilepsy treated?

My patients often ask, "How many seizures is too many? Should I change my medications?" The answers to these questions are different for each patient. Optimal seizure control allows you to lead a normal, active life. If you think that you are having too many seizures, discuss this with your doctor. Uncontrolled seizures can result in limits on driving, loss of employment, deterioration in school performance, and loss of self-esteem. If your seizures are not under control within a year after diagnosis, request referral to a specialist in brain disorders or epilepsy.

The most common treatment for epilepsy is the daily use of anticonvulsant, or antiepileptic, drugs to prevent seizures. These medications act on brain signaling to limit hyperexcitability. While medications do not cure epilepsy, they allow many people to live normal active lives free or nearly free of seizures. Not all patients with seizures require treatment with antiepileptic drugs, and some patients need only one or two years of drug therapy. Most patients with epilepsy, however, will require one or more drugs for many years. Overall, there is about a 60% chance of good seizure control with a single drug, and about 75% with additional drugs.

There are nearly two dozen different medications approved for the treatment of seizures. Certain medications work best for certain types of seizures, and your doctor will choose your first medication based on the type of epilepsy you have. This may not ultimately be the "best" drug for you, and changes in your medications may be necessary in order to find the best combination to prevent seizures with the fewest possible side effects. It is generally agreed that using a single medication is best, when possible. Using two medications may improve seizure control, but can also greatly increase the chance of side effects.

Because antiepileptic drugs work by decreasing brain "hyperactivity", it is not surprising that many side effects are related to dulling of normal brain "activity". Therefore, nearly all the antiepileptic drugs can cause sleepiness, difficulty with concentration and memory, blurred vision, and trouble with balance in some patients. The "newer" antiepileptic medications (Neurontin, Lamictal, Topamax, Trileptal, Keppra, Zonegran) may be better tolerated than older medications.

In general, no one drug has been proven to be more effective than the others for treatment of most seizures, and your doctor will often choose a drug depending on its potential side effects or how many times per day it needs to be taken. As mentioned before, it may take some time to find exactly the right combination of medications for you. Because antiepileptic drugs work by preventing seizures, it is important that you take them regularly. If the level of medication in your blood is too low, you may not be protected against a seizure.

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6. Who is a candidate for surgery?

Some patients with seizures may be candidates for brain surgery. Most patients are considered for epilepsy surgery when trials of two or more antiepileptic medications have failed to fully control seizures. The most common type of surgery removes the part of the brain that causes the seizure. In order for a patient to be a surgical candidate, we must be able to determine the exact area where the seizure begins, and to make sure that this area can be safely removed. Other types of surgery "disconnect" parts of the brain to prevent seizures from spreading.

In order to determine whether someone is a candidate for surgery, several tests must be performed. These include MRI (magnetic resonance imaging), which gives a detailed picture of the brain, video-EEG monitoring to see exactly where the seizures begin in the brain, neuropsychological testing (tests of memory and language), and usually a Wada test, to ensure that the seizure focus can be safely removed. The goal of the epilepsy surgical evaluation is to determine the likelihood that a particular patient will be helped by surgery, and what the specific risks of the surgery will be. The patient can then make a decision about whether or not they want to consider surgery.

Another type of surgery, the vagus nerve stimulator, involves electronic stimulation using a device implanted in the chest and connected to the vagus nerve in the neck. This procedure may significantly improve seizures, but is less likely to result in complete seizure.

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7. Is there a cure for epilepsy?

In some patients, seizures resolve on their own, and antiepileptic drugs can be stopped without the seizures returning. In most patients, medications suppress seizures, but the seizures may return when the medications are stopped.

Epilepsy surgery is the only potential "cure" for seizures. Depending on where the seizures begin, epilepsy surgery can result in seizure freedom in 40-90% of patients.

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8. What type of follow-up care is necessary after surgery?

Patients usually go home 4 to 5 days after epilepsy surgery, and can return to most activities after 2-4 weeks. A period of recuperation (usually 2-3 months) is necessary before returning to work or school. The patient will continue to follow up with his neurologist and neurosurgeon. Sometimes rehabilitation (physical therapy, occupational therapy, or speech therapy) is needed.

The patient will continue to take antiepileptic medications for several years, and the blood levels of medications and other blood tests will be followed. Neuropsychological testing is done one year after surgery to see if there are any long-term effects from the surgery.

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9. Can the seizures reoccur?

Seizures can recur after successful epilepsy surgery in about 20-30% of patients, with times of recurrence ranging from 1 to more than 10 years. Most commonly, seizures recur after antiepileptic medications are stopped, and can be controlled again if medications are restarted. Less often, seizures recur even though the patient is still taking medications.

To learn more about epilepsy, visit our Epilepsy Health Information section.

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