What is epilepsy?
Epilepsy is a chronic condition affecting the brain that causes repeated seizures. It is the fourth most common neurological disorder worldwide.
Epilepsy affects people in many ways. Seizures are just one aspect of epilepsy that affect daily life. Epilepsy may also result in behavioral, social, and cognitive problems.
Epilepsy symptoms
The main symptom of epilepsy is repeated or recurrent seizures, which occur due to uncontrolled, abnormal firing of nerve cells in the brain that cause changes to physical and mental function.
Signs and symptoms of epileptic seizures depend on which area of the brain is affected. People with epilepsy may experience:
- Abnormal eye movements
- Changes in sensation (hearing, vision, taste, smell, numbness, tingling)
- Complete loss of muscle tone (drop attacks)
- Drooling or frothing at the mouth
- Lip-smacking, hand-rubbing, chewing motions, finger motions
- Staring spells
- Temporary confusion and difficulty thinking, speaking, or understanding
- Temporary loss of consciousness or awareness
- Uncontrolled muscle movements (twitching, jerking, convulsions)
Some people with repeated seizures may experience strange feelings or sensations before the seizure happens. These warning signs are called auras. For some people, the auras are long enough and reliable enough that they can warn of an impending seizure.
What causes epilepsy?
About 50 percent of epilepsy cases have no known cause. The remainder of people with epilepsy have an underlying cause such as:
Structural abnormalities in the brain:
- Abnormal blood vessels in the brain such as arteriovenous malformations
- Congenital brain conditions (abnormalities present at birth)
Injuries to the brain:
- Brain injuries that happen while a baby develops before birth or during birth
- Infections such as meningitis, encephalitis, or brain abscesses
- Traumatic brain injuries from car accidents, falls, projectiles, or other events
- Strokes
Other health conditions:
- Autoimmune disorders in which the immune system attacks brain cells
- Brain tumors
- Degenerative processes that damage or destroy brain tissue, including dementia and Alzheimer’s disease
- Metabolic disorders
- Genetic changes
Types of epilepsy
There are many different types of epilepsy. Epileptologists (neurologists who specialize in epilepsy) classify epilepsies based on the types of seizures, what causes them, and other symptoms.
Developmental and epileptic encephalopathies (DEEs) are severe types of epilepsy that begin early in life, usually during infancy. DEEs are characterized by a combination of repeated seizures and encephalopathy (a condition affecting brain function).
Learn more about the Pediatric Epilepsy Program at Children’s Hospital of Philadelphia
Epilepsies that affect fewer than 200,000 people worldwide are considered rare. There are about two dozen types of rare epilepsy, including:
- Angelman syndrome is an inherited condition caused by abnormal changes in the UBE3A gene. Seizures usually begin in children with Angelman syndrome between 2 and 3 years of age.
- CDKL5 deficiency disorder is an inherited epilepsy that affects infants usually within the first three months of life. The condition is caused by changes in the CDKL5 gene that carries the code to make a protein needed for normal brain development.
- Pyridoxine-dependent epilepsy is an inherited epilepsy with seizures beginning in infancy and sometimes even before birth. These seizures respond well to supplemental treatment with pyridoxine (vitamin B6).
- Rasmussen syndrome is a type of chronic inflammation in which cells from the immune system damage only one side of the brain. This inflammatory damage causes seizures, cognitive and speech impairments, and problems moving one side of the body (hemiparesis). The condition usually occurs in children under 10.
- Tuberous sclerosis complex (TSC) is an inherited disorder that causes tumors with a root-shaped (tuberous) appearance in the brain. Epilepsy is common in people diagnosed with TSC.
How is epilepsy diagnosed?
Having seizures is not enough for an epilepsy diagnosis because not all seizures are caused by epilepsy. In addition, not all episodes that look like seizures are seizures. Careful testing is the only way to be sure you are having recurrent seizures that fit the epilepsy diagnosis criteria.
We begin with a medical consultation and review your personal medical history and habits, family medical history, current medications or medication changes, current symptoms, risk factors for seizures, seizure frequency and duration, and seizure triggers.
Based on this information, we recommend specific tests for epilepsy designed to help us look for changes in the brain that could be causing seizures, including:
Epilepsy Monitoring Unit at Penn Medicine
For some patients, outpatient diagnostic tests are not able to capture the information your doctor needs to fully understand your epilepsy and create a treatment plan. If this happens, we may recommend special inpatient testing at our Epilepsy Monitoring Unit (EMU) located at The Pavillion at the Hospital of the University of Pennsylvania. Here, patients receive extended, multi-day epilepsy monitoring in a safe, comfortable center equipped with the latest monitoring technology and a specially trained staff.
Treating and managing epileptic seizures
Epilepsy is a lifelong condition for which there is currently no cure. But most people with epilepsy can get relief from seizures with the right treatment plan.
The first treatment option for most people with epilepsy is medication. Anti-seizure medications successfully control seizures in about 70 percent of people with epilepsy. Epilepsy that does not respond to medication therapy is known as drug-resistant epilepsy.
Certain exposures, moods, or events called triggers can cause abnormal electrical activity in the brain that results in seizures. Your doctor can help you identify and understand any seizure triggers you may have and work with you to find ways to avoid those triggers.
Doctors may recommend epilepsy surgery for people who do not achieve seizure control with medications and lifestyle changes. Surgery is typically considered after a person with epilepsy does not respond well to two or three different anti-seizure medications.
Advanced surgical treatment options at Penn Medicine
Surgical treatments for focal epilepsy remove areas of the brain that cause abnormal electrical activity. Surgeries for generalized seizures often involve implanted devices to control or stop seizures within the brain. These treatments may include:
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Patient stories
Actress returns to stage after struggling with seizures
Her seizure medications weren't helping, so actress Hannah Parke turned to Penn Medicine for the relief she needed to get back onstage.
Epilepsy surgery gives patient a new lease on life
Minimally invasive laser interstitial thermal therapy (LITT) surgery reduced the epilepsy symptoms a patient had experienced for more than 30 years.
A minimally invasive solution to seizures
When Betsy Berlin's seizures returned after 24 years, medication was no longer helping. A minimally invasive procedure gave her the relief she needed.