Epilepsy

Types of epilepsy

Focal (partial)

Seizures that are localized to a specific area within the brain. Focal seizures can be further categorized as focal seizures without loss of consciousness or focal seizures with impaired awareness.

Generalized seizures

Seizures that involve multiple or all areas of the brain are generalized seizures. There are a variety of types of generalized seizures including

Causes of epilepsy

The cause of epilepsy in more than half of the cases is unknown. In other cases, it can be caused by a variety of factors including:

• Genetics — epilepsy can be passed down from your parents through genes
• Trauma to the brain or head — trauma to the brain or head from a car accident or intense force to the head can cause epilepsy

Risk factors for epilepsy

• Age — young children or older adults are at the highest risk of developing epilepsy
• Gender — males are more likely to develop epilepsy than females
• Family history — if you have a family history of epilepsy, you are more likely to develop it as well
• Brain injury — if you have suffered a brain injury such as infection, trauma, stroke or other conditions, you are more likely to develop epilepsy
• Alzheimer’s disease or dementia — patients with Alzheimer’s disease or dementia are more likely to develop epilepsy later in the disease progression

Symptoms of epilepsy

Symptoms of epilepsy may include:

• Staring blankly
• Falling
• Shaking or tremors
• Blacking out
• Losing control over bladder or bowels
• Temporary loss of consciousness
• Confusion

Diagnosis of epilepsy

If your doctor suspects you have epilepsy, he or she will refer you to a neurologist for further testing and treatment. During an exam, your neurologist will take a full medical history, perform a neurological exam and order a series of tests to determine the cause of your symptoms.

Testing includes:

• Neurological exam — during a neurological exam, your doctor will evaluate your mental state, cognition, reflexes and motor abilities to ascertain if you have epilepsy and what type of epilepsy you have.
• EEG (Electroencephalogram) - an EEG is a neurological test that evaluates the electrical activity in the brain. It is the most commonly used test to diagnose epilepsy. People with epilepsy often have abnormal activity even when they are not having a seizure.

Treatment for epilepsy

There is not a cure for epilepsy, so the goal of treatment is to manage symptoms and control occurrences.

Non-surgical epilepsy treatments include:

Anti-seizure medications

Most patients’ seizures (more than 70 percent according to the Epilepsy Society) are fully controlled with anti-seizure medications (AEDs). AEDs work by regulating the area in the brain that causes seizures. They must be taken at the same time each day to be most effective and do not work during an active seizure. Your doctor will start you at a low dose and make modifications to your treatment based on your reaction to the initial medication. Some patients may need a combination of AEDs to find relief.

Some patients will not experience relief from anti-seizure medications alone and will need more advanced care.

Surgical treatment options for epilepsy include:

Temporal lobe resection

Temporal lobe resection, also known as lobectomy, is a procedure where part of the brain that is causing seizures is removed. A lobectomy is appropriate for patients who cannot tolerate medications or the medications are not effective. The goal of the procedure is to stop or reduce the number of seizures you are experiencing or to make the seizures less severe.

Disconnection procedure for epilepsy

During a disconnection procedure for epilepsy, your surgeon will cut nerve pathways where the seizure impulses travel in the brain. Disconnection is appropriate for patients who are having severe seizures originating from multiple areas of the brain that can’t be controlled with medication and/or the tissue where the seizures are originating can’t be removed safely. Types of disconnection procedures include functional hemispherectomy, corpus callosotomy and multiple subpial transections.

Implantable vagus (vagal) nerve stimulation (VNS)

Vagus nerve stimulation is a neurological procedure used to treat severe epilepsy that is not responding to other therapies. During this procedure, a device is implanted into the chest and works by sending mild, painless electrical impulses to the vagus nerve.

A team of Mercy Health specialists, including your neurologist, neurosurgeon and other advanced practice providers, will evaluate your case to determine which procedure is most appropriate for you.