EPILEPSY

Seizure signs and symptoms may include:

• Temporary confusion
• A staring spell
• Uncontrollable jerking movements of the arms and legs
• Loss of consciousness or awareness
• Psychic symptoms

Symptoms vary depending on the type of seizure. In most cases, a person with epilepsy will tend to have the same type of seizure each time, so the symptoms will be similar from episode to episode.

Doctors generally classify seizures as either focal or generalized, based on how the abnormal brain activity begins.

Focal seizures

When seizures appear to result from abnormal activity in just one area of your brain, they’re called focal (partial) seizures. These seizures fall into two categories.

• Focal seizures without loss of consciousness (simple partial seizures). These seizures don’t cause a loss of consciousness. They may alter emotions or change the way things look, smell, feel, taste or sound. They may also result in involuntary jerking of a body part, such as an arm or leg, and spontaneous sensory symptoms such as tingling, dizziness and flashing lights.
• Focal dyscognitive seizures (complex partial seizures). These seizures involve a change or loss of consciousness or awareness. During a complex partial seizure, you may stare into space and not respond normally to your environment or perform repetitive movements, such as hand rubbing, chewing, swallowing or walking in circles.

Symptoms of focal seizures may be confused with other neurological disorders, such as migraine, narcolepsy or mental illness. A thorough examination and testing are needed to distinguish epilepsy from other disorders.

Generalized seizures

Seizures that appear to involve all areas of the brain are called generalized seizures. Six types of generalized seizures exist.

• Absence seizures. Absence seizures, previously known as petit mal seizures, often occur in children and are characterized by staring into space or subtle body movements such as eye blinking or lip smacking. These seizures may occur in clusters and cause a brief loss of awareness.
• Tonic seizures. Tonic seizures cause stiffening of your muscles. These seizures usually affect muscles in your back, arms and legs and may cause you to fall to the ground.
• Atonic seizures. Atonic seizures, also known as drop seizures, cause a loss of muscle control, which may cause you to suddenly collapse or fall down.
• Clonic seizures. Clonic seizures are associated with repeated or rhythmic, jerking muscle movements. These seizures usually affect the neck, face and arms.
• Myoclonic seizures. Myoclonic seizures usually appear as sudden brief jerks or twitches of your arms and legs.
• Tonic-clonic seizures. Tonic-clonic seizures, previously known as grand mal seizures, are the most dramatic type of epileptic seizure and can cause an abrupt loss of consciousness, body stiffening and shaking, and sometimes loss of bladder control or biting your tongue.

DIAGNOSIS

To diagnose your condition, your doctor will review your symptoms and medical history. Your doctor may order several tests to diagnose epilepsy and determine the cause of seizures.

• Neurological examination. Your doctor may test your behavior, motor abilities, mental function and other areas to diagnose your condition and determine the type of epilepsy you may have.
• Blood tests. Your doctor may take a blood sample to check for signs of infections, genetic conditions or other conditions that may be associated with seizures.

Your doctor may also suggest tests to detect brain abnormalities, such as:

• Electroencephalogram (EEG). This is the most common test used to diagnose epilepsy. In this test, doctors attach electrodes to your scalp with a paste-like substance. The electrodes record the electrical activity of your brain. Recording the seizures may help the doctor determine what kind of seizures you’re having or rule out other conditions.
• Computerized tomography (CT) scan. A CT scan uses X-rays to obtain cross-sectional images of your brain. CT scans can reveal abnormalities in your brain that might be causing your seizures, such as tumors, bleeding and cysts.
• Magnetic resonance imaging (MRI). An MRI uses powerful magnets and radio waves to create a detailed view of your brain. Your doctor may be able to detect lesions or abnormalities in your brain that could be causing your seizures.
• Functional MRI (fMRI). A functional MRI measures the changes in blood flow that occur when specific parts of your brain are working. Doctors may use an fMRI before surgery to identify the exact locations of critical functions, such as speech and movement, so that surgeons can avoid injuring those places while operating.
• Positron emission tomography (PET). PET scans use a small amount of low-dose radioactive material that’s injected into a vein to help visualize active areas of the brain and detect abnormalities.
• Single-photon emission computerized tomography (SPECT). A SPECT test uses a small amount of low-dose radioactive material that’s injected into a vein to create a detailed, 3-D map of the blood flow activity in your brain during seizures.
Doctors also may conduct a form of a SPECT test called subtraction ictal SPECT coregistered to magnetic resonance imaging (SISCOM), which may provide even more detailed results.
• Neuropsychological tests. In these tests, doctors assess your thinking, memory and speech skills. The test results help doctors determine which areas of your brain are affected.

RECOMMENDED MEDICATIONS

Medicines to prevent epileptic seizures are called antiepileptics. The goal is to find an effective antiepileptic medicine that causes the fewest side effects.

There are many antiepileptic medicines (called AEDs, anticonvulsants, or antiseizure medicines). But they do not all treat the same types of seizures. The first step your doctor takes in choosing a medicine to treat your seizures is to identify the types of seizures you have.

Medicine choices

Many medicines are used to treat epilepsy. Some are used alone, and some are used only along with other medicines. Your medicine options depend in part on what types of seizures you have. The medicines listed below are not the only medicines used for epilepsy, but they are the most common.

Medicines used for partial seizures, including those with secondary generalization:

• Carbamazepine (such as Carbatrol).
• Lamotrigine (Lamictal)
• Levetiracetam (Keppra)
• Oxcarbazepine (such as Trileptal).

Medicines used for primary generalized (tonic-clonic) seizures:

• Lamotrigine (Lamictal)
• Levetiracetam (Keppra)
• Valproate (such as Depakene).

Medicines used for absence seizures:

• Ethosuximide (Zarontin)
• Valproate (such as Depakene).

Medicines used for atypical absence, myoclonic, or atonic seizures:

• Lamotrigine (Lamictal)
• Levetiracetam (Keppra)
• Valproate (such as Depakene).

Other medicines used for seizures include:

• Clobazam (Onfi).
• Clonazepam (Klonopin).
• Ezogabine (Potiga).
• Felbamate (Felbatol).
• Gabapentin (such as Neurontin).
• Lacosamide (Vimpat).
• Topiramate (such as Topamax).
• Phenobarbital (Luminal).
• Phenytoin (such as Dilantin).
• Pregabalin (Lyrica).
• Rufinamide (Banzel).
• Tiagabine (Gabitril).
• Vigabatrin (Sabril).
• Zonisamide (Zonegran).

Aside from these common problems, though, the medicines have different side effects, health risks, and costs. A medicine that works for someone else may not work for you.