Epilepsy: Beyond the Seizure

What Is Epilepsy?

With epilepsy, seizures happen because of clusters of nerve cells in the brain called neurons. Normally, neurons produce electrical and chemical signals that communicate with other neurons, muscles and organs to create our thoughts, feelings and actions. With epilepsy, the neurons in the brain may send the wrong signals.

Epilepsy is sometimes called “the epilepsies” because of the different causes and types of the condition. Some people may stop what they are doing, briefly lose awareness of their surroundings and stare into space for a short time. Others may have convulsions, meaning their muscles contract repeatedly, and lose consciousness. Some people don’t have seizures very often, while others may have many seizures daily.

While you would want to follow up with a physician about any seizure, having a seizure does not by itself mean a person has epilepsy.

What Are Common Epilepsy Symptoms?

Epilepsy symptoms can look very different in different people. That is because seizures affect different parts of the brain. Some people may not even realize they are having seizures at first.

The most common symptom of epilepsy is having repeated seizures. These episodes may last from a few seconds to a few minutes. During a seizure, you may have these signs:

• Emotional symptoms — Feeling fear, anxiety or déjà vu before a seizure.
• Loss of awareness — No response to others or not remembering what happened during the episode.
• Loss of consciousness — Fainting or being unresponsive.
• Sensory changes — You may notice unusual smells, tastes, sounds or visual changes before or during a seizure.
• Staring spells — You may stop what you are doing and stare into space for a short time.
• Temporary confusion — You may feel mixed up or have trouble understanding what is happening around you.
• Uncontrolled movements — This can include jerky arm and leg movements, muscle stiffness or repeated motions.

Some people have a warning sign called an aura before a seizure begins. An aura is a small seizure that may mean a larger one is coming. It can include sudden emotions, strange sensations, or changes in vision.

Symptoms can also vary based on the type of seizure:

• Focal seizures — Begin in one area of the brain and may affect your movements or awareness
• Generalized seizures — Involve both sides of the brain and include full-body movements or unconsciousness

“It is important to pay attention to even subtle symptoms,” said Dr. Husain. “Early recognition can help guide diagnosis and treatment.”

If you or someone you know has repeated or unexplained episodes like these, find medical care as soon as possible. You will also want to track what happens before, during and after a seizure. Doing this can help your care team better understand your condition.

What Causes Epilepsy?

Epilepsy does not have a single cause. In many cases, no one will know the exact reason. Still, researchers have found several factors that may change brain activity and raise the risk of seizures.

Common causes and risks include:

• Brain conditions — Tumors, infections or structural differences in the brain may trigger abnormal electrical activity.
• Developmental disorders — Conditions such as autism or neurodevelopmental delays are sometimes linked with epilepsy.
• Genes — Some types of epilepsy run in families. Certain genes may affect how brain cells communicate.
• Head injuries — Trauma from accidents or falls can damage brain tissue and lead to seizures.
• Infections — Diseases such as meningitis, encephalitis or other infections affecting the brain can lead to seizures.
• Prenatal injury — Brain damage before birth may happen because of an infection, lack of oxygen or poor nutrition.
• Stroke and vascular disease — Reduced blood flow to the brain can damage cells and raise seizure risk, especially in older adults.

In about half of all cases, physicians do not find a clear cause, which is called idiopathic epilepsy. Even without a known cause, treatment can still be effective.

Understanding the cause can help guide care. It may also help your physician decide the best treatment plan and whether the condition may change over time.

How Is Epilepsy Diagnosed?

Diagnosing epilepsy involves more than confirming that you have had a seizure. Your physician will work to understand the type of seizures you are having and what may be causing them.

The process usually begins with a detailed medical history. Your physician may ask:

• What happened before, during and after the episode?
• How long did the episode last?
• How often do symptoms occur?
• Is there a family history of seizures?
• Have you had any recent injuries or illnesses?

It can be helpful to bring a witness to your physician’s visit. A witness is someone who has seen your seizures or can share a video recording if one is available.

After reviewing your history, your physician may do a physical and neurological exam. The exam helps assess your reflexes, coordination and mental function

A physician may also use several tests to confirm a diagnosis:

• Blood tests — These can help rule out infections, genetic conditions or other health issues.
• Brain imaging — MRI or CT scans can show changes or problems in the brain, including tumors.
• Electroencephalogram (EEG) — This test measures electrical activity in the brain. It can detect unusual patterns linked to seizures.
• Neuropsychological testing — This evaluates memory, thinking and behavior, which may be affected by seizures.

In some cases, your physician may want to monitor you for a longer time. This could involve staying in a hospital or wearing a portable EEG device at home to record your brain activity.

Physicians usually make an epilepsy diagnosis after a person has had two or more seizures that are not caused by a known trigger. Your care team will also decide on the type of epilepsy, which is important for choosing the right treatment.

It can take time to get an accurate diagnosis. But it is an important step toward managing your condition and having the best possible quality of life.

Lifestyle and Condition Management

With the right approach, many people can manage their condition and lead full, active lives. Treatment often includes medication to control seizures. Your physician will work with you to find the right medication and dose. It may take time to find what works best.

Along with medical treatment, lifestyle choices play a major role in managing epilepsy. Here are some strategies that may help:

• Eat a balanced diet — In some cases, physicians may advise you to follow a specific diet to help control seizures.
• Get enough sleep — Lack of sleep is a common seizure trigger. Aim for a consistent sleep schedule.
• Manage stress — Stress can affect brain activity. Try deep breathing, exercise or counseling.
• Stay away from triggers you know about — Triggers aren’t the same for everyone. They may include flashing lights, alcohol or illness.
• Stay physically active — Regular activity supports overall brain and body health.
• Take medications as prescribed — Skipping doses can raise your risk of seizures.

Safety is also a vital part of daily life with epilepsy. Based on your condition, your physician may ask you to follow these safeguards:

• Don’t swim alone.
• Use caution when cooking or bathing.
• Talk with your physician and family about driving restrictions based on how controlled your seizures are.

Support can make a big difference. Connect with others who understand epilepsy: It can help you feel less alone. Education also empowers you to recognize symptoms and respond properly.

“It is not just about controlling seizures,” said Dr. Husain. “It is about helping people feel confident and supported in their daily lives.”

Regular follow-up care is a top priority. Your needs may change over time, and your care team can adjust your treatment plan as needed.

With the right combination of medical care, lifestyle adjustments and support, many people with epilepsy can reduce seizures and have a full and active life.