Epilepsy Awareness Month: Understanding Its Symptoms, Causes, Types and Treatment Options

For centuries, epilepsy was surrounded by mystery and myth. Descriptions date back to Babylonian texts more than 3,000 years ago. In ancient Greece, epilepsy was called the "sacred disease" and was associated with the divine.

The reality is that epilepsy is a brain disorder that causes seizures in everyday people of all ages, ethnicities and walks of life. Medical advances in diagnosis and treatment have allowed more than 80 percent of people diagnosed with epilepsy to lead a full, normal life. We spoke with MUSC Health’s Dr. Ramit Singla, a neurologist at MUSC Health Medical Center Downtown in Columbia, to learn more about the types of epilepsy, symptoms and treatments for the disorder, which affects an estimated 50 million people worldwide, according to the World Health Organization.

What is epilepsy?

Epilepsy is a brain disorder that causes seizures, which occur when unusual electrical activity disrupts normal brain signals. Neurons are always talking to each other, but when they "misfire," a seizure occurs. Someone who has two seizures at least 24 hours apart is considered to have an epilepsy disorder.

Are there different types of seizures?

Yes. There are two main categories of seizures based on the location of the seizure and the nature of the seizure itself.

1. A partial, or focal, seizure is caused by abnormal electrical activity in a specific area of the brain, which causes certain muscles on one side of the body to shake uncontrollably for the duration of the seizure. Partial seizures can be simple or complex, depending on whether an individual remains conscious (simple) or loses consciousness (complex.)
2. Generalized seizures are caused by abnormal electrical activity in both hemispheres of the brain, causing loss of consciousness. Generalized seizures include various types, such as:
   
   1. Absence seizure: Also called petit mal seizure, an absence seizure generally lasts around 30 seconds to a minute and causes an altered state of consciousness. An individual may stare or blink rapidly and typically is not aware of the seizure when it is over.
   2. Atonic seizure: A patient will lose muscle tone, go limp, fall if standing and remain unresponsive until the seizure is over.
   3. Tonic-clonic seizure: The most common type of generalized seizure, a tonic-clonic seizure has the characteristics of what many people consider a classic seizure or convulsion. During the tonic phase, an individual loses consciousness, and the body stiffens. In the clonic phase, the body, including arms and legs, will stiffen and extend, then contract, jerk and shake. Generally, the seizure lasts for a few minutes. After the seizure, the individual may be confused or sleepy.
   4. Myoclonic seizure: Myoclonic seizures are characterized by rapid, brief muscle jerks.

Is one type more prevalent?

No. Seizures vary based on age group.

What causes epilepsy?

About 40 to 50 percent of the time, we can find a cause, but 50 to 60 percent, we are not able to find a cause for epilepsy. Seizures can be most commonly caused by:

• Injury
• Head trauma
• Stroke
• Dementia
• Illness such as meningitis, encephalitis, abscess in the brain
• Prenatal factors such as infections that are passed along during birth
• Congenital conditions, such as tuberous sclerosis and neurofibromatosis

Identifying the type of seizure allows an effective treatment plan to be formulated, as certain medications work better for certain seizures.

What can trigger a seizure?

Fever, lack of sleep and stress are the big three triggers. Certain video games or watching TV can also trigger a seizure in someone who has risk factors for having seizures.

How is epilepsy diagnosed?

Based on new terminology and advances in treatment, there is a significant difference in the management and diagnosis of epilepsy. Obtaining a patient’s medical history, physical exam and description of seizures, along with diagnostic testing, is vital. In certain pediatric patients, we may do genetic testing

An evaluation may include:

Electroencephalogram (EEG): This is a noninvasive test and the most common way to diagnose epilepsy. During the procedure, which can be done in an outpatient setting, small electrodes are attached to the scalp to record brain activity. An EEG lasts about 20 to 40 minutes, but in some instances may take longer to help ensure a correct diagnosis.

• Computerized tomography (CT scan): A CT scan provides images of the brain and helps to detect any structural abnormalities that explain the seizures.\
• Magnetic resonance imaging (MRI): MRI provides a more detailed view of the brain using radio waves and a powerful magnet.
• PET scan: This measures the brain's blood flow and metabolic activity.

These are a few initial tests. Genetic testing may be considered in younger patients who have a family history of seizures.

Is there an age of onset?

There is no set age for the onset of seizures. Sometimes certain seizures are more common or are seen in certain younger age groups. They can be benign seizures as well, but sometimes they can be due to certain syndromes.

What treatments are available?

Significant advances have been made in the number of medications available to treat specific types of seizures. Most medications are oral and must be taken once or twice daily. Normally, we start with a low dose. If seizures continue, we increase the dosage or add another medication. If that does not stop seizures, we discuss other options like Keto diet or surgical options.

What surgical interventions can be done?

Surgery can depend on a lot of factors. Our goal is for the patients to have a good life. Options include:

Vagus nerve stimulator (VNS): The VNS is a tiny metal device that stimulates the vagus nerve, which runs from the lower neck to the brain on both sides. The VNS is inserted in the chest to mitigate the severity, number and length of seizures. Small wires are inserted into the lower left side of the neck to the brain. The patient or a family member can activate the stimulator through a handheld device when or before a seizure begins.

Responsive neurostimulation: RNS can stop a seizure before it occurs. A stimulator and tiny wires are placed inside the skull bone at the site where abnormal brain activity occurs. The device monitors brain activity, and if abnormal bursts of electricity are detected, it responds instantly with small pulses of energy to diminish the abnormal activity.

• Deep brain stimulation: Electrodes and wires are planted inside the brain and send electrical impulses to stop brain signals that trigger seizures.
• Corpus callosotomy: The corpus callosum connects the left and right sides of the brain and carries signals across the hemispheres. In certain patients, when medications and other options fail to prevent seizures, removing the corpus callosum may be considered to prevent abnormal electrical currents from spreading to the other half of the brain.
• Removal of growths: If imaging detects a mass of tissue, such as an abnormal growth that is not at the tumor, we may consider removing it surgically.

If surgery is considered to provide the best outcome for a patient, a multidisciplinary team meeting is held with the family, primary care physician, anesthesiology, neurosurgeon and neurology teams to discuss outcomes, as well as risks and benefits, always prioritizing the patient;s safety and quality of life.

Can someone with epilepsy live a normal life?

Living with epilepsy requires careful management and life adjustments, but 70 to 80 percent of people diagnosed with epilepsy can lead a full, normal life if they are medication compliant, avoid triggers, have a support system and have adequate epilepsy education.

What famous people are living with epilepsy?

According to the National Epilepsy Support Service, Elton John, Chief Justice John Roberts and Lil Wayne have been diagnosed with epilepsy. Other notable people who had epilepsy include Prince, Agatha Christie, Alfred Nobel, Socrates, Julius Caesar, Theodore Roosevelt and Edgar Allen Poe.

What do I do if someone has a seizure?

Do not panic; seizures last only a few minutes. Lay the person on the ground, not on a table or a chair where they could fall. Make sure nothing is wrapped around the neck, such as a tie or scarf, and turn the head to one side to prevent choking. Do not put your hands or fingers in someone's mouth. Ask for help, call 911, and time the seizure.

---

Dr. Ramit Singla sees patients at MUSC Health Columbia Medical Center Downtown. He is located at 2345 Forest Drive, Columbia, SC 29204.