While experiencing a seizure may sound scary, for the 3.4 million people in the United States living with epilepsy, seizures are familiar and controllable.

Epilepsy is a neurological condition that affects the nervous system and is commonly referred to as a seizure disorder. It is the fourth most common neurological disorder. Epilepsy is usually diagnosed after a person has had at least two unprovoked seizures (or after one seizure with a high risk for more) not caused by a known medical condition.

Seizure symptoms can vary widely from staring blankly for a few seconds to repeated twitching of the arms or legs as well as periods of unusual behavior, sensations and sometimes loss of awareness.

Diagnosing epilepsy

The path to an epilepsy diagnosis may require time, patience and active communication between patient and provider. “There are particular tests used to reach an accurate diagnosis including EEG and MRI scan,” according to Dr. Mayur Chalia, a neurologist specializing in clinical neurophysiology and epilepsy at Marshfield Medical Center.

“The testing in the form of brain MRI helps in detecting structural abnormalities such as stroke, tumor, brain injury or infection while an EEG – electroencephalography – helps in detecting electrical abnormalities of the brain,” Dr. Chalia said. “Fifty to 60% of patients can have unknown cause of epilepsy, even with complete evaluation.”

Risk factors can lead to seizure likelihood

More commonly identified causes of epilepsy in adults include:

• Brain abnormalities that occur in utero (before birth)
• Low oxygen during birth (or hypoxia)
• Traumatic brain injury
• Brain infection, such as meningitis or encephalitis
• Stroke resulting from artery blockage
• Brain tumor, either benign or malignant
• Neurodegenerative diseases, such as Alzheimer’s disease
• Bleeding into the brain/abnormal blood vessels in the brain
• Conditions with intellectual and developmental disabilities
• Family history of epilepsy or fever-related seizures

Misconceptions

Many misconceptions surround epilepsy can paint a picture far from reality.  These misconceptions can be due to incorrect television portrayals or general misinformation.

One such misconception is that people with epilepsy shake and jerk during a seizure. “Not every seizure leads to shaking and jerking, nor does a person always lose consciousness during a seizure. Shaking and jerking while unconscious are usually associated with tonic clonic seizures. Different types of seizures can affect people differently,” Dr. Chalia said.

Another common misconception is that you should restrain someone during a tonic clonic seizure and put your finger in the person’s mouth. “During a tonic clonic seizure you should never hold the person down or put anything in their mouth as it can lead to physical injury,” Dr. Chalia said.

New research is changing thinking

Given the variables of complexity and neurological damage, more than one treatment plan is available. Research continues to drive treatment development.

“Failure of two appropriately chosen and taken anti-seizure medications in controlling seizures is called drug-resistant epilepsy, which is noted in about 30% of patients,” Dr. Chalia said. “For some, surgery may be possible to remove the area of the brain causing the seizures, but it remains under-utilized. With advancing research, there has been development of newer imaging and seizure localization techniques that can be beneficial. For others, surgery is not an option or they may not want it at this point, so neuromodulation is another option. It involves using a device to send small electric currents to the nervous system.”

Overall, epilepsy research has started to change thinking and approaches to patient care, as providers slowly move toward a more rational basis by which to treat this common condition, Dr. Chalia said.

If you have questions about managing epilepsy symptoms, talk with your doctor.