Epilepsy
Information
This
page contains the following information about Epilepsy:
Epilepsy
encompasses a group of disorders characterized by recurrent seizures
– brief electrical disturbances in the brain that can cause
a variety of symptoms such as strange sensations, changes in behavior
or emotions, muscle spasms, convulsions, and a sudden loss of
awareness or consciousness.
About
10 percent of all people – approximately 8 million Americans
– may experience a seizure during their lifetime. However,
only 3 percent of the population have recurrent seizures, or epilepsy.
Sometimes,
a clear cause of epilepsy can be identified. A common cause of
epilepsy is head injury due to an automobile accident or gunshot
wound. Other causes include stroke, infection, poisoning, and
brain tumors. In some cases, epilepsy is genetic.
NewYork-Presbyterian
offers state-of-the-art outpatient and inpatient care for children
and adults with epilepsy. The faculty and staff of our Comprehensive
Epilepsy Centers include some of the world's foremost clinicians
and researchers.
Patients
and their families benefit from the care of an experienced, compassionate,
multidisciplinary team that includes epileptologists, neurologists,
neurosurgeons, neuroradiologists, clinical nurse specialists,
neuropsychologists and psychiatrists.
In
addition, NewYork-Presbyterian is the only hospital in New York
City with pediatric epileptologists on staff.
Types
of Seizures
There
are two main types of seizures: generalized seizures and partial
(focal) seizures. Generalized
seizures, which affect the entire brain, include:
- Absence,
or petit mal, seizure – a brief lapse in awareness,
lasting a few seconds, causing the person to stare or twitch
the eyelids or face muscles. These seizures, which may occur
up to hundreds of times a day, commonly begin in before age
2 and end after childhood.
- Tonic-clonic,
or grand mal, seizure – a sudden and complete loss
of consciousness, stiffening the arms and legs and causing the
person to fall (the tonic phase) before beginning a rhythmic
jerking (the clonic phase).
- Tonic
seizure – the same as tonic-clonic, except not followed
by a rhythmic jerking phase
- Myoclonic
seizure – involve very brief, lightning-like jerks
of any part of the body
- Atonic
seizure – Sudden loss of muscle tone resulting in collapse,
often times head-first, into the ground.
Partial
(focal) seizures affect one part of the brain. Partial seizures,
which may spread and become generalized seizures, include:
- Complex
partial seizure (psychomotor attacks) – often beginning
with an aura, or warning, such as a sense of fear, an unpleasant
smell, or change in perception. After the aura, consciousness
may be altered, speech stops, and the person may perform automatic,
repetitive movements such as chewing, swallowing, fidgeting
of the hands, or purposeless moving from place to place.
- Simple
partial seizure – affects the motor or sensory areas of
the brain, causing jerking movements in the hand or facial muscles,
sensory symptoms such as flashing lights or a buzzing sound,
but without altering consciousness.
Diagnosing
Epilepsy
A
neurologist may conduct a physical examination, including a detailed
history of seizures, followed by an electroencephalogram (EEG),
a test that measures electrical activity in the brain. Other tests,
such as computed tomography (CT), magnetic resonance imaging (MRI),
and blood tests are often used to better understand the type of
epilepsy a patient may have.
The
Comprehensive Epilepsy Centers at NewYork-Presbyterian also uses
state-of-the-art electroradiography techniques to locate the epicenter
of the seizure at its new six-bed epilepsy monitoring unit, which
is integrated into one of the world's oldest and most respected
Neurology services at our downtown campus. Access to state-of-the-art
diagnostic methods such as functional MRI can help identify important
areas of the brain that need to be avoided during surgery. This
diagnostic approach is especially useful in designing optimal
therapeutic strategies for patients with difficult-to-treat seizures.
Treating
Epilepsy
Medication
is the first option used in epilepsy treatment. The majority (two-thirds)
of people with epilepsy can control their seizures with antiepileptic
drugs (AEDs), which suppress the abnormal electrical activity
in the brain that leads to seizures. In some patients, AEDs also
suppress normal nerve-cell activity, which produces side effects
such as drowsiness. AEDs may be selected according to the type
of epilepsy and the degree of side effects associated with the
medication.
For
patients who cannot control their seizures with medication, NewYork-Presbyterian's
Comprehensive Epilepsy Centers offer state-of-the-art treatments.
Epilepsy surgery aims to remove the nerve cells that cause seizures.
Vagus nerve stimulation (VNS), a breakthrough treatment pioneered
at our Weill-Cornell campus, uses an implantable device to regulate
electrical activity in the brain. NewYork-Presbyterian has used
VNS to treat more patients with severe epilepsy than any other
epilepsy center in the world.
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Seizure
First Aid: What
to Do if a Person is Having a Seizure
For
seizures (lasting less than 5 minutes), DO:
- If
the person is falling, help him or her to the ground
safely.
- Protect
the person from nearby hazards.
- Loosen
tight or restrictive clothing.
- Turn
the person on his/her side to keep the air passages
open.
- Look
for medical I.D.
- Offer
reassurance as the person recovers from the seizure.
DO
NOT:
- Place
anything in the person's mouth. A person cannot swallow
his/her tongue during a seizure. However, objects
placed in the mouth can cause injury or choking.
- Attempt
to give the patient medications, unless he/she requests
it.
- Restrain
the patient.
- Panic.
Most seizures stop on their own after 1 or 2 minutes.
For
seizures lasting more than 5 minutes, repeated seizures,
or if the person does not wake up after movements have
stopped, call an ambulance or other emergency medical
personnel (911).
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Commonly
Asked Questions and Answers About Epilepsy
How common is epilepsy?
Epilepsy occurs in about one percent of the population in the
U.S., or more than two million people.
Does having a single seizure mean you have epilepsy?
No. Epilepsy occurs when a person has recurrent seizures.
How long do seizures last?
Different types of seizures may last longer than others. For example,
tonic-clonic (grand mal) seizures may last a few minutes, while
absence seizures may last for only a few seconds.
How does a person feel after an epileptic seizure?
Often, people feel confused, sleepy, and irritable following a
seizure. Some types, such as complex partial seizures, are forgotten
immediately after they occur.
Do seizures injure the brain?
The average seizure does not seem to have a lasting effect on
the brain. Many people with epilepsy have had many seizures during
the course of their life without change in their intelligence,
perception, or alertness.
When does epilepsy first appear?
Epilepsy most often appears in children and the elderly. However,
epilepsy that is caused by head trauma or a brain tumor can occur
at any stage of life.
Can a person with a normal EEG still have epilepsy?
Yes. A routine EEG usually takes about a half hour to record electrical
activity in the brain, so it is possible that activity may be
normal during that time. Also, the electrodes of an EEG are placed
on top of the scalp and may not be able to record abnormal activity
deep in the brain.
Will epilepsy interfere with daily activities?
The vast majority of people with epilepsy lead fully productive
lives. Children can participate in most sports with only a few
restrictions, although careful supervision is still necessary
to ensure safety. Most adults with epilepsy can drive if their
seizures are well controlled and they are under the care of a
physician. However, each state has different guidelines for how
long a person must be seizure-free before they can drive, work
at exposed heights, or operate dangerous machinery.
What are some of the special issues faced by women with epilepsy?
Many women with epilepsy experience irregular menstrual cycles,
sexual dysfunction, infertility, and miscarriages. In addition,
many antiseizure medications decrease the effectiveness of oral
contraceptives and hormone replacement therapy, and all increase
the risk of birth defects. Additional studies have shown that
some antiseizure drugs may increase the risk of osteoporosis.
Can a woman with epilepsy have children?
In the past, women with epilepsy were warned not to have children,
for fear of passing on the disease, and to prevent birth defects.
Today, doctors at NewYork-Presbyterian are experienced in treating
women with epilepsy, and helping them improve their chance of
becoming pregnant and delivering a healthy baby.
Epilepsy
Research
NewYork-Presbyterian's
Comprehensive Epilepsy Centers, located on the campuses of Columbia
and Cornell Universities, are renowned for their excellence in
epilepsy research. Research conducted at these centers, with a
special focus on epilepsy in children and women, has advanced
our understanding of the causes, consequences, and treatment of
epilepsy, including the use of many new anti-seizure medications
and the effects of epilepsy and its treatment on mood. In addition,
the Comprehensive Epilepsy Centers train future leaders in epilepsy
research through national and international epilepsy fellowships.
The
Comprehensive Epilepsy Centers have launched two groundbreaking
clinical trials focusing on the special problems faced by women
with epilepsy:
- The
Study for Menopausal Women with Epilepsy, an NIH-sponsored study
to determine the effects of hormone replacement therapy in women
with epilepsy.
- The
Study of New Treatments for Seizures Affected by Menstruation,
an NIH-sponsored study to evaluate the ability of natural progesterone
to reduce seizures in women during the menstrual cycle.
Other
Links and Organizations
The
American Epilepsy Society
Mission is to "promotes research and education for professionals
dedicated to the prevention, treatment and cure of epilepsy."
Citizens
United for Research in Epilepsy (CURE)
The
Epilepsy Foundation
"A national, charitable organization, founded in 1968 and
dedicated to the welfare of people with epilepsy". Its mission
is "to work for children and adults affected by seizures
through research, education, advocacy and service."
The
EpiCentre
Westmead, Australia
"Established for people with epilepsy and their families.
Its aim is to provide information about epilepsy and its treatment."
National
Institute of Neurological Disorders and Stroke
"The nation's leading supporter of biomedical research on
disorders of the brain and nervous system."
Columbia
Comprehensive Epilepsy Center
The
Comprehensive Epilepsy Center of NewYork Weill Cornell Medical
Center
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