Epilepsy and Seizures

Seizures differ widely depending on which part of the brain they originate in and how much of the brain they affect. These are the symptoms of the different kinds of seizures:

Focal (Partial) Seizures

Before

• Aura, or signs that a seizure is about to occur
• Déjà vu
• Feelings of impending doom
• Fear
• Euphoria
• Visual changes
• Hearing abnormalities
• Changes in your sense of smell

During Simple Focal Seizure

• Sight may be altered
• Muscles are affected. The seizure activity is limited to an isolated muscle group. For example, it may only include the fingers, or larger muscles in the arms and legs.
• Sweating
• Nausea
• Paleness
• You don’t lose consciousness in this type of seizure.

During Complex Focal Seizure

• Loss of consciousness is likely
• Loss of awareness of what's going on around you. You may look awake, but have a variety of unusual behaviors including gagging, lip smacking, running, screaming, crying, or laughing.
• Tiredness or sleepiness after the seizure

Generalized Seizures

Absence (or Petit Mal) Seizure

• Brief changed state of consciousness
• Staring
• Mouth or face twitching
• Rapid blinking
• Usually lasts less than 30 seconds
• When the seizure is over, you may not recall what just occurred.
• May occur several times a day.

Atonic Seizure (Drop Attack)

• Sudden loss of muscle tone
• May fall from a standing position or suddenly drop your head.
• Limpness
• Unresponsive

Generalized Tonic-Clonic (Grand Mal) Seizure (GTC)

Five Distinct Phases

• Your whole body flexes (contracts)
• Your whole body extends (straightens out)
• Tremors (shaking)
• Your body flexes (contracts) again
• Muscles relax as the seizure ends

After

• Sleepiness
• Problems with vision
• Problems with speech
• Severe headache
• Fatigue
• Body aches

Note: Not all of these phases occur in everyone with this type of seizure.

Myoclonic Seizure

• Quick movements
• Sudden jerking of a group of muscles
• Usually occurs several times a day or for several days in a row.

If your doctor suspects epilepsy, he or she will ask about your symptoms and your health history. You’ll be asked about other factors that may have caused your seizure, such as:

• Drug or alcohol use
• A recent injury to the head
• High fever or infection
• Genetic abnormality

Other tests may be done to rule out other problems:

• Neurological Exam
• Blood Tests: To check for problems in blood sugar and other factors.
• Electroencephalogram: To test your brain's electrical activity
• Magnetic Resonance Imaging (MRI): This procedure  uses large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within your body.
• Computed Tomography (CT) Scan: A diagnostic imaging procedure that uses X-rays and computer technology to make horizontal, or axial, images (often called slices) of the body or head. CT scans show more detail than standard X-rays.
• Spinal Tap (also called Lumbar Puncture): Your doctor places a special needle into the lower back, into the area around the spinal cord. There he or she can measure the pressure in the spinal canal and brain. Your doctor will remove a small amount of cerebral spinal fluid (CSF) and test it for an infection or other problems.

The goal of epilepsy treatment is to control, stop or reduce how often seizures occur. This is usually done with medicine, but the type of medicine will depend on the type of seizure – as well as a number of other factors. While you are taking medicine, you may need tests to see how well the medicine is working. You may have:

• Blood Tests: You may need blood tests often to check the level of medicine in your body and its effects on your other organs. Based on this level, your health care provider may change the dose.
• Urine Tests: Your urine may be tested to see how your body is reacting to the medicine.
• Electroencephalogram (EEG): An EEG is a procedure that records the brain's electrical activity by attaching electrodes to your scalp. This test is done to see how medicine is helping the electrical problems in your brain.

If medicine doesn’t work well enough for you, your health care provider may advise other types of treatment, such as:

• Vagus Nerve Stimulation (VNS): This treatment uses a small, implanted battery to send small pulses of energy to the brain from one of the vagus nerves, a pair of large nerves in the neck. The battery is programmed to send energy impulses every few minutes to the brain. When you feel a seizure coming on, you may activate the impulses by holding a small magnet over the battery. In many cases, this will help to stop the seizure. VNS can have side effects such as hoarse voice, pain in the throat, or change in voice.
• Surgery: Surgery may be an option if your seizures are hard to control and always start in one part of the brain that doesn’t affect speech, memory, or vision. In this case, surgery may be done to remove the part of your brain where the seizures are occurring or to help stop the spread of bad electrical currents through your brain. Surgery for epilepsy seizures is very complex and is done by a specialized surgical team. Because the brain does not feel pain, and being awake and able to follow commands allows your surgeons to better check different areas of your brain during the procedure, you may be awake during the surgery.