Epilepsy & Seizure Treatment

Generalized seizures affect both sides of the brain and usually result in loss of consciousness and may produce jerking muscle spasms, body rigidity, tremors, falling, weakness, limpness and nonresponsive behavior.

The types of generalized seizures are:

• Petit mal or absence seizures are most common in children. They typically last 5-10 seconds and involve a nonresponsive stare and subtle abnormal movements.
• Tonic seizures involve sudden stiffness in your extremities, often during sleep.
• Atonic seizures cause loss of muscle control that can make you collapse.
• Clonic seizures are characterized by repetitious jerking movements of your arms and legs and can include numbness and tingling sensations.
• Myoclonic seizures produce brief, rapid muscle twitches that usually last only a few seconds.
• Tonic-clonic or grand mal seizures are the most severe type of generalized seizures. Body stiffness, violent shaking, a rapid loss of consciousness and loss of bladder control are among the symptoms.

Focal seizures occur in localized regions of the brain and may or may not result in loss of consciousness or impairment. Symptoms vary depending on the location where the seizure occurs. Feelings of euphoria, fear, déjà vu or changes in your sense of smell or hearing often happen before the onset of a focal seizure.

Focal seizure symptoms include:

• Changes in your vision
• Muscle spasms
• Nausea
• Uncontrollable laughing, crying or yelling
• Difficulty swallowing
  
  

Recurring focal seizure are the most common type of seizure experienced by epilepsy patients. Epilepsy seizure symptoms can include confusion, convulsions, loss of consciousness and other neurological symptoms. You may stare into space, fall, shake and lose awareness of what’s going on around you.

While epilepsy seizures occur randomly, drug and alcohol use, stress, insomnia and strobe or flashing lights are known to trigger them.

Most people are diagnosed with epilepsy while being treated at a hospital for a seizure. A hospital neurologist will perform a physical evaluation, review your medical history to understand your risk factors for epilepsy and seizures and order tests. If they determine you need to be treated for epilepsy, they will prescribe you anti-seizure medications and refer you to a neurologist for follow-up care.

Other people are diagnosed with epilepsy before every being hospitalized after seeking treatment for seizures or other symptoms. In this instance, your primary care provider may refer you to a general neurologist or an epileptologist, which is a neurologist who specializes in diagnosing and treating epilepsy.

Whether you’ve been admitted to a hospital or are visiting an outpatient clinic, a physician will examine you, review your medical history and ask you what happens when you experience a seizure. They may order blood tests, an MRI or CT scan, an electroencephalogram (EEG) to measure your brain waves and other tests.

They may also recommend you be admitted to an epilepsy monitoring unit (EMU). This can be particularly helpful if you are unable to describe what happens during your seizures.

An Epilepsy Monitoring Unit is a specialized hospital unit that observes patients who have known or suspected seizures. During your stay, which typically lasts 3 to 5 days, you’ll be monitored via an EEG and other advanced diagnostic equipment and videotaped. The data collected can reveal where in the brain your seizures originate, which can help your epilepsy care team design a personalized and holistic care plan.

Novant Health operates EMUs at all three of its epilepsy centers

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As part of your evaluation, a neurologist may reduce the dosage of your anti-seizure medication to induce a seizure so they can observe your symptoms and learn where in the brain the seizure occurs. In rare cases, this can cause status epilepticus, a prolonged seizure lasting 5-10 minutes or longer.

These seizures can be life threatening if not treated with medication, which is why we only induce seizures at EMUs where you are being monitored 24/7 by a specially trained team .

There is also a risk that you may also experience temporary itching, redness or hair loss from the glue used to secure testing equipment electrodes to your skin.

Anti-seizure medication is commonly used for the treatment of seizures and epilepsy. These drugs effectively manage attacks in roughly two-thirds of people diagnosed with epilepsy. In fact, if you are responding well to your medications, you may be able to rely on your primary care provider to manage your seizures. If not, your primary care provider may refer you to a neurologist.

Surgery may be recommended if you have focal seizures that are not responding to medication. If you are a good candidate for surgery and your care team can determine the focal point of your seizures, a neurosurgeon may be able to remove it. This may eliminate the need for medication or improve how well they work.

If you are ineligible for surgery, you may be a good candidate for nerve stimulation via an implantable device. The options here include:

• Vagus Nerve Stimulator: This pacemaker-like device is placed in the chest and sends intermittent signals to the brain to help reduce seizures.
• NeuroPace: This responsive stimulation therapy is our- our newest treatment option for epilepsy. It involves placing electrodes at the site of your seizures and attaching them to a stimulator device placed in the skull. The device detects seizures as they are beginning and stimulates the electrodes to prevent it from progressing.

If medications are not helping control your seizures or you want to avoid taking medications, your doctor may recommend a high-fat, low-carbohydrate diet. This involves carefully measuring your food and restricting your daily carbohydrate consumption with the help of a dietician.

The ketogenic diet, which restricts carb intake to 20 mg a day, has been found to lower seizures in many children with epilepsy who don’t respond to medications. It is rarely prescribed for adults, however, because it is so restrictive and hard to follow.