Diagnosis

Pediatric epilepsy consultation Pediatric epilepsy consultation

To diagnose your condition, your doctor will review your symptoms and medical history. Your doctor may order several tests to diagnose epilepsy and determine the cause of seizures.

  • Neurological examination. Your doctor may test your behavior, motor abilities, mental function and other areas to diagnose your condition and determine the type of epilepsy you may have.
  • Blood tests. Your doctor may take a blood sample to check for signs of infections, genetic conditions or other conditions that may be associated with seizures.

Your doctor may also suggest tests to detect brain abnormalities, such as:

Treatment

Doctors generally begin by treating epilepsy with medication. If medications don't treat the condition, doctors may propose surgery or another type of treatment.

Medication

Most people with epilepsy can become seizure-free by taking one anti-seizure medication, called anti-epileptic medication. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications. Your doctor will advise you about the appropriate time to stop taking medications.

More than half the children with epilepsy who aren't experiencing epilepsy symptoms can eventually discontinue medications and live a seizure-free life. Many adults also can discontinue medications after two or more years without seizures.

Finding the right medication and dosage can be complex. Your doctor will consider your condition, frequency of seizures, your age and other factors when choosing which medication to prescribe. Your doctor will also review any other medications you may be taking, to ensure the anti-epileptic medications won't interact with them.

Your doctor likely will first prescribe a single medication at a relatively low dosage and may increase the dosage gradually until your seizures are well-controlled.

Anti-seizure medications may have some side effects. Mild side effects include:

  • Fatigue
  • Dizziness
  • Weight gain
  • Loss of bone density
  • Skin rashes
  • Loss of coordination
  • Speech problems
  • Memory and thinking problems

More severe but rare side effects include:

  • Depression
  • Suicidal thoughts and behaviors
  • Severe rash
  • Inflammation of certain organs, such as your liver

To achieve the best seizure control possible with medication, follow these steps:

  • Take medications exactly as prescribed.
  • Always call your doctor before switching to a generic version of your medication or taking other prescription medications, over-the-counter drugs or herbal remedies.
  • Never stop taking your medication without talking to your doctor.
  • Notify your doctor immediately if you notice new or increased feelings of depression, suicidal thoughts, or unusual changes in your mood or behaviors.
  • Tell your doctor if you have migraines. Doctors may prescribe one of the anti-epileptic medications that can prevent your migraines and treat epilepsy.

At least half of all people newly diagnosed with epilepsy will become seizure-free with their first medication. If anti-epileptic medications don't provide satisfactory results, your doctor may suggest surgery or other therapies. You'll have regular follow-up appointments with your doctor to evaluate your condition and medications.

Surgery

Epilepsy surgery Epilepsy surgery

Surgery is most commonly done when tests show that your seizures originate in a small, well-defined area of your brain that doesn't interfere with vital functions such as speech, language, motor function, vision or hearing. In surgery, your doctor removes the area of your brain that's causing the seizures.

If your seizures originate in an area of the brain that controls movement, speech and other functions, you may be awake during part of the surgery. Doctors will monitor you and ask you questions during the procedure.

If your seizures originate in a part of your brain that can't be removed, your doctor may recommend a different type of surgery in which surgeons make several cuts in your brain (multiple subpial transection). These cuts are designed to prevent seizures from spreading to other parts of your brain.

Although many people continue to need some medication to help prevent seizures after successful surgery, you may be able to take fewer drugs and reduce your dosages.

In a small number of cases, surgery for epilepsy can cause complications such as permanently altering your thinking (cognitive) abilities. Talk to your surgeon about his or her experience, success rates and complication rates with the procedure you're considering.

Therapies

  • Vagus nerve stimulation. In vagus nerve stimulation, doctors implant a device called a vagus nerve stimulator underneath the skin of your chest, similar to a heart pacemaker. Wires from the stimulator are connected to the vagus nerve in your neck.

    The battery-powered device sends bursts of electrical energy through the vagus nerve and to your brain. It's not clear how this inhibits seizures, but the device can usually reduce seizures by 20 to 40 percent.

    Most people still need to take anti-epileptic medication, although some people may be able to lower their medication dose. You may experience side effects from vagus nerve stimulation, such as throat pain, hoarse voice, shortness of breath or coughing.

  • Ketogenic diet. Some children with epilepsy have been able to reduce their seizures by following a strict diet that's high in fats and low in carbohydrates.

    In this diet, called a ketogenic diet, the body breaks down fats instead of carbohydrates for energy. After a few years, some children may be able to stop the ketogenic diet and remain seizure-free.

    Consult a doctor if you or your child is considering a ketogenic diet. It's important to make sure that your child doesn't become malnourished when following the diet.

    Side effects of a ketogenic diet may include dehydration, constipation, slowed growth because of nutritional deficiencies and buildup of uric acid in the blood, which can cause kidney stones. These side effects are uncommon if the diet is properly and medically supervised.

Potential future treatments

Researchers are studying deep brain stimulation as a potential treatment for epilepsy. In deep brain stimulation, surgeons implant electrodes into a specific part of your brain. The electrodes are connected to a generator implanted in your chest or the skull that sends electrical pulses to your brain and may reduce your seizures.

Implantable, pacemaker-like devices that help prevent seizures are also under investigation. These responsive stimulation or "closed loop" devices analyze brain activity patterns to detect seizures before they happen and deliver an electrical charge or drug to stop the seizure.

Pacemaker for epilepsy

In addition, new minimally invasive surgical techniques, such as MRI-guided laser ablation, show promise at reducing seizures with fewer risks than traditional open brain surgery for epilepsy.

Researchers are also studying stereotactic radiosurgery as a potential treatment for some types of epilepsy. In this procedure, doctors direct radiation at the specific area of your brain that is causing your seizure.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

Understanding your condition can help you control it.

  • Take your medication correctly. Don't adjust your dosage before talking to your doctor. If you feel your medication should be changed, discuss it with your doctor.
  • Get enough sleep. Lack of sleep can trigger seizures. Be sure to get adequate rest every night.
  • Wear a medical alert bracelet. This will help emergency personnel know how to treat you correctly.
  • Exercise. Exercising may help keep you physically healthy and reduce depression. Make sure to drink enough water and rest if you get tired during exercise.

In addition, make healthy life choices, such as managing stress, limiting alcoholic beverages and avoiding cigarettes.

Coping and support

Uncontrolled seizures and their effect on your life may at times feel overwhelming or lead to depression. It's important not to let epilepsy hold you back. You can still live an active, full life. To help cope:

  • Educate yourself and your friends and family about epilepsy so that they understand the condition.
  • Try to ignore negative reactions from people. It helps to learn about epilepsy so that you know the facts as opposed to misconceptions about the disease. And try to keep your sense of humor.
  • Live as independently as possible. Continue to work, if possible. If you can't drive because of your seizures, investigate public transportation options near you. If you aren't allowed to drive, you may want to consider moving to a city with good public transportation options.
  • Find a doctor you like and with whom you feel comfortable.
  • Try not to constantly worry about having a seizure.
  • Find an epilepsy support group to meet people who understand what you're going through.

If your seizures are so severe that you can't work outside your home, there are still ways to feel productive and connected to people. You may consider working from home.

Let people you work and live with know the correct way to handle a seizure in case they are with you when you have one. You may offer them suggestions, such as:

  • Carefully roll the person onto one side.
  • Place something soft under his or her head.
  • Loosen tight neckwear.
  • Don't try to put your fingers or anything else in the person's mouth. No one has ever "swallowed" his or her tongue during a seizure — it's physically impossible.
  • Don't try to restrain someone having a seizure.
  • If the person is moving, clear away dangerous objects.
  • Stay with the person until medical personnel arrive.
  • Observe the person closely so that you can provide details on what happened.
  • Time the seizures.
  • Be calm during the seizures.

Preparing for your appointment

You're likely to start by seeing your family doctor or a general practitioner. However, in some cases when you call to set up an appointment, you may be referred immediately to a specialist, such as a doctor trained in brain and nervous system conditions (neurologist) or a neurologist trained in epilepsy (epileptologist).

Because appointments can be brief, and because there's often a lot to talk about, it's a good idea to be well-prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

  • Keep a detailed seizure calendar. Each time a seizure occurs, write down the time, the type of seizure you experienced and how long it lasted. Also make note of any circumstances, such as missed medications, sleep deprivation, increased stress, menstruation or other events that might trigger seizure activity.

    Seek input from people who may observe your seizures, including family, friends and co-workers, so that you can record information you may not know.

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements that you're taking.
  • Take a family member or friend along. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.

    Also, because you may not be aware of everything that happens when you're having a seizure, your doctor may want to ask questions of someone who has witnessed them.

  • Write down questions to ask your doctor.

Preparing a list of questions will help you make the most of your time with your doctor. List your questions from most important to least important in case time runs out. For epilepsy, some basic questions to ask your doctor include:

  • What is likely causing my seizures?
  • What kinds of tests do I need?
  • Is my epilepsy likely temporary or chronic?
  • What is the best course of action?
  • What are the alternatives to the primary approach that you're suggesting?
  • How can I ensure that I don't hurt myself if I have another seizure?
  • I have these other health conditions. How can I best manage them together?
  • Are there any restrictions that I need to follow?
  • Should I see a specialist? What will that cost, and will my insurance cover it?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions:

  • When did you first begin experiencing seizures?
  • Do your seizures seem to be triggered by certain events or conditions?
  • Do you have similar sensations just before the onset of a seizure?
  • Have your seizures been frequent or occasional?
  • What symptoms do you have when you experience a seizure?
  • What, if anything, seems to improve your seizures?
  • What, if anything, appears to worsen your seizures?

What you can do in the meantime

Certain conditions and activities can trigger seizures, so it may be helpful to:

  • Avoid excessive alcohol consumption
  • Avoid nicotine usage
  • Get enough sleep
  • Reduce stress

Also, it's important to start keeping a log of your seizures before you visit your doctor.

Epilepsy care at Mayo Clinic

Aug. 12, 2017
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