Mayo Clinic Explains Epilepsy
Lily Wong-Kisiel, M.D., Pediatric Neurologist, Mayo Clinic:
Hi, I'm Dr. Lily Wong-Kisiel, a pediatric neurologist at Mayo Clinic. In this video, we'll cover the basics of epilepsy. What is it? Who gets it? The symptoms diagnosis and treatment. Whether you're looking for answers for yourself or someone you love, we're here to give you the best information available. First of all, epilepsy is common. Around 3 million people in the U.S. have epilepsy, making it the fourth most common neurological disease after migraine, stroke and Alzheimer's. Epilepsy happens as a result of abnormal electrical brain activity, also known as a seizure, kind of like an electrical storm inside your head. And because your brain controls so much, a lot of different things can go wrong. You may have periods of unusual behaviors, feelings and sometimes loss of awareness. There are many types of seizures, including two main categories: focal, meaning they start in a particular part of your brain, or generalized, meaning the seizures initially involve all areas of the brain. There are some myths about epilepsy we can dismiss. If you are with someone experiencing a seizure, don't put anything in their mouth. They can't actually swallow their tongue. Don't restrain them. And don't worry, epilepsy isn't contagious, so you can't catch it.
Who gets it?
Although children or older adults are more susceptible, anyone can develop epilepsy. When epilepsy is diagnosed in older adults, it's sometimes from another neurological issue, like a stroke or a brain tumor. Other causes can be related to genetic abnormalities, prior brain infection, prenatal injuries or developmental disorders. But in about half of people with epilepsy, there's no apparent cause.
What are the symptoms?
Because they happen in the brain, seizures can affect any process your brain handles. Therefore, symptoms can vary. Many individuals with epilepsy tend to have the same type of seizure each time. However, some will have more than one type. So, how do you recognize a seizure? Keep an eye out for temporary confusion, a staring spell, uncontrollable jerking, loss of consciousness, fear, anxiety or deja vu.
Let's talk about the two types of seizures again: focal and generalized. Focal seizures happen one of two ways: without loss of awareness or with impaired awareness. In those where you remain conscious, you may experience altered emotions or change in sensation like smell, sound or taste. You may also have dizziness, tingling or see flashing lights. You could also experience involuntary jerking of body parts like your arm or your leg. When you lose or have altered awareness, you can pass out or stare into space and not really respond normally. Hand rubbing, chewing, swallowing or walking in circles can happen in this kind of seizure. Because these symptoms overlap with migraine or other neurological disorders, heart problems or psychiatric conditions, tests are needed for a diagnosis. Generalized onset seizures, the ones that happen across all areas of the brain, show up in a variety of ways. Absence seizures are marked by staring absently into space. Blinking and lip smacking can also happen. Tonic seizures involve a stiffening of the back, arm and legs. The opposite of tonic seizures are atonic seizures, which result in a loss of muscle control. Instead of going stiff, everything goes slack. Clonic seizures usually affect the neck, face and arms with repeated jerking movements. Similar to clonic seizure, myoclonic seizures involve sudden brief jerks or twitches of the arms. Lastly, there are tonic-clonic seizures. Like the name suggests, these involve parts of both tonic and clonic signs. Body stiffening and shaking, loss of bladder control or biting your tongue can also happen. Knowing the kind of seizure you have is key to treatment.
How is it diagnosed?
Even after having a single seizure, sometimes the diagnosis of epilepsy can't be made. Regardless, if you do have something that seems like a first-time seizure, see a physician. Your doctor may assess your motor abilities, mental function and other areas to diagnose your condition and determine if you have epilepsy. They may also order additional diagnostic tests. They could include neurological exam, blood tests, EEG, CT scan, brain imaging and sometimes neuropsychological tests. Because your brain is such a complicated piece of machinery, neurologists, epileptologists, neurosurgeons, neuroradiologists, mental health specialists, and other professionals all work together to provide exactly the care you need.
How is it treated?
The best care starts with an accurate diagnosis. The medications we have for epilepsy are incredibly effective. More than half of the cases are seizure-free after their first medication. But when medication does not work at stopping seizures completely, there are other emerging ways of treating epilepsy, including surgery and brain stimulation. And a comprehensive level 4 epilepsy center can help find you the best way to manage your care. For patients undergoing treatment, it's important to keep a detailed seizure journal. Each time you have a seizure, write down the time, the type and how long it lasted, making note of anything out of the ordinary, like missed medication, sleep deprivation, increased stress, menstruation, or anything else that could trigger it.
Though we don't always know why people suffer from epilepsy, ongoing research continues to build our knowledge and improve treatment options. And better treatment means happier patients. If you'd like to learn even more about epilepsy, watch our other related videos or visit mayoclinic.org. We wish you well.