Gerald Dove, MD is a Board Certified Neurologist with Noran Neurological Clinic. He is additionally certified in Clinical Neurophysiology and Epilepsy. He has undergone further training and certification, enabling him to perform EMG’s for both his own patients and for other providers’ patients when ordered, and is also trained to read and interpret electroncephalograms, or EEG’s. In this Question and Answer session, Dr. Dove answers some common questions about epilepsy and seizure.
Q. What is Epilepsy? What is the difference between epilepsy and seizures?
A. A seizure is what happens when the brain has abnormal electrical activity leading to a sudden change in a person’s behavior or experience. On the other hand, the term Epilepsy is used to describe a condition where a person has a tendency for recurrent seizures, which cannot be easily fixed. I will try to illustrate with an example; Low glucose (hypoglycemia) can cause seizures. If someone experiences a seizure due to low glucose, they do not necessarily have epilepsy. In this case the seizure occurred due to low glucose and if they avoid low glucose, they will never experience a seizure. On the other hand, someone with epilepsy will experience seizures, even if their glucose was normal or other provoking factors were eliminated.
Q. Is it possible to have seizures and not have epilepsy?
A. The answer is yes. The term epilepsy implies an innate tendency to experience seizures. Seizure, on the other hand, means a sudden change in a person’s behavior or experience due to abnormal electrical discharge in the brain. So if you experience a seizure (or multiple seizures), without having an innate tendency to have them, you don’t have epilepsy, despite the seizures. Situations that can lead to seizures that may not be due to epilepsy include alcohol withdrawal; illicit drug usage; some prescribed medications some anti depressant medications, some antibiotics, some antipsychotic medications and some metabolic disorders including low glucose, low calcium, low magnesium. In these situations, the seizures are provoked or brought on by the change due to these factors. If these factors are eliminated, a seizure does not occur.
Q. What causes epilepsy?
A. There are many causes of epilepsy. Some kinds of epilepsy are genetic (or hereditary), but more commonly, epilepsy is acquired. In many cases (up to 50%), there is no identified cause.
The causes of epilepsy vary in different age groups. For patients who have epilepsy for the first time under age 25, this can be due to genetic factors, perinatal factors such as hypoxia at birth, metabolic disorders, brain infections such as meningitis and encephalitis, from febrile convulsions at an earlier age, and brain trauma.
For patients above age 50 who experience epilepsy for the first time, some of the more common causes include stroke, dementia, brain tumors, brain infections, and other inflammatory disorders.
Patients in the age range of 25-50 years tend to be the least likely to experience epilepsy for the first time. Though rarer in this age group, epilepsy can still occur due to the same causes in those who are less than 25 and older than 50 age groups. Other causes of epilepsy considered more common in this group would include brain toxicity from drugs and alcohol.
Q. How is epilepsy Diagnosed?
A. In order to diagnose epilepsy, you need to visit with a Neurologist or an Epileptologist. A neurologist is a doctor who specializes in treating disorders of the brain , spinal cord and nerves. An Epileptologist is a neurologist who specializes in epilepsy.
At the visit with the Neurologist or Epileptologist, the doctor will perform a history which would include questions about seizures, risk for epilepsy and family history. The doctor will also perform a neurologic examination and will request tests which include an EEG, a brain MRI and some blood tests. The diagnosis of epilepsy is made after information gathered through this means is analyzed.
Q. How is epilepsy treated?
A. There are a number of approaches to treating epilepsy. The first approach is by medications, also called anti epileptic drugs (AED). There are about 25 medications on the market for treatment of epilepsy. Some are effective for the different types of epilepsy, whereas others may have side effects that are not attractive in some populations, so the decision to choose a specific AED is dependent on various factors.
Brain surgery is another option for treating some kinds of epilepsy, when AED medications are not effective. This is not for everyone.
Diets including the Ketogenic diet, modified Adkin’s diet and Adkin’s diet have been proven to be of added benefit, when medications alone have not been effective in controlling seizures.
There are also devices such as the Vagus Nerve Stimulator (VNS), Deep Brain Stimulator and the RNS neurostimulator that help reduce seizures, in conjunction with AED.
Q. Many people think of seizure and imagine a loss of consciousness and uncontrollable, violent body movements. Is this common, and are there other types of epileptic seizures that can happen? What do they look like?
A. This question can be best answered by remembering the basic premise, that “a seizure is what happens when the brain has abnormal electrical activity”. Building from our knowledge that the brain has multiple, varied, protean functions, it is not difficult to imagine that abnormal electrical activity in different parts of the brain will have different manifestations. Some seizures occur when this abnormal electrical activity is generalized . These are called generalized epileptic seizures. There are other seizures that occur when this electrical activity is limited to a small (or focal) part of the brain . These are called focal (or partial) epileptic seizures. As you can imagine the manifestations will be very different in these situations. Thus it follows that there are different manifestations of seizures.
Some of the manifestations of generalized epileptic seizures include absence seizures (or the so called ‘petit mal’ seizures). These manifest as a brief staring episode, without any other manifestation. Myoclonic seizures are another example of generalized seizures which manifest as a brief jerk of an arm, leg or whole body without loss of consciousness. We are all aware of ‘grand mal’ seizures (better called generalized tonic clonic seizures), which manifests as loss of consciousness and uncontrollable violent body movements. Other seizure types in this broad category of generalized epileptic seizures include tonic seizures (where there is sudden brief increased muscle tone), atonic seizures (where there is loss of muscle tone, sometimes with falls) and clonic seizures.
Focal epileptic seizures have varied manifestations , depending on the part of the brain that is involved. These can range in severity from brief subjective experiences without loss of awareness or responsiveness (also called simple partial seizure or ‘aura’) to more those associated with loss of consciousness (also called complex partial seizure). Sometimes the focal epileptic seizure can progress to a generalized tonic clonic seizure. Some manifestations of focal epileptic seizures can include smell sensation, visual hallucination, hearing a noise, ‘déjà vu’ feeling or some other manifestation.
Q. Does it hurt to have a seizure?
A. There are different types of seizure manifestations. Minor or small seizures such as simple partial seizures or absence (‘petit mal’) seizures do not cause any pain. On the other hand, there can be effects of generalized tonic clonic seizures (also called “ Grand Mal Seizures’) that can be painful. These effects can be simplistically divided into direct effects of the seizure and indirect effects of the seizure. Direct effects that are associated with pain include biting the tongue, a dislocation of the shoulder, a rib fracture, vertebrae fracture, muscle aches or headaches. Indirect effects occur as a result of a fall during a seizure and these can include a skin laceration or a skull fracture.
Q. Are there certain triggers that a person with epilepsy should be certain to avoid?
A. There are some triggers for epilepsy. Some of these triggers are specific to different types of epilepsy. Thus, it is important that you identify the kind of epilepsy you have, and then you can be educated about which triggers to avoid. In general, situations such as alcohol withdrawal, alcohol intoxication, hypoglycemia (low glucose), illicit or some prescribed drug intoxication or use, sleep deprivation, and hormonal changes such as menstrual cycle can trigger seizures in some patients with epilepsy.
Beyond these more ‘general’ triggers, there are also some more specific triggers for certain defined epilepsy types. I must stress that these don’t apply to the overwhelming majority of patients with epilepsy. These types of epilepsy which are relatively rare, the so called ‘reflex epilepsies’, can have specific triggers, such as strobe or flashing lights, hot water, reading a book, and specific foods, such as milk, etc. It is again, important to note these are very rare and don’t apply to most patients with epilepsy.
Q. What should I do if I or someone I love may be experiencing seizures?
A. First and foremost, don’t panic. Look for a neurology clinic or epilepsy clinic in your area. Call and make an appointment to see a neurologist or epileptologist. A neurologist is a doctor that specializes in treating diseases of the brain, spinal cord and nerves. An epileptologist is a neurologist, that specializes in epilepsy. Obviously, it is preferred that you see an epileptologist, but there may be situations where none is available where you live, so you can see a neurologist. Most neurologists have some expertise in managing epilepsy.
Q. Are there conditions that are often related to or often occur alongside epilepsy?
A. Yes there are. These conditions can be simplistically divided into two groups; those conditions that can cause epilepsy to occur with epilepsy, and those that can be caused by epilepsy or the treatment of epilepsy.
Some conditions or disorders that can cause epilepsy include some genetic or hereditary disorders, brain tumors, brain infections, strokes, and dementia. The second group of conditions include depression, other mood disorders, memory loss, reduced fertility, and osteoporosis.
Q. Are there any other questions about epilepsy and seizures you often hear from people?
A. What restrictions do I have when I have epilepsy?
- Do not drive for 3 months after a seizure that is associated with loss of consciousness or loss of motor control
- Do not climb heights unattended
- Do not climb a ladder more than 2 feet in height unattended.
- Do not swim unattended
- Do not lift weights, such as in bench pressing, unattended
Is Epilepsy infectious or contagious?
Thank you Dr. Dove for providing us with some great information!
To learn more about Dr. Gerald Dove and how he works with his patients, visit his video bio at: http://www.noranclinic.com/providers/gerald_dove.html
If you have additional questions about epilepsy or seizure and would like to schedule an appointment with a neurologist experienced in the management of this condition, please contact Noran Neurological Clinic at 612-879-1500.