Epilepsy
There are many different types of seizures, many kinds of epilepsy, and many epilepsy syndromes.1 In the US, more than 3.4 million people have active epilepsy: 3 million adults and 470,000 children.2
In the US, at least 150,000 people are diagnosed every year; one in 26 people will develop epilepsy.3
A diagnosis of epilepsy can make life challenging. Even when seizures are controlled by medication, people with epilepsy can still be at risk for breakthrough seizures.4 People who have occasional seizures risk significant consequences, including:
- Immediate suspension of driving privileges5
- A high risk of seizure-related injuries and emergency room visits4,6
- Status epilepticus, a dangerously prolonged seizure which can be life-threatening1
- SUDEP, or Sudden Unexpected Death in Epilepsy. In neurology, SUDEP is second only to stroke as a cause of total years of potential life lost4,7,8
Despite these challenges, people with epilepsy have jobs in all walks of life, have made important achievements, and, with the right treatment, can thrive.
Epilepsy Symptoms
People with epilepsy have seizures that are not caused by a known event, such as a traumatic brain injury or a high fever.1 Seizures and symptoms vary widely, depending on the type of epilepsy. Seizures may:1
- Come with convulsions
- Involve a lapse of awareness and staring
- Involve loss of consciousness
- Happen infrequently
- Happen hundreds of times a day
- Seem dreamlike to the person having them
- Involve automatisms, such as blinking, twitching, moving one’s mouth, or walking in circles
- Cause sudden loss of muscle tone, causing one to fall or drop one’s head
Some people with epilepsy experience an aura, a prodrome, or a warning that a seizure is coming, while others do not.1
Diagnosis
Epilepsy is diagnosed when a person has at least two unprovoked seizures (with no known cause), at least 24 hours apart.1
Beyond that, tests may be used to determine the type of seizures or to rule out other disorders, including:1
- An electroencephalogram (EEG)
- Video monitoring during EEG
- A magnetoencephalogram (MEG)
- Brain scans, including
- CT (computed tomography)
- MRI (magnetic resonance imaging)
- PET (positron emission tomography)
- Single photon emission computed tomography (SPECT)
Treatment
It is important to get seizures under control as quickly as possible.1 Neurologists and epileptologists look for a treatment that delivers powerful efficacy with the fewest side effects.
Many different antiseizure medications (ASMs) are available, targeting many different channels and receptors in the brain, and including both presynaptic and postsynaptic neurons.8 Other treatment options may include:1
- Diet
- Devices
- Surgery
ASMs may be taken alone or in combination, depending on the type of epilepsy and how it responds to treatment.1 Some people whose seizures have been controlled for long periods of time without a breakthrough seizure may be able to taper off of their medications while under their doctor’s supervision.1
Learn about our epilepsy treatment for convulsive seizures and focal seizures.
When beginning treatment for epilepsy, patients should be sure to communicate frequently with their treatment teams for best results.
References:
- National Institute of Neurological Disorders and Stroke. Health Information: Epilepsy and Seizures. Accessed April 11, 2023. https://www.ninds.nih.gov/health-information/disorders/epilepsy-and-seizures#.
- Centers for Disease Control and Prevention. Epilepsy: Epilepsy Data and Statistics. Accessed April 11, 2023. https://www.cdc.gov/epilepsy/data/index.html.
- Sirven, JI. Epilepsy: A Spectrum Disorder. Cold Spring Harb Perspect Med 2015;5:a022848.
- Bonnett LJ, Powell GA, Tudur Smith C, Marson AG. Breakthrough seizures—further analysis of the standard versus new antiepileptic drugs (SANAD) study. PLoS One. 2017;12(12):1–16.
- Koubeissi, MZ, Azar NJ. Epilepsy Board Review: A Comprehensive Guide. Springer Nature; 2017.
- Manjunath R, Paradis PE, Parisé H, Lafeuille MH, Bowers B, Duh MS, Lefebvre P, Faught E. Burden of uncontrolled epilepsy in patients requiring an emergency room visit or hospitalization. Neurology. 2012 Oct 30;79(18):1908-16. doi: 10.1212/WNL.0b013e318271f77e. Epub 2012 Oct 17. PMID: 23077014.
- Devinsky O, Hesdorffer DC, Thurman DJ, et al. Sudden unexpected death in epilepsy: epidemiology, mechanisms, and prevention. Lancet Neurol. 2016;15(10):1075-88.
- Devinsky O, Spruill T, Thurman D, et al. Recognizing and preventing epilepsy-related mortality: A call for action. Neurology. 2016;86(8):779-786.
- Hakami T. Neuropharmacology of Antiseizure Drugs. Neuropsychopharmacol Rep. 2021 Sep;41(3):336-351. doi: 10.1002/npr2.12196. Epub 2021 Jul 23. PMID: 34296824; PMCID: PMC8411307.
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