Epilepsy

Signs and Symptoms

Seizures or convulsions are a symptom of epilepsy, but not everyone who has seizures has epilepsy. Most patients with epilepsy have more than one type of seizure. To understand epilepsy, it's useful first to understand the types of seizures that may occur.

The two categories of seizures are generalized and partial. Partial seizures also are known as local or focal seizures. Generalized seizures result from electrical impulses arising from the entire brain. Partial seizures begin from activity in a smaller part of the brain. The part of the brain where a seizure is triggered is called the seizure focus.

Generalized seizures typically occur with no warning. There are six types of generalized seizures.

• Tonic-clonic ("grand-mal" seizure) -- You lose consciousness and often collapse. Your body becomes stiff and then begins jerking. Finally, you fall into a deep sleep. During grand-mal seizures, injuries such as tongue-biting can occur, or you can lose bladder control.

• Absence seizure ("petit mal" seizure) -- You lose awareness and stare blankly for a few seconds. Usually, there are no other symptoms. These seizures may occur several times a day.

• Myoclonic seizure -- Your body may jerk, as if being shocked by electricity. The jerks can range from a single muscle jerking to involvement of the entire body.

• Clonic seizure -- Both sides of your body jerk rhythmically at the same time.

• Tonic seizure -- Your muscles suddenly become very stiff.

• Atonic or akinetic seizure -- This causes your muscles to relax, particularly in the arms and legs, which can cause you to suddenly fall. It frequently causes injuries, such as facial cuts.

Partial seizures are divided into simple, complex and those seizures that evolve from partial-onset into generalized tonic-clonic seizures. The difference between simple and complex seizures is that during simple partial seizures, you retain awareness. During complex partial seizures, you lose awareness.

• Simple partial seizure -- You may experience movements such as jerking or stiffening, various sensations, peculiar memories such as a feeling of "deja-vu" or various emotions. Full consciousness is retained.

• Complex partial seizure -- Same as above except that your awareness is impaired and you may appear to be "out of touch" or "spaced out." You also may involuntarily chew, walk, fidget, or perform other repetitive movements or simple actions.

• Secondarily generalized seizure -- If a partial seizure evolves into a tonic-clonic ("grand mal") seizure, it's known as a secondarily generalized seizure.

Diagnosis

During your visit to the Epilepsy Center, our team of doctors and other medical professionals will work to precisely diagnose your medical condition. Your neurologist will determine the type of seizures you're having and the cause and type of epilepsy you have. This information will help determine the best treatment plan for you.

Our staff will ask you about your medical history, as well as your immediate family's medical history. We will ask many questions about your seizures. If you have lost consciousness during your seizures, please bring a family member or friend to your evaluation who might help describe what happens during your seizures. Some of the questions you can expect include:

• How old were you when your seizures began?
• What was happening around you when you had your first seizure?
• Does it seem like anything in particular triggers your seizures?
• What do you experience during your seizures?
• What do observers notice when you have your seizures?
• How long do the seizures last?
• How frequently do they occur?
• What treatments have you received for your seizures and what were the results of these treatments?

If your primary care doctor has sent your previous medical records, we will review this information. Be sure to tell your neurologist about any medications you are currently using, including over-the-counter medications, vitamins, nutritional supplements or herbal remedies.

You will receive a complete neurological examination. This evaluation may include scheduling you for certain tests, such as blood or urine tests; an electroencephalogram (EEG), which measures electrical activity in your brain; an electrocardiogram (ECG), which measures heart activity; imaging tests such as X-rays, magnetic resonance imaging (MRI) or computed tomography (CT) scans; and other procedures.

Treatment

Most seizures can be prevented with medication. The type of medication you receive will depend on many factors. Your neurologist will explain how to take your medication and what side effects might occur. Over time, your medication regimen may be changed during additional visits to your neurologist. Be sure to take your medication exactly as directed, and call your neurologist if you have questions or are having unexpected side effects.

In some cases, surgery may be recommended. Your neurologist will explain how surgery may help you, as well as the possible risks and complications of the surgical procedure.

Surgical procedures may be considered to prevent seizures or to implant devices that deliver medications or stimulators to emit electrical impulses. These procedures include:

• Focal resections -- The removal of a small area of the brain where seizures originate. This procedure often results in complete seizure control.

• Vagus nerve stimulation -- This procedure involves minor surgery and is a relatively new treatment that helps prevent or lessen the severity of seizures. An electrical stimulator is placed beneath the skin of the upper chest. The stimulator, which emits electrical impulses, is connected to an electrode that is attached to a nerve in the neck through a small incision. A patient with a vagus nerve stimulator continues to take medication but sometimes can reduce the amount or number of medications.

Your neurology team at the Epilepsy Center, along with your primary care physician, will design a treatment plan tailored to your medical condition, state of health and individual needs. You may need more than one kind of treatment, or treatment requiring several visits to UCSF Medical Center. You also may be referred to additional doctors or other medical professionals.

Most medical treatments can involve some risks or complications. Your neurologist will explain any possible risks or complications from the treatments you'll receive. Don't be afraid to ask your doctors, nurses or therapists about your treatment. If your treatment includes medication, be sure to take it exactly as the doctor has ordered. And remember to keep all your follow-up appointments with our doctors and other medical staff.

Prevention and follow-up

To help cope with epilepsy and reduce your chance of injury from seizures, we recommend these guidelines:

• Carry identification, including a bracelet, card or necklace that shows you have epilepsy. In an emergency, this information can ensure that you receive the right care.

• Explain to your family, friends and co-workers how to care for you if you have a seizure.

• Follow your state regulations about driving motor vehicles.

• If you are having regular or even occasional seizures, avoid dangerous situations at work and during leisure activities. For example, do not work in high places, on ladders or scaffolding, or near sharp or moving objects. Be careful when you play sports. Don't swim or go mountain climbing by yourself.

• Don't stop taking your seizure medication or change the amount you take unless you discuss this with your doctor.

• Talk with your doctor or pharmacist before you take other medications in addition to your seizure drugs.

If you are pregnant or are thinking of becoming pregnant and you have been diagnosed with epilepsy, talk to your neurologist as soon as possible. You may need to take vitamin supplements to protect your baby.