Epilepsy and Seizures

Seizures come in many different forms and vary widely in their intensity, duration and characteristics. Some of the most common kinds of seizure include:

• Absence Seizure: Characteristics include rapidly moving the eyes, arms and legs, as well as repeated blinking and staring. Another name for this kind of seizure is Petit Mal.
  
• Atonic Seizure: The patient temporarily loses muscle strength and becomes limp. Often the patient will fall down or drop the head and become unconscious. Another name for Atonic Seizure is Drop Attack.
  
• Catamenial Seizure: Includes muscle jerks, shaking and loss of consciousness in connection with a woman's menstrual cycle.
  
• Febrile Seizure: Occurs in infants and young children after a sudden rise in body temperature. Symptoms include breathing problems, restlessness, unconsciousness, shaking, rigidity and backward eye-rolling.
  
• Grand Mal Seizure: Grand Mal seizures occur in stages. The first stage, Tonic, is marked by muscle flexing, straightening and shaking. In the Clonic stage, muscle jerks alternate with relaxation. These stages are often followed by a Postical period, in which the patient experiences fatigue, speech and vision problems, body aches, headache and other symptoms. Another name for Grand Mal seizure is Generalized Tonic Clonic (GTC) seizure.
  
• Myoclonic Seizure: Characterized by sudden repeated jerking movement of specific muscle groups, this kind of seizure may happen over the course of a day or several days.
  
• Partial (or Focal) Seizure: These are confined to a particular part of the brain. A Simple Focal seizure is characterized by muscle spasms, contractions alternating with relaxation and other physical symptoms. Consciousness or memory are not affected. In a Complex Focal seizure, the patient usually loses consciousness but still exhibits strange behaviors, including crying, laughing, running, gagging and smacking their lips.
  
• Temporal Lobe Seizure: Originates in the memory circuits and is characterized by short-term disruptions in muscle control, emotions or memory.
  
• Tonic Clonic Seizure: Marked by muscle spasms and unconsciousness.

Diagnosing seizures in general--and epilepsy in particular--starts with a complete physical examination and thorough review of the patient's medical history. This includes any known instances of epilepsy and seizures among the patient's family members.

If the patient recently experienced a seizure for the first time, the doctor will want to know as many details as possible about the episode, including dates, times and observations before, during and after the event. Eyewitness accounts can be very helpful. The doctor will probably also order one or more procedures to help identify possible causes of the seizure, along with the extent of any damage. Diagnostic testing for seizures might include:

• Blood tests such as a Complete Blood Count (CBC) and others.
  
• Electroencephalogram (EEG): measures electrical impulses in the brain through electrodes on the scalp.
  
• Magnetic Resonance Imaging (MRI): imaging technology that uses magnets, radio waves and computers to obtain detailed images of the brain and other organs.
  
• Computed Tomography (CT) scan: Imaging technology that uses X-rays and nuclear medicine to obtain stacked cross-sectional images of the brain and other organs.
  
• Spinal Tap (Lumbar Puncture): A diagnostic procedure that analyzes the pressure and contents of the fluid surrounding the brain and spinal column.

Treatment for epilepsy and other kinds of seizures usually focuses on minimizing future episodes, managing seizures when they occur, and controlling any factors known to trigger them. In cases where the seizure is caused by a controllable condition, like an infection or high fever, treatment focuses on solving the underlying problem and preventing future episodes.

Generally, ongoing treatment will involve medications and/or surgery. Both kinds of treatments can have complications, and it's important to balance the benefits against possible risks. For example, a child who experiences a single episode of unconfirmed seizure-like symptoms may be suffering from an isolated incident and not require treatment. At Baptist Neurology Group, we take numerous factors into account before recommending drug therapy or surgery for seizures. These factors include:

• What triggered the seizure?
  
• Is the patient's EEG normal?
  
• What is the patient's age and ability to withstand anti-seizure medications or surgery?
  
• Has the patient experienced seizures before? How many? When?
  
• Do other members of the patient's family have Epilepsy or seizures?
  
• Is there any other neurological impairment?

The goal of medical therapy for seizures is to prevent the episodes from occurring or to reduce their severity and frequency. There are many medication choices available. Most are classified as anticonvulsant or antiepileptic and can be taken orally. Many can be given intravenously if the patient is in the hospital.

Some anti-seizure medications are used for specific types of seizures, others are used more generally. Each has its own list of side effects, including unsteadiness, rashes, liver problems and changes in mood. Because most side effects are dosage-related, it may be necessary to adjust the dosage and frequency of any new drug until side effects are minimized without sacrificing effectiveness.

Some of the most common drugs used to control epileptic and other types of seizures include:

When medications alone cannot control a patient's seizures, a number of surgical alternatives can help. Generally, surgery is an option only when the seizures originate in a part of the brain that can be removed or deactivated without affecting normal brain and neurological functioning.

Because Baptist Neurology Group is integrated into the Baptist Health system, we partner with Lyerly Neurosurgery, another Baptist Health affiliate, to coordinate care when a surgical option makes sense. Some surgical procedures to control epileptic and other seizures include:

• Corpus Callosotomy: This procedure severs the nerves that connect the two halves of the brain. This confines the abnormal electrical impulses that cause a seizure to one half of the brain, which reduces the severity of generalized and atonic seizures.
  
• Hemispherectomy: Performed in young children with severe seizures, this procedure removes all or part of an entire hemisphere of the brain. Because the young patient is still developing, many of the normal functions that normally occur in the removed hemisphere can be re-mapped to the remaining hemisphere.
  
• Lobectomy or Cortical Resection: Removal of all or part of the brain's left or right temporal, parietal, frontal or occipital lobe. This procedure is sometimes used for patients with Simple or Complex Partial (Focal) seizures.
  
• Multiple Sub-pial transection: This procedure is used when seizures originate in a part of the brain that cannot be removed without sacrificing important functioning. Instead of removing brain tissue, the surgeon cuts the key pathways between specific nerve cells in the brain.

Other treatment alternatives

In addition to medications and surgical procedures, neurologists have other treatments available to help control seizures. Among them:

• Vagus Nerve Stimulation (VNS): Doctors implant a small control unit which delivers electrical energy directly to the brain through a large vein in the neck. The energy helps reduce certain kinds of seizures on an ongoing basis.
  
• Ketogenic Diet: Used in children with seizures, the diet contains foods that are high in fats, which the body uses for energy.