Epilepsy

Overview

What Is It?

An individual is considered to have epilepsy when seizures recur over a period of time without an obvious provoking reason, such as alcohol withdrawal or electrolyte imbalances in the blood.

In a healthy brain, nerve cells communicate with each other through electrical impulses that work together to control the body. But when those cells, called neurons, misfire or signal abnormally, a person can experience a number of sensations, emotions, behaviors, convulsions, muscle spasms and even loss of consciousness. Any or all of those symptoms may be seizures. If a person has more than one unprovoked seizure, she may be suffering from epilepsy. An individual is considered to have epilepsy when seizures recur over a period of time without an obvious provoking reason, such as alcohol withdrawal, low blood sugar or electrolyte imbalances in the blood.

Epilepsy can be successfully treated with antiepileptic medication or, in selected cases, surgical removal of the brain region that generates seizures. In some patients it can spontaneously disappear.

The symptoms of epilepsy are complex. A seizure can be as subtle as staring off into space for a few moments, as if daydreaming. Other types of seizures cause more dramatic symptoms, including uncontrollable movements, loss of consciousness, stiffening, jerking and loss of some bodily functions, among other symptoms. These symptoms can be as brief as a few seconds or as long as several minutes.

According to the Epilepsy Foundation and the U.S. Centers for Disease Control and Prevention (CDC), about 200,000 Americans will learn that they have epilepsy this year, and more than 3 million are currently living with the disorder. About one in 100 adults have active epilepsy, and more than one-third are not getting sufficient treatment. Men are at a slightly higher risk to develop epilepsy in childhood, but in adulthood the incidence of epilepsy is equal among men and women. The CDC estimates that this neurological disease costs approximately $15.5 billion annually in medical costs and lost or reduced earnings and production.

Epilepsy is not contagious and is not caused by mental illness or retardation. But for most people who suffer from this chronic condition, the stigma associated with it is enormous and affects just about every aspect of life. Family life, driving, employment, social interactions and self-image are just a few lifestyle considerations that confront people with epilepsy. Just the fear of having a seizure produces tremendous ongoing anxiety for some people—a burden for even those whose seizures are generally well controlled with medication.

There is no single cause of epilepsy, and in many cases, no known cause is ever found. Conditions that can lead to epilepsy include:

• injury to the brain before, during or after birth or in adulthood
• infections that damage the brain
• toxic substances that affect the brain
• injury and lack of oxygen to the brain
• disturbance in blood circulation to the brain (stroke and other vascular problems)
• metabolism or nutritional imbalance
• tumors of the brain
• genetic or hereditary abnormalities
• high fever (known as febrile seizures)
• other degenerative diseases such as dementia
• malformation of the brain

Seizures can be triggered by a variety of things, such as failure to take seizure-controlling medication as prescribed, lack of sleep, alcohol consumption or hormonal changes associated with the menstrual cycle. Failure to take medication (called noncompliance by physicians) is the most common trigger.

Epilepsy and Reproductive Health Issues

Epilepsy is associated with many reproductive health issues for women. Although it is not well understood, researchers know that the female hormones estrogen and progesterone act on certain brain cells, including those in a part of the brain called the temporal lobe, where partial seizures often begin. Therefore, estrogen and progesterone can affect the frequency and severity of seizures. Some women experience changes in their seizure patterns at times of hormonal fluctuations such as puberty, ovulation, the beginning of menstruation, pregnancy and even at menopause. This hormone-seizure interaction makes each life stage—and sometimes each menstrual period—a unique challenge. Because seizures disrupt regions of the brain that regulate reproductive hormones, women who have seizures also are more likely to have reproductive problems such as polycystic ovarian disease, early menopause and irregular ovulation leading to infertility. In addition, studies have shown that certain antiepileptic drugs may cause reproductive problems. Women should discuss this with their physicians.

Even birth control choices are affected by epilepsy. Certain antiepileptic medications (medications that control seizures) make hormonal birth control less effective in preventing pregnancy. Hormonal birth control includes oral contraceptives (birth control pills), long-acting progestin shots and implants and intrauterine devices that release hormones. While most women with epilepsy can have healthy babies, they are advised to work with health care professionals knowledgeable about seizure disorders to guard against increased risks for malformations to the baby or complications during pregnancy.

Why Epilepsy Happens

Epilepsy was one of the first brain disorders described, dating back to ancient Babylon more than 3,000 years ago. The word "epilepsy" comes from a Greek work that means to "attack" or "seize." Over the years, many misconceptions have ensued. Epilepsy is a disorder in which the normal pattern of brain activity becomes disturbed. During a seizure, neurons fire as many as 500 times a second, far exceeding the normal rate of about 80 times a second. The resulting seizure can occur at any time of day or night with little or no warning. Attacks can occur frequently or rarely.

Genetic abnormalities may be a significant factor contributing to epilepsy. The condition may run in some families, and some researchers say that more than 500 genes could be linked to the disorder.

For many people, epilepsy is the result of brain injury from other conditions or disorders. Heart attacks and strokes, for example, deprive the brain of oxygen and can cause damage that produces epilepsy. Conditions that affect the brain's normal functions such as brain tumors and degenerative conditions such Alzheimer's disease also may trigger it. Metabolic disorders such as pyruvate deficiency and other brain disorders such as cerebral palsy, neurofibromatosis and autism are all associated with an increased risk of epilepsy, as well.

Virtually any sort of injury to the brain, from head trauma to poisoning (such as from carbon monoxide or even illegal drug use) to infections can lead to seizures and epilepsy. Toxic substances such as alcohol may also trigger it.

Cases that do not involve brain damage, injury, known genetic factors or any other known cause are known as idiopathic epilepsy. Research continues on the cause of epilepsy.

Types of Seizure and Epilepsy: Many and Varied

To date, researchers have identified more than 20 kinds of seizures and numerous syndromes and other conditions that include recurring seizures. People can have one or more than one type of seizure. In general, there are two kinds of seizures:

Partial seizures. Partial seizures are the most common type of seizure in people with epilepsy; about 60 percent of people with epilepsy have partial seizures, which occur in just one part of the brain and affect the physical and mental activity controlled by that area of the brain. Also called focal seizures, partial seizures may be simple or complex.

During a simple partial seizure, you remain conscious and may experience numbness, weakness, inability to speak and jerking of the arm or leg. Another term that physicians use is "auras," which refers to unexplained feelings such as joy, sadness, anger or nausea or altered sensations (déjà vu, jamais vu and often-unpleasant smells). In a complex partial seizure (also called a psychomotor or temporal lobe seizure), you experience an altered consciousness, display repetitious behavior or movements and are not able to interact with others until the seizure subsides. Emotional changes may also occur during the seizure. Complex partial seizures occur in adults, although the condition typically begins in childhood. Repeated seizures in the temporal lobe of the brain can, over a long period of time, affect memory and learning.

Generalized seizures. There are many types of generalized seizures, which result from abnormal neuronal activity on both sides of the brain. Generalized seizures involve bursts of electrical energy that sweep through the whole brain at once, causing loss of consciousness for seconds or minutes, falls or muscle spasms that lead to convulsions.

Absence seizures. Formerly called petit mal seizures, partial seizures are a common type of generalized seizure that typically starts in childhood and typically stops when the child reaches puberty. During an absence seizure, a child may experience temporary lapses of consciousness that look like blank staring.

When seizures occur, a health care professional will determine if they are associated with epilepsy or another condition. Determining the underlying cause is critical to effective and appropriate treatment.

The many types of epilepsy are usually described by a specific group of symptoms. Some of the more common types include:

• Frontal lobe epilepsy. Sudden onset and termination of a cluster of very short seizures are the hallmarks of this type of epilepsy.
• Occipital lobe epilepsy. This type usually begins with visual hallucinations, rapid eye blinking or other eye-related symptoms. After that, it resembles temporal or frontal lobe epilepsy.
• Temporal lobe epilepsy. This type typically has a "warning" or aura of altered perceptions (déjà vu, jamais vu, epigastric sensations, foul taste or odor) followed by altered awareness, confusion and responsiveness and other unusual behaviors and patterns of cognition.

Diagnosis

When health care professionals use the term "epilepsy," they are referring to a medical condition that involves two or more spontaneously recurrent seizures. The term "seizure" refers to the event. In other words, not all seizures are epilepsy.

Accurate diagnosis of epilepsy requires a detailed medical history and a battery of tests that provide a comprehensive picture of the brain. Developmental, neurological and behavioral assessments are performed.

To assist the health care team in making a diagnosis, you may be asked to keep a detailed seizure diary. This type of record keeping also may be recommended as a lifelong management strategy to help record how medication and other factors affect seizure activity.

A seizure diary could include the following information (some of which may need to be recorded by a family member or partner):

• Date and time the seizure occurred.
• A detailed description of the seizure, including length of the seizure and your symptoms. Be specific. Note what you were doing when the seizure occurred.
• Record all medications taken, including both over-the-counter and prescribed, as well as the dose and time taken. Be sure to include a note about your last dose of antiepileptic medication (if you are currently taking any). Record if you skipped or changed your dosage, whether by accident or with the guidance of your health care professional.
• Describe the food and beverages you consumed within the 24 hours prior to the seizure, as well as the times you ate or drank.
• Record information about your menstrual period.
• Describe how you were feeling and the events or situations that you experienced within the two to three days before your seizure. (Be sure to note your sleeping habits, daily activities and general health.)

In addition to taking a detailed medical history, your health care professional may order blood tests to check on your general health and to determine if you have an infection, genetic disorder or vitamin deficiency or if you've been exposed to any poisons, such as lead. If your health care professional suspects your seizure may be caused by an infection or bleeding in the brain, he or she may perform brain imaging or a spinal tap, in which a small amount of fluid is taken from your spinal canal to be tested.

Other important tests involve recording your brain's activity:

• Electroencephalogram (EEG). This painless test records the electrical activity in your brain to see if there are any irregularities. Small electrodes are pasted to your head and connected to a computer to record the electrical activity. Abnormal brain activity patterns may indicate epilepsy. You may have the test, which lasts for about one to two hours or longer if your doctor recommends, at a hospital or doctor's office. A normal EEG doesn't rule out epilepsy, and you may need to have an EEG more than once before a diagnosis is made. Sometimes, the health care professional may ask that you do not sleep the night before the test or awaken early to enhance the chance of seeing an abnormality.
• Brain imaging. There are a variety of tests, similar to X-rays, that help your health care professional examine your brain. Magnetic resonance imaging (MRI) scans, computed tomography (CT) scans, single photon emission tomography (SPECT) and positron emission tomography (PET) scans are three imaging techniques used to view the brain. All three types of imaging may or may not be necessary in the evaluation of your epilepsy. Typically, you'll be asked to lie on a table and the MRI, CT, SPECT or PET machine will be moved over your head to scan your brain. These procedures are painless. You may have an injection of a substance that makes the scan easier to read. After the injection, some people say they experience a metallic taste in the mouth, feel flushed or have brief nausea.

Other tests may be performed to measure your motor abilities, behavior and intellectual capacity to evaluate how the disorder is affecting you.

Treatment

Accurate diagnosis of the type of epilepsy a person has is critical to determining the right treatment. It's also important to begin treatment as quickly as possible to avoid any harm that can be caused by recurrent seizures. The standard treatment for epilepsy is medication, called antiepileptic drugs (AEDs) or antiseizure medication. Although antiepileptic medications don't cure epilepsy, they help prevent seizures in about 70 percent of people who take them. Other treatment approaches include the ketogenic diet, vagus nerve stimulation and surgery.

More than 20 medicines are available to treat epilepsy. You and your health care professional will decide which one is right for you based on the type of seizures you have, your lifestyle and age and, for women, how likely you are to become pregnant. Some of the more common drugs used to prevent seizures include:

• Acetazolamide (Diamox Sequels)
• Carbamazepine (Tegretol, Tegretol XR, Carbatrol)
• Clonazepam (Klonopin)
• Clorazepate (Tranxene)
• Diazepam (Diastat Acudial)
• Ethosuximide (Zarontin)
• Felbamate (Felbatol)
• Gabapentin (Neurontin)
• Lacosamide (Vimpat)
• Lamotrigine (Lamictal)
• Levetiracetam (Keppra)
• Levetiracetam extended-release tablets (Keppra XR)
• Oxcarbazepine (Trileptal)
• Phenobarbital
• Phenytoin (Dilantin)
• Pregabalin (Lyrica)
• Primidone (Mysoline)
• Tiagabine (Gabitril)
• Topiramate (Topamax)
• Valproic acid (Depakote, Depakote ER)
• Zonisamide (Zonegran)

You and your health care professional most likely will need to work through a trial-and-error period to determine the drug and dosage that works best for you. While the goal usually is to treat with just one type of drug, some individuals with epilepsy will need to use more than one medication to reduce their seizures. When more than one drug is necessary, usually no more than one new medication is added at a time so that interactions or side effects can be monitored. Some drugs will need to be taken once a day while others must be taken several times. It's extremely important to take the drugs as directed.

Medication Side Effects

Side effects from antiepileptic drugs vary from person to person. The goal of medication therapy is to find the right drug (or combination) at the right dosage so you don't experience side effects. Some common side effects include fatigue, sleepiness, dizziness, double vision, memory and thinking impairment, weight gain or weight loss. Severe side effects range from allergic reaction (including rash or difficulty breathing) to slurred speech and bone loss, which can lead to osteoporosis over the long term. Antiepileptic medications also increase the risks for birth defects. Other possible medication side effects may include excessive hair growth, mood changes, depression and irritability. It's important to report all side effects to your health care professional so he or she can tailor the dosage to suit you. If you experience severe side effects, don't wait; call for help immediately.

Antiepileptic Medication and Hormonal Contraceptives

Certain antiepileptic drugs can make contraceptives containing hormones ineffective and increase your risk for an unplanned pregnancy. Hormonal birth control includes oral contraceptives (birth control pills), long-acting progestin shots, implants and skin patches that release hormones. Antiepileptic drugs that may reduce hormonal contraceptive effectiveness include:

• Carbamazepine (Tegretol, Tegretol XR, Carbatrol)
• Oxcarbazepine (Trileptal)
• Phenobarbital
• Phenytoin (Dilantin)
• Felbamate (Felbatol)
• Topiramate (Topamax)

Antiepileptic medications that do not interfere with hormonal birth control are:

• Gabapentin (Neurontin)
• Lamotrigine (Lamictal)
• Levetiracetam (Keppra)
• Tiagabine (Gabitril)
• Pregabalin (Lyrica)

Women who take antiepileptic medications can use all other types of birth control methods, including barrier methods (diaphragms, spermicidal vaginal creams and gels, the contraceptive sponge, intrauterine devices, cervical caps and condoms). Discuss your options, preferences and lifestyle considerations with your health care professional to help you choose a method that works best for you.

The oral contraceptive pill may drop the levels of lamotrigine (Lamictal), which would require adjustment of your lamotrigine dose by your health care provider.

Pregnancy and Epilepsy

With proper care, women with epilepsy have more than a 90 percent chance of having a normal pregnancy and a healthy baby. But as with other chronic conditions (such as diabetes or high blood pressure), women with epilepsy should be closely monitored, ideally before conception, during pregnancy and after delivery. Because pregnancy affects your weight and body metabolism, it can affect blood levels of antiepileptic medications. One of the most important considerations for a woman with epilepsy who is pregnant or considering pregnancy is to work with a health care professional who is knowledgeable about seizure disorders.

About two-thirds of women with epilepsy experience no change in their condition during pregnancy. Twenty-five to 40 percent experience more seizures and a minority see some improvement. Following birth, seizures usually revert to what they were like prior to pregnancy.

When giving birth, women with epilepsy are slightly more likely to experience hemorrhage, eclampsia, premature labor and cesarean sections, but epilepsy alone is not an indication for these procedures.

There is some increased risk (4 to 6 percent for women with epilepsy compared to 2 to 3 percent for the general female population) that your child may have a birth defect such as cleft lip or palate, heart abnormalities or neurological problems. The risk is higher if you are on more than one antiepileptic medication during pregnancy. You should also avoid valproic acid (Depakote) during conception and pregnancy if there are other medication alternatives. Experts recommend that you work closely with your health care professional to ensure that you're taking the appropriate antiepileptic medication and dose to minimize the risk of seizures during pregnancy and to minimize the risk of birth defects.

Your health care professional may adjust your medications if you are pregnant or plan to become pregnant. Additionally, you may be referred to a genetic counselor for help in assessing the risks of birth defects.

Also, women with epilepsy are more prone to vaginal bleeding and high blood pressure during pregnancy, as well as an increased risk for early labor and delivery.

It's important to be in good general health before pregnancy, if possible. Getting adequate rest, exercise and nutrition are essential. Your health care professional will advise you to take vitamins and folic acid (at least 400 micrograms per day is recommended for women who are planning to become pregnant or who may become pregnant) prior to conception to reduce the risk of birth defects affecting the fetal spinal column. Many physicians recommend that folic acid supplementation begin with the first prescription for an antiepileptic drug because many pregnancies are not planned, and folic acid is most important in the first 28 days of fetal life. Folic acid is also important for many other biological processes. You may also need to take vitamin K supplements after you reach 34 weeks of pregnancy to reduce the risk of a blood-clotting disorder in infants called neonatal coagulopathy that can result from fetal exposure to certain epilepsy medications.

After birth, most mothers can safely breastfeed. Only minor amounts of epilepsy medications get excreted into breast milk, much less than the baby was exposed to in the womb and usually not enough to cause harm. Rarely, the baby may become drowsy and not feed properly; if so, these symptoms should be monitored carefully. Overall, most experts believe the benefits of breastfeeding outweigh the risks in women with epilepsy. Ask your health care professional about your options.

Becoming Seizure-Free

Although there is no cure for epilepsy, there is a chance you could become seizure-free. Some health care professionals will advise patients to discontinue medication after one to two years without a seizure while others advise waiting up to five years. Don't discontinue medication without advice from your health care professional.

You are less likely to remain seizure-free after discontinuing medication if your seizures have been difficult to control; you have abnormal imaging studies; you need a combination of medications; you have other neurological problems in addition to epilepsy; you have abnormal EEG results while on medication; or you are diagnosed with a particular epileptic syndrome such as juvenile myoclonic epilepsy.

Surgery

When seizures cannot be controlled by medications, surgery may be an option. According to the Epilepsy Foundation, people with epilepsy are candidates for surgery if:

• They have documented epileptic seizures, not psychogenic nonepileptic seizures
• They have seizures that always start in just one part of the brain
• They have tried standard medications without success or have had a bad reaction to medications
• They have seizures in a part of their brain that can be removed without affecting speech, memory, eyesight or other important functions

There are a few surgical procedures available to treat epilepsy. The type of seizures and the area of the brain where the seizures originate determine the type of surgery used.

Four basic types of surgery include:

• Cortical resection. Appropriate for partial seizures that originate in the right or left temporal lobe area of the brain, this procedure involves removing the seizure-producing area and is the most effective form of surgery for epilepsy.
• Corpus callosotomy. In this procedure the network of neural connections between the right and left sides of the brain (hemispheres) are severed. This procedure won't stop seizures entirely, but it interrupts the spread of seizures across the whole brain as in generalized seizures. People who experience uncontrolled generalized seizures or drop attacks may be considered good candidates for corpus callosotomy.
• Hemispherectomy. This is a more radical approach in which an entire side of the brain is removed or functionally disconnected from the other side. This procedure is a last resort, usually reserved for children under the age of 13 who have a rare, progressive disease that affects one whole hemisphere of the brain, called Rasmussen's encephalitis. This procedure works in some children because the brain is capable of taking over some of the lost functions, and many children can recover fully.
• Multiple subpial transaction. If you experience seizures that originate in parts of the brain that control movement or language, removal of these areas would lead to paralysis or loss of language. Rather than removing those areas, multiple subpial transection is used to make small incisions in the brain, which interfere with the spread of seizure impulses.

Surgery for epilepsy should be performed only at specialized epilepsy centers, most of which are university-based. There are risks associated with any surgery, and there is no guarantee that seizures will be eliminated. Depending on the resection site, the group of health professionals involved in your presurgical evaluation will inform you about any surgical risks.. Even after surgery, your health care professional may recommend that you continue to take antiepileptic drugs for at least two years or indefinitely depending on your type of epilepsy.

Vagus Nerve Stimulation

When medication fails to stop seizures, vagus nerve stimulation (VNS) may be appropriate for adults and children 12 and older. This therapy administers small pulses of electrical stimulation to the brain via a battery-powered device that's implanted in the chest like a pacemaker. Thin wires are threaded under the skin and attached to the vagus nerve in the lower neck. The VNS is programmed by a physician to deliver small bursts of electrical stimulation every few minutes. If a person feels a seizure coming on, he or she can activate the stimulation by passing a magnet over the device.

Complete seizure control is rarely achieved, so antiepileptic medication is also prescribed with vagus nerve stimulation therapy. Side effects of therapy may include hoarseness or discomfort in the throat. Approximately one-third of those treated with vagus nerve stimulation experience a major improvement in seizure control. One-third have some relief, and one-third see no change.

New devices that deliver electrical stimulation directly to the brain rather than through the vagus nerve are currently in testing and may provide attractive treatment options in the future. The deep brain stimulator, which stimulates a specific deep brain region called the thalamus, was approved by the FDA in March 2010. Another stimulator called the responsive neurostimulator (RNS) has been submitted to the FDA for approval.

Ketogenic Diet

This high-fat, low-carbohydrate diet causes the body to break down fats instead of carbohydrates to survive. It creates a condition in your body called ketosis. Researchers believe that byproducts of ketosis inhibit seizures. A study published in the June 2008 issue of the journal The Lancet Neurology confirmed the efficacy of the ketogenic diet in helping to prevent seizures in children with drug-resistant epilepsy.

The ketogenic diet is not easy to maintain, and possible side effects include retarded growth due to nutritional deficiency and kidney stones due to build up of uric acid in the blood. If it's not strictly followed—even a few cookie crumbs or toothpaste can negate the effects—it won't work.

This diet is usually reserved for children under age 12 (but is being tried more in adults now) who don't respond well to medications. This therapy must be guided by a dietitian and supplemented with sugar-free vitamins and minerals. The diet is typically started in a hospital so you can be closely monitored for the first few days. About a third of children who try the ketogenic diet become seizure free or nearly seizure free; a third improve but still have seizures; and another third do not respond at all or find the diet too difficult to adhere to.

Coping With Epilepsy

Many women with epilepsy live relatively normal lives. However, the challenges presented by epilepsy can be overwhelming. According to a study conducted by the International Bureau for Epilepsy and a group of epileptologists, fear and uncertainty about seizure occurrence ranked as the worst aspect of living with the disorder. Like other chronic conditions, epilepsy can cause enormous stress, which in turn can lead to depression and other health issues for both you and your family.

Having epilepsy can affect your sense of independence, self-esteem, sexuality, personal relationships and just about every aspect of daily life. For example, most states won't issue drivers license unless you can document that you've gone a specific period of time without a seizure.

Consider taking these steps to help manage the challenges epilepsy presents:

• Join a support group online or in person to learn how others with epilepsy cope.
• Take one day at a time.
• Learn as much as you can about the disorder and your treatment options.
• Wear a medical alert bracelet so emergency responders know how to treat you correctly.
• Carry an updated list of your antiepileptic medication at all times.
• Be aware of any seizure triggers you may have and avoid them, if possible. Seizures can be triggered by a variety of things including lack of sleep, alcohol, stress and stimulating environments that involve fast eye movements—such as flashing holiday lights or video games—or situations that cause dizziness, such as some amusement park rides.
• Don't withdraw. Stay active to fight depression, which is common in people with epilepsy and may be related to epilepsy itself or to some antiepileptic drugs. If you are depressed, seek help. There are antidepressant medications that can work with your antiepileptic drugs to help you feel better.
• Make sure you get enough sleep, eat a balanced diet and exercise regularly. It's been shown that exercise can improve seizure control in some people. Ask your health care professional which activities are right for you.
• Be honest with those around you about your condition and help educate them to combat any misconceptions they might have about epilepsy.
• Ask for help, if you need it.
• Discuss any sexual problems you may have with your health care professional. Seizure medications can affect hormone levels and may reduce your sex drive, affecting intimate relationships.

The Americans with Disabilities Act makes it unlawful for employers to discriminate against people with epilepsy. It's against the law to fire or refuse to hire you because of your condition, except in extraordinary cases where seizures would make it impossible for you to do your job and some other position cannot be provided for you. If you suspect that you or someone you know with epilepsy has been discriminated against, contact the U.S. Equal Employment Opportunity Commission (EEOC) for support or information; call 1-800-669-4000 or check out www.eeoc.gov.

What To Do During A Seizure

Help others learn more about epilepsy and what to do when someone experiences a seizure. The Epilepsy Foundation recommends the following steps if you see someone having a seizure with convulsions or loss of consciousness:

• Roll the person on his or her side to prevent choking on any fluids or vomit.
• Cushion the person's head.
• Loosen any tight clothing around the neck.
• Do not restrict the person from moving unless he or she is in danger.
• Do not put anything in the person's mouth or attempt to force his or her mouth open with your figures. This could cause choking or damage to the person's jaw, tongue or teeth. Contrary to widespread belief, people cannot swallow their tongues during a seizure or any other time.
• Remove any sharp or solid objects that the person might hit during the seizure.
• Note how long the seizure lasts (if possible, time it with your watch) and what symptoms occurred so you can tell a health care professional or emergency personnel if necessary.
• Stay with the person until the seizure ends.
• After the seizure ends, the person will probably be groggy and tired. He or she also may have a headache and be confused or embarrassed. Be patient and try to help him or her find a place to rest, if desired. If necessary, call a taxi, a friend or a relative to help the person get home safely.

Call 911 if:

• The person is pregnant or has diabetes.
• The seizure happened in water.
• The seizure lasts longer than five minutes.
• The person does not begin breathing and return to consciousness after the seizure stops.
• Another seizure starts before the person regains consciousness.
• The person injures himself or herself during the seizure.
• This is a first seizure or you think it might be. If in doubt, check to see if the person has a medical identification card or bracelet stating that he or she has epilepsy or a seizure disorder.

If you see someone having a non-convulsive seizure (staring, automatic or purposeless actions or mumbling nonsensically), remember that the person's behavior is not intentional. The person may wander aimlessly or make alarming or unusual gestures. You can help by following these guidelines:

• Remove any dangerous objects from the area around the person or in his or her path.
• Don't try to stop the person from wandering unless he or she is in danger.
• Don't shake the person or shout.
• Stay with the person until he or she is completely alert.

Prevention

Epilepsy, a central nervous system disorder, is a life-altering condition for which frequently there is no identifiable cause. What we do know is that injury to and infections in the brain can cause epilepsy. Taking certain safety precautions may help to prevent epilepsy:

• Avoid injury or trauma to the head. Use seatbelts, put children in car seats and use helmets when bicycling or skateboarding.
• Counsel children and teenagers about the risk of epilepsy related to sport injuries.
• Avoid illegal drugs and toxic substances. Exposure to lead and carbon monoxide is known to cause seizures. Illegal drug use and overdoses of prescription drugs, such as antidepressants, may also cause seizures.
• Practice good prenatal care. Treatment of high blood pressure and infections during pregnancy go a long way toward preventing neurological damage to unborn babies.

Facts to Know

1. Epilepsy is usually described as a family of brain disorders that involve nerve cells that misfire, or signal abnormally, causing a seizure.
2. Epilepsy can affect anyone at any age. However, the disease most often begins before the age of 2 or after age 65.
3. More than 3 million people in the United States have had an unprovoked seizure or have been diagnosed with epilepsy.
4. There is no single cause of epilepsy. Some of the known causes include injury to the brain before, during or after birth; infections and injury that damage the brain and can happen at any age; toxic substances that affect the brain; and occasionally genetic causes.
5. About 3 percent of the population will be diagnosed with epilepsy by the time they reach age 75.
6. In 70 percent of new cases of epilepsy, there is no apparent cause.
7. Generalized seizures are more common in children younger than 10; after that age, more than half of people diagnosed with epilepsy will have partial seizures.
8. In general, medications can control epilepsy in 70 percent of people with the disease.
9. Strokes, Alzheimer's disease and alcoholism can cause epilepsy.
10. Reproductive hormones influence seizure activity. Some women with epilepsy experience changes in the pattern of their seizures at times of hormonal fluctuations such as during puberty, menstruation, ovulation, pregnancy and menopause.

Questions to Ask

Review the following Questions to Ask about epilepsy so you're prepared to discuss this important health issue with your health care professional.

1. What is my diagnosis?
2. What factors possibly contributed to my epilepsy?
3. What types of seizures am I experiencing?
4. I've been suffering from irregular periods. Is there a connection to epilepsy?
5. Why do I have many more seizures around the time of my periods?
6. What treatment do you recommend?
7. How do antiepileptic medications work? What are their side effects?
8. Will those medications have any effects on my birth control?
9. Can I get pregnant and have a healthy baby?
10. What kinds of things can I do to reduce the amount and severity of my seizures?
11. When is a seizure considered a medical emergency? What are the first aid procedures for different seizure types?
12. What do I need to do so that I can live safely and successfully?
13. Where can I find emotional, social and economic support?

Key Q&A

Lifestyle Tips

1. Don't put up with workplace discrimination
   If you are dealing with workplace conflicts, remember: It's against the law for an employer to fire or refuse to hire you because of your condition, except in extraordinary cases where seizures would make it impossible for you to do your job and no reasonable accommodation can be found. When Congress passed the Americans with Disabilities Act, epilepsy was one of many disabilities specifically included. Even fear of a person's disability can form the basis for discrimination, according to the U.S. Supreme Court.
2. Combat myths and misconceptions about epilepsy with facts
   Don't worry about what other people may think about epilepsy. Educate them about your condition with the facts. Not only will sharing information help combat the many myths and misconceptions about epilepsy, you'll also bolster your self-confidence by discussing the disorder, rather than trying to conceal it. Use information available from reliable sources, such as the Epilepsy Foundation and, of course, your own personal success stories.
3. Know the symptoms of depression, a common companion of epilepsy
   Clinical depression—a serious, but treatable mental illness—is common in people with epilepsy. Depression can be triggered by the stress caused by living with a chronic condition like epilepsy. Some antiepileptic medications can increase the risk for depression. A few common signs of depression are excessive crying, inability to concentrate, sleeping more or less than normal, loss of pleasure in things that used to bring enjoyment, eating more or less than normal, and a depressed mood on most days for most of the day. These symptoms must occur for two weeks or longer to qualify as depression symptoms. If you become depressed, seek help. There are antidepressant medications that can work with antiepileptic drugs.
4. Put your health first: Create and follow a healthy lifestyle plan
   It's not always easy to make yourself and your health your top priority. But, making a plan can get you started and keep you focused. Begin with the basics: Eat a balanced diet, rich in fruits, vegetables and low-fat food choices; take a multivitamin with calcium; and exercise regularly—your goal should be to pick a time and do some form of physical activity consistently, for at least 30 minutes most days of the week. Build stress-busting exercise and mental relaxation techniques into your daily routine. Gentle stretches and deep breathing exercises for 20 minutes or more each day will help you relax and refocus. Above all, take your antiepileptic medications as directed by your health care professional.
5. Know your seizure triggers and avoid them, if you can
   Seizures can be triggered by a variety of things. Not taking medications as prescribed is the most common seizure trigger. Alcohol, stress and lack of sleep can also be triggers. Highly stimulating environments that involve rapid eye movements or that cause dizziness, such as amusement park rides or crowded shopping malls with flashing holiday lights, might trigger seizures. Keeping a seizure diary can help you track the types and patterns of your seizures. This record may help you identify—and avoid—seizure triggers and will help your health care professional team treat your disorder.
6. If you don't have epilepsy, take steps to prevent it
   Although genetics plays a role in who develops epilepsy, the disorder can also be caused by other, mostly preventable causes. Take the following safety precautions to help prevent epilepsy from developing:
   • Always use seatbelts, put youngsters in car seats and insist that children wear helmets when bicycling and skateboarding to avoid head injury and trauma.
   • Avoid illegal drugs and toxic substances, which can cause seizures.
   • During pregnancy, get regular checkups to diagnose, monitor and treat high blood pressure, if it develops, to prevent neurological damage to unborn babies.

Organizations and Support

For information and support on coping with Epilepsy, please see the recommended organizations, books and Spanish-language resources listed below.

American Epilepsy Society
Website: https://www.aesnet.org
Address: 342 North Main Street
West Hartford, CT 06117
Phone: 860-586-7505

Antiepileptic Drug Pregnancy Registry
Website: https://www.aedpregnancyregistry.org
Address: Massachusetts General Hospital
121 Innerbelt Road, Room 220
Somerville, MA 02143
Hotline: 1-888-233-2334

CURE (Citizens United for Research in Epilepsy)
Website: https://www.cureepilepsy.org
Address: 730 N. Franklin Street, Suite 404
Chicago, IL 60610
Hotline: 1-800-765-7118
Phone: 312-255-1801
Email: info@cureepilepsy.org

Epilepsy Foundation
Website: https://www.epilepsyfoundation.org
Address: 8301 Professional Place
Landover, MD 20785
Hotline: 1-800-332-1000

National Association of Epilepsy Centers
Website: https://www.naec-epilepsy.org
Address: 5775 Wayzata Boulevard, Suite 200
Minneapolis, MN 55416
Hotline: 1-888-525-6232
Phone: 952-525-4526
Email: info@naec-epilepsy.org

National Institute of Neurological Disorders and Stroke
Website: https://www.ninds.nih.gov
Address: NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
Hotline: 1-800-352-9424
Phone: 301-496-5751

Books

Epilepsy: Patient and Family Guide
by M.D. Orrin Devinsky

Seizures and Epilepsy in Childhood: A Guide
by John M. Freeman MD, Eileen P. G. Vining MD, Diana J. Pillas

Treating Epilepsy Naturally: A Guide to Alternative and Adjunct Therapies
by Patricia Murphy

Spanish-language resources

Medline Plus: Epilepsy
Website: https://www.nlm.nih.gov/medlineplus/spanish/epilepsy.html
Address: Customer Service
8600 Rockville Pike
Bethesda, MD 20894
Email: custserv@nlm.nih.gov