Today, people with epilepsy have more treatment options available than ever before, says Ellen Kotwas-Song, MD, a neurologist at Rockland Neurological Associates and a consulting neurologist at Nyack Hospital.
“Generally speaking, people whose epilepsy is well controlled on medication can lead healthy and active lives,” she says. “The key is to find a neurologist you feel comfortable with, go regularly to your medical appointments and take your medication as directed.”
Epilepsy can start at any age, but most commonly appears in childhood or in older adults, Dr. Kotwas-Song says. “In older adults, epilepsy often starts after a person has had a stroke,” she notes. “But in many cases, we don’t have a clear answer about what has caused a person’s epilepsy.” Some patients are able to tell if a seizure is coming on, either through an unusual smell, or a feeling that something is about to happen.
There are two broad types of epilepsy: generalized onset and focal onset.
In generalized onset epilepsy, seizures start in a generalized fashion throughout the brain. These seizures are more common in younger people. A person with a generalized seizure tends to have impaired consciousness, meaning they are not aware of their surroundings. They may experience a stiffening or jerking of their arms and legs.
Focal onset epilepsy starts in one location of the brain, but can spread. A person with focal onset epilepsy may be aware of what is happening, or they may have impaired consciousness. Symptoms may include twitching or jerking of the arm or leg on one side of the body, or unusual repetitive behavior, such as lip-smacking or picking.
Diagnosis and Treatment
To diagnose epilepsy, the doctor will get information about what happens during the patient’s seizures, either from the patient, or from a family member of someone else who has witnessed them.
The doctor will order an electroencephalogram (EEG), a test used to evaluate the electrical activity in the brain, usually along with an MRI or CT of the brain.
In order to determine the best treatment, the doctor will want to know whether the seizure was caused by an underlying medical issue, such as very low blood sugar in a diabetic. If no underlying cause can be found, the doctor will start the patient on some type of anti-seizure medication. The drug prescribed will depend on the type of seizure. “We try to find the most effective medication for the type of seizure the person has,” Dr. Kotwas-Song says. “Medications overall are much better tolerated than in the past, with fewer side effects.”
There is a subset of people with epilepsy who have tried at least two medications that have not successfully controlled the seizures. This is known as “drug-resistant epilepsy.” These patients are generally referred to an epilepsy specialist known as an epileptologist. There are a range of treatment options available to these patients, including surgery or an implanted device.
Living With Epilepsy
Once a person has started epilepsy medication, their doctor will determine when it is safe for them to start driving again. “There are state laws about driving with epilepsy, but generally most people are able to drive again once their epilepsy is under control,” says Dr. Kotwas-Song.
Women with epilepsy who are considering becoming pregnant should review their seizure medications with their neurologist to make sure they are safe for the developing baby. With proper management, women with epilepsy can have healthy babies, Dr. Kotwas-Song says. “It’s important for your neurologist to monitor you regularly during pregnancy,” she says.
For everyone with epilepsy, taking your medication as prescribed is the most significant thing you can do, Dr. Kotwas-Song emphasizes. “One of the most common reasons for breakthrough seizures is a person stopping medication on their own,” she says. “That is why compliance with medication is so important.”