The most common question patients who have been diagnosed with epilepsy ask is, “Why did this happen to me?” There are many causes such as a genetic predisposition, prior brain injury or infection, or a structural cause in the brain. However, in some cases, there is no definite answer, says Ellen Kotwas-Song, MD, a neurologist at Rockland Neurological Associates and a consulting neurologist at Montefiore Nyack Hospital. Fortunately, the majority of epilepsy cases can be controlled with medication, she says.
An estimated 3.4 million people have epilepsy in the United States. “It’s more common than most people realize,” Dr. Kotwas-Song said. Having a single seizure does not mean you have epilepsy, she noted. “There are many other reasons for an isolated seizure, such as low blood sugar, withdrawal from alcohol, or an electrolyte imbalance,” she said. It is important to have a careful medical evaluation if this occurs.
If a person has two seizures not explained by one of these causes, they should be evaluated by a neurologist to see if they have epilepsy, Dr. Kotwas-Song said. To diagnose or rule out epilepsy, the neurologist will do an evaluation that can include a brain MRI and an electroencephalogram (EEG).
If a person is diagnosed with epilepsy, the neurologist will determine which type the person has. 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.
Treatment depends on factors including the type of epilepsy a person has. “We also look for medication that is safest in terms of side effects,” Dr. Kotwas-Song said. Some medications require more blood test monitoring than others, which also can affect the choice of treatment.
Once a person is on medication, they may stay on it for the rest of their lives. If a person’s epilepsy is well controlled for several years, it may be possible to have them try slowly tapering off the drug to see if seizures return. “It’s a difficult decision, and it’s not for everyone,” Dr. Kotwas-Song said. “Some people feel safer staying on medication.”
Living with Epilepsy
A major issue for people with epilepsy is driving restrictions. Every state has a law about driving after any type of seizure. “At some point most people can return to driving, but it depends on your state law,” Dr. Kotwas-Song said.
People with epilepsy are counseled to avoid certain activities, including avoiding work that requires climbing to high heights, as well as taking baths and swimming. “These activities should be especially avoided if a person is newly diagnosed or their epilepsy is not well controlled,” she said.
Pregnant women can be safely treated for epilepsy, without adverse affects for the baby, but medication must be carefully monitored during pregnancy. “Blood levels of drugs can change during pregnancy, so the dose may have to be adjusted,” Dr. Kotwas-Song said. When a woman of childbearing age is put on medication for epilepsy, the neurologist will discuss plans for any future pregnancies. “None of the medications are completely risk-free for pregnancy, so it’s important to talk with your doctor before you become pregnant,” she said.
The best way a person with epilepsy can prevent seizures is to take their medication as directed. “Don’t skip doses, and don’t let your medication run out,” Dr. Kotwas-Song said. “The number-one cause of breakthrough seizures is missed doses of medication.”