Epilepsy

Epilepsy is a long-term brain condition that causes repeated seizures. Seizures happen when there’s abnormal electrical activity in your brain. Symptoms can range from brief staring spells or confusion to strong shaking and temporary loss of consciousness.

Epilepsy can develop after a brain injury, stroke or tumor. But in many cases, the cause isn’t known.

About 50 million people worldwide have epilepsy. Anyone of any age, race or sex can develop this condition. A healthcare provider can help you manage it.

Types of epilepsy

Healthcare providers often group epilepsy types based on where abnormal electrical activity starts in your brain. They’re similar to seizure types and include:

• Generalized epilepsy (generalized seizures): Seizures start on both sides of your brain at the same time.
• Focal epilepsy (focal seizures): Seizures start in one specific area of your brain. They may stay in that area or spread to other parts of your brain.
• Unknown: An exact placement isn’t known yet.

From here, your provider may give you a specific epilepsy or seizure type based on the lobe in your brain where seizures are, like temporal lobe epilepsy. Types may also focus on features specific to the seizure itself, like absence seizures, tonic–clonic seizures or febrile seizures, among others.

Epilepsy symptoms

The main symptom of epilepsy is repeated seizures. Symptoms can look different depending on the type of seizure. But many people have similar symptoms each time they have one.

Common symptoms include:

• Automatic movements, like lip-smacking, chewing or rubbing your hands
• Brief loss of awareness or consciousness
• Confusion or trouble thinking, speaking or understanding others
• Fast heartbeat or rapid breathing
• Staring spells or a blank look
• Stomach discomfort, chills, warmth or goosebumps
• Strong emotions, like fear, anxiety or déjà vu
• Uncontrolled movements, like jerking, twitching or sudden loss of muscle control
• Unusual sensations, like changes in vision, hearing, smell, taste, or feelings of tingling or numbness

Epilepsy causes

Abnormal electrical activity in your brain causes epilepsy. Your brain works by sending electrical signals between nerve cells. These signals help control how you think, feel, move and respond to the world around you.

In epilepsy, these signals don’t always send in an organized way. Instead, many brain cells fire all at once or much faster than they should. This sudden burst of electrical activity causes symptoms.

This condition can have many causes, and sometimes no clear one is found. Possible causes may include:

• Structural: Damage to your brain, like from a growth abnormality, stroke, bleeding in your brain, a brain tumor or a serious head injury
• Genetic: Changes in genes that affect how brain cells communicate
• Infection: Brain infections, like meningitis or encephalitis, and some viral infections (like HIV)
• Metabolic: Rare imbalances in your body’s chemicals that affect brain function
• Immune: Autoimmune conditions that cause brain inflammation (like autoimmune encephalitis)

What triggers epilepsy symptoms?

Epilepsy triggers are things that can make seizures more likely to happen. Common triggers may include:

• Alcohol use or withdrawal
• Illness or fever
• Lack of sleep or poor sleep quality
• Missed doses of anti-seizure medicine
• Stress

You may also notice symptoms happen more often when you’re dehydrated or skipping meals. Triggers can vary from person to person, so learning what affects you may help you better manage this condition.

Risk factors

You may have a higher risk of developing epilepsy if you have:

• Alcohol use disorder
• Alzheimer’s disease
• Biological family history, especially if close relatives have epilepsy
• Brain infections
• Brain tumors
• Neurologic conditions, like cerebral palsy
• Problems before or during birth, like being born early, having a low birth weight or not getting enough oxygen during delivery
• Seizures at a young age (febrile seizures)
• Stroke
• Structural brain differences present at birth or bleeding in your brain
• Traumatic brain injuries

Having one or more risk factors doesn’t mean you’ll develop epilepsy. But it may raise the likelihood.

Complications

Possible complications may include:

• Injuries, like falls, burns or cuts during a seizure
• Mental health conditions, like anxiety and depression
• Sleep problems
• Thinking and learning problems, like trouble with memory, attention and following directions

Some activities require your full attention and quick reactions, like driving, swimming alone, climbing or operating heavy equipment. These may not be 100% safe if you have epilepsy. Your healthcare provider can help you understand which activities are safe for you and what precautions you should take.

Serious medical complications may include:

• Status epilepticus: A seizure lasts a long time or happens back-to-back without recovery. This is a medical emergency and needs urgent care.
• Sudden unexplained death in epilepsy (SUDEP): This is a rare but serious risk. It’s more likely if you have frequent or unmanaged seizures, usually during sleep.

How doctors diagnose epilepsy

You may get an epilepsy diagnosis if you have more than one seizure. This usually means:

• You had two or more seizures that weren’t caused by something temporary, like a fever or low blood sugar, and they happened more than 24 hours apart.
• You had one seizure, but tests or your medical history show a high chance of having more seizures in the future.
• Your provider identified a specific epilepsy syndrome, even if you’ve only had one seizure.

Seizures caused by something short term, like illness, alcohol withdrawal or a recent head injury, don’t count toward an epilepsy diagnosis. But they may if there’s evidence your brain has an ongoing risk.

If you’ve had a seizure, your provider will likely refer you to a neurologist. One of the most important parts of diagnosis is describing what happened. Your provider will ask what you remember before, during and after the seizure.

But many people don’t remember what happened. So, it can help to bring someone who saw it or to have them write down or record what they noticed.

What tests diagnose epilepsy?

To confirm the diagnosis and rule out other conditions, your provider may order tests like:

• A neurological exam
• Blood tests
• EEG
• MRI scan

Even if test results are normal, your doctor may still diagnose epilepsy based on your seizure history and symptoms.

Epilepsy treatments

There’s no cure for epilepsy. But there are many options to treat it. Your provider might recommend:

• Anti-seizure medications: These are the most common treatments. They work by calming abnormal electrical signals in your brain. It can take time to find the right medicine and dose.
• Surgery: If medications don’t work well, surgery may be an option. Surgery treats the part of your brain causing seizures. Providers only recommend it after careful testing.
• Devices (neurostimulation): These are implanted devices that send mild electrical signals to your brain or nerves to reduce seizures. The device usually works alongside medication. Common ones include vagus nerve stimulation or deep-brain stimulation.
• Lifestyle changes: Certain meal plans, like the ketogenic diet, may reduce seizures in some cases, especially in children. Managing triggers like sleep and stress may also play a role.

Your healthcare provider will help you choose the best option based on your seizure type, age and general health.

When should I see my healthcare provider?

Visit the emergency room if you have a seizure for the first time. If others notice that you “zoned out” or briefly lost awareness, give a provider a call. They may refer you to a neurologist for further testing and care.

If you’re with someone who’s having a seizure that lasts longer than five minutes or has several seizures in a row without fully waking up in between, call 911 or your local emergency services number.

What can I expect if I have epilepsy?

Epilepsy is a long-term condition that affects everyone differently. A healthcare provider can help you manage symptoms, but it may take a little time to find the perfect plan. You’ll need to see your healthcare provider regularly, and they may adjust your treatment plan over time.

Managing epilepsy often includes caring for your overall well-being. This not only includes your brain, but also your sleep, stress and mental health. Your care team can help you find what works best for you.

How to prevent epilepsy

Not all cases of epilepsy can be prevented. But some steps may help lower the risk:

• Manage fevers in young children (to reduce risk of febrile seizures).
• Protect your head from falls, accidents and sports injuries.
• Reduce stroke risk (manage blood pressure, diabetes and avoid smoking).
• Take care of yourself during pregnancy and birth.