Epilepsy and SeizuresWhat is epilepsy?Epilepsy is a neurological condition involving the brain that makes people more susceptible to having recurrent, unprovoked seizures. It is one of the most common disorders of the nervous system and affects people of all ages, races, and ethnic background. Almost 3 million Americans live with epilepsy.Anything that interrupts the normal connections between nerve cells in the brain can cause a seizure. This includes a high fever, low blood sugar, high blood sugar, alcohol or drug withdrawal, or a brain concussion. Under these circumstances, anyone can have one or more seizures. However, when a person has two or more unprovoked seizures, he or she is considered to have epilepsy. There are many possible causes of epilepsy, including an imbalance of nerve-signaling chemicals called neurotransmitters, tumors, strokes, and brain damage from illness or injury, or some combination of these. In the majority of cases, there may be no detectable cause for epilepsy.What is a seizure?The brain is the center that controls and regulates all voluntary and involuntary responses in the body. It consists of nerve cells that communicate with each other through electrical activity.A seizure occurs when part(s) of the brain receives a burst of abnormal electrical signals that temporarily interrupts normal electrical brain function.What are the different types of seizures?The type of seizure depends on which part and how much of the brain is affected and what happens during the seizure.  The two broad categories of epileptic seizures are generalized seizures (absence, atonic, tonic-clonic, myoclonic) and partial (simple and complex) seizures. Within these categories, there are several different types of seizures, including: Focal or partial seizures. Focal seizures take place when abnormal electrical brain function occurs in one or more areas of one

side of the brain. Focal seizures may also be called partial seizures. With focal seizures, particularly with complex focal seizures, a person may experience an aura, or premonition, before the seizure occurs. The most common aura involves feelings, such as deja vu, impending doom, fear, or euphoria.  Visual changes, hearing abnormalities, or changes in the sense of smell can also be auras. Two types of focal seizures include: Simple focal seizures. The person may have different symptoms depending on which area of the brain is involved. If the

abnormal electrical brain function is in the occipital lobe (the back part of the brain that is involved with vision), sight may be altered, but muscles are more commonly affected. The seizure activity is limited to an isolated muscle group, such as the fingers, or to larger muscles in the arms and legs. Consciousness is not lost in this type of seizure. The person may also experience sweating, nausea, or become pale.

Complex focal seizures. This type of seizure commonly occurs in the temporal lobe of the brain, the area of the brain that controls emotion and memory function. Consciousness is usually lost during these seizures. Losing consciousness may not mean that a person passes out--sometimes, a person stops being aware of what's going on around him or her. The person may look awake, but may have a variety of unusual behaviors. These behaviors may range from gagging, lip smacking, running, screaming, crying, and/or laughing. When the person regains consciousness, he or she may complain of being tired or sleepy after the seizure. This is called the postictal period.

Generalized seizures. Generalized seizures involve both sides of the brain. There is loss of consciousness and a postictal state after the seizure occurs. Types of generalized seizures include the following: Absence seizures (also called petit mal seizures). These seizures are characterized by a brief, altered state of consciousness

and staring episodes. Typically, the person's posture is maintained during the seizure. The mouth or face may twitch or the eyes may blink rapidly. The seizure usually lasts no longer than 30 seconds. When the seizure is over, the person may not recall what just occurred and may go on with his or her activities, acting as though nothing happened. These seizures may occur several times a day. This type of seizure is sometimes mistaken for a learning problem or behavioral problem. Absence seizures almost always start between ages 4 to 12 years.

Atonic (also called drop attacks). With atonic seizures, there is a sudden loss of muscle tone and the person may fall from a standing position or suddenly drop his or her head. During the seizure, the person is limp and unresponsive.

Generalized tonic-clonic seizures (GTC or also called grand mal seizures). The classic form of this kind of seizure, which may not occur in every case, is characterized by five distinct phases. The body, arms, and legs will flex (contract), extend (straighten out), and tremor (shake), followed by a clonic period (contraction and relaxation of the muscles) and the postictal period. Not all of these phases may be seen in everyone with this type of seizure. During the postictal period, the person may be sleepy, have problems with vision or speech, and may have a bad headache, fatigue, or body aches.

Myoclonic seizures. This type of seizure refers to quick movements or sudden jerking of a group of muscles. These seizures tend to occur in clusters, meaning that they may occur several times a day, or for several days in a row.

Infantile spasms. This rare type of seizure disorder occurs in infants before six months of age. There is a high occurrence rate of this seizure when the child is awakening, or when he or she is trying to go to sleep. The infant usually has brief periods of movement of the neck, trunk, or legs that lasts for a few seconds. Infants may have hundreds of these seizures a day. This can be a serious problem, and can have long-term complications that affect growth and development.

Febrile seizures. This type of seizure is associated with fever and is not epilepsy, although a fever may trigger a seizure in a child who has epilepsy. These seizures are more commonly seen in children between six months and five years of age, and

there may be a family history of this type of seizure. Febrile seizures that last less than 15 minutes are called simple, and typically do not have long-term neurological effects. Seizures lasting more than 15 minutes are called complex and there may be long-term neurological changes in the child.

What causes a seizure?A person may experience one or many different types of seizures. While the exact cause of the seizure may not be known, the more common seizures are caused by the following: In newborns and infants:

Birth trauma Congenital (present at birth) problems Fever or infection Metabolic or chemical imbalances in the body

In children, adolescents, and adults: Alcohol or drugs Head trauma Infection Congenital conditions Genetic factors Progressive brain disease Alzheimer's disease Stroke Unknown reasons

Other possible causes of seizures may include the following: Brain tumor Neurological problems Drug withdrawal Medications Use of illicit drugsWhat are the symptoms of a seizure?The person may have varying degrees of symptoms depending on the type of seizure. The following are general symptoms of a seizure or warning signs of seizures. Symptoms or warning signs may include: Staring Jerking movements of the arms and legs Stiffening of the body Loss of consciousness Breathing problems or breathing stops Loss of bowel or bladder control Falling suddenly for no apparent reason, especially when associated with loss of consciousness Not responding to noise or words for brief periods Appearing confused or in a haze Nodding the head rhythmically, when associated with loss of awareness or even loss of consciousness Periods of rapid eye blinking and staringDuring the seizure, the person's lips may become bluish and breathing may not be normal. The movements are often followed by a period of sleep or disorientation.The symptoms of a seizure may resemble other problems or medical conditions. Always consult your doctor for a diagnosis.How are seizures diagnosed?The full extent of the seizure may not be completely understood immediately after onset of symptoms, but may be revealed with a comprehensive medical evaluation and diagnostic testing. The diagnosis of a seizure is made with a physical examination and diagnostic tests. During the examination, the doctor obtains a complete medical history of the person and family and asks when the seizures occurred. Seizures may be due to neurological problems and require further medical follow-up.Diagnostic tests may include: Blood tests Electroencephalogram (EEG). A procedure that records the brain's continuous, electrical activity by means of electrodes

attached to the scalp. Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a

computer to produce detailed images of organs and structures within the body. Computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-

rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

Lumbar puncture (spinal tap). A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes the brain and spinal cord.

Treatment of a seizureSpecific treatment for a seizure will be determined by your doctor based on: Your age, overall health, and medical history Type of the seizure Frequency of the seizures Your tolerance for specific medications, procedures, or therapies Expectations for the course of the condition Your opinion or preferenceThe goal of seizure management is to control, stop, or decrease the frequency of the seizures without interfering with the normal activities of daily living (ADLs). The major goals of seizure management include the following: Proper identification of the type of seizure Using medication specific to the type of seizure Using the least amount of medication to achieve adequate control Maintaining appropriate medication levelsTreatment may include: Medications. There are many types of medications used to treat seizures and epilepsy. Medications are selected based on the type

of seizure, age of the patient, side effects, the cost of the medication, and the adherence with the use of the medication.Medications used at home are usually taken by mouth (as capsules, tablets, sprinkles, or syrup), but some can be given rectally (into the person's rectum). If the person is in the hospital with seizures, medication may be given by injection or intravenously by vein (IV).It is important to take your medication on time and as prescribed by your doctor. Different people use up the medication in their body differently, so adjustments (schedule and dosage) may need to be made for the most effective seizure control.All medications can have side effects, although some people may not experience certain side effects. Discuss your medication's possible side effects with your doctor.While you are taking medications, different tests may be done to monitor the effectiveness of the medication. These tests may include the following: Blood work. Frequent blood draws testing is usually required to check the level of the medication in the body. Based on this

level, the doctor may increase or decrease the dose of the medication to achieve the desired level. This level is called the therapeutic level and is where the medication works most efficiently. Blood work may also be done to monitor the effects of medications on body organs.

Urine tests. These tests are sometimes performed to see how the person's body is responding to the medication. Electroencephalogram (EEG). An EEG is a procedure that records the brain's continuous, electrical activity by means of

electrodes attached to the scalp. This test is done to monitor how the medication is helping the electrical problems in the brain.

Vagus nerve stimulation (VNS). Some people, whose seizures are not being well-controlled with seizure medications, may benefit from a procedure called vagus nerve stimulation (VNS). VNS is currently most commonly used for people over age 12 who have partial seizures that are not controlled by other methods.VNS attempts to control seizures by sending small pulses of energy to the brain from the vagus nerve, which is a large nerve in the neck. This is done by surgically placing a small battery into the chest wall. Small wires are then attached to the battery and placed under the skin and around the vagus nerve. The battery is then programmed to send energy impulses every few minutes to the brain. When the person feels a seizure coming on, he or she may activate the impulses by holding a small magnet over the battery. In many cases, this will help to stop the seizure.

There are some side effects that may occur with the use of VNS. These may include, but are not limited to, the following: Hoarseness Pain or discomfort in the throat Change in voice

Surgery. Another treatment option for seizures is surgery. Surgery may be considered in a person who: Has seizures that are unable to be controlled with medications. Has seizures that always start in one area of the brain. Has a seizure in a part of the brain that can be removed without disrupting important behaviors such as speech, memory, or

vision.Surgery for epilepsy and seizures is very complicated and performed by a specialized surgical team. The operation may remove the part of the brain where the seizures are occurring, or, sometimes, the surgery helps to stop the spread of the bad electrical currents through the brain.

A person may be awake during the surgery. The brain itself does not feel pain. With the person awake and able to follow commands, the surgeons are better able to make sure that important areas of the brain are not damaged.Surgery is not an option for everyone with seizures. Discuss this treatment option with your doctor for more information.

More information regarding the person with seizures or epilepsy Make sure you or your child (if age appropriate) understand the type of seizure that is occurring and the type of medication(s) that

are needed. Know the dose, time, and side effects of all medications. Consult your doctor before taking other medications. Medications for seizures can interact with many other medications, causing

the medications to work improperly and/or causing side effects. Young women of childbearing age who are on seizure medications need to be informed that seizure medications are harmful to a

fetus, and the medication may also decrease the effectiveness of oral contraceptives. Check with your state to understand any laws about people with epilepsy or seizures operating a motor vehicle. If a person has good control over the seizures, only minimal restrictions need to be placed on activities, in most cases. Specific follow-up will be determined by your doctor. Medications for seizures may not be needed for the person's entire life. Some people may be taken off their medications if they

have been seizure-free for one to two years. This will be determined by your doctor.http://www.hopkinsmedicine.org/healthlibrary/conditions/nervous_system_disorders/epilepsy_and_seizures_85,P00779/Epilepsy - overviewShare on facebookShare on twitterBookmark & Share Printer-friendly version Epilepsy is a brain disorder in which a person has repeated seizures over time. Seizures are episodes of disturbed brain activity that cause changes in attention or behavior.

CausesEpilepsy occurs when permanent changes in the brain cause it to be too excitable or irritable. As a result, the brain sends out abnormal signals. This leads to repeated, unpredictable seizures. (A single seizure that does not happen again is not epilepsy.)Epilepsy may be due to a medical condition or injury that affects the brain. Or the cause may be unknown (idiopathic).Common causes of epilepsy include:

Stroke  or transient ischemic attack (TIA) Dementia , such as Alzheimer disease Traumatic brain injury Infections, including brain abscess, meningitis, encephalitis, and HIV/AIDS Brain problems that are present at birth (congenital brain defect) Brain injury that occurs during or near birth Metabolism disorders present at birth (such as phenylketonuria) Brain tumor Abnormal blood vessels in the brain Other illness that damages or destroys brain tissue

Epileptic seizures usually begin between ages 5 and 20. But they can happen at any age. There may be a family history of seizures or epilepsy.

SymptomsSymptoms vary from person to person. Some people may have simple staring spells. Others have violent shaking and loss of alertness. The type of seizure depends on the part of the brain affected and cause of epilepsy.Most of the time, the seizure is similar to the one before it. Some people with epilepsy have a strange sensation before each seizure. Sensations may be tingling, smelling an odor that is not actually there, or emotional changes. This is called an aura.Your doctor can tell you more about the specific type of seizure you may have:

Absence (petit mal) seizure  (staring spells) Generalized tonic-clonic (grand mal) seizure  (involves the entire body, including aura, rigid muscles, and loss of alertness) Partial (focal) seizure  (can involve any of the symptoms described above, depending on where in the brain the seizure starts)

Exams and TestsThe doctor will perform a physical exam. This will include a detailed look at the brain and nervous system.An EEG (electroencephalogram) will be done to check the electrical activity in the brain. People with epilepsy often have abnormal electrical activity seen on this test. In some cases, the test shows the area in the brain where the seizures start. The brain may appear normal after a seizure or between seizures.

To diagnose epilepsy or plan for epilepsy surgery, you may need to:

Wear an EEG recorder for days or weeks as you go about your everyday life. Stay in a special hospital where brain activity can be watched on video cameras. This is called video EEG.

Tests that may be done include:

Blood chemistry Blood sugar CBC  (complete blood count) Kidney function tests Liver function tests Lumbar puncture  (spinal tap) Tests for infectious diseases

Head CT or MRI scan often done to find the cause and location of the problem in the brain.

TreatmentTreatment for epilepsy includes medications, lifestyle changes, and sometimes surgery.If epilepsy is due to a tumor, abnormal blood vessels, or bleeding in the brain, surgery to treat these disorders may make the seizures stop.Medication to prevent seizures, called anticonvulsants, may reduce the number of future seizures:

These drugs are taken by mouth. Which type you are prescribed depends on the type of seizures you have. Your dosage may need to be changed from time to time. You may need regular blood tests to check for side effects. Always take your medication on time and as directed. Missing a dose can cause you to have a seizure. Do not stop taking or

change medications on your own. Talk to your doctor first. Many epilepsy medications cause birth defects. Women who plan to become pregnant should tell their doctor in advance in

order to adjust medications.Many epilepsy medicines may affect the health of your bones. Talk to your doctor about whether you need vitamins and other supplements.Epilepsy that does not get better after two or three anti-seizure drugs have been tried is called "medically refractory epilepsy." In this case, the doctor may recommend surgery to:

Remove the abnormal brain cells causing the seizures. Place a vagus nerve stimulator (VNS). This device is similar to a heart pacemaker. It can help reduce the number of seizures.

Some children are placed on a special diet to help prevent seizures. The most popular one is the ketogenic diet. A diet low in carbohydrates, such as the Atkins diet, may also be helpful in some adults. Be sure to discuss these options with your doctor before trying them.Lifestyle or medical changes can increase the risk of a seizure in adults and children with epilepsy. Talk with your doctor about:

New prescribed medications, vitamins, or supplements Emotional stress Illness, especially infection Lack of sleep Pregnancy Skipping doses of epilepsy medications Use of alcohol or other recreational drugs

Other considerations:

Persons with epilepsy should wear medical alert jewelry so that prompt medical treatment can be obtained if a seizure occurs. Persons with poorly controlled epilepsy should not drive. Check your state's law about which people with a history of

seizures are allowed to drive. Do not use machinery or do activities that can cause loss of awareness, such as climbing to high places, biking, and

swimming alone.

Support GroupsThe stress of having epilepsy or being a caretaker of someone with epilepsy can often be helped by joining asupport group. In these groups, members share common experiences and problems.

Outlook (Prognosis)Some people with epilepsy may be able to reduce or even stop their anti-seizure medicines after having no seizures for several years. Certain types of childhood epilepsy go away or improve with age, usually in the late teens or 20s.For many people, epilepsy is a lifelong condition. In these cases, anti-seizure drugs need to be continued. There is a very low risk of sudden death with epilepsy.

Possible Complications

Difficulty learning Breathing in food or saliva into the lungs during a seizure, which can cause aspiration pneumonia Injury from falls, bumps, self-inflicted bites, driving or operating machinery during a seizure Permanent brain damage (stroke or other damage) Side effects of medications

When to Contact a Medical ProfessionalCall your local emergency number (such as 911) if:

This is the first time a person has a seizure A seizure occurs in someone who is not wearing a medical ID bracelet (which has instructions explaining what to do)

In the case of someone who has had seizures before, call 911 for any of these emergency situations:

This is a longer seizure than the person normally has, or an unusual number of seizures for the person Repeated seizures over a few minutes Repeated seizures in which consciousness or normal behavior is not regained between them (status epilepticus)

Call your health care provider if any new symptoms occur:

Loss of hair Nausea or vomiting Rash Side effects of medicines such as drowsiness, restlessness, confusion, sedation Tremors or abnormal movements, or problems with coordination

PreventionThere is no known way to prevent epilepsy. Proper diet and sleep, and staying away from illegal drugs and alcohol may decrease the likelihood of triggering seizures in people with epilepsy.Reduce the risk of head injury by wearing helmets during risky activities. This can lessen the likelihood of a brain injury that leads to seizures and epilepsy.

Alternative NamesTemporal lobe epilepsy; Seizure disorder

ReferencesAbou-Khalil BW, Gallagher MJ, Macdonald RL. Epilepsies. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds.  Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, Pa: Elsevier Saunders; 2012:chap 67.Foreman B, Hirsch LJ. Epilepsy emergencies: diagnosis and management. Neurol Clin. 2012;30:11-41.Harden CL, Hopp J, Ting TY, et al. Practice Parameter update: Management issues for women with epilepsy - Focus on pregnancy (an evidence-based review): Obstetrical complications and change in seizure frequency: Report of the Quality Standards Subcommittee and Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology and American Epilepsy Society. Neurology. 2009;73;126-132Wiebe S. The epilepsies. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, Pa: Elsevier Saunders; 2011:chap 410.

Update Date: 2/10/2014

Updated by: Joseph V. Campellone, M.D., Division of Neurology, Cooper University Hospital, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.http://www.nlm.nih.gov/medlineplus/ency/article/000694.htm

Epilepsy is a condition of the brain causing seizures. A seizure is a disruption of the electrical communication between neurons Someone is said to have epilepsy if they experience two or more unprovoked seizures separated by at least 24 hours

The Epilepsy Foundation is your unwavering ally in the fight against epilepsy and seizures. You don't walk alone.

What is epilepsy? Will I have seizures forever?You may have a lot of questions about epilepsy. We will help you understand the basics, answer the most common questions, and help you find resources and other information you may need. However, information alone won’t help you manage your epilepsy and find a way to cope with the effects on your daily life. You’ll need to learn how to use the information and make it work for you.

What is Epilepsy?Epilepsy is a neurological condition which affects the nervous system. Epilepsy is also known as a seizure disorder. It is usually diagnosed after a person has had at least two seizures that were not caused by some known medical condition.

What are Seizures?Seizures seen in epilepsy are caused by disturbances in the electrical activity of the brain.  The seizures in epilepsy may be related to a brain injury or a family tendency, but most of the time the cause is unknown…Seizures are caused by disturbances in the electrical activity of the brain.

65 MILLION: Number of people around the world who have epilepsy. OVER 2 MILLION: Number of people in the United States who have epilepsy. 1 IN 26 people in the United States will develop epilepsy at some point in their lifetime. BETWEEN 4 AND 10 OUT OF 1,000: Number of people on earth who live with active seizures at any one time.  150,000: Number of new cases of epilepsy in the United States each year ONE-THIRD: Number of people with epilepsy who live with uncontrollable seizures because no available treatment works for

them. 6 OUT OF 10: Number of people with epilepsy where the cause is unknown.

Authored by: Patricia O. Shafer, RN, MN on 1/2014Reviewed by: Joseph I. Sirven, MD | Patricia O. Shafer, RN, MN on 3/2014

Not everyone who has a serious head injury (a clear cause of seizures) will get epilepsy. When seizures begin from both sides of the brain at the same time it's called generalized epilepsy.  Epilepsy is more likely to occur in a brother or sister if the child with epilepsy has generalized seizures.  Having seizures and epilepsy doesn’t mean you or your child are any different or less important than anyone else!

Heredity (genetics or the physical traits we get from our parents) plays an important role in many cases of epilepsy. For instance, not everyone who has a serious head injury (a clear cause of seizures) will get epilepsy. Those who do develop

epilepsy may be more likely to have a history of seizures in their family. This family history suggests that it is easier for them to develop epilepsy than for people with no genetic tendency.

When seizures begin from both sides of the brain at the same time it's  called generalized epilepsy. Generalized epilepsy is more likely to involve genetic factors than partial or focal epilepsy. 

In recent years, genetic links to some forms of partial epilepsy have been found.

Are the brothers and sisters of children with epilepsy more likely to develop it? Their risk is slightly higher than usual, because there may be a genetic tendency in the family for seizures and epilepsy. Even so, most brothers and sisters will not develop epilepsy. Epilepsy is more likely to occur in a brother or sister if the child

with epilepsy has generalized seizures.  Remember, epilepsy is not “contagious” and people can’t “catch it” like a cold.

If I have epilepsy, will my children also have it?Most children of people with epilepsy do not develop seizures or epilepsy. However, since genes are passed down through families, it is possible. Here are a few general points to remember. Less than 2 people out of every 100 develop epilepsy at some point during their lifetime. The risk for children whose father has epilepsy is only slightly higher. If the mother has epilepsy and the father does not, the risk is still less than 5 in 100. If both parents have epilepsy, the risk is a bit higher. Most children will not inherit epilepsy from a parent, but the chance of

inheriting some types of epilepsy is higher.

Learning the facts and understanding the risks of passing it along to your children can help.

If you have epilepsy, you may be afraid that your children will have epilepsy, too. However, it’s important to know the facts.The risk of passing epilepsy on to your children is usually low. Epilepsy shouldn’t be a reason not to have children. Medical testing may help people who have a known genetic form of epilepsy understand their risks.If a child does develop epilepsy, remember that many children can get complete control of seizures. For some,  the epilepsy may go away. Most importantly, having seizures and epilepsy doesn’t mean you or your child are any different or less important than anyone else!

Authored by: Steven C. Schachter, MD | Patricia O. Shafer, RN, MN | Joseph I. Sirven, MDReviewed by: Joseph I. Sirven, MD | Patricia O. Shafer, RN, MN on 7/2013

Some people may find that seizures occur in a pattern or are more likely to occur in certain situations. Sometimes these connections are just by chance, but other times it’s not. Keeping track of any factors that may precipitate a seizure (also called seizure triggers) can help you recognize when a seizure may be coming. You can then be prepared and learn how to lessen the chance that a seizure may occur at this time.Some people will notice one or two triggers very easily, for example their seizures may occur only during sleep or when waking up. Other people may notice that some triggers bother them only when a lot is going on at once or it is during a 'high risk' time for them (for example when under a lot of stress or when sick).

What are some commonly reported triggers? Specific time of day or night Sleep deprivation – overtired, not sleeping well, not getting enough sleep At times of fevers or other illnesses Flashing bright lights or patterns Alcohol or drug use Stress Associated with menstrual cycle (women) or other hormonal changes Not eating well, low blood sugar Specific foods, excess caffeine or other products that may aggravate seizures Use of certain medications

What is reflex epilepsy? Is this related to triggers?Some people may notice that their seizures occur in response to very specific stimuli or situations, as if the seizure is a 'reflex'. There is a type of epilepsy called 'reflex epilepsy' – in this type, seizures occur consistently in relation to a specific trigger. For example, one type of reflex epilepsy is photosensitive epilepsy where seizures are triggered specifically by flashing lights. Other types of reflex epilepsies may be seizures triggered by the act of reading or by noises. These reflex epilepsies are not common, but knowing if you have this form of epilepsy will help you learn how to manage them!

How can I tell if something is a trigger?Great question and a common one too! Sometimes people think just because a situation happened once or twice, it’s a trigger to all their seizures. It’s important to realize that a trigger is something that occurs fairly consistently before seizures and more often than by chance. To identify triggers, try a few of these strategies: Whenever you have a seizure, note what time of day it occurs, special situations surrounding it, or how you felt. Note if any of

the commonly reported triggers were present. Write these in your seizure diary. Do this consistently, for each seizure. If you notice that a situation or event is happening pretty consistently before seizures, now you need to know if it also happens at

other times.o For example, you note that you were sleep deprived before 2 out of 3 seizures in the past 3 months. But when you look at

your sleep patterns, you didn’t have seizures all the other times you were sleep deprived. And you don’t sleep well most of the time. In this situation, sleep deprivation isn’t good for you, but probably doesn’t trigger seizures all by itself. You still need to work on improving your sleep, but there may be other things going on too.

o Track a suspected trigger in your diary. Note whenever it happens and not just when you have a seizure. Then you can see how often it happens with seizures as compared to other times.

If you have a form of reflex epilepsy, talk to your doctor about the trigger. Knowing the type of epilepsy and trigger can help you build in ways to avoid the triggers whenever possible or find ways to lessen their effect on you.

For more information:

Syncope    Share on email Share on print

What is syncope?Syncope (pronounced “sin ko pea”) is the brief loss of consciousness and posture caused by a temporary decrease in blood flow to the brain. Syncope may be associated with a sudden fall in blood pressure, a decrease in heart rate or changes in blood volume or distribution. The person usually regains consciousness and becomes alert right away, but may experience a brief period of confusion.Syncope is often the result of an underlying medical condition that could be related to your heart, nervous system or blood flow to the brain.What are the symptoms of syncope?The most common symptoms of syncope include:Most common causes

“Blacking out” Light-headedness Falling for no reason Dizziness Drowsiness Grogginess Fainting, especially after a meal or after exercise Feeling unsteady or weak when standing

Syncope is often preceded by other symptoms (called premonitory symptoms), such as light-headedness, nausea and palpitations (irregular heartbeats that feel like “fluttering” in the chest).Many people with syncope learn, on their own, to avoid a syncopal event or “passing out.” They recognize the premonitory symptoms and sit or lie down quickly and elevate their legs.Because syncope could be the sign of a more serious condition, it is important to seek treatment right away after a syncope episode occurs.With accurate diagnosis and appropriate treatment, syncope can be resolved in most patients.What causes syncope?There are many causes of syncope. If blood does not circulate properly, or the autonomic nervous system does not work the way it should, changes in blood pressure and heart rate can cause fainting. Metabolic abnormalities and anemia may also cause syncope.Autonomic Nervous System (ANS)

The ANS automatically controls many functions of the body such as breathing, blood pressure, heart rate and bladder. In most situations, we are unaware of the workings of the ANS because it functions in an involuntary, reflexive manner.Types of SyncopeVasovagal syncope (also called cardio-neurogenic syncope)Vasovagal syncope is the most common type of syncope that occurs when the blood pressure drops suddenly, reducing blood flow to the brain. When you stand up, gravity causes blood to settle in the lower part of your body, below the level of the diaphragm. In response, the heart and autonomic nervous system (ANS) react to maintain your blood pressure.

Vasovagal syncope may occur in patients who have a condition called orthostatic hypotension. In this condition, the blood vessels do not constrict normally when the patient stands, causing blood to pool in the legs and the blood pressure to drop quickly.Situational syncopeSituational syncope is a type of vasovagal syncope that occurs only during particular situations that cause unusual patterns of stimulation to certain nerves. The “stimulus” that triggers an exaggerated neurological reflex can be a wide range of different events such as dehydration, intense emotional stress, anxiety, fear, pain, hunger or use of alcohol or drugs. Hyperventilation (breathing in too much oxygen and getting rid of too much carbon dioxide too quickly) associated with panic or anxiety also can cause syncope. Other stimuli include coughing forcefully, turning the neck or wearing a tight collar (carotid sinus hypersensitivity), or urinating (miturition syncope).Postural syncope (also called postural hypotension)Postural syncope occurs when the blood pressure drops suddenly due to a quick change in position, such as from lying down to standing. Postural syncope can be related to certain medications or dehydration.Cardiac syncopeCardiac syncope is the loss of consciousness due to a heart or blood vessel condition that interferes with blood flow to the brain. These conditions may include an abnormal heart rhythm (arrhythmia), obstructed blood flow in the heart or blood vessels, valve disease, aortic stenosis, blood clot, or heart failure.Neurologic syncopeNeurologic syncope is the loss of consciousness due to a neurological condition such as seizure, stroke, transient ischemic attack (TIA) or other rare causes including migraines and normal pressure hydrocephalus.In about one-third of cases, the cause of syncope is unknown.How common is syncope?Syncope is a common condition, affecting 3 percent of men and 3.5 percent of women at some point in life. It becomes more prevalent with advancing age, occurring in as many as 6 percent of people over age 75. Syncope affects patients of all ages, both with and without other medical conditions.How is syncope diagnosed?All patients with syncope should be evaluated by a doctor. Your primary care physician can provide a referral to the Center for Syncope and Autonomic Disorders for a complete evaluation to determine the cause of your syncope.The Center for Syncope and Autonomic Disorders combines experience, expertise and a team approach to diagnosing syncope. There are several tests that can be performed to find the underlying cause of syncope. The initial evaluation includes a screening tilt table test, blood volume determination, hemodynamic testing and autonomic nervous system testing.The syncope evaluation begins with a careful review of your medical history and a physical exam. The doctor will ask you detailed questions about your symptoms and syncope episodes, including whether you have any premonitory symptoms and the circumstances in which your symptoms occur.Your heart rate and blood pressure will be measured and recorded while you are in different positions including lying down, sitting and standing.Tests to determine causes of syncope

The head-up tilt test or tilt table test records your blood pressure and heart rate on a minute-by-minute or beat-by-beat basis while the table is tilted in a head-up position at different levels. In some patients, this test may reveal abnormal cardiovascular reflexes that produce syncope.

Blood volume determination : an intravenous (IV) line is inserted into a vein in your arm and a small amount of a radioactive substance (tracer) is injected. Blood samples are then taken and analyzed. The blood volume test is used to evaluate if the amount of blood in your body is appropriate for your gender, height and weight. The blood volume analyzer system used at Cleveland Clinic can provide accurate test results within 35 minutes.

Hemodynamic testing : Three sets of images are taken after a radioactive material has been administered into the IV. The purpose of hemodynamic testing is to evaluate the intravascular pressure and blood flow that occur when the heart muscle contracts and pumps blood throughout the body.

Autonomic reflex testing : A series of different tests are done to monitor blood pressure, blood flow, heart rate, skin temperature and sweating in response to certain stimuli. Taking these measurements can help determine whether or not the autonomic nervous system is functioning normally or if nerve damage has occurred.The results of all these tests will help your doctor determine if the cause of your syncope is related to dysfunction of the autonomic nervous system, cardiac dysfunction, neurological disorders or hemodynamic abnormalities.If necessary after the initial evaluation, other tests may be needed, including electrophysiology studies, autonomic nervous system testing, neurological evaluation, computed tomography scan, Holter monitoring or echocardiogram. Vestibular function testing may be performed to rule out the presence of inner ear problems. If any of these tests are ordered, your doctor will explain why they are needed and what will happen during the test.Getting the test resultsWhen the test results are available, your referring physician will receive a complete report and treatment recommendations. Your referring physician will explain the results of the test and discuss your treatment options.How is syncope treated?Depending on the results of your evaluation and the underlying cause of syncope, treatment is aimed at preventing a syncope recurrence. Treatment may include:

Taking new medications or making changes to your current medications

Wearing support garments or compression stockings to improve circulation Making certain dietary changes such as eating small, more frequent meals; increasing salt, fluid and potassium; and avoiding caffeine

and alcohol Taking certain precautions when changing positions from sitting to standing Elevating the head of your bed while sleeping. You can do this by using extra pillows or by placing risers under the legs of the head of

the bed to elevate it. Avoiding or changing the situations or “triggers” that cause a syncope episode Biofeedback training to control a rapid heartbeat. Biofeedback specialists can provide an evaluation; please call the Department of

Psychology and Psychiatry at 216.444.6115 or 800.223.2273 ext. 46115 for more information. Pacemaker implantation to regulate the heart rate — only as needed for certain medical conditions Implantable cardiac defibrillator (ICD), which constantly monitors your heart rate and rhythm and corrects a fast, abnormal rhythm

— only as needed for certain medical conditionsYour health care team will develop a treatment plan that is right for you and your doctor will discuss your treatment options.Some states require that patients diagnosed with syncope notify the state’s drivers’ license bureau. Check your state’s regulations to be sure.OutlookAbout 30 percent of people with one episode of syncope will have a recurrence. The underlying cause of syncope and the patient’s age, gender and presence of other medical conditions will affect the prognosis or outlook for the future.With the proper diagnosis and treatment, syncope can be managed and controlled. The prognosis or outlook for the future is dependent on the underlying cause of syncope.<NINDS Syncope Information PageSynonym(s):   FaintingWhat is Syncope?

Syncope is a medical term used to describe a temporary loss of consciousness due to the sudden decline of blood flow to the brain. Syncope is commonly called fainting or “passing out.” If an individual is about to faint, he or she will feel dizzy, lightheaded, or nauseous and their field of vision may “white out” or “black out.”  The skin may be cold and clammy.  The person drops to the floor as he or she loses consciousness.  After fainting, an individual may be unconscious for a minute or two, but will revive and slowly return to normal.  Syncope can occur in otherwise healthy people and affects all age groups, but occurs more often in the elderly. There are several types of syncope.  Vasovagal syncope usually has an easily identified triggering event such as emotional stress, trauma, pain, the sight of blood, or prolonged standing.  Carotid sinus syncope happens because of constriction of the carotid artery in the neck and can occur after turning the head, while shaving, or when wearing a tight collar.  Situational syncope happens during urination, defecation, coughing, or as a result of gastrointestinal stimulation.  Syncope can also be a symptom of heart disease or abnormalities that create an uneven heart rate or rhythm that temporarily affect blood volume and its distribution in the body.   Syncope isn’t normally a primary sign of a neurological disorder, but it may indicate an increased risk for neurologic disorders such as Parkinson’s disease, postural orthostatic tachycardia syndrome (POTS), diabetic neuropathy, and other types of neuropathy.  Certain classes of drugs are associated with an increased risk of syncope, including diuretics, calcium antagonists, ACE inhibitors, nitrates, antipsychotics, antihistamines, levodopa, narcotics, and alcohol.Is there any treatment?

The immediate treatment for an individual who has fainted involves checking first to see if their airway is open and they are breathing.  The person should remain lying down for at least 10-15 minutes, preferably in a cool and quiet space.   If this isn’t possible, have the individual sit forward and lower their head below their shoulders and between their knees.   Ice or cold water in a cup is refreshing.  For individuals who have problems with chronic fainting spells, therapy should focus on recognizing the triggers and learning techniques to keep from fainting.   At the appearance of warning signs such as lightheadedness, nausea, or cold and clammy skin, counter-pressure maneuvers that involve gripping fingers into a fist, tensing the arms, and crossing the legs or squeezing the thighs together can be used to ward off a fainting spell.  If fainting spells occur often without a triggering event, syncope may be a sign of an underlying heart disease. What is the prognosis?

Syncope is a dramatic event and can be life-threatening if not treated properly. Generally, however, people recover completely within minutes to hours.  If syncope is symptomatic of an underlying condition, then the prognosis will reflect the course of the disorder.What research is being done?

The National Institute of Neurological Disorders and Stroke (NINDS) and other institutes of the National Institutes of Health (NIH) conduct research related to syncope in laboratories at the NIH and support additional research through grants to major medical institutions across the country.  Much of this research focuses on finding better ways to prevent and treat syncope.   NIH Patient Recruitment for Syncope Clinical Trialshttp://www.ninds.nih.gov/disorders/syncope/syncope.htmBenign Rolandic Epilepsy

Involves twitching, numbness or tingling of the child's face or tongue (a partial seizure). Seizures last no more than 2 minutes. Child remains fully conscious. The syndrome represents about 15 percent of all epilepsies in children. Because the seizures may be infrequent and usually occur at night, many children do not take medication. In almost every case, the seizures stop on their own by age 15.

What is it like?A typical attack involves twitching, numbness, or tingling of the child's face or tongue (a partial seizure), which often interferes with speech and may cause drooling. These seizures last no more than 2 minutes and the child remains fully conscious. Sometimes the child also may have tonic-clonic seizures, usually during sleep. The seizures are usually infrequent, but they may occur in widely spaced clusters.The name derives from the rolandic area of the brain, which is the part that controls movements.   As noted below, “benign” does not refer to the degree of intensity of the seizures but of the universal tendency to outgrow having seizures.  The official modern name is “benign epilepsy with centro-temporal spikes” or BECTS.

Who gets it?This syndrome represents about 15% of all epilepsies in children. The seizures begin at an average age of about 6 to 8 years (range 3-13) and are a bit more likely to affect boys. The children generally have normal intelligence, which is not affected by the seizures. The syndrome is more common in children who have close relatives with epilepsy.

Tell me moreOther tests, such as the neurologic examination and MRI (if performed), are normal.  Some children will have learning difficulties and behavioral problems during the period of time that they have seizures. The problems typically disappear once the seizures stop and the EEG reverts to normal.

How is it treated?Because the seizures may be infrequent and usually occur at night, many children do not take any seizure medicines for BRE. Medication may be prescribed if a child has daytime seizures, a learning disorder, a mild mental handicap, or frequent seizures during sleep. The seizures usually can be controlled by any of the common seizure medicines. Neurontin (gabapentin), Trileptal (oxcarbazepine), Tegretol or Carbatrol (carbamazepine), Keppra (levetiracetam) or Vimpat (lacosamide) are most often prescribed in the United States.Diagnosing EpilepsyFONT SIZEAAAEvaluating patients with epilepsy is aimed at determining what type of seizures they are having (epileptic versus nonepileptic) and their cause. Various seizure types respond best to specific treatments. The diagnosis ofepilepsy is based on:

The patient's medical history, including any family history of seizures, associated medical conditions, and current  medications. Also helpful to the doctor is the input of people who have witnessed a patient's seizures, especially if there is a loss of consciousness. Some important questions a patient will be asked include:

o At what age did the seizures begin?o What circumstances surrounded your first seizure?o What factors seem to bring on the seizures?o What do you feel before, during, and after the seizures?o How long do the seizures last?o Have you been treated for epilepsy before?o What medications were prescribed and in what dosages?o Was the treatment effective?

Tests that will be performed include:

A complete physical and neurological exam of muscle strength, reflexes,eyesight, hearing, and ability to detect various sensations An electroencephalogram (EEG) test, which measures electrical impulses in thebrain* Imaging studies of the brain, such as those provided by magnetic resonance imaging (MRI) Blood tests  to measure red and white blood cell counts, blood sugar, bloodcalcium, and electrolyte levels; and to

evaluate liver and kidney function; blood tests help rule out the presence of other illnesses.

Other tests , as needed, including magnetic resonance spectroscopy (MRS), positron emission tomography (PET) and single photon emission computed tomography (SPECT)*An important part of the diagnostic process is the electroencephalogram (EEG), because it is the only test that directly detects electrical activity in the brain, and seizures are defined by abnormal electrical activity in the brain. During an EEG, electrodes (small metal disks) are attached to specific locations on your head. The electrodes are attached to a monitor to record the brain's electrical activity. The EEG is useful not only to confirm a diagnosis of epilepsy, but also to determine the type of epilepsy.A routine EEG only records about 20-30 minutes of brain waves (however, the entire EEG procedure takes about 90 minutes). Because 30 minutes is such a short amount of time, the results of routine EEG studies are often normal, even in people known to have epilepsy. Therefore, prolonged EEG monitoring may be necessary. Some monitors allow the patient to stay at home and continue his or her normal activities.Prolonged EEG-video monitoring is another diagnostic method. During this type of monitoring, an EEG monitors the brain's activity and cameras videotape body movements and behavior during a seizure. Prolonged monitoring often requires the patient to spend time in a special hospital facility for several days. Prolonged EEG-video monitoring is the only definitive way to diagnose epilepsy.http://www.webmd.com/epilepsy/guide/diagnosing-epilepsy

Types of EpilepsyShare this:In this article

Idiopathic Generalized Epilepsy

Idiopathic Partial Epilepsy

Symptomatic Generalized Epilepsy

Symptomatic Partial Epilepsy Listen

Epilepsy is the occurrence of sporadic electrical storms in the brain commonly called seizures. These storms cause behavioral

manifestations (such as staring) or involuntary movements (such as grand mal seizures).

There are several types of epilepsy, each with different causes, symptoms, and treatments.

When making a diagnosis of epilepsy, your doctor may use one of the following terms: idiopathic, cryptogenic, symptomatic,

generalized, focal, or partial. Idiopathic means there is no apparent cause. Cryptogenic means there is a likely cause, but it has not

been identified. Symptomatic means that a cause has been identified. Generalized means that the seizures are involving the whole

brain at once. Focal or partial means that the seizure starts from one area of the brain.

Major Types of Epilepsy

Types of Epilepsy Generalized Epilepsy Partial Epilepsy

Idiopathic (genetic causes) - Childhood absence epilepsy- Juvenile myoclonic epilepsy- Epilepsy with grand-mal seizures on awakening Others

- Benign focal epilepsy of childhood

Symptomatic (cause unknown) or cryptogenic (cause unknown)

- West syndrome- Lennox-Gastaut syndrome- Others 

- Temporal lobe epilepsy- Frontal lobe epilepsy Others

Idiopathic Generalized Epilepsy

In idiopathic generalized epilepsy, there is often, but not always, a family history of epilepsy. Idiopathic generalized epilepsy tends to

appear during childhood or adolescence, although it may not be diagnosed until adulthood. In this type of epilepsy, no nervous system

(brain or spinal cord) abnormalities, other than the seizures, can be identified on either an EEG or imaging studies ( MRI). The brain is

structurally normal on a brain magnetic resonance imaging (MRI) scan, although special studies may show a scar or subtle change in

the brain that may have been present since birth.

People with idiopathic generalized epilepsy have normal intelligence and the results of the neurological exam and MRI are usually

normal. The results of the electroencephalogram (EEG -- a test which measures electrical impulses in the brain) may show epileptic

discharges affecting a single area or multiple areas in the brain (so called generalized discharges).

The types of seizures affecting patients with idiopathic generalized epilepsy may include:

Myoclonic seizures (sudden and very short duration jerking of the extremities)

Absence seizures (staring spells)

Generalized tonic-clonic seizures (grand mal seizures)

Idiopathic generalized epilepsy is usually treated with medications. Some people outgrow   this condition and stop having seizures, as

is the case with childhood absence epilepsy and a large number of patients with juvenile myoclonic epilepsy.http://www.webmd.com/epilepsy/guide/types-epilepsyDiagnosing epilepsy 

Epilepsy is usually difficult to diagnose quickly. In most cases, it cannot be confirmed until you have had more than one

seizure.

It can be difficult to diagnose because many other conditions, such asmigraines and panic attacks, can cause similar symptoms.

If you have had a seizure, you will be referred to a specialist in epilepsy, normally a neurologist (a doctor who specialises in

conditions affecting the brain and nervous system).

Describing your seizures

Some of the most important pieces of information needed to diagnose epilepsy are the details about your seizure or seizures.

The doctor will ask you what you can remember and any symptoms you may have had before it happened, such as feeling strange

before the seizure or experiencing any warning signs. It may be useful to talk to anyone who witnessed your seizure and ask them

exactly what they saw, especially if you cannot remember the seizure.

The doctor will also ask about your medical and personal history and whether you use any medicines, drugs or alcohol.

The doctor may be able to make a diagnosis of epilepsy from the information you give, but they might run further tests such as

an electroencephalogram (EEG) or magnetic resonance imaging (MRI) scan.

However, even if these tests don't show anything, it is still possible that you have epilepsy.

Electroencephalogram (EEG)

An EEG test can detect unusual brain activity associated with epilepsy by measuring the electrical activity of your brain through

electrodes placed on your scalp.

During the test, you may be asked to breathe deeply or close your eyes and you may be asked to look at a flashing light.  The test will

be stopped immediately if it looks like the flashing light could trigger a seizure.

In some cases, an EEG may be carried out while you are asleep (sleep EEG) or you may be given a small, portable EEG recording

device to monitor your brain activity over 24 hours (ambulatory EEG).

Magnetic resonance imaging (MRI) scan

An MRI scan is a type of scan which uses strong magnetic fields and radio waves to produce detailed images of the inside of your

body.

It can be useful in cases of suspected epilepsy because it can often detect possible causes of the condition,  such as defects in the

structure of your brain or the presence of a brain tumour. 

An MRI scanner is a large tube that contains powerful magnets. You lie inside the tube during the scan.http://www.nhs.uk/Conditions/Epilepsy/Pages/Diagnosis.aspx