SEIZURES AND EPILEPSY CONTENT CREATED BY Lern more t www.helth.hrvrd.edu
TALK WITH YOUR DOCTOR Tble of Contents WHAT IS A SEIZURE? 4 WHAT IS EPILEPSY? 6 TESTING 7 TREATMENT OPTIONS 9 ANTI-SEIZURE MEDICATION 10 LIVING WITH EPILEPSY 12 Lerning you hve seizure disorder is life-chnging. It my tke some tril nd error to find the tretment tht works best for you with the fewest side effects. By working closely with your doctor, you cn tke steps to control seizures nd help minimize their effect on your life. If this is your first visit, here re some things to discuss with your doctor: Wht kind of seizures do I hve? Wht is likely the cuse of my seizures? Do I need mediction to get my seizures under control? Are there specific things I should void doing until my seizures re under control? If fmily member or friend sw me hve seizure, how did they describe wht hppened? If this is follow-up visit, your doctor will wnt to know: Hve you hd ny seizures in the pst three months? If so, how mny? Wht might hve triggered them? If you tke nti-seizure medicine, hve you hd trouble tking your medicine exctly s prescribed? Are you hving ny side effects from medictions? Hve you strted tking ny new prescription medictions or over-the-counter drugs, herbs, or supplements since your lst visit? If you re womn, re you thinking bout tking birth control pills or getting pregnnt? 2 seizures nd epilepsy seizures nd epilepsy 3
WHAT IS A SEIZURE? WHAT CAUSES SEIZURES? Seizures re cused by brin mlfunction. Nerve cells in the brin generte tiny electricl nd chemicl signls tht pss from cell to cell. These signls direct the brin s ctivity, including thinking, feeling, hering, nd interpreting wht you see. They lso control muscle movement. A seizure occurs when group of nerve cells suddenly strt firing t the sme time. This cn crete wve of electricl ctivity tht spreds over prt of the brin, or throughout the whole brin. When this electricl disturbnce involves the whole brin, the result is clled generlized seizure. Doctors used to cll this grnd ml seizure. During generlized seizure, with little wrning, person suddenly loses consciousness nd my become temporrily very stiff, stretching out the rms nd legs nd/or rching the bck fll down hve jerking movements of the rms, legs, nd trunk muscles Mny things cn mke the brin s electricl ctivity go hywire. They include: high or low blood levels of cids, sodium, clcium, or blood sugr illegl drugs such s crck cocine nd mphetmines use of some prescription medicines, such s some ntidepressnts, sthm medicines, nticncer drugs, penicillin, nd others withdrwl from lcohol or sedtives illnesses such s very high blood pressure, eclmpsi ( problem tht cn occur during pregnncy), liver filure, nd kidney filure specific problems in the brin, like hed injury, developmentl brin disorder, stroke, brin tumor or infection in or ner the brin high fever (minly in children) Anyone who hs seizure for the first time needs to see his or her doctor to determine the cuse of it. pss urine nd sometimes feces A seizure usully stops within two minutes. Afterwrd, person my feel confused nd sleepy. Over the following 24 hours, she or he my hve sore muscles, hedche, or trouble concentrting, or feel very tired. 4 seizures nd epilepsy seizures nd epilepsy 5
WHAT IS EPILEPSY? Epilepsy is n illness chrcterized by repeted seizures. Norml EEG EEG during generlized seizure Often, doctors cn t identify specific reson why person hs epilepsy. Mny people with epilepsy hve generlized seizures. But some hve wht re clled prtil or focl seizures, which cn be of two types: Simple prtil seizure: A person my be wke nd wre during this type of seizure. Symptoms depend on the prt of the brin involved nd cn include jerking movements in one prt of the body; experiencing bnorml smells, sounds, or chnges in vision; nuse; or emotionl symptoms, such s unexplined fer or rge. Complex prtil seizure: The person my seem lert nd wre, but ctully is not. He or she my hve blnk stre or pper to be dydreming, mke chewing or lip-smcking motions, or mke repetitive hnd movements. Unusul behviors, such s wlking round room nd pulling books off bookshelf while not responding to wht others re sying, cn lso occur. When this type of seizure repetedly occurs in the prt of the brin clled the temporl lobe, this type of complex prtil seizure lso is clled temporl lobe epilepsy. 6 seizures nd epilepsy WHAT TESTS ARE NEEDED? An electroencephlogrm (EEG) is pinless test tht looks for bnorml electricl ptterns in the brin. It cn help dignose seizure disorder nd my predict how likely it is tht you will hve seizures in the future. Other tests my be needed to look for wht is cusing seizures, such s: n MRI or CT scn tht cretes pictures of the brin. These tests re usully norml in people with epilepsy, but cn revel the cuse of other types of seizures. blood tests for the levels of sugr or certin minerls in the blood. lumbr puncture ( spinl tp ) to check for possible brin infection. seizures nd epilepsy 7
TREATMENT OPTIONS Tretment often depends on wht kind of seizure you hd. Some seizures re "provoked," mening cused by n underlying helth problem. In tht cse, your tretment will focus on fixing tht problem. FURTHER DIAGNOSIS In 40% to 50% of people with epilepsy, the first EEG will show specific combintion of ptterns tht confirms the dignosis. If your first EEG is norml, repet EEG tests usully will detect the bnorml brin-wve pttern. Sometimes, even when series of EEG tests fils to show signs of seizure ctivity, epilepsy cn be dignosed bsed on the reports of people who hve seen your seizures. If someone sw you hve seizure, tht person cn offer importnt informtion. If someone cn tke video (with phone or cmer) of you hving seizure, tht cn help your doctor determine the type of seizure you hd nd wht might hve cused it. Your doctor will lso do thorough physicl nd neurologicl exm nd my recommend some other tests. 8 seizures nd epilepsy 1 Your first seizure If you hve hd one "unprovoked" seizure, you my never hve nother. If your exms nd tests were norml, your doctor might suggest you do nothing, especilly if you hven't hd brin injury nd don't hve close fmily members with epilepsy. 2 Multiple seizures If you hve hd t lest two seizure episodes nd hve been dignosed with epilepsy, your doctor will likely suggest you tke medicine to prevent future seizures. There re mny nti-seizure drugs to choose from, so you ll work with your doctor to find the one, or combintion, tht works best with the fewest side effects. 3 Frequent seizures On the rre occsion when mediction doesn t gretly reduce the number of seizures, surgery sometimes cn help. Whether surgery is right for you depends on how often nd how severe your seizures re, your risk of brin dmge or injury from frequent seizures, your overll helth, nd the likelihood tht surgery will be successful. seizures nd epilepsy 9
EXTRA PRECAUTIONS FOR WOMEN Women tking nti-seizure drugs need to tke specil precutions. Some medictions cn reduce the effectiveness of birth control pills, including the morning-fter pill. If you tke the pill, sk your doctor if you should use bck-up method of birth control. ANTI-SEIZURE MEDICATION The medictions used to prevent seizures usully come in pill form. Since there re mny different types of nti-seizure mediction, it my tke some tril nd error to find the one tht works best for you. Some people need regulr blood tests to check the level of mediction in the bloodstrem. Some of the older nti-seizure drugs cn weken bones over time. Ask your doctor bout steps to protect bone helth. These include tking clcium nd vitmin D supplements nd getting regulr exercise. Some people my need to tke bone-preserving drug. It s importnt to tke your nti-seizure medicine on time nd s directed. Missing dose cn leve you open to hving seizure. Ask your doctor wht you should do if you miss dose. It is lso very importnt tht you never stop tking your medicine without your doctor s oky nd guidnce. 10 seizures nd epilepsy If you re thinking bout hving bby Tlk with your doctors before you become pregnnt. Mny drugs used to prevent seizures increse the chnces of hving bby with birth defect. But stopping nti-seizure medicine could men more nd longer seizures, which re not good for n unborn bby. The good news: the chnce of hving helthy, norml bby is very high. Stopping mediction during pregnncy If you ve been seizure-free for severl yers nd hve norml EEG, you my be ble to stop your ntiseizure mediction while you re pregnnt. If tht isn t good ide, you my be ble to chnge from combintion of drugs to just one. All women of childbering ge should tke folic cid supplement This is especilly importnt for women tking nti-seizure drugs, becuse these medictions lower levels of folic cid. The usul recommended dose is 400 microgrms per dy the mount found in most multiple vitmins. seizures nd epilepsy 11
LIFESTYLE CONCERNS Most people with seizures cn enjoy n ctive lifestyle. But common-sense precutions re importnt: When you swim Be sure lifegurd is present never swim lone. LIVING WITH EPILEPSY Most people who hve epilepsy cn void seizures if they get enough sleep, mnge stress, nd tke their medictions s directed. But to be on the sfe side, there re things you cn do to help keep you sfe if seizure does occur: Don t lock the door when you go into your bthroom or bedroom. Tke showers insted of bths to lessen the chnce of drowning during seizure. Replce glss doors in your house with sfety glss or plstic. 12 seizures nd epilepsy Wer helmet Protect your hed when riding bike, skiing, nd doing similr ctivities. Avoid risky situtions Until you nd your doctor re confident your seizures re under control, don't do ctivities where hving seizure would put you or someone else in dnger, like driving cr or operting hevy mchinery. Wer medicl lert or ID brcelet Also, let fmily members, friends, nd the people you work with know bout your seizure disorder. Is it sfe for you to drive? Ask your doctor if driving is sfe for you once your seizures re well-controlled. Stte lws vry, so check with your Deprtment of Motor Vehicles. seizures nd epilepsy 13
WHAT OTHERS CAN DO IF A SEIZURE OCCURS If person with known seizure disorder hs brief seizure, it's not necessry to cll doctor or go to n emergency room. However, emergency cre is importnt when: the person does not completely return to his or her norml stte fter the seizure nd post-seizure period, which generlly lsts less thn 30 to 60 minutes. the seizure lsts for more thn few minutes. the person hs multiple seizures. the person is injured during the seizure. If you re with or ner someone hving generlized seizure, the most importnt thing is to prevent him or her from getting injured: Help the person lie down Turn him or her onto one side Plce something soft under the hed Do not hold down the person's rms or legs. Most seizures lst only minute or two. If you re with or ner someone who is hving prtil seizure: Sty with the person Tlk clmly The person my be ble to respond to simple instructions, such s, "Sit down." If necessry fter the seizure, explin where you re nd wht hppened. 14 seizures nd epilepsy Protect them from self-injury Loosen tight clothing Do not prevent moving SEIZURE MYTH X A person will swllow his or her tongue. You my hve herd tht person hving seizure will bite or swllow his or her tongue, mking it hrd to brethe. You my lso hve herd tht it cn be helpful to put something in the person s mouth to prevent this. This is not true. In fct, it cn cuse more hrm thn good! During seizure, the muscles in person s fce nd jw might tighten up. A clenched jw cn mke the person bite down hrd during the seizure so hrd tht nything plced in the mouth cn brek. The person my swllow the item or choke on it, or even brek his or her teeth. seizures nd epilepsy 15
CONTENT CREATED BY Hrvrd Helth Publictions nd Hrvrd Medicl School content should not be used for dignosis or tretment, or s substitute for visits to your medicl provider. Alwys seek the dvice of your helth cre provider if you hve questions regrding your helth or ny medicl condition. 2016 Hrvrd University. All Rights Reserved. Hrvrd Helth Publictions nd Hrvrd Medicl School do not endorse drug products. EPL-H0416 seizures nd epilepsy