Epilepsy – Seizure Types, Symptoms and Treatment Options

Epilepsy is a disorder of the brain characterized by repeated seizures. A seizure is usually defined as a sudden alteration of behavior due to a temporary ... SkiptoMainContent NOTICE MyAANS,password-protectedresources,andpurchasesarecurrentlyexperiencingissuesandareunavailable.Weareworkingtogetthisfixedassoonaspossible. Thesitenavigationutilizesarrow,enter,escape,andspacebarkeycommands.Leftandrightarrowsmoveacrosstoplevellinksandexpand/closemenusinsublevels.UpandDownarrowswillopenmainlevelmenusandtogglethroughsubtierlinks.Enterandspaceopenmenusandescapeclosesthemaswell.Tabwillmoveontothenextpartofthesiteratherthangothroughmenuitems. 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Inepilepsythebrain'selectricalrhythmshaveatendencytobecomeimbalanced,resultinginrecurrentseizures.Inpatientswithseizures,thenormalelectricalpatternisdisruptedbysuddenandsynchronizedburstsofelectricalenergythatmaybrieflyaffecttheirconsciousness,movementsorsensations.   Epilepsyisusuallydiagnosedafterapersonhashadatleasttwoseizuresthatwerenotcausedbysomeknownmedicalcondition,suchasalcoholwithdrawalorextremelylowbloodsugar. Ifseizuresarisefromaspecificareaofthebrain,thentheinitialsymptomsoftheseizureoftenreflectthefunctionsofthatarea.Therighthalfofthebraincontrolstheleftsideofthebody,andthelefthalfofthebraincontrolstherightsideofthebody.Forexample,ifaseizurestartsfromtherightsideofthebrainintheareathatcontrolsmovementinthethumb,thentheseizuremaybeginwithjerkingoftheleftthumborhand. TypesofSeizures Seizuresvarysomuchthatepilepsyspecialistsfrequentlyre-classifyseizuretypes.Typically,seizuresbelonginoneoftwobasiccategories:primarygeneralizedseizuresandpartialseizures.Thedifferencebetweenthesetypesisinhowtheybegin.Primarygeneralizedseizuresbeginwithawidespreadelectricaldischargethatinvolvesbothsidesofthebrainatonce.Partialseizuresbeginwithanelectricaldischargeinonelimitedareaofthebrain. Epilepsyinwhichtheseizuresbeginfrombothsidesofthebrainatthesametimeiscalledprimarygeneralizedepilepsy.Hereditaryfactorsareimportantinpartialgeneralizedepilepsy,whichismorelikelytoinvolvegeneticfactorsthanpartialepilepsy—aconditioninwhichtheseizuresarisefromalimitedareaofthebrain. Somepartialseizuresarerelatedtoheadinjury,braininfection,strokeortumorbut,inmostcases,thecauseisunknown.Onequestionthatisusedtofurtherclassifypartialseizuresiswhetherconsciousness(theabilitytorespondandremember)isimpairedorpreserved.Thedifferencemayseemobvious,buttherearemanydegreesofconsciousnessimpairmentorpreservation. Thefollowingfactorsmayincreasetheriskofseizuresinpeoplepredisposedtoseizures: Stress Sleepdeprivationorfatigue Insufficientfoodintake Alcoholuseordrugabuse Failuretotakeprescribedanticonvulsantmedications Abouthalfofthepeoplewhohaveoneseizurewithoutaclearcausewillhaveanotherone,usuallywithinsixmonths.Apersonistwiceaslikelytohaveanotherseizureifthereisaknownbraininjuryorothertypeofbrainabnormality.Ifthepatientsdoeshavetwoseizures,thereisaboutan80percentchanceofhavingmore.Ifthefirstseizureoccurredatthetimeofaninjuryorinfectioninthebrain,itismorelikelythepatientwilldevelopepilepsythaniftheseizuredidnothappenatthetimeofinjuryorinfection. PrevalenceandIncidence AccordingtotheEpilepsyFoundation,epilepsyaffectsthreemillionpeopleintheU.S.and50millionworldwide.Epilepticseizuresmaybetiedtoabraininjuryorgenetics,butfor70percentofepilepsypatients,thecauseisunknown.TheEpilepsyTherapyProjectnotesthat10percentofpeoplewillhaveseizuresintheirlifetime. Epilepsyaffectsmorethan300,000childrenundertheageof15—andmorethan90,000youngpeopleinthisgrouphaveseizuresthatcannotbeadequatelytreated.Theonsetratestartstoincreasewhenindividualsage,particularlyastheydevelopstrokes,braintumorsorAlzheimer'sdisease,allofwhichmaycauseepilepsy.Reportsindicatethatmorethan570,000adultsovertheageof65sufferfromthedisorder. Morementhanwomenhaveepilepsy.Childrenandadolescentsaremorelikelytohaveepilepsyofunknownorgeneticorigin.Braininjuryorinfectioncancauseepilepsyatanyage.TheEpilepsyFoundationalsoreportsthat70percentofchildrenandadultswithnewlydiagnosedepilepsycanbeexpectedtoenterremissionafterhavinggonefiveyearsormorewithoutaseizurewhileonmedication.Inaddition,75percentofpeoplewhoareseizure-freeonmedicationcanbeweanedfrommedicationeventually.AccordingtotheNationalInstituteofNeurologicalDisordersandStroke,20percentofepilepsypatientshaveintractableseizures—seizuresthatdonotrespondtotreatment. Thereasonswhyepilepsybeginsaredifferentforpeopleofdifferentages.Butwhatisknownisthatthecauseisundeterminedforabouthalfofallindividualswithepilepsy,regardlessofage.Childrenmaybebornwithadefectinthestructureoftheirbrainortheymaysufferaheadinjuryorinfectionthatcausestheirepilepsy.Severeheadinjuryisthemostcommonknowncauseinyoungadults.Formiddle-ageindividuals,strokes,tumorsandinjuriesaremorefrequentcatalysts.Inpeopleage65andolder,strokeisthemostcommonknowncause,followedbydegenerativeconditionssuchasAlzheimer'sdisease.Often,seizuresdonotbeginimmediatelyafterapersonhasaninjurytothebrain.Instead,aseizuremayoccurmanymonthslater. EpilepsyRiskFactors Prematurebirthorlowbirthweight Traumaduringbirth(suchaslackofoxygen) Seizuresinthefirstmonthoflife Abnormalbrainstructuresatbirth Bleedingintothebrain Abnormalbloodvesselsinthebrain Seriousbraininjuryorlackofoxygentothebrain Braintumors Infectionsofthebrainsuchasmeningitisorencephalitis Strokeresultingfromblockageofarteries Cerebralpalsy Mentaldisabilities Seizuresoccurringwithindaysafterheadinjury Familyhistoryofepilepsyorfever-relatedseizures Alzheimer'sdisease(lateintheillness) Lengthyfever-related(febrile)seizures Alcoholordrugabuse Diagnosis Adoctormakeshisorherepilepsydiagnosisbasedonsymptoms,physicalsignsandtheresultsofsuchtestsasanelectroencephalogram(EEG),computedtomography(CTorCATscan)ormagneticresonanceimaging(MRI). Itisessentialthatthetypeofepilepsyandthetypeofseizuresbotharediagnosedproperly.Thereareseveralmajorclassificationsofseizuresandmostareassociatedwithspecificformsofthedisorder. Treatment Epilepsymaybetreatedwithantiepilepticmedications(AEDs),diettherapyandsurgery.Medicationsaretheinitialtreatmentchoiceforalmostallpatientswithmultipleseizures.Somepatientswhoonlyhaveasingleseizureandwhosetestsdonotindicateahighlikelihoodofseizurerecurrencemaynotneedmedications.Themedicationstreatthesymptomsofepilepsy(theseizures),ratherthancuringtheunderlyingcondition.Theyarehighlyeffectiveandcompletelycontrolseizuresinthemajority(approximately70%)ofpatients.Thedrugspreventseizuresfromstartingbyreducingthetendencyofbraincellstosendexcessiveandconfusedelectricalsignals. Withmanydifferentantiepilepticdrugscurrentlyavailable,choosingtherightmedicationforanindividualpatienthasbecomecomplicated.Choiceofmedicationdependsonavarietyoffactors,someofwhichincludethetypeofseizureandtypeofepilepsy,thelikelysideeffectsofthemedication,othermedicalconditionsthepatientmayhave,potentialinteractionswiththepatient’sothermedications,age,genderandcostofthemedication. Beforeanydrugisprescribed,patientsshoulddiscusspotentialbenefits,sideeffectsandriskswiththeirdoctors. Diettherapymaybeutilizedinsomepatientswithspecificformsofepilepsy.ThemostcommondietsutilizedaretheketogenicdietandthemodifiedAtkinsdiet.Theketogenicdietisaspecialhigh-fat,adequateproteinandlowcarbohydratedietthatisinitiatedoverthreetofourdaysinthehospital.ThemodifiedAtkinsdietissimilartotheketogenicdietbutisslightlylessrestrictive.Itcanbeinitiatedasanoutpatient.Bothdietshavebeenshowntoreduceseizuresinapproximatelyhalfthepatientsthatareidentifiedtobeappropriatecandidates.Thesearemainlychildrenwithrefractoryepilepsywhoarenotsurgicalcandidates. Whileapproximately70percentofpatientshavewell-controlledseizureswiththesemodalities,theremaining30percentdonotandareconsideredmedically-resistant.Patientswithmedically-resistantepilepsyareoftentreatedatspecializedepilepsycentersinamulti-disciplinaryfashion. Theteamoftrainedspecialiststhatcollaboratetoprovidethesepatientswithcomprehensivediagnosisandtreatmentofepilepsymayinclude: Adultepileptologists Pediatricepileptologists Epilepsynursepractitioners Epilepsyneurosurgeons EEGtechnicians Clinicalneuropsychologists Psychiatrists Neuroradiologists Nuclearmedicineradiologists Dietitians Neurosciencenurses Inpatientswhoseseizuresaremedicallyresistant,surgeryprovidesthebestchanceofcompletecontrolofseizures.However,notallpatientswithrefractoryepilepsyaresuitablecandidatesforsurgery.Inadditiontobeingrefractory,theyneedtohavepartial,ratherthangeneralizedepilepsy(i.e.theirepilepsyarisesfromasinglepartofthebrain,ratherthanfrombothsidesorfromalloverthebrain). Furthermore,theepilepticregionshouldbeinapartofthebrainthat,ifremoved,isunlikelytoresultinmajorneurologicalcomplications.Whetherornotpatientsarelikelytobenefitfromsurgeryisdeterminedbydetailedtesting(pre-surgicalevaluation). Pre-surgicalevaluationconsistsofaone-ortwo-phaseprocesstodetermineifsurgeryisthebestoptionandcanprovidegoodseizurecontrolwithminimalrisk.PhaseIinvolvesallnon-invasive(non-surgical)tests.PhaseIItestinginvolvesinvasivetests(requiressurgery)thatareusedinselectpatients. PhaseIEvaluation(noninvasivetests) NoteverypatientrequireseverytestavailableinthePhaseIevaluation.Adultandpediatricepilepsypatientsareevaluatedbyepileptologistswhodeterminethenecessaryandappropriatetestsonanindividualizedbasis.ThefollowingtestsmayberequiredinthephaseIevaluation: Electroencephalography(EEG) Thisistheinitialtestperformedineverypatientandisusuallydoneasanoutpatientprocedure(picturedhere).Itisusednotonlytodiagnoseepilepsy,butalsotodetermineiftheepilepticseizuresarecomingfromasmallpartofthebrain(partialseizures),oralloverthebrain(generalized). AlthoughmostpatientsdonothaveseizureswhentheEEGisbeingrecorded,theyoftenhaveabnormalbrainactivityintheEEG(spikesorsharpwaves)thatindicatestheyhaveatendencytohaveseizures.Thelocationofthisactivityallowsthephysiciantodeterminewhetherpatientshavepartialorgeneralizedseizures.   InpatientVideo-EEGmonitoringinAdultandPediatricEpilepsymonitoringUnits(EMU) Thisisthemostimportantpre-surgicaltestandisperformedwithelectrodesattachedtothescalp(noninvasivemonitoring).PatientsareadmittedtothehospitalforseveraldaysandthepurposeistorecordseizureswithsimultaneousvideoandEEG.Allthedataareanalyzedbyatrainedepileptologist.DetailedanalysisofthesymptomsduringseizuresaswellasthelocationofEEGchangesduringseizures(ictalEEGonset),andabnormalitiesnotedinbetweenseizures(interictal),indicatethelikelylocationwhereseizuresoriginatewithinthebrain. MagneticResonanceImaging(MRI) Thismaydetectanabnormalitythatcouldbethecauseoftheepilepsy(lesionalepilepsy)ormaybenormal(non-lesionalepilepsy).WithmorepowerfulMRImachinesanduseofspecialprotocolsandsoftware,subtlebrainabnormalitiesareincreasinglybeingidentified. Positronemissiontomography(PET) PETscanslookatthemetabolicactivityofthebrainandallowphysicianstodetermineifthebrainisfunctioningnormally.Inpatientswithepilepsy,decreasedbrainfunctionisseenintheregionwhereseizuresoriginate,whenthepatientisnotactuallyhavingaseizure.Ontheotherhand,ifthepatienthasaseizureduringthetest,increasedbrainfunctionisseen.PETscanmayshowabnormalitiesevenifthebrainMRIisnormal.PETscansareusuallydoneintheoutpatientsetting. Single-photonemissioncomputedtomography(SPECT) Whenapersonhasaseizure,anincreasedamountofbloodflowstothebrainregionwheretheseizurebegins.SPECTscansperformedduringseizurescanidentifythebrainregionwherebloodflowincreasesandthusindicatewheretheybegin.SPECTscansareperformedwhenthepatientisadmittedtothehospitalforvideo-EEGmonitoring. Neuropsychologicalevaluation,functionalMRI:NeuropsychologicalevaluationandfunctionalMRIareusedtoassesscognitivefunctions,especiallylanguageandmemoryfunctionpriortosurgery,toseewhichsideofthebrainisdominantforlanguageandtodetermineifthereisdecreasedmemoryfunctionintheepilepticregion.Thisallowspredictionofcognitivedeficitsaftersurgery.FunctionalMRI(fMRI)measuresbloodflowchangesinareasofthebrainduringtheperformanceofspecificcognitivetasks. Intracarotidamobarbital/methohexital(Wadatest) Thistestinvolvestheinjectionofamedicationsuchassodiumamobarbitalormethohexitalintoonecarotidarteryatatimeandisperformedinselectedcases.Themedicationcausestemporary(1-5minutes)paralysisofonehalfofthebrainallowingindependenttestingoflanguageandmemoryfunctionintheotherhalf.Thistestisalsousedtopredictpost-operativedeficitsinlanguageandmemoryfunction. Resultsofvideo-EEGmonitoringarecomparedwiththoseobtainedfromtheotherteststoseeiftheyallpointtothesameregionofthebrainasbeingtheoriginofepilepticseizures.Ifallthetestresultsareconcordant,thepatientislikelytobeagoodsurgicalcandidate.Thus,thePhaseIevaluationisdesignedtofindtheareaofthebrainthatislikelytobegeneratingtheseizures(thefocus),todetermineifthatareacanbesafelyremoved,andpredictwhatkindofoutcomemightbeexpectedwithregardtoseizurereductionorseizurefreedom. AfterthePhaseIevaluation,theepilepsyteammeetstodiscusspatientmanagementoptionsinamulti-disciplinarysettingtoindividualizetreatments.Atthattime,basedontheresultsofthePhaseIevaluation,patientsmaybedeemedgoodorpoorsurgicalcandidates.Insomecases,itmaybeunclearandmoretestingisneeded.ThisadditionaltestingiscalledPhaseIIevaluationandisperformedinselectcases,wheredespiteallpriortests,theseizurefocusisnotdefinedwellenoughforsurgicaltreatment. PhaseIIevaluationinvolvesvideo-EEGmonitoringwithelectrodesthatareplacedinsidetheskull(invasivemonitoring).Asthereismoreriskfrominvasivemonitoring,thedecisionaboutthenecessityforaPhaseIIevaluationisusuallymadebytheepilepsyteamasawholeanddiscussedindetailwiththepatient. PhaseIIEvaluation Thereareseveralsurgicalimplantationoptions.Eachinvolvestheimplantationofelectrodeseitheronthesurfaceofthebrain,orwithinthebrain.Thebenefitoftheseelectrodesisthattheyareclosertotheareaproducingtheseizuresthanthoseplacedsimplyonthescalp.Aftersurgicalplacementofelectrodes,thepatientsaretransferredtotheepilepsymonitoringunitandepileptologistsperformvideo-EEGmonitoringinasimilarfashiontothephaseImonitoring. Theelectrodetypesandimplantationarraysdifferandmayinclude: Subduralelectrodes Asubduralelectrodegridisathinsheetofmaterialwithmultiplesmall(couplemillimetersinsize)recordingelectrodesimplantedwithinit.TheseareplaceddirectlyonthesurfaceofthebrainandhavetheadvantageofrecordingtheEEGwithouttheinterferenceofskin,fattissue,muscleandbonethatmaylimitscalpEEG.Shapesandsizesofthesesheetsarechosentobestconformtothesurfaceofthebrainandtheareaofinterest. Depthelectrodes Thesearesmallwireswhichareimplantedwithinthebrainitself.Eachwirehaselectrodeswhichsurroundit.Theseelectrodesareabletorecordbrainactivityalongtheentirelengthoftheimplantedwire.Theyhavetheadvantageofrecordingactivityfromstructuresdeeperinthebrain.Theycanbeimplantedthroughsmallskinpokes. Combination Inanumberofinstances,itisbeneficialtoimplantacombinationofsubduralelectrodesanddepthelectrodes. Stereoelectroencephalography Increasinglycommon,invasivemonitoringmaybedoneusingthestereoelectroencephalographyapproach(stereoEEG).Withthisapproach,multipledepthelectrodesareimplantedinaspecificpatternthatisindividualizedtothepatient.Thethree-dimensionalspacewhichiscoveredbythedepthelectrodesisdesignedtoencompasstheseizurefocus. Functionalmapping ThisisusuallyperformedinpatientswithimplantedsubduralelectrodeswhiletheyareintheEMU.Afterasufficientnumberofseizuresarerecorded,briefelectricalstimulationisprovidedthrougheachelectrodeseparatelytodeterminethenormalfunctionofthepartofthebrainunderneaththeelectrode.Thisispainless.Thepurposeistomapoutcriticallyimportantareasofthebrainsuchasthosenecessaryformotor,sensoryandlanguagefunctionsandtodetermineifthereisanyoverlapwiththeseizure-generatingregions.Thisallowstailoringofsurgicalresectionstominimizetheriskofmajorneurologicaldeficitsaftersurgery. SurgicalProcedures Surgeryforthetreatmentofepilepsyinvolvesresection,disconnection,stereotacticradiosurgeryorimplantationofneuromodulationdevices.Withinthesecategories,therearemultipleoptionsdependingontheclinicalscenario. Surgicalresections Surgicalresection(removalofabnormaltissue)forepilepsymayfallintothefollowingbroadcategories: Lesionectomy Alesionisagenerictermforbrainabnormalitiesthatshowuponimaging.Sometypesoflesions—suchascavernousmalformations(bloodvesselabnormality)andtumors—arepronetocauseseizures.Whenthepre-operativetestingindicatesthattheselesionsarethecauseoftheepilepsy,theycanberemovedsurgically. Lobectomy Eachhemisphere,orhalf,ofthebrainisdividedintofourmainlobes—thefrontal,temporal,parietalandoccipital.Seizuresmayarisewithinanyofthelobes.Alobectomyisanoperationtoremovealobeofthebrain.Removalofoneofthetemporallobes—calledatemporallobectomy—isthemostcommontypeofepilepsysurgeryperformed.Othertypesoflobectomiesmayrelyonmorespecializedtestingandsurgerytoprovealackofvitalfunction(suchasspeech,memory,vision,motorfunction). Multilobarresection Amultilobarresectioninvolvesremovalofpartsoralloftwoormorelobesofthebrain.Itisreservedformorewidespreadabnormalitiescausingseizures,providingthatnovitalfunctionsareinthoseregions. Hemispherectomy Thebrainisdividedintoaleftandrighthemisphere.Inrareinstances,childrenmayhavesevere,uncontrollableanddevastatingseizuresthatcanbeassociatedwithweaknessononesideofthebody.Thismayoccurwithalargeamountofdamageorinjurytooneofthehemispheres.Surgerytoremoveordisconnectahemisphere,ahemispherectomymaybecurative.Therearemanysubtypesofthissurgery,thetwomaindivisionsbeinganatomicandfunctionalhemispherectomy.Anatomichemispherectomyinvolvesremovingtheentirehalfofthebrainthatisinjuredandisgeneratingthedebilitatingseizures.Thisincludesthefourlobesofthehemisphere—frontal,temporal,parietalandoccipital.Functionalhemispherectomyinvolvesseparatingtheabnormalhemispherefromthenormalonebydisconnectingfibersthatcommunicatebetweenthetwo.Often,someportionsoftheabnormalbrainaresurgicallyremovedinordertoperformthisdisconnection. Functionalhemispherectomy Functionalhemispherectomyinvolvesseparatingtheabnormalhemispherefromthenormalonebydisconnectingfibersthatcommunicatebetweenthetwo.Often,someportionsoftheabnormalbrainaresurgicallyremovedinordertoperformthisdisconnection.Thisis,veryoften,surgicallycurative. Surgicaldisconnection Thesesurgeriesinvolvecuttinganddividingfiberbundlesthatconnectportionsofthebrain.Therationaleistoseparatetheareaofthebraingeneratingtheseizuresfromthenormalbrain. Corpuscallosotomy Thecorpuscallosumisoneofthemainfiberbundlesthatconnectthetwohemispheres.Whendebilitatinggeneralizedseizuresorfalling-typeseizuresstartononesideofthebrainandquicklyspreadtotheother,patientsmaybecandidatesforthisprocedure.Alargepartofthisfiberbundlemaybecut.Theprocedureispalliative,meaningthatalthoughseizuresmayimprove,theyusuallydonotdisappear. Multiplesubpialtransections(MST) Incertaincasesofepilepsy,wheretheseizuresaredeemedtobearisingfromanareaofthebrainthatcannotbesafelyremoved,multiplesubpialtransectionscanbeperformed.Inthisprocedure,asmallwireisplacedintothebraintoperformtransectionsatmultiplepointsinagivenregionwhichcandecreaseseizuresbydisconnectingthecross-communicationofneurons. Stereotacticradiosurgery Stereotacticradiosurgeryinvolvesthedeliveryofafocusedbeamofradiationtoaspecifictargetarea.GammaKniferadiosurgery,oneofthemostcommonformsofradiosurgery,usesgammaraystotargettheareatobetreated.Inepilepsy,itisgenerallyreservedforsmall,deep-seatedlesionsthatarevisibleonMRimaging. Neuromodulation TherearecurrentlytwoFDA-approveddevicesthatmodulatethenervoussystemwiththegoalofimprovedseizurecontrol.Thisincludesvagusnervestimulationandresponsiveneurostimulation.Bothdevicesareconsideredpalliativeinthatthegoalisimprovedseizurecontrol,andrarelydopatientsbecomeseizurefree. Vagusnervestimulation Thevagusnervestimulator(VNS)isanFDA-approveddeviceforthetreatmentofepilepsythatisnotcontrolledwithantiepilepticmedications.Itinvolvesthesurgicalplacementofelectrodesaroundthevagusnerveintheneckandageneratorplacedbelowthecollarboneintheupperchestregion.Itrequirestwoseparateincisions,butisanoutpatientprocedure.Subsequently,aprogrammercanbeusedbytheepileptologist(fromoutsidetheskin)tochangetheintensity,durationandfrequencyofstimulationtooptimizeseizurecontrol.VNSdecreasesseizurefrequencybyatleasthalfin40to50percentofpatients,butrarelyeliminatesallseizures.Itisanoptionforthosewhoarenotcandidatesforothertypesofsurgery. Responsiveneurostimulation(RNS) TheNeuroPaceresponsiveneurostimulation(RNS)devicewasapprovedbytheFDAin2014asatreatmentforadultswithpartial-onsetseizureswithoneortwoseizureonset-zones,whoseseizureshavenotbeencontrolledwithtwoormoreantiepilepticdrugs.Surgeryinvolvesplacinganeurostimulatorintheskullandconnectingtotwoelectrodesthatareplacedeitheronthesurfaceorintothebrain,inoraroundtheareawhichisdeemedtobethelikelyonsetregionfortheseizure.Thedevicerecordsbrainwaves(EEG),andistrainedbytheepileptologisttodetecttheelectricalsignatureoftheseizureonsetandthendeliveranimpulsewhichcanstoptheseizure.Datacollectedbytheneurostimulatorcanbyuploadedbythepatientwiththeuseofahand-heldwandtoasecureweb-basedapplicationwhichcanbeaccessedbytheepileptologist.Thissurgeryisgenerallyreservedforpatientswhoarenotacandidateforsurgicalresection,sincetheRNSimprovesseizurecontrolbutrarelystopsseizuresfromoccurring. Improvedtechnologyandtestinghasmadeitpossibletoidentifymoreaccuratelywhereseizuresoriginateinthebrain(epileptogenicregions),andadvancesinsurgeryhavemadeoperativemanagementsaferforallformsofsurgeryforepilepsy.Ofthesurgeriespresented,surgicalresectionoffersthebestchanceofrenderingapatientseizure-free.However,thebenefitsofsurgeryshouldalwaysbeweighedcarefullyagainstitspotentialrisks. LivingandCopingwithEpilepsy Peoplewithepilepsyareatriskfortwolife-threateningconditions:tonic-clonicstatusepilepticusandsuddenunexplaineddeathinepilepsy(SUDEP).Tonic-clonicstatusepilepticusisalong-lastingseizurethat'sconsideredamedicalemergency.Ifnotstoppedwithinabout30minutes,itmaycausepermanentinjuryordeath. SUDEPisarareconditioninwhichyoungormiddle-agedpeoplewithepilepsydiewithoutaclearcause.Itaccountsforlessthantwopercentofdeathsamongpeoplewithepilepsy.Theriskisaboutonein3,000peryearforallpeoplewithepilepsy.However,itcanbeashighasonein300forthosewhohavefrequent,uncontrollableseizuresandtakehighdosesofseizuremedicines.ResearchersareuncertainwhySUDEPcausesdeath.Somebelievethataseizurecausesanirregularheartrhythm.Morerecentstudieshavesuggestedthatthepersonmaysuffocatefromimpairedbreathing,fluidinthelungsandlyingfacedownonbedding. Althoughtheriskislow,peoplewithepilepsyalsocandiefrominhalingvomitduringorjustafteraseizure. Mostwomenwithepilepsycanbecomepregnant,buttheyshoulddiscusstheirepilepsyandthemedicationstheyaretakingwiththeirdoctorsbeforegettingpregnant.Manypatientswithepilepsytakehighdosesofmedicationthatmayleadtopotentiallyharmfuldrugexposuretounbornbabies.Insomecases,medicationsmaybereducedbeforepregnancy,particularlyifseizuresarewell-controlled.Whileseizuremedicationscanproducebirthdefects,severebirthdefectsarerareininfantsofwomenwhoreceiveregularprenatalcareandwhoseseizuresarecarefullymanaged.Womenwithepilepsyhavea90percentorbetterchanceofhavinganormal,healthybaby. Epilepsyisachronicconditionthataffectspeopleindifferentways.Manypeoplewithepilepsyleadnormal,activelives.Between70and80percentofpeoplewithepilepsycansuccessfullycontroltheirseizuresthroughmedicationorsurgicaltechniques. Somepeoplefindthattheyrarelyhavetothinkaboutepilepsy,exceptwhentakingtheirmedicationsorgoingtoseethedoctor.Nomatterhowepilepsyaffectsaperson,itisimportanttorememberthatbeingwell-informedabouttheconditionandkeepingapositiveattitudeareimportant.Workingcloselywithahealthcareteamandadheringtoprescribedmedicationsareessentialtohelpingcontrolseizuressothatthepatientcanleadafull,balancedlife. AdditionalInformation Videos WatchaGoodDayPApieceonepilepsy,featuringaninterviewwithtwodoctors. RebootingKimberly'sBrain:astoryofayoungwoman'sepilepsytreatment. Learnaboutapatientwithepilepsywho,withnewtreatment,isabletohaveababy. Hazelbeganexhibitingsymptomsofepilepsybeforeherfirstbirthday.Learnabouthertreatmentjourney. Thesewebsitesofferadditionalhelpfulinformationonepilepsy,itscauses,treatmentoptions,supportandmore(Note:thesesitesarenotundertheauspiceofTheAmericanAssociationofNeurologicalSurgeons,andtheirlistinghereshouldnotbeseenasanendorsementofthesesitesortheircontent). Healthline EpilepsyFoundation NationalInstituteofNeurologicalDisordersandStrokeEpilepsyPage EpilepsyTherapyProject CentersforDiseaseControlandPreventionEpilepsyPage AmericanEpilepsySociety InternationalLeagueAgainstEpilepsy/InternationalBureauforEpilepsy TheAANSdoesnotendorseanytreatments,procedures,productsorphysiciansreferencedinthesepatientfactsheets.Thisinformationisprovidedasaneducationalserviceandisnotintendedtoserveasmedicaladvice.Anyoneseekingspecificneurosurgicaladviceorassistanceshouldconsulthisorherneurosurgeon,orlocateoneinyourareathroughtheAANS’FindaBoard-certifiedNeurosurgeon”onlinetool.   FindaBoard-certifiedNeurosurgeonNearYou SearchHere SupporttheNREFWhenYouShop RegisterwithiGive.comorAmazonSmileanddesignatetheNREFasyourcharity. DonateHere Patients FindaBoard-certifiedNeurosurgeon NeurosurgicalConditionsandTreatments PatientEducationVideos