FitSugar

John Travolta's Son Dies From Possible Complications of Kawasaki Disease

FitSugar — Mon, 05 Jan 2009 10:00:00 -0800

Sad news came over the weekend when John Travolta and Kelly Preston's son, Jett Travolta, passed away while on vacation in the Bahamas. At only 16 years old, Jett reportedly was found in a bathtub on Friday, Jan. 2., after suffering from a seizure and hitting his head.

At age two, Jett was diagnosed with Kawasaki disease, a condition that involves swelling of the arteries, which can cause serious complications involving heart and blood vessels that supply oxygen to the heart. Kawasaki disease can cause aneurysms, which can cause fatal heart attacks. It's not clear though whether Jett's death was a result of Kawasaki disease.

To hear more about Jett's condition read more.

Jett had also been suffering from seizures his entire life, on an average of one every four days. Travolta's lawyers said, "each seizure was like a death," since Jett would convulse and lose consciousness. To prevent these episodes, Jett had been taking Depakote, a strong antiseizure medication. The stories stating that John refused to give his son the medicine because of his Scientology views are not true. The drug helped tremendously in the beginning, reducing the frequency of Jett's seizures to one every three weeks, but eventually, the drug lost its effectiveness, and Jett's seizures returned to a frequency of once a week. After consulting with neurosurgeons, Travolta and Preston decided to stop using Depakote, although there's no evidence that discontinuation of the drug caused Jett's seizure. An autopsy is scheduled for today with the hope that details on the cause of Jett's death will be revealed.

Our hearts and sympathies go out to John and Kelly's family and friends during this tragic and difficult time.

Source

Epilepsy Myth

FitSugar — Fri, 27 Jul 2007 02:00:00 -0700

I just read this and knew I had to share it: it is a myth that a person having a seizure can swallow their tongue, therefore you should never put anything in their mouth. If you put an object in someone's mouth who is having a seizure, they could bite it and the piece of stick or pencil could get lodged in their throat and block their ability to breath. Which is ultimately more dangerous than a seizure.

A recent survey conducted at University College London found that many myths surrounding epilepsy were prevalent in about 30 - 35 % of the population questioned, about 4,600 people.

Seizures are caused by sudden bursts of electrical activity in the brain, which interrupts normal communication between the brain and the body and epilepsy is diagnosed in people who have regularly recurring seizures. Experts recommend that if someone has a seizure, objects around them should be removed and their head needs to be cushioned if they are on the floor. Apart from that the seizure should be allowed to run its course. An ambulance should be called in the case of: first seizures, those lasting over five minutes, if the person is hurt or has several seizures.

I think it is important to shed light on old myths and share the facts - you never know when you might need them.

Generalized tonic-clonic seizure

admin — Wed, 03 Sep 2008 17:51:26 -0700

Illustrations

Central nervous system

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

A generalized tonic-clonic seizure is a seizure involving the entire body, which usually involves muscle rigidity, violent muscle contractions, and loss of consciousness.

Alternative Names

Seizure - tonic-clonic; Seizure - grand mal; Grand mal seizure; Seizure - generalized

Causes, incidence, and risk factors

Generalized tonic-clonic seizures (also called grand mal seizures) are the type of seizure that most people associate with the term "seizure," convulsion, or epilepsy. They may occur in people of any age, as a single episode or as a repeated, chronic condition (epilepsy). The majority of seizures that do occur as just a single episode are generalized tonic-clonic seizures rather than other types.

Generalized seizures are caused by abnormal electrical activity at multiple locations in the brain and/or over a large area of the brain. This results in loss of consciousness and body stiffening, which is followed by shaking of the arms and legs.

Abnormal electrical activity may start in one part of the brain and cause isolated symptoms (see partial seizures). Sometimes this abnormal electrical activity spreads through the brain, resulting in a generalized seizure. Seizures can be caused by a specific area of the brain that is injured or inflamed, or they can be due to stress on the brain from a more widespread systemic process, such as severely low blood sugar.

Some of the more common causes of seizures include:

Idiopathic seizures have no identifiable cause. They usually begin between ages 5 and 20, but can occur at any age. There are no other neurological problems, but the patient often has a family history of epilepsy or seizures.
Congenital defects (present from before birth) and injuries that occur near the time of birth can cause seizures to begin in infancy or early childhood.
Febrile seizure (in children) are usually caused by rapidly rising fevers in children.
Acute severe infections of any part of the body, chronic infections (such as neurosyphilis), and complications of AIDS or other immune disorders can cause seizures.
Seizures related to metabolic problems can occur at any age, and may be due to:
- Diabetes mellitus complications
- Electrolyte imbalances
- Kidney failure, uremia (toxic accumulation of wastes)
- Nutritional deficiencies
- Phenylketonuria (PKU)-- rarely causing seizures in infants
- Low blood sodium or glucose
Brain injury usually causes seizures 2 years after the injury. Early seizures (within 2 weeks of injury) do not necessarily indicate that chronic seizures (epilepsy) will develop
Tumors and brain lesions (such as hematomas) are more common after age 30. They most commonly cause partial (focal) seizures at first, then progress to generalized tonic-clonic seizures.
Other causes include:
- Use of alcohol or other recreational drugs, or withdrawal from alcohol or drugs
- Disorders affecting the blood vessels (stroke, TIA), a common cause of seizures after age 60.
- Degenerative disorders (senile dementia Alzheimer type)

Risk factors include:

Any injury to the brain
Family history of seizures
Severe medical problems that affect electrolytes
Using recreational drugs and certain medications
Heavy alcohol use

Symptoms

Many patients have an aura (sensory warning sign) preceding the seizure. This can include a visual, taste, smell, sensory, or other hallucination or dizziness.

The seizure itself involves:

Loss of consciousness or fainting, usually lasting between 30 seconds and 5 minutes
General muscle contraction and rigidity (tonic posture), usually lasting 15-20 seconds
Violent rhythmic muscle contraction and relaxation (clonic movement), usually lasting for 1-2 minutes
Biting the cheek or tongue, clenched teeth or jaw
Incontinence (loss of urine or stool control)
Stopped breathing or difficulty breathing during seizure
Blue skin color

Almost all people lose consciousness, and most people have both tonic and clonic muscle activity.

After the seizure, the person usually has:

Normal breathing
Sleepiness lasts for one hour or longer
Loss of memory (amnesia) regarding events surrounding the seizure episode
Headache
Drowsiness
Confusion, temporary and mild
Weakness for 24-48 hours following seizure (Todd's paralysis)

Signs and tests

Diagnosis of a grand mal seizure is based on the symptoms and excluding other medical problems that can look like a seizure (such as heart arrhythmia). A neuromuscular examination may or may not reveal neurologic deficits (decreases in brain functions) when the person is not actively having seizures.

An EEG may show characteristic changes and in some cases may show the focus (location of the cause of the seizure). An EEG can be normal in between seizures and a normal EEG does not rule out a seizure disorder.

Tests for the cause may include various blood tests (depending on the suspected cause), including:

Complete blood count
Blood chemistry, blood glucose
Liver function tests
Kidney function tests (BUN, creatinine, etc.)
tests for infectious diseases (depending on the suspected cause)

Tests for the cause may include procedures such as:

Head CT or MRI scan
Lumbar puncture (spinal tap)

Disorders that may cause symptoms resembling seizures include transient ischemic attacks, rage, or panic attacks.

Treatment

EMERGENCY FIRST-AID TREATMENT

Protect the person from injury. Clear the area of furniture or other objects that may cause injury from falls during the seizure.
Do not attempt to force a hard object (such as a spoon or a tongue depressor, etc.) between the teeth. You can cause more damage than you can prevent.
Do not attempt to hold the person down during the seizure.
Turn the person to the side if vomiting occurs. Keep the person on his or her side while sleeping after the seizure is over.
If the person having a seizure turns blue or stops breathing, try to position the head to prevent the tongue from blocking the airway. Breathing usually starts on its own once the seizure is over.
CPR or mouth-to-mouth breathing is rarely needed after seizures and cannot be performed during the seizure.

If a person has repeated or prolonged seizures without regaining consciousness or returning to normal behavior, the body may develop a severe lack of oxygen. This an emergency situation - seek immediately medical help.

EMERGENCY TREATMENT BY MEDICAL PERSONNEL

Measures to protect the airway may be needed, including use of tubes to keep the airway open. Breathing should be supported as needed.
Thiamine or intravenous glucose may be given.
Medications such as diazepam (Valium) or lorazepam, or anticonvulsant medications such as phenytoin or phenobarbital may control prolonged, repeated generalized seizures. They are usually injected into a vein.
General anesthesia with muscle-paralyzing medications may be needed.
After status epilepticus is controlled, the patient will be given anticonvulsants. Tests will be done to determine the cause of the condition, if it is not already known.

AFTER THE SEIZURE

Treat any injuries from bumps or falls. Record details of the seizure to report to the health care provider. Important details include:

Date and time of the seizure
How long it lasted
What body parts were affected
Type of movements or other symptoms
Possible causes
Behavior after the seizure

Treating the cause, if one has been identified, may stop seizures. This may include medication, surgical repair of tumors or brain lesions, or other treatments. An isolated seizure with an obvious trigger (such as fever and toxic reaction) is treated by eliminating or avoiding the precipitating factor.

An isolated seizure without an obvious trigger may not require treatment.

Anti-seizure medicines may prevent or reduce the number of future seizures. Medicines may be used alone or in combination with another drug.

Women who might get pregnant may need to take additional medications or vitamins to reduce the risk of birth defects associated with some of these medications. Such women may need to be followed in a high-risk pregnancy clinic.

Patients who continue to have seizures despite several medications may benefit from a vagal nerve stimulator (implantable device that stimulates a nerve in the neck) or from brain surgery to remove tissue responsible for causing the seizures.

Informational jewelry or cards (such as Medic-Alert bracelets) alerting others about the seizures may help a patient receive prompt medical treatment if a one occurs.

Expectations (prognosis)

Seizures can occur as a single isolated occurrence, as closely repeated seizures, or at various intervals. Seizures that recur create a condition known as epilepsy.

Seizures that occur singly or in closely associated groups are commonly caused by a condition such as brain injury. They may occur as an isolated incident or may develop into a chronic seizure disorder. Seizures within the first 2 weeks of a brain injury do not necessarily mean that a chronic seizure disorder will develop.

A seizure-free period may indicate that reduction or elimination of medications may be possible. Medications should be changed only under the supervision of the health care provider.

Death or permanent brain damage from seizures is rare. A serious injury can occur if a seizure occurs while driving or operating dangerous equipment; these activities are often restricted for people with poorly controlled seizure disorders.

Infrequent seizures may not severely restrict the patient's lifestyle. Work, school, and recreation do not necessarily need to be restricted.

Complications

Recurrent seizures (seizure disorder)
Prolonged or closely occurring seizures without returning to normal behavior(status epilepticus)
Injury from falls, bumps, and biting oneself
Injury to oneself or others if seizure occurs during driving or operating machinery
Inhaling fluid into the lungs, pneumonia
Permanent brain damage (stroke or other damage)
Side effects of medications (with or without observable symptoms)
Learning disorders (either from seizures or medications)

Women planning to get pregnant need to tell their doctor in advance in order to adjust their medications, since many anti-epileptic medications cause birth defects.

Calling your health care provider

Call your local emergency number (911) if this the first time a person has had a seizure or a seizure is occurring in someone without a medical ID bracelet (instructions explaining what to do). In the case of someone who has had seizures before, call the ambulance 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 where consciousness or normal behavior is not regained between them (status epilepticus)

Call your health care provider if any new symptoms occur, including possible side effects of medications (drowsiness, restlessness, confusion, sedation, or others), nausea/vomiting, rash, loss of hair, tremors or abnormal movements, or problems with coordination.

Prevention

Generally, there is no known prevention for seizures. However, you can decrease the likelihood of triggering a seizure by taking medicines as directed, getting enough sleep, eating a proper diet, and abstaining from alcohol and drugs.

Reduce the chance of head injuries by wearing head protection and avoiding risky behavior.

References

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders; 2003.

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002.

Review Date: 11/21/2006

Reviewed By: Daniel Kantor, M.D., Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

A.D.A.M. Copyright

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-2009 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

adam.com

Source Doc: 1_000695

Partial (focal) seizure

admin — Wed, 03 Sep 2008 17:51:26 -0700

Overview

Definition
Alternative Names
Causes, incidence, and risk factors
Symptoms
Signs and tests
Treatment
Expectations (prognosis)
Complications
Calling your health care provider
Prevention
References

Illustrations

Central nervous system

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

A partial seizure is an episode of abnormal electrical activity in one specific part of the brain.

Alternative Names

Simple seizure; Jacksonian seizure; Seizure - partial (focal)

Causes, incidence, and risk factors

All seizures are caused by abnormal electrical disturbances in the brain. Partial (focal) seizures occur when this electrical activity remains confined to a limited area of the brain; they may sometimes progress to generalized seizures, which affect the whole brain.

Partial seizures can be further characterized as simple (not affecting awareness and memory) or complex (affecting awareness and memory of events before, during, and immediately after the seizure, and affecting behavior).

The abnormal electrical activity results from localized areas of abnormal brain tissue. These areas may have been present since birth or earlier (congenital), or they may develop following head trauma, infections, stroke, and certain other conditions. In many patients, no obvious cause can be determined. Partial seizures are more likely to be caused by a definable lesion in adults than in children.

A partial (focal) seizure may occur at any age, as a single episode or as a repeated, chronic seizure disorder (epilepsy). They are seen less frequently in children than in adults, but still account for about 45% of pediatric seizure disorders.

Risk factors include any injury to the brain. This includes trauma, stroke, brain tumors, infections (such as meningitis), or prior brain surgery.

Symptoms

Patients with focal seizures can have any of the symptoms below. Patients with simple focal seizures do not lose consciousness and will be aware and remember the events that occur at the time. Patients with complex partial seizures will have abnormal consciousness and may or may not remember any or all of the symptoms or events surrounding the seizure.

Abnormal motor control
- Muscle contraction /relaxation (clonic activity) -- common
- Affecting one side of the body (leg, part of the face, or other isolated area)
- Abnormal head movements
- Forced turning of the head
Automatisms -- purposeless, complex movement (such as picking at clothes)
- Abnormal mouth behaviors
- Lip smacking
- Chewing/swallowing without cause
Forced turning of the eyes
Abnormal sensations
- Numbness, tingling, crawling sensation, etc.
- May occur in only one part of the body or may spread
- May occur with or without motor symptoms
Hallucinations (visual, hearing, touch, smells, etc.)
Abdominal pain or discomfort
Nausea
Sweating
Flushed face
Dilated pupils
Rapid heart rate/pulse

Other symptoms:

Black out spells -- periods of time lost from memory
Changes in vision
Sensation of deja vu
Changes in mood or emotion

Signs and tests

The diagnosis is based on the symptoms, taking into consideration the patient's other history. It is extremely difficult to diagnose a single focal seizure. However, the diagnosis is easier to make in patients who have recurrent, stereotyped episodes --especially if there are risk factors such as a history of head injury.

Some of the tests that may be performed include:

EEG -- this can show characteristic changes confirming partial (focal) seizures, and may show the focus (the location of the cause). A normal EEG does not rule out seizures.
EEG monitoring over several days may be necessary in order to record an event while it is occurring.
Head CT or head MRI scan -- these may show the location and extent of the lesion causing the symptom.

Treatment

Whenever someone has a seizure for the first time, he or she should be taken to an emergency room, as there may be a serious underlying medical condition which needs to be treated. First-aid measures should be performed as appropriate, including protecting the person from injury during the seizure, preventing him or her from inhaling vomit or mucus into the lungs, keeping the airway clear, and assistance with breathing.

Treatment of the causes may stop the seizures. This may include medication, surgical repair of tumors or brain lesions, and other treatments.

An isolated seizure with an obvious avoidable trigger, such as fever or toxic reactions, is treated by removing or treating the precipitating factor.

An isolated seizure may not require treatment. Findings on MRI or EEG may determine how likely recurrent seizures are and may help determine the need for ongoing treatment, such as anticonvulsants (anti-seizure medications). The response to these drugs varies, and medication and dosage may have to be adjusted repeatedly.

Multiple, repeated seizures are usually treated with anti-seizure drugs such as phenytoin or carbamazepine for preventive, long-term use. Follow-up includes review of the need for drugs and monitoring for side effects. Drugs may need to be continued indefinitely.

Some patients with seizures that are difficult to treat may respond to a vagal nerve stimulator -- a device that stimulates a nerve in the chest and reduces the number of seizures. Other patients may respond to surgery that removes the abnormal brain cells responsible for causing seizures.

Patients who have seizures that could result in loss of motor control or consciousness should be advised not to drive, swim alone, or engage in other activities during which a seizure could endanger themselves or others.

The patient might need to wear informational jewelry or cards (such as Medic-Alert) to aid in obtaining prompt medical treatment if a seizure occurs.

Expectations (prognosis)

The outlook is largely determined by the underlying cause of the focal seizures. Patients who have recurrent seizures that are not due to a temporary condition (e.g., a drug side effect or infection) have a chronic condition called epilepsy.

Seizures that occur singly or in a closely associated group are commonly triggered by an acute condition such as brain injury and may occur as an isolated incident, or they may develop into a chronic seizure disorder. Seizures within the first 2 weeks of a brain injury do not necessarily mean that a chronic seizure disorder will develop. EEG and MRI findings may help determine whether the condition is likely to become chronic.

Death or permanent brain damage from seizures is rare, but either can occur if the seizure is prolonged or if many seizures occur in close proximity (status epilepticus).

Serious injury can occur if the seizure happens while the person is driving or operating dangerous equipment. These activities may be restricted for people with poorly controlled seizure disorders.

Infrequent seizures, however, need not severely restrict lifestyle. Work, school, and recreation do not necessarily need to be restricted, but precautions should be taken to reduce risks if a seizure should occur.

Complications

Generalized seizures
Epilepsy (recurrent seizures)
Prolonged or closely occurring seizures (status epilepticus)
Injury from falls, bumps, biting self
Injury caused by a seizure during driving or operating machinery
Aspiration pneumonia
Permanent brain damage (stroke or other damage)
Side effects of medications (with or without observable symptoms)
Complications of surgery
Women who choose to get pregnant should inform their doctor in advance for appropriate adjustments in medications (many of the anti-epileptic medications can cause birth defects)

Calling your health care provider

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 where consciousness or normal behavior is not regained between them (status epilepticus)

Call your health care provider if any new symptoms occur (including possible side effects of medications):

Drowsiness, restlessness, confusion, sedation
Nausea/vomiting
Rash
Loss of hair
Tremors or abnormal movements
Problems with coordination
Fevers, infections

Prevention

Treating the underlying disorders may reduce the risk of further seizures. In most cases, the seizures may not be preventable.

Avoid head injury by wearing helmets during risky activities, and avoid illegal drug use or excessive alcohol intake.

References

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders; 2003.

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002.

Review Date: 8/7/2006

Reviewed By: Daniel Kantor, M.D., Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 1_000697

Febrile seizures

admin — Wed, 03 Sep 2008 17:53:30 -0700

Overview

Definition
Alternative Names
Causes, incidence, and risk factors
Symptoms
Signs and tests
Treatment
Expectations (prognosis)
Complications
Calling your health care provider
Prevention
References

Illustrations

Grand mal seizure

Central nervous system

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

A febrile seizure is a convulsion in a child triggered by a fever. Such convulsions occur without any underlying brain or spinal cord infection or other neurologic cause.

Alternative Names

Seizure - fever induced

Causes, incidence, and risk factors

About 3-5% of otherwise healthy children between the ages of 9 months and 5 years will have a seizure caused by a fever. Toddlers are most commonly affected. There is a tendency for febrile seizures to run in families. Most occur well within the first 24 hours of an illness, not necessarily when the fever is highest. The seizure is often the first sign of a fever.

The first febrile seizure is one of life's most frightening moments for parents. Most parents are afraid that their child will die or have brain damage. Thankfully, simple febrile seizures are harmless. There is no evidence that simple febrile seizures cause death, brain damage, epilepsy, mental retardation, a decrease in IQ, or learning difficulties.

Most febrile seizures are triggered by fevers from viral upper respiratory infections, ear infections, or roseola. Meningitis causes less than 0.1% of febrile seizures but should ALWAYS be considered, especially in children less than one year old or those who still look ill when the fever comes down.

A simple febrile seizure stops by itself within a few seconds to 10 minutes, usually followed by a brief period of drowsiness or confusion. Anticonvulsant medicines are generally not needed.

A complex febrile seizure is one that lasts longer than 15 minutes, occurs in an isolated part of the body, or recurs during the same illness.

About a third of children who have had a febrile seizure will have another one with a subsequent fever. Of those who do, about half will have a third seizure. Few children have more than three febrile seizures in their lifetime.

If there is a family history, if the first seizure happened before 12 months of age, or if the seizure happened with a fever below 102, a child is more likely to fall in the group that has more than one febrile seizure.

Symptoms

A febrile seizure may be as mild as the child's eyes rolling or limbs stiffening. Quite often a fever triggers a full-blown convulsion that involves the whole body.

Febrile seizures may begin with the sudden sustained contraction of muscles on both sides of a child's body -- usually the muscles of the face, trunk, arms, and legs. A haunting, involuntary cry or moan often emerges from the child, from the force of the muscle contraction. The contraction continues for seemingly endless seconds, or tens of seconds. The child will fall, if standing, and may pass urine.

He may vomit. He may bite his tongue. The child may not be breathing, and may begin to turn blue.

Finally, the sustained contraction is broken by repeated brief moments of relaxation -- the child's body begins to jerk rhythmically. The child is unresponsive to the parent's voice.

Febrile seizures are different than tremors or disorientation also seen with fevers. The movements are the same as in a grand mal seizure.

Signs and tests

A febrile seizure may be diagnosed by the health care provider when a grand mal seizure occurs in a child with a fever and no prior history of seizure disorders (epilepsy). In infants and young children, it is important to rule out other causes for a first-time seizure, especially meningitis.

In a typical febrile seizure, the examination usually shows no abnormalities other than the illness causing the fever. Typically, a full seizure workup including an EEG, head CT, and lumbar puncture (spinal tap) is not warranted.

However, the child's condition must meet strict medical criteria if these tests are to be avoided:

The child must be developmentally normal.
The seizure must be generalized (not focal), meaning more than one part of the body is involved.
The seizure may not last longer than 15 minutes.
The child cannot have had more than one febrile seizure in 24 hours.
The child's neurologic exam performed by a health care provider must be normal to be called a simple febrile seizure.

If all of these criteria are met, no further studies are likely to be required.

Treatment

During the seizure, leave your child on the floor. You may want to slide a blanket under him if the floor is hard. Move him only if he is in a dangerous location. Remove objects that may injure him. Loosen any tight clothing, especially around the neck. If possible, open or remove clothes from the waist up. If he vomits, or if saliva and mucus build up in the mouth, turn him on his side or stomach. This is also important if it looks like the tongue is getting in the way of breathing.

DO NOT try to force anything into his mouth to prevent him from biting the tongue, as this increases the risk of injury. DO NOT try to restrain your child or try to stop the seizure movements.

Focus your attention on bringing the fever down. Inserting an acetaminophen suppository into the child's rectum is a great first step, if you have some. DO NOT try to give anything by mouth. Apply cool washcloths to the forehead and neck. Sponge the rest of the body with lukewarm (not cold) water. Cold water or alcohol may make the fever worse. After the seizure is over and your child is awake, give the normal dose of ibuprofen or acetaminophen.

After the seizure, the most important step is to identify the cause of the fever.

Expectations (prognosis)

Most children outgrow febrile seizures by age 5.

A small number of children who have had a febrile seizure go on to develop epilepsy, but not because of the febrile seizures. Children who would develop epilepsy anyway will sometimes have their first seizures during fevers. These are usually prolonged, complex seizures.

Previous neurologic problems and a family history of epilepsy also make future epilepsy more common. The number of febrile seizures is not related to future epilepsy.

Complications

An injury from falling down or bumping into objects
Biting oneself
Breathing fluid into the lungs, pneumonia
Injury from prolonged or complicated seizures
Side effects of medications used to treat and prevent seizures (if prescribed)
Complications if a serious infection, such as meningitis, caused the fever
Seizures unrelated to fever

Calling your health care provider

Children should see a doctor as soon as possible after their first febrile seizure.
If the seizure is lasting several minutes, call 911 to have an ambulance bring your child to the hospital.
If the seizure ends quickly, drive the child to an emergency room when it is over.
A child should also see a doctor if repeated seizures occur during the same illness, or if this looks like a new type of seizure for your child.
Call or go in if any other symptoms occur before or after the seizure, such as nausea, vomiting, rash, tremors, abnormal movements, problems with coordination, drowsiness, agitation, confusion, or sedation. It is normal for children to sleep or be briefly drowsy or confused immediately following a seizure.

Prevention

Because febrile seizures can occur as the first sign of illness, prevention is often not possible. Neither an initial nor recurrent febrile seizure suggests that your child is not being properly cared for.

Occasionally, a health care provider will prescribe diazepam to prevent or treat recurrent febrile seizures. However, parents must recognize that no medication is completely effective in preventing febrile seizures.

References

Leung AK, Robson WL. Febrile seizures. J Pediatr Health Care. 2007 Jul-Aug;21(4):250-5.

Warren CR. Evaluation and management of febrile seizures in the out-of-hospital and emergency department settings. Ann Emerg Med. 2003; 41(2): 215-222.

Jankowiak J. Seizures in children with fever: Generally good outcome. Neurology. 2003; 60(2): E1-2.

Review Date: 7/27/2007

Reviewed By: Daniel Rauch, M.D., FAAP., Director, Pediatric Hospitalist Program, New York University School of Medicine, New York, NY. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 1_000980

Seizure disorders

FitSugar — Wed, 08 Oct 2008 17:35:11 -0700

Overview

Signs and Symptoms
What Causes It?
What to Expect at Your Provider's Office
Treatment Options
Following Up
Supporting Research

HEALTH GUIDE REFERENCE FROM A.D.A.M

Seizures occur when your brain cells, which communicate through electrical signals, send out abnormal signals. Recurrent seizures from one of many chronic processes are considered epilepsy. Epilepsy can occur at all ages, but it is most common in the elderly. Seizures are not considered to be epilepsy if they occur only once or are correctable.

Signs and Symptoms

There are several types of seizures, each with its own symptoms. Seizures are usually classified as partial (involving a part of the brain) or generalized (involving most or all of the brain). Depending on the type of seizure, symptoms may include:

Aura (before generalized seizures), including lethargy, depression, irritability, involuntary jerks of limbs, abdominal pains, pale complexion, headache, constipation, or diarrhea
Loss of consciousness
Falling down
Staring during momentary episodes of unconsciousness
Total body muscle spasms
Temporary cessation of breathing
Bluish color of skin and mucous membranes
Dilated pupils that do not react to light
Bowel or bladder incontinence
Increased pulse and blood pressure
Increased salivation and sweating
Deep coma, post-seizure confusion, and deep sleep

What Causes It?

Seizures are caused by hyperexcitable nerve cells in the brain (cerebral cortex) that fire abnormally. No one knows why this happens. The following conditions are associated with seizure activity:

Central nervous system infection (bacterial meningitis, encephalitis)
Drug toxicity or withdrawal (for example, alcohol or illicit drug use)
Genetic mutations
Head trauma
Electrolyte or metabolic abnormalities
Drugs that lower the seizure threshold
High fevers
Brain abnormalities (for example, tumors, stroke)
Low sugar and low calcium levels in the blood

What to Expect at Your Provider's Office

Precipitating events (for example, head trauma) and risk factors (for example, family or personal history of seizures) are important factors to discuss with your health care provider. It is also important to note how you felt before and after the seizure. Your health care provider will do blood tests and an electroencephalogram (EEG) to help in your diagnosis. You may also have a computerized tomography (CT) scan, a magnetic resonance imaging (MRI) scan, and a positron emission tomography (PET) scan.

Treatment Options

The goal of therapy is to stop the seizures, minimize drug side effects, prevent recurrences, and help you readjust to your home life and work environment after a seizure.

Drug Therapies

Your health care provider will most likely prescribe medication to help control your seizures (30 - 70% of people who have one seizure will have a second seizure within 1 year). You may need to try several medications or combinations before you find one that works for you. Medications can include anticonvulsants (anti-seizure drugs) and sedatives.

If medications do not work, ask your doctor about a procedure called vagus nerve stimulation.

Complementary and Alternative Therapies

You should always see a doctor if you or your child has a seizure. Taking some supplements and adjusting one's diet may help some people lessen the frequency of seizures, but the same supplements may have the opposite effect in some people. You should never take any supplements without your doctor's knowledge. You should never take any medication your doctor has prescribed without your doctor's knowledge, either. Make sure to inform all of your health care providers of any medications, herbs, supplements, and regimens you are using.

Nutrition and Supplements

A ketogenic diet -- high in fat and low in protein and carbohydrates -- may help control the frequency of seizures. It has been used most frequently in children, and seems to be more effective for children than adults. A doctor needs to closely monitor this diet, both for side effects and for compliance with its rigid structure.
Some studies have shown a connection with food allergies and seizures in children. Avoid alcohol, caffeine, and aspartame, along with any supplements that have stimulating effects. A holistically oriented health care provider can help you pinpoint possible food allergies.
Taurine (500 mg three times per day) is an amino acid that may help inhibit seizures. It acts in a similar fashion to GABA (gamma aminobutyric acid, 500 mg two times per day), another amino acid that is often low in people with seizures. Take one of these only under your doctor's supervision.
Folic acid may be depleted during seizures and in some people with seizures. However, taking extra folic acid can reduce the effectiveness of anticonvulsant drugs and lead to more seizures. Take folic acid only under your doctor's supervision.
Vitamin B12 (100 - 200 mcg per day): B12 levels may be reduced by some anticonvulsant drugs.
Vitamin B6 (20 - 50 mg per kilogram of body weight) may help control seizures in children, but B6 may also interfere with anticonvulsant medications, leading to more seizures. Take only under your doctor's supervision.
Vitamin E (400 IU per day) may help reduce the frequency of seizures when used with prescription drugs, but studies have shown mixed results.
Manganese (5 mg per day) levels are often low in people with epilepsy.
Anticonvulsant drugs may cause low levels of calcium, vitamin D, and vitamin K, so people who take anticonvulsant drugs should ask their doctor about taking a supplement. You should know that calcium can interfere with anticonvulsant drugs and should be taken only under a doctor's supervision.
Melatonin (3 g at bedtime) may not only decrease the frequency of seizures in children but also increase seizures in some people. Take melatonin only under a doctor's supervision.
5-HTP can help increase serotonin levels in the brain, which some researchers think can lessen seizures by having a calming effect on the nervous system. Others feel that raising serotonin levels past a certain threshold may actually increase the frequency of seizures. While no conclusive studies exist, some doctors are using 5-HTP to treat seizures. This therapy should be used only under strict medical supervision. 5-HTP can have dangerous interactions with other medications, such as antidepressants and certain neurological drugs. Make sure your doctor has a complete list of your medications before starting you on 5-HTP therapy.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

Many of the herbs used to treat seizures have sedative effects, and they interact with other herbs, supplements, and prescription medications. Take these herbs only under a doctor's supervision, so that they can monitor side effects and interactions. Most of these herbs have been used traditionally for seizures, but scientific evidence showing they work is lacking.

Brahmi (Bacopamonnieri), an herb used in Ayurvedic medicine to treat epilepsy.
Chamomile (Matricaria recutita), a sedative herb. Take 400 - 1,600 mg per day or 3 cups tea per day. Steep 2 - 4 g flowerheads in one cup boiling water, strain, and cool. Or use commercially prepared tea bags. Your doctor should determine the dose.
Kava (Piper methysticum) has been used as a sedative herb for seizures. However, there is some concern that kava can be very damaging to the liver even if taken for a short time. Take kava only under your doctor's supervision, so they can monitor liver function. Do not take kava if you have Parkinson's disease.
Valerian (Valeriana officinalis, 120 mg three times per day) is a sedative and anticonvulsive. It interacts with several medications, herbs, and alcohol, so take it only under your doctor's supervision. Valerian is sometimes combined with lemon balm (Melissa officinalis ), another herb that has sedative effects.
Passionflower (Passiflora incarnata) may treat and prevent seizures. Dose is 3 cups tea per day. Steep 2 g in one cup boiling water, strain, and cool. Or take 45 - 60 drops of liquid extract.

Avoid the following herbs:

Ginkgo (Ginkgo biloba) and ginseng (Panax ginseng and Panax quinquefolius) have caused seizures in some people.
There is some evidence that GLA, a type of fatty acid found in evening primrose oil (Oenothera biennis) and borage oil (borago officinalis), may worsen epilepsy, although it has not been confirmed.
St. John's wort (Hypericum perforatum) interacts with a number of medications and herbs used to treat epilepsy.
White willow (Salix alba) may interact with medications for epilepsy.

Avoid these essential oils:

Eucalyptus (Eucalyptus globulus)
Fennel (Foeniculum vulgare)
Hyssop (Hyssopus officinalis)
Pennyroyal (Mentha pulegium)
Rosemary (Rosmarinus officinalis)
Sage (Salvia officinalis)
Tansy (Tanacetum vulgare)
Thuja (Thuya occidentalis)
Wormwood (Artemesia absinthium)

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for seizure disorders based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

Belladonna -- for seizures that occur in individuals with a high fever
Causticum -- for individuals whose seizures may be triggered by receiving bad news or by feelings of sadness such as from grief; this remedy is most appropriate for individuals who tend to feel hopeless and fearful
Cicuta -- for individuals who develop seizures after a head injury
Cuprum metallicum -- for individuals whose seizures are accompanied by mental dullness; may be triggered by menstruation or vomiting

Physical Medicine

Chiropractic, osteopathic, or naturopathic manipulation may be helpful, especially in children or for seizures after head trauma.

Acupuncture

Acupuncture may be helpful with specific acupressure points that have been used to stop seizures. However, a recent study for people with severe epilepsy showed no benefit. Chinese medical literature contains examples of treating seizure disorders through traditional acupuncture, as well as scalp and auricular (ear) acupuncture or a combination of all these techniques. If you choose to have acupuncture, work with a qualified acupuncturist and keep all of your other health care providers well-informed about your treatments.

Following Up

Determining the best dosage or drug combinations is an inexact science. Your health care provider will monitor you until your seizures are under control.

Supporting Research

Coman DJ, Sinclair KG, Burke CJ, Appleton DB, Pelekanos JT, O'Neil CM, Wallace GB, Bowling FG, Wang D, DeVivo DC, McGill JJ. Siezures, ataxia, developmental delay and the general pediatrician: Glucose transporter 1 deficiency syndrome. J Paediatr Child Health. 2006;42(5):263-7.

Duncan JS, Sander JW, Sisodiya SM, Walker MC. Adult epilepsy. Lancet. 2006;367(9516):1087-100.

Guerrini R, Parmeggiani L. Practitioner review: Use of antiepileptic drugs in children. J Child Psychol Psychiatry. 2006;47(2):115-26.

Jackson N, Ridge CA, Delanty N. Imaging in patients with a first seizure. Ir Med J. 2006;99(6):173-5.

Muller M, Byres M, Jaspars M. et al. 2D NMR spectroscopic analyses of archangelicin from the seeds of Angelica archangelica. Acta Pharm. 2004;54:277-85.

Perucca E, Aldenkamp A, Tallis R, Kramer G. Role of valproate across the ages. Treatment of epilepsy in the elderly. Acta Neurol Scand Suppl. 2006;184:28-37.

Towne AR. Epidemiology and outcomes of status epilepticus in the elderly. Int Rev Neurobiol. 2007;81:111-27.

Yuan CS, Mehendale S, Xiao Y, et al. The gamma-aminobutyric acidergic effects of valerian and valerenic acid on rat brainstem neuronal activity. Anesth Analg. 2004;98:353-8.

Review Date:
2/27/2008
Reviewed By:
Steven D. Ehrlich, NMD, private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Temporal lobe seizure

admin — Wed, 03 Sep 2008 17:56:15 -0700

Overview

Definition
Alternative Names
Causes, incidence, and risk factors
Symptoms
Signs and tests
Treatment
Expectations (prognosis)
Complications
Calling your health care provider
Prevention
References

Illustrations

Central nervous system

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

This type of seizure involves a temporary movement disturbance that often involves a change in a person's behavior, unusual sensations, or various other symptoms. It arises from abnormal electrical activity in the temporal lobe on one or both sides of the brain.

Alternative Names

TLE; Seizure - temporal lobe

Causes, incidence, and risk factors

A seizure is an episode of abnormal electrical activity in the brain that can involve loss of consciousness or reduction of consciousness, involuntary movements, and overwhelming sensations.

Temporal lobe seizures can affect people of any age, and can occur as a single episode or can be repeated as part of a chronic (ongoing) condition. (See seizure disorder).

Information in the brain is transmitted from nerve cell to nerve cell by an electrochemical process. Certain patterns of electrical activity can cause seizures, which are episodes during which electrical signals spread in abnormal patterns within the brain. This process can be detected by an electroencephalograph (EEG).

Given the right conditions (such as exposure to certain drugs, high fever, or electrical stimulation), anyone can have a seizure.

Temporal lobe seizures commonly result from damage to specific areas in the temporal lobe of the brain. This damage includes scarring, called mesial temporal sclerosis. Causes can include traumatic injury, infection, damage to a portion of the temporal lobe due to lack of oxygen, brain tumors, genetic syndromes, and lesions of any sort.

Because the temporal lobe is involved in processing emotion and sensations, seizures in this area may begin with feelings of fear, feelings of joy (sometimes with religious associations and the sensation of a "presence"), recall of certain music, or smells and other unusual symptoms.

Symptoms

The early warning symptoms (called an aura) include:

Abnormal sensations
Epigastric sensations ("a funny feeling in my gut," "stomach rising")
Hallucinations or illusions (vision, smells, tastes, or other sensory illusions)
Sensation of deja vu, recalled emotions or memories
Sudden, intense emotion not related to anything occurring at the time

During the seizure:

Consciousness maintained during the seizure (partial)
Consciousness reduced or lost during the seizure (partial complex)

Movement disturbances include:

Abnormal mouth behaviors
- Lip smacking
- Chewing or swallowing without cause
- Profuse salivation "slobbering"
Abnormal head movements
- Forced turning of the head
- Forced turning of the eyes
- Usually in the direction opposite of the location of the brain lesion
Repetitive movements, such as picking at clothing
Rhythmic muscle contraction and relaxation (rare) -- affecting one side of the body, one arm, leg, part of face, or other isolated area

Abnormal sensations include:

Numbness, tingling, crawling sensation
Occurring in only one part of the body or spreading
Preceding motor symptoms
Sensory hallucinations (visual, hearing, touch, etc.)

Autonomic symptoms include:

Other symptoms include:

Changes in vision, speech, thought, awareness, personality
Loss of memory (amnesia) regarding events around the seizure (partial complex seizure)

Signs and tests

Diagnosis of temporal lobe seizure is suspected primarily on the basis of the symptoms presented and the results of tests. Diagnosis may include a complete physical examination, including a detailed neuromuscular examination, which may or may not be normal.

An EEG (electroencephalograph, recording of the brain's electrical activity) shows characteristic changes confirming partial (focal) seizures, and may show the focus (location of the cause).
A head CT scan or a cranial MRI may show the location and extent of the lesion.
A lumbar puncture may be necessary if there is suspicion of an infection causing the seizure.

Treatment

The goals of treatment are to perform emergency measures, if necessary, and to reduce the rate of future seizures.

Emergency treatment may not be required, unless the seizure becomes generalized or consciousness is lost. First-aid measures should be performed as appropriate, including protection from injury, prevention of breathing vomit or mucus into the lungs, and airway protection or assistance with breathing.

Record details of the seizure and report them to the health care provider. Important details include date and time of the seizure, how long it lasted, which body parts were affected, type of movements or other symptoms, possible causes and other factors which provide information about the episode (such as what immediately preceded it).

The treatment of causes may stop the occurrence of seizures. This may include medical treatment of seizure disorders like epilepsy, surgical repair of tumors or brain lesions, and other treatments as needed.

Oral anticonvulsants (anti-seizure medications taken by mouth) are used to prevent or reduce the number of future seizures. Response is individual, and the medication and the dosage may have to be adjusted repeatedly.

Multiple, repeated seizures are usually treated with long-term use of an antiepileptic drug.

Follow-up includes reviewing the need for drugs at least yearly. Drugs may be required indefinitely. Monitoring the level of medicine in the blood is important to continue control of seizures, and to reduce side effects.

Pregnancy, lack of sleep, skipping doses of medications, use of recreational drugs (including alcohol), or illness may cause seizures in a person with a previously well-controlled seizure disorder.

Use of informational jewelry or cards (such as Medic-Alert or similar) that indicate a seizure disorder may be advised. These accessories may help in obtaining quick medical treatment if a seizure happens.

Expectations (prognosis)

Seizures can occur as a single event or be recurrent. Seizures that recur with no identified causes are most commonly a chronic, lifelong condition termed epilepsy.

Seizures that occur once or in a single cluster are commonly caused by an acute condition, such as brain injury. They may occur secondary to an isolated incident, but can then develop into a chronic seizure disorder. Seizures within the first 2 weeks of a brain injury do not necessarily mean that a chronic seizure disorder will develop.

Serious injury can occur if seizure happen while driving, or when operating dangerous equipment. Each state has different policies on driving restrictions. Swimming and bathing without supervision are also not recommended. Contact sports are not advisable. These activities may be restricted for persons with poorly controlled seizure disorders.

Complications

Progression to generalized seizures
Repeated seizures (epilepsy)
Prolonged seizures, closely occurring seizures (status epilepticus)
Injury from falls, bumps, biting self, etc.
Injury from seizure occurring during driving or operating machinery
Breathing fluid, such as saliva, during a seizure can cause pneumonia
Permanent brain damage (stroke or other damage)
Side effects of medications (with or without observable symptoms)

Calling your health care provider

Go to the emergency room or call 911 if:

This is the first time the person has had a seizure, or this is a new type or prolonged seizure
This is an emergency situation
If sequential seizures occur, or if there is repeat seizure activity where consciousness is not regained in between seizures (status epilepticus).
Any new symptoms occur, including possible side effects of medications, such as changes in mental status (drowsiness, restlessness, confusion, sedation, or others), nausea or vomiting, rash, loss of hair, tremors or abnormal movements, problems with coordination

Prevention

Treatment of any lesions or disorders may reduce the seizures. In many cases, epilepsy is caused by a genetic disorder and may not be preventable.

References

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders; 2003.

Marx J. Rosen's Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002.

Review Date: 9/7/2006

Reviewed By: Kenneth Gross, M.D., Neurology, North Miami, FL. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

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Source Doc: 1_001399

Petit mal seizure

admin — Wed, 03 Sep 2008 17:51:26 -0700

Overview

Definition
Alternative Names
Causes, incidence, and risk factors
Symptoms
Signs and tests
Treatment
Support Groups
Expectations (prognosis)
Complications
Calling your health care provider
References

Illustrations

Central nervous system

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

A petit mal seizure is a temporary disturbance of brain function caused by abnormal electrical activity in the brain and characterized by abrupt, short-term lack of conscious activity ("absence") or other abnormal change in behavior.

Alternative Names

Seizure - petit mal; Absence seizure; Seizure - absence

Causes, incidence, and risk factors

Petit mal seizures occur most commonly in people under age 20, usually in children ages 6 to 12. They may occur in combination with other types of seizures.

Typical petit mal seizures last only a few seconds, with full recovery occurring rapidly and no lingering confusion. Such seizures usually manifest themselves as staring episodes or "absence spells" during which the child's activity or speech ceases.

The child may stop talking in mid-sentence or cease walking. One to several seconds later, speech or activity resume. If standing or walking, a child seldom falls during one of these episodes.

"Spells" can be infrequent or very frequent, occurring many times per hour. Up to hundreds of seizures can occur in a single day. They may occur for weeks to months before they are noticed. They can interfere with school function and learning. Teachers may interpret these seizures as lack of attention or other misbehavior.

Atypical petit mal seizures begin slower, last longer, and may have more noticeable muscle activity than typical petit mal seizures. There is usually no memory of the seizure.

No cause can usually be found for typical petit mal seizures. No neurologic or other disorders are usually discovered. Atypical seizures may or may not be associated with other neurologic disorders.

Causes may be unidentifiable, or identified as congenital brain abnormalities, complications of kidney or liver disease, or brain injuries from trauma or birth complications. Sometimes, a family history of seizures indicates a hereditary type of seizures.

Symptoms

TYPICAL

Muscle activity changes
- No movement
- Hand fumbling
- Fluttering eyelids
- Lip smacking
- Chewing
Consciousness changes
- Staring episodes (unintentional)
- Lack of awareness of surroundings
- Sudden halt in conscious activity (movement, talking, etc.)
- May be provoked by hyperventilation or flashing lights, in some cases
- Abrupt beginning of seizure
- Each seizure lasts no more than a few seconds
- Full recovery of consciousness, no confusion
No memory of seizure

ATYPICAL

Atonic seizure
- No muscle movement
- Slumping, loss of posture
- Loss of muscle tone
- Falling down
Consciousness changes
- Unintentional staring
- Lack of awareness of surroundings
- Sudden stop of conscious activity (movement, talking, etc.)
- Hand fumbling
- Fluttering eyelids
- May be provoked by hyperventilation, in some cases
- May have slower, gradual beginning of seizure
- Each lasts only seconds to minutes
- Recovery may be slower
- May have short period of confusion or bizarre behavior
No memory of seizure

Note: Unexplained difficulties in school and learning difficulties may be the first indication of petit mal seizures.

Signs and tests

The physical examination is usually normal, although some neurologic abnormalities may be present in some patients.

Transmission of information from nerve cell to nerve cell occurs by an electrochemical process that can be detected as electrical activity by an electroencephalograph (EEG). A single or multiple EEG exams may be necessary to show changes typical of petit mal seizures. Occasionally, a patient may need to have EEG monitoring from 1 to several days to detect these EEG changes.

Various laboratory tests, a head CT scan, or a head MRI may be used to rule out specific causes of the seizures.

Treatment

As seizures can interfere with learning or result in injury, the goal of treatment is to prevent or minimize the number of seizures and to minimize any side effects of the treatments. In some cases, treatment of identifiable causes may reduce or eliminate seizures.

Anticonvulsant (antiseizure) medications may prevent or minimize the number of seizures. Petit mal seizures usually respond to valproic acid, ethosuximide, clonazepam, and certain other drugs. Response to medications varies and the medication and dosage may have to be adjusted repeatedly. For some drugs, monitoring of plasma drug levels is important for continued control of seizures and reduction of medication side effects.

Absence status epilepticus (multiple, frequently-repeated seizures) may be treated with intravenous medications and other treatments.

Support Groups

American Epilepsy Socieity -- www.aesnet.org

Expectations (prognosis)

Almost all children with petit mal seizures have significantly fewer (or no) seizures with the use of medications. Petit mal seizures may stop spontaneously after the child reaches adulthood, they may continue indefinitely, or the person may progress to a grand mal seizure.

Long-term prognosis depends on whether there are any underlying neurological problems or other seizure types in addition to the petit mal seizures.

Most people with petit mal seizures live a fairly normal life, with few restrictions on school activities or social life. As adulthood approaches, restrictions may be placed on driving or operating dangerous machinery if seizures continue.

Complications

Learning disabilities
Absence status epilepticus
Injury from falls
Injury caused by seizure during driving/operating machinery
Side effects of medications (with or without symptoms)
Progression to generalized tonic-clonic seizure

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if a seizure lasts longer than 2 to 3 minutes or if there is no history of previous seizures. This is an emergency situation.

Go to the emergency room or call the local emergency number (such as 911) if symptoms of absence status epilepticus occur:

Prolonged changes in mental status such as confusion or poor responsiveness
Prolonged seizure activity/unconscious activity and automatic behaviors (people may eat or move without being aware of where they are or what they are doing)

This may be an emergency situation.

Call your health care provider if this is the first time the person has had seizures.

Call your health care provider if this is a new type of seizure for the person or if other types of seizures begin occurring.

Call your health care provider if any new symptoms occur, including possible side effects of medications such as changes in mental status (drowsiness, restlessness, confusion, sedation or others), nausea and vomiting, rash, loss of hair, tremors or abnormal movements, rash, fevers, or problems with coordination.

References

Hirtz D, Ashwal S, Berg A, et al. Practice parameter: Evaluating a first nonfebrile seizure in children: Report of the Quality Standards Subcommittee of the American Academy of Neurology, the Child Neurology Society, and the American Epilepsy Society. Neurology. 2000;55;616-623.

Hirtz D, Berg A, Bettis D. Practice parameter: Treatment of the child with a first unprovoked seizure: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society.Neurology. 2003;60;166-175.

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, Mo: WB Saunders; 2003.

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002.

A.D.A.M. Copyright

adam.com

Source Doc: 1_000696

Seizures

admin — Thu, 04 Sep 2008 19:07:11 -0700

Overview

Definition
Considerations
Common Causes
Home Care
Call your health care provider if
What to expect at your health care provider's office
Prevention
References

HEALTH GUIDE REFERENCE FROM A.D.A.M

Definition

A seizure is a sudden change in behavior due to an excessive electrical activity in the brain.

Considerations

There are a wide variety of possible symptoms of seizures, depending on what parts of the brain are affected. Many types of seizures cause loss of consciousness with twitching or shaking of the body. However, some seizures consist of staring spells that can easily go unnoticed. Occasionally, seizures can cause temporary abnormal sensations or visual disturbances.

Seizures can generally be classified as either "simple" (no change in level of consciousness) or "complex" (change in level of consciousness). Seizures may also be classified as generalized (whole body affected) or focal (only one part or side of the body is affected).

Epilepsy is a chronic disorder with recurrent seizures. Some types of epilepsy are hereditary.

Common Causes

Any condition that results in abnormal electrical excitation of the brain may result in a seizure, including:

Also, any medical condition that irritates brain cells may result in a seizure. Common medical conditions that commonly cause seizures include:

Hypoglycemia (low blood sugar)
Drug use (especially cocaine or stimulants)
Alcohol withdrawal
Very high fever (fever convulsions in children)

Home Care

People with epilepsy should always wear a medical alert tag.

Most seizures are self-limiting and stop by themselves after various periods of time. However, a person having a seizure may be injured; breathe food, fluid, or vomit into the lungs; or not get enough oxygen. During a seizure, it is important to protect the person from injury. Turn the person on his or her side, so that any vomit is expelled. See seizure first aid.

After a convulsion, most people go into a deep sleep. Don't prevent the person from sleeping. He or she will probably be disoriented, or possibly agitated for awhile after awakening.

Stay with the person until recovery or until you have professional medical help. Meanwhile, monitor their pulse, rate of breathing, and blood pressure.

DO NOT restrain the person.
DO NOT place anything between the person's teeth during a seizure (including your fingers).
DO NOT move the person unless he or she is in danger or near something hazardous.
DO NOT try to make the person stop convulsing. He or she can't control the seizure and is not aware of what is happening at the time.
DO NOT give the person anything by mouth until the convulsions have stopped and the person is fully awake and alert.

Some patients with epilepsy may have a vagal nerve stimulator implanted in their chest. In these persons, a seizure can be halted by activating the device. Other patients may have been prescribed medication to administer rectally during a seizure. Never try to administer anything (even medications) by mouth.

Call your health care provider if

Report all seizures (even a mild one) to the health care provider. If the patient is known to have epilepsy or recurrent seizures, their doctor should be notified so that medications can be adjusted or other instructions given.

If this is the first time a patient has ever had a seizure, or if this an unusually prolonged seizure for someone known to have a seizure disorder, call for emergency transportation to the hospital. These symptoms may represent a life-threatening condition, such as a stroke or meningitis.

What to expect at your health care provider's office

The doctor will perform a physical examination and ask questions to help understand the cause of the seizures, such as:

Did it occur or start on one side of the body?
Was there movement of the muscles and if so, what was the pattern?
Are there any risk factors (such as recent head injury)?
Was consciousness maintained during the seizure?
How long did the seizure last?
What are the frequency of the seizures?
Was there any warning (aura) of the seizures?
Were there any other symptoms present (visual changes, abnormal smells)?

The following diagnostic tests may be performed:

Medications are often prescribed. Instructions for taking them should be strictly followed. Family members should observe and record any seizures to ensure the patient gets proper treatment.

People with uncontrolled seizures should not drive. Each state has a different law that determines which patients are allowed to drive. People with seizures also should not swim or bike alone.

Prevention

There is no specific way to prevent seizures. Use helmets when appropriate to prevent head injury. This will lessen the likelihood of a brain injury and subsequent seizures. Avoid recreational drugs. People with epilepsy should take medication as directed and avoid excessive amounts of alcohol.

References

Goetz, CG. Textbook of Clinical Neurology. 2nd ed. St. Louis, MO: WB Saunders; 2003: 1158-1160.

Marx J. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002:145-149, 1445.

Review Date: 8/6/2007

Reviewed By: Daniel Kantor, M.D., Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network.

A.D.A.M. Copyright

adam.com

Source Doc: 1_003200

Epilepsy

FitSugar — Wed, 08 Oct 2008 17:35:12 -0700

In This Report

Highlights
Introduction
Causes
Outlook and Effects
Diagnosis
Treatment
Treatment After The First S...
Medications
Surgery
Lifestyle Changes
Resources
References

HEALTH GUIDE REFERENCE FROM A.D.A.M

Highlights

Drug Approval

In 2007, the Food and Drug Administration (FDA) approved levetiracetam (Keppra) for treatment of primary generalized tonic-clonic seizures in adults, and children ages 6 years and older, who have idiopathic generalized epilepsy. Levetiracetam was previously approved for partial-onset seizures and myoclonic seizures.

Carbamazepine and Genetic Testing

In 2007, the FDA recommended that patients of Asian ancestry get a genetic test prior to taking carbamazepine (Tegetrol, Equetro, Carbatrol). Rare, but serious, side effects of carbamazepine include life-threatening skin reactions such as Stevens-Johnson syndrome. The risk for these skin reactions is significantly higher for patients of Asian ancestry. A simple blood test can check for the presence of a genetic mutation that increases this risk. Patients who test positive for this gene should not take carbamazepine unless the benefits clearly outweigh the risks.

Epilepsy and Suicide Risk

People with epilepsy have a high risk for suicide, especially within 6 months of diagnosis, suggests a 2007 study in Lancet Neurology. The researchers found that suicide risk was especially high for people who have both epilepsy and another psychiatric condition (such as depression, anxiety, schizophrenia, or alcoholism). The researchers recommend that doctors carefully monitor newly diagnosed patients.

Ketogenic Diet

The ketogenic diet, which is characterized by high fat and low carbohydrate intake, is resurging in popularity for the treatment of children with difficult-to-control seizures, according to a 2007 review in Pediatrics. The ketogenic diet helps stop or reduce seizures in about a third of children. The diet is complex. Parents should seek supervision and guidance from a doctor or trained health professional.

Introduction

Epilepsy is characterized by unprovoked, recurring seizures that disrupt the nervous system and can cause mental and physical dysfunction. In the U.S., about 2.5 million people are affected by epilepsy and seizures. About 10% of the American population will experience at least one seizure during their lifetime.

The structures of the brain include: the brainstem, consisting of the spinal cord, the medulla oblongata, the pons and the midbrain; the cerebellum; the cerebrum (one half, or hemisphere shown); and the diencephalon.

Epilepsy affects all age groups. Males have a slightly higher risk than females. The incidence is highest in children, with another, but lesser, peak occurring after age 60. According to one estimate, 14% of epilepsy patients are under 15 years old, and about 25% are over age 64.

Every year, 25,000 - 40,000 American children have a first seizure that is unrelated to a fever. Epilepsy is decreasing in childhood but increasing in the elderly, probably because of mild strokes and cardiac arrest.

Epilepsy is not a single disorder but rather a wide spectrum of problems. What all types of epilepsy share are recurrent, unprovoked seizures caused by an uncontrolled electrical discharge from nerve cells in the cerebral cortex. This part of the brain controls higher mental functions, general movement, and the functions of the internal organs in the abdominal cavity, perception, and behavioral reactions.

Seizures are a symptom of epilepsy. Epilepsy types are generally put into two categories, which are based on the specific biologic mechanisms involved in the seizure and the anatomical location of the seizure. The two types are:

Partial (also called focal or localized) seizures. These seizures are more common than generalized seizures and occur in one or more specific locations in the brain. In some cases, partial seizures can spread to wide regions of the brain. They are likely to develop from specific injuries, but in most cases the exact origins are unknown.
Generalized seizures. These seizures typically occur in both sides of the brain. Many forms of these seizures are genetically based. There is usually normal neurologic function.

Experts are finding, however, that these categories do not actually reflect what is now known about the brain's anatomy. For example, the words "partial" and "generalized" suggest that seizures either involve only part of the brain or are widespread. However, a number of events in the brain occur with either type, muddying these distinctions. Researchers are now in the process of making clearer definitions and terms that reflect what actually is happening in the brain.

New classification systems better define specific epilepsies. Some professional groups now suggest that epilepsies be classified in the following five ways:

Type of seizure (partial or generalized)
Description of the seizure onset and evolution
Specific syndromes that are associated with one or more seizure types (however, not all seizures will be part of a syndrome)
Specific causes of the seizures, if known
Degree of impairment

These seizures are subcategorized as "simple" or "complex partial."

Simple Partial Seizures. A person with a simple partial seizure (sometimes known as Jacksonian epilepsy) does not lose consciousness, but may experience confusion, jerking movements, tingling, or odd mental and emotional events. Such events may include deja vu, mild hallucinations, or extreme responses to smell and taste. After the seizure, the patient usually has temporary weakness in certain muscles.
Complex Partial Seizures. Slightly over half of seizures in adults are complex partial type. About 80% of these seizures originate in the temporal lobe, the part of the brain located close to the ear. Disturbances there can result in loss of judgment, involuntary or uncontrolled behavior, or even loss of consciousness. They may lose consciousness briefly and appear to others as motionless with a vacant stare. Emotions can be exaggerated; some sufferers even appear to be drunk. After a few seconds, a patient may begin to perform repetitive movements, such as chewing or smacking of lips. Episodes usually last no more than 2 minutes. They may occur infrequently, or as often as every day. A throbbing headache may follow a complex partial seizure.

In some cases, simple or complex partial seizures evolve into what are known as secondarily generalized seizures. The progress may be so rapid that the partial stage is not even noticed.

While the term "partial" implies the seizures affect only small or specific brain locations, in reality, they almost always involve diffuse and even widespread areas. In the future, the term "focal seizures" will most likely replace the term "partial seizures," and its subcategories. Until new classifications are more widely in use, this report will continue to use the term "partial seizures" and its subcategories.

Generalized seizures are caused by nerve cell disturbances that occur in more widespread areas of the brain than do partial seizures. Therefore, they have a more serious effect on the patient. They are further subcategorized as tonic-clonic (or grand mal) or absence (petit mal) seizures.

Tonic-Clonic (Grand Mal) Seizures. The first stage of a grand mal seizure is called the tonic phase, in which the muscles suddenly contract, causing the patient to fall and lie stiffly for about 10 - 30 seconds. Some people experience a premonition or aura before a grand mal seizure. Most, however, lose consciousness without warning. If the throat or larynx is affected, there may be a high-pitched musical sound (stridor) when the patient inhales. Spasms occur for about 30 seconds to 1 minute. Then the seizure enters the second phase, called the clonic phase. The muscles begin to alternate between relaxation and rigidity. After this phase, the patient may lose bowel or urinary control. The seizure usually lasts a total of 2 - 3 minutes, after which the patient remains unconscious for a while and then awakens to confusion and extreme fatigue. A severe throbbing headache similar to migraine may also follow the tonic-clonic phases.
Absence (Petit Mal) Seizures. Absence or petit mal seizures are brief losses of consciousness that occur for 3 - 30 seconds. Physical movement and loss of attention may stop for only a moment. Such seizures may pass unnoticed by others. Small children may simply appear to be staring or walking distractedly. Petit mal may be confused with simple or complex partial seizures, or even with attention deficit disorder. [See In-Depth Report #30: Attention deficit hyperactivity disorder.] In petit mal, however, a person may experience attacks as often as 50 - 100 times a day. About 25% of patients with petit mal develop grand mal seizures. An electroencephalogram (EEG) test that shows a specific brain wave pattern can usually identify these patients.

Click the icon to see a depiction of a tonic-clonic seizure.

Atonic (Akinetic) Seizures. A person who has an atonic (or akinetic) seizure loses muscle tone. Sometimes it may affect only one part of the body so that, for instance, the jaw slackens and the head drops. At other times, the whole body may lose muscle tone, and the person can suddenly fall. A brief atonic episode is known as a drop attack.

Simply Tonic or Clonic Seizures. Seizures can also be simply tonic or clonic. In tonic seizures, the muscles contract and consciousness is altered for about 10 seconds, but the seizures do not progress to the clonic or jerking phase. Clonic seizures, which are very rare, occur primarily in young children, who experience spasms of the muscles but not tonic rigidity.

Myoclonic. Myoclonic seizures are a series of brief jerky contractions of specific muscle groups, such as the face or trunk.

Epilepsy is also grouped according to a set of common characteristics, including:

Patient age
Type of seizure or seizures
Whether a cause is known or not (idiopathic)

A few syndromes and inherited epilepsies are listed as follows. They do not represent all epilepsies.

West Syndrome (Infantile Spasms). West syndrome, also called infantile spasms, is a disorder that involves spasms and developmental delay in children within the first year, usually in infants ages 4 - 8 months.

Benign Familial Neonatal Convulsions. Benign familial neonatal convulsions (BFNC) are a rare, inherited form of generalized seizures that occur in infancy. BFNC appears to be caused by genetic defects that affect ion channels in nerve cells that carry potassium.

Juvenile Myoclonic Epilepsy (Impulsive Petit Mal). Juvenile myoclonic epilepsy, also called impulsive petit mal epilepsy, is characterized by generalized seizures, usually tonic-clonic marked by jerky movements (called myoclonic jerks), and sometimes absence seizures. This accounts for 7% of epilepsies, and usually occurs in individuals ages 8 - 20.

Adult Myoclonic Epilepsy. Some research suggests that adult myoclonic epilepsy may be a previously un-described and distinct syndrome. It involves the development of generalized epilepsy of unknown causes in middle-aged adults.

Lennox-Gastaut Syndrome. Lennox-Gastaut syndrome is a severe form of epilepsy in young children that causes multiple seizures and some developmental retardation. It usually involves absence, tonic, and partial seizures.

Myoclonic-Astatic Epilepsy. Myoclonic-astatic epilepsy (MAE) is a combination of myoclonic seizures and astasia (a decrease or loss of muscular coordination), often resulting in the inability to sit or stand without aid.

Progressive Myoclonic Epilepsy. Progressive myoclonic epilepsy is an inherited disorder occurring in children ages 6 - 15. It usually involves tonic-clonic seizures and marked sensitivity to light flashes. Although the disease was previously considered to be progressive throughout life, current therapies have significantly improved its outlook.

Autosomal Dominant Nocturnal Frontal Lobe Epilepsy. Autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) is a rare, inherited syndrome that usually occurs during childhood, typically around age 11. However, onset varies widely within families. Seizures can be dystonic (twisting contractions) or tonic (muscle contractions), or involve thrashing. They are brief, frequent, and occur in clusters during the night. The seizures often subside with age. ADNFLE appears to be caused by an alteration in the brain receptor neuronal nicotinic acetylcholine,

Landau-Kleffner Syndrome. Landau-Kleffner syndrome is an epileptic condition that results in the inability to communicate either with speech or by writing (aphasia).

Contactin-Associated Protein-Like 2 (CASPR2) Epilepsy. CASPR2 is associated with a childhood epilepsy and autism disorder found in closely related relatives in Amish communities.

Status epilepticus (SE) is a serious, potentially life-threatening, condition that can lead to chronic epilepsy. It occurs in 100,000 - 150,000 people in the U.S. each year, over half of whom are children. Permanent brain damage or death can result if the seizure is not treated effectively.

The condition is defined as recurrent convulsions that last for more than 20 minutes and are interrupted by only brief periods of partial relief. Although any type of seizure can be sustained or recurrent, the most serious form of status epilepticus is the generalized convulsive or tonic-clonic type. In more than a third of cases, status epilepticus occurs with the first seizure. The trigger is often unknown, but can include the following:

Failure to take anti-epileptic medications (accounts for about a third of status epilepticus events)
Abrupt withdrawal of certain anti-epileptic drugs, particularly barbiturates and benzodiazepines
High fever
Poisoning
Electrolyte imbalances (imbalance in calcium, sodium, and potassium)
Cardiac arrest
Stroke. In one study, about 9% of stroke patients with seizures had status epilepticus, which resulted in higher disability after the stroke, particularly if these severe seizures occurred within a week of the stroke
Low blood sugar in people with diabetes
Central nervous system infection
Brain tumor
Alcohol withdrawal

Causes

The cause of a seizure is determined in about 28% of partial epilepsy patients. In the rest, however, epilepsy is deemed idiopathic, which means that the cause is unknown. The age of seizure onset can sometimes offer a clue. Idiopathic epilepsy is rare in children and young adults.

Epileptic seizures are triggered by abnormalities in the brain that cause a group of nerve cells in the cerebral cortex to become activated simultaneously, emitting sudden and excessive bursts of electrical energy. A seizure's effect depends on the location in the brain where this electrical hyperactivity occurs. Effects range from brief moments of confusion to minor spasms to loss of consciousness.

Click the icon to see an animation about the nervous system.

Ion Channels. Sodium, potassium, and calcium act as ions in the brain. They produce electric charges that must fire regularly in order for a steady current to pass from one nerve cell in the brain to another. If the ion channels that carry them are genetically damaged, a chemical imbalance occurs. This can cause nerve signals to misfire, leading to seizures. Abnormalities in the ion channels are believed to be responsible for absence and many other generalized seizures.

Neurotransmitters. Abnormalities may occur in neurotransmitters, the chemicals that act as messengers between nerve cells. Three neurotransmitters are of particular interest:

Gamma aminobutyric acid (GABA), which helps prevent nerve cells from over-firing.
Serotonin's role in epilepsy is also being studied. Serotonin is a brain chemical that is important for well-being and associated behaviors (eating, relaxation, sleep). Imbalances in serotonin are also associated with depression.
Acetylcholine is a neurotransmitter that is important for learning and memory.

Dozens of genetic syndromes representing a variety of seizure patterns may account for the different forms epilepsy.

A genetic cause has been identified for at least some cases of juvenile myoclonic epilepsy, which represents 10% of all epilepsy cases. (Such research and other studies have pointed to the GABA signaling system as an important player in many cases of epilepsy.)

Febrile seizures are caused by high fever. They usually occur in children ages 3 months to 5 years. Between 10 - 15% of children with epilepsy have a history of febrile seizures before they develop epilepsy. However, febrile seizures are quite common and occur in about 3% of all children under 5 years old. Nearly all are brief and have no long-lasting effect.

In young children, high fever from a vaccination can, in rare instances, trigger seizures. These seizures are almost always temporary and have no serious consequences.

Some controversy arose a few years ago over the possibility that the DTP (diphtheria-tetanus-pertussis) vaccine might trigger epilepsy or other neurologic diseases. Some experts suggest that children who have neurologic events following their DTP shot already have a preexisting impairment such as epilepsy, which is revealed, but not caused by, the vaccine. Children with existing epilepsy may be at risk for seizures 2 or 3 days after the vaccination. Infants with suspected neurologic problems may have their vaccinations delayed until their neurologic situation is clarified, but not beyond their first birthday. Also, a newer version of the DTP vaccine does not contain a live virus and so reduces the risk of any seizure.

Brain Tumors. Both cancerous and noncancerous brain tumors can cause seizures in all patients.

Hydrocephalus and Shunts. Hydrocephalus occurs when cerebrospinal fluid (CSF) accumulates in the brain, leading to excessive swelling of the brain ventricles. The resulting pressure can damage the brain's tissue. Hydrocephalus itself is not commonly known to cause seizures, but its treatment, which involves insertion of a shunt, may cause them. The shunt is a device that drains the excess fluid from the brain. Up to half of children who receive shunts may experience epileptic seizures, particularly if the shunt is placed before 2 years of age. More research on its relationship to epileptic seizures is needed.

Focal Cortical Dysplasia. This is an abnormality in fetal development in which the normal migration of nerve cells is altered. It can cause very severe epilepsy that is difficult to treat.

Hippocampal Sclerosis. Hardened tissue (sclerosis) in the brain's hippocampus is the most commonly identified abnormality in patients with partial epilepsy. Such abnormal brain tissue leads to structural reorganization, and both the loss and regeneration of nerve cells.

Cavernous Angiomas. Cavernous angiomas are blood vessels that grow abnormally and, like a tumor, can put pressure on nerve tissue.

Other Causes of Seizures in Children. Seizures in infants and children may be due to birth defects, difficulties during delivery, or poisoning.

Alcohol Abuse. Alcohol abuse is one of the most common causes of adolescent- and adult-onset seizures. Seizures, nearly always generalized tonic-clonic, occur in about 10% of adults during withdrawal. Multiple seizures happen in about 60% of these patients. The first seizure occurs 7 hours to 2 days after the last drink, and the time between the first and last seizure is usually 6 hours or less. [For more information, see In-Depth Report #56: Alcoholism.]

Sudden withdrawal from certain antianxiety or antidepressant drugs such as benzodiazepines, barbiturates, and tricyclic antidepressants can also contribute to seizures.

Head Injuries in Adults. Head injuries to adults can cause seizures, with the risk highest in severe head trauma. A first seizure related to the injury can occur years later, but only very rarely. People with mild head injuries, which involve loss of consciousness for fewer than 30 minutes, have only a slight risk that lasts up to 5 years after the injury.

Head Injuries in Infants and Children. Infants are at high risk for head trauma, and the severity of injury may be difficult to determine. The risk of even one seizure is generally only a concern after severe head trauma. Most children who have had a minor or not very serious head injury do not need to have medications to prevent seizures, especially when an evaluation in the emergency department was unnecessary.

Stroke. Seizure is a symptom of a major stroke. Even injury to the brain from small strokes may cause seizures. Patients who have had a severe stroke are 5 times more likely to develop epilepsy than patients who have had a mild stroke.

Seizures in adults can also be caused by:

Low blood sugar (hypoglycemia), a complication of diabetes in both children and adults.
Medications such as theophylline, meperidine, tricyclic antidepressants, phenothiazines, lidocaine, quinolones, penicillins, selective serotonin re-uptake inhibitors, isoniazid, antihistamines, cyclosporine, interferons, cocaine, lithium, amphetamines, and alcohol (withdrawal).
Occupational exposure to environmental triggers. High exposure to certain chemicals has been linked with seizures.
Alzheimer's or other degenerative brain diseases in the elderly.
Infections of the brain and central nervous system such encephalitis and meningitis.

The organs of the central nervous system (brain and spinal cord) are covered by three connective tissue layers called the meninges. They consist of the pia mater (closest to the CNS structures), the arachnoid, and the dura mater (farthest from the CNS). The meninges help support blood vessels and contain cerebrospinal fluid. The structures are involved in meningitis, an inflammation of the meninges, which, if severe, may become encephalitis, an inflammation of the brain.

Between 20 - 45% of cases of untreatable seizures have a psychologic rather than physical origin. In this form of epilepsy, known as pseudoepilepsy or psychogenic epilepsy, the patient has no conscious intent of forcing a seizure and does not show unusual emotional behavior or signs of hysteria. It is very difficult to treat and can be very disabling. Pseudoepilepsy can usually be distinguished from true epilepsy using an electroencephalogram (EEG), which measures brain waves. The cause of pseudoepilepsy is unknown.

Outlook and Effects

Most patients can control their seizures with a single drug and stop drug treatment completely after 2 years without seizures. In fact, patients who respond well to an anti-epileptic drug (AED), have a better chance for remaining seizure-free in the future. In general, patients who do not have good control with medications are more likely to have difficulty with epilepsy treatment.

Injuries from Falls. Because many people with seizures fall, injuries are common. Although such injuries are usually minor, people with epilepsy have a higher incidence of fractures than those without the disorder. Epilepsy patients who take the drug phenytoin have an even higher risk, since the drug can cause osteoporosis.

Household Accidents. According to a 2006 study, the kitchen and bathroom are two of the most dangerous places for children with epilepsy. Parents should take precautions to prevent burning accidents from stoves and other heat sources. Children with epilepsy should never be left alone when bathing.

Driving and the Risk for Accidents. Being unable to drive is an extremely distressing and severe component of epilepsy. Drivers with well-controlled epilepsy are not at a high or unacceptable risk for automobile accidents. Uncontrolled epilepsy, however, poses a high risk. Needless to say, seizures can be very dangerous if they occur while a person is driving. Studies have reported that more than a fourth of drivers with uncontrolled epilepsy had a seizure-related accident at some time. Many of these accidents resulted in injuries to the patient or others.

Certain factors can help predict who may safely drive:

A long duration between seizures. In one study, being seizure-free for 6 months reduced the risk for accidents by 85%, and being seizure-free for 1 year lowered the risk by 93%. State laws restricting driving in people with seizures vary from requiring seizure-free periods of 3 months (which is too short for protection) to 18 months.
Having few seizure-related accidents.
Having a reliable pre-seizure warning sign, such as an aura.

Accidents while Swimming. Swimming poses another danger for people with epilepsy, particularly those with tonic seizures, which can cause the diaphragm to expel air quite suddenly. People with epilepsy who swim should avoid deep and cloudy water (a clear swimming pool is best), and always swim with a knowledgeable, competent, and experienced companion or have a supervisor on site.

Epileptic patients who are cured have a normal lifespan. Their long-term survival rates are lower than average if medications or surgery fail to stop the seizures. The lower survival rate is partly due to a higher-than-average risk for death due to accidents and suicide. The specific cause of the seizure may also contribute to fatalities.

There is a very low risk for sudden death in patients with epilepsy. Although the causes of such events are not fully known, experts suspect heart arrhythmias in many cases.

Long-Term General Effects. In general, the long-term effects of seizures vary widely depending on the seizure's cause. The long-term outlook for children with idiopathic epilepsy (epilepsy of unknown causes) is very favorable. One study reported that 68 - 92% of these patients were seizure-free after 20 years. Another study reported that they had a survival rate no different from children without these seizures.

Children whose epilepsy is a result of a specific condition (for example, a head injury or neurologic disorder) have higher mortality rates than the normal population, but their lower survival rates are most often due to the underlying condition, not the epilepsy itself.

Effect on Memory and Learning. The studies on the effects of seizures on memory and learning vary widely and depend on many factors. In general, the earlier a child has seizures and the more extensive the area of the brain affected, the poorer the outcome. Children with seizures that are not well-controlled are at higher risk for intellectual decline.

Social and Behavioral Consequences. Learning and language problems, and emotional and behavioral disorders, occur in a significant number of children with several of the partial epilepsy syndromes. These children perform worse on behavioral tests than do other children. Whether these problems are caused by the seizure disorder and anti-seizure medications or are simply part of the seizure disorder remains unclear.

Effect on Mental Functioning in Adults. The effects of adult epilepsy on mental functioning are not clear. More research is needed in this area, as results have been contradictory.

Psychological Health. About 25 - 75% of adults with epilepsy show signs of depression. People with epilepsy have a high risk for suicide, particularly in the first 6 months following diagnosis. The risk for suicide is highest among people who have epilepsy and an accompanying psychiatric condition such as depression, anxiety disorder, schizophrenia, or chronic alcohol use.

Overall Health. Many patients with epilepsy describe their overall health as "fair" or "poor," compared to those who do not have epilepsy. People with epilepsy also report a higher frequency of pain, depression, anxiety, and sleep problems. In fact, their overall health state is comparable to people with other chronic diseases, including arthritis, heart problems, diabetes, and cancer. Treatments can cause considerable physical effects, such as osteoporosis and weight changes.

Effects on Sexual Function. There have been studies suggesting that up to two-thirds of patients with epilepsy experience sexual disturbances, including impotence in men. Causes of these problems may be emotional, medication induced, or a result of changes in hormone levels:

Epilepsy in childhood may cause disturbances in hormones regulating puberty.
Persistent seizures in adults may be associated with other hormonal and neurologic changes that contribute to sexual dysfunction.
Negative emotions due to epilepsy can reduce sexual drive.
Medications may be responsible for many of these cases, although newer drugs may reduce this problem.

Studies have been conflicting on the effects of fertility from epilepsy, but most suggest that fertility rates among women with epilepsy are lower than among women in the general population. A number of factors, including anti-epileptic drugs (AEDs) or social factors such as marriage at an older age, may contribute to this lower rate. Certain AEDs, particularly valproate, disrupt ovulation and menstruation by increasing male hormone levels and weight and causing polycystic ovaries.

Preparing to Become Pregnant. A woman should visit her doctor at least 3 months before becoming pregnant to talk about risks of medications and the possibility of making any changes.

A woman who has been seizure-free for 2 or more years may attempt to discontinue drugs under her doctor’s supervision.
If she has not been seizure-free, she should continue medications but try to reduce them to a single drug, if possible. (Again, under a doctor’s supervision.)
If a woman taking antiseizure medications has an unplanned pregnancy, there may be no point in switching medications right away, since the effects of the drugs last for 10 weeks. However, she should notify her doctor immediately.
Folic acid is recommended for all pregnant women, and women with epilepsy should talk with their doctor about taking a supplement of folic acid (5 mg) at least 3 months before conception as well as during the first trimester.

Effect of Pregnancy on Seizure Frequency. The frequency and intensity of seizures vary widely in women with epilepsy. About 25% of pregnant women with epilepsy face an increase in events, and the risk is highest in those who have more than one seizure per month prior to becoming pregnant. In most cases, however, there is no change at all. Some pregnant women even have a decrease in seizures. The risk is lower in women who experience less than one seizure in the 9 months prior to becoming pregnant.

The following conditions may contribute to an increase in seizures during pregnancy:

Nausea and vomiting (vitamin B6 and antihistamines may help with nausea)
Fluid retention
Higher estrogen levels
Psychological and emotional stress
Medication noncompliance from fear of side effects
Problems with sleeping
Changes in absorption of anticonvulsants

Anti-epileptic drug levels are monitored at least three times during the pregnancy, more often if seizures are occurring or levels are not normal. Dosage levels should be adjusted accordingly.

Effects of Epilepsy on the Pregnant Patient and the Fetus. Women who become pregnant have a risk for uncontrolled seizures and birth defects from antiseizure medications. In studies of women who were carefully monitored, however, 95% of pregnancies (which is close to normal) had favorable outcomes.

Isolated seizures do not appear to pose any adverse effects to the mother or the unborn child, but repeated seizures and status epilepticus can lead to great dangers. In one study, the effect of epilepsy on complications during pregnancy was the same as in non-epileptic women except for a higher rate of premature deliveries (8.2% in the women with epilepsy).

Drugs Used During Pregnancy. Some types of anti-epileptic drugs (AEDs) can increase the risks for birth defects, especially when taken during the first trimester of pregnancy. Expert guidelines advise that pregnant women use the most effective medication for their type of epilepsy at the lowest dose possible to control seizures. They should also have their doctors take blood tests during pregnancy to monitor their drug levels.

The fetus should be carefully monitored with ultrasonic evaluation and sometimes amniocentesis (visual tests and examination of the fluid in the womb for birth defects and other fetal problems).

In general, research indicates that 90% of women who take AEDs will give birth to healthy children. Still, doctors recommend that women of child-bearing age use a drug other than valproate if possible.

The risk for malformation is higher when more medications are used. For example, there is a 3% risk of birth defects with women who use one anticonvulsant. The risk increases to 20% when four drugs are used.

Birth Defects Associated with Medication. The most common birth defects related to anti-epileptic drugs are:

Cleft lip or palate (risks from lamotrigine, phenobarbital, phenytoin, valproate especially when taken during the first trimester).
Genital or urinary abnormalities (risk from most standard drugs).
Neural tube defects (NTD) in the skull or spinal column (risk of 2% with valproate and 1% with carbamazepine). These complications are most often due to lower folic acid levels caused by both pregnancy itself and antiseizure drugs. Folic acid supplements can help prevent this problem.
Mental impairment (known risk with phenytoin and valproate; inconclusive in carbamazepine and phenobarbital).
Heart defects (risk from phenobarbital, phenytoin, valproate).

Many antiseizure drugs also cause a deficiency in vitamin K clotting factors that increases the risk for hemorrhage in the newborn. Treatment with vitamin K during the last month of pregnancy and a single dose given to the newborn is recommended.

Labor and Delivery. Seizures occur during labor and after delivery in a small percentage of women with epilepsy. The following labor complications are more common among pregnant women with epilepsy: Vaginal bleeding, anemia, and preeclampsia (extremely high blood pressure in the third trimester). If seizures occur during labor, they are generally treated intravenously with benzodiazepines or phenytoin. If tonic-clonic seizures, absence seizures, or status epilepticus occur, a cesarean section may be appropriate.

Postnatal Care

Monitoring the Infant. The infant should be thoroughly examined for any birth defects. Also, if the mother was given phenobarbital or primidone while pregnant, the infant should be monitored for up to 8 months to see if withdrawal symptoms develop. Drug dosages will also need to be adjusted for the mother after delivery.

Breast-feeding. Women on most AEDs typically can nurse their babies, since usually only a small amount of the drug enters the breast milk. The lowest levels are with phenytoin and valproate. (Ethosuximide and possibly levetiracetam are exceptions and should be avoided when a woman is breast-feeding. Women taking phenobarbital are also usually advised not to nurse.) A mother should watch for signs of lethargy or extreme sleepiness in her infant, which could be caused by her medication.

Diagnosis

An epilepsy diagnosis is often made during an emergency visit for a seizure. If a person seeks medical help for a previous or suspected seizure, the doctor will ask about the patient's medical history, including seizure events.

Conditions that cause similar symptoms to epilepsy include:

Syncope. Syncope, a brief lapse of consciousness in which blood flow is reduced to the brain, can mimic epilepsy. It often misdiagnosed as epilepsy. Patients with syncope do not have the rhythmic contracting and then relaxing of the body's muscles.
Migraines. Migraine headaches, particularly migraine with auras, may sometimes be confused with epilepsy. With epileptic seizure, the preceding aura is often seen as multiple, brightly colored, circular spots, while migraine sufferers tend to see black, white, or colorless lined or zigzag flickering patterns. Typically the migraine pain expands gradually over minutes toward one side.
Panic Attacks. In some patients, partial seizures may resemble a panic disorder. Symptoms of panic disorder include palpitations, sweating, trembling, sensation of breathlessness, chest pain, feeling of choking, nausea, faintness, chills or flushes, fear of losing control, and fear of dying.
Narcolepsy. Narcolepsy, a sleep disorder that causes a sudden loss of muscle tone and excessive daytime sleepiness, can be confused with epilepsy.

Electroencephalogram (EEG). The most important diagnostic tool for epilepsy is an EEG, which measures brain waves. Ideally, it should be performed within 24 hours of a seizure. An EEG recording session may last for less than an hour, but in some cases the doctor will want a day-long recording. Long-term monitoring may be necessary in some cases when patients do not respond to medications. Portable EEG units are available in some places, which can be used to monitor patients throughout normal activities. EEGs are not foolproof. Repeated EEGs are often needed to confirm a diagnosis, particularly for certain partial seizures that often produce an initially normal EEG reading.

Video Electroencephalography (Video EEG). For this task, patients are admitted to a special part of the hospital where they are monitored both by EEG and are also watched by a video camera. Patients may need this for a variety of reasons including withdrawal or addition of medications in a patient with difficult-to treat-epilepsy, before epilepsy surgery for some patients, and also when psychogenic nonepileptic seizures are suspected.

Computerized Tomography (CT) Scans. Usually, the first brain imaging test ordered for most adults and children with first-time seizures is a CT scan. This imaging technique is sensitive enough for most purposes. In children, even if the scan is normal, the doctor will follow up to be sure other problems are not present.

A CT (computed tomography) scan is a much more sensitive imaging technique than x-ray, allowing high definition of both the bony structures and the soft tissues. Clear images of organs such as the brain, muscles, joint structures, veins and arteries, as well as anomalies like tumors and hemorrhages may be obtained with or without the injection of contrasting dye.

Magnetic Resonance Imaging (MRI). Experts strongly recommend MRIs for children with first seizures in certain cases, such as children under 1 year old and those with seizures that are associated with any unexplained significant mental or motor problems. These images may help to determine if the disorder can be treated with surgery, and may be used as a guide for surgeons.

Other Advanced Imaging Techniques. More advanced scanning techniques are emerging as important tools for epilepsy researchers. By detecting abnormalities, such as changes in brain activity, positron emission tomography (PET) may help locate damaged or scarred locations in the brain where partial seizures are triggered. These findings may help determine which patients with severe epilepsy are good candidates for surgery. Single-photon emission computer tomography (SPECT) may also be used to decide if the surgery should be performed and what part of the brain needs to be removed. Both of these imaging techniques are generally only needed when an MRI of the brain has not been helpful.

Treatment

You cannot stop a seizure, but you can help the patient prevent serious injury.

Remain calm, and do not panic, then take the following actions:

Wipe away any excess saliva to prevent obstruction of the airway. Do not put anything in the patient's mouth. It is an old wives' tale that people having seizures will swallow their tongues.
Turn the victim gently on the side. Do not try to hold the patient down to prevent shaking.
Rest the patient's head on something flat and soft to protect it from banging on the floor and to support the neck.
Move sharp objects out of the way to prevent injury.

Do not leave the seizure victim alone. Anyone nearby should call 911. Patients should be taken to an emergency room when:

A first-time seizure occurs
Any seizure lasts beyond 2 - 3 minutes
The patient has been injured
The patient is pregnant
The patient is diabetic
Parents, caregivers, or bystanders are at all uncertain

Not all patients with chronic epilepsy need to go to the hospital after a seizure. Hospitalization may not be necessary in many patients whose seizure is not severe or repetitive, and who have no risk factors for complications. All patients or caregivers, however, should contact their doctor after a seizure occurs.

Initial Management. The earlier a patient is treated, the better the results. Initial management of status epilepticus consists of:

Administer any seizure medications
Support systems to maintain or attain normal breathing, blood pressure, electrolyte balances, body temperature, and heart functions
Oxygen for patients who may need it
Attention by medical personnel trained to determine any treatable cause of status epilepticus, such as drug withdrawal, low blood sugar, infection, substance abuse (particularly cocaine), or eclampsia (elevated blood pressure induced by pregnancy)

Medications for Status Epilepticus. Doctors will try one or more of the following medications initially:

Benzodiazepine. An intravenously (IV), intramuscularly, or rectally administered benzodiazepine such as lorazepam (Ativan), diazepam (Valium), clonazepam, or midazolam (Versed) is usually used.
Phenytoin or Fosphenytoin. Many doctors use phenytoin or fosphenytoin if seizures are not controlled by a benzodiazepine.
Phenobarbital. Although effective, barbiturates, such as phenobarbital (Barbita, Luminal), are generally used only when other drugs have failed.

All of these medications carry a risk for hypotension, an abrupt and possibly dangerous drop in blood pressure, which may require treatment.

Treatment After The First Seizure

Children with febrile seizures rarely have any long-term effects and generally do not require drug treatment. In very rare cases, children experience severe fever-related seizures known as complex febrile convulsions. In such cases, there is a risk for brain injury that may lead to temporal lobe epilepsy, but this is very small. Such seizures last over 15 minutes, occur more than once within 24 hours, and may affect only one side of the body.

Treatment with anti-epileptic drugs (AEDs) is usually initiated or strongly considered for the following patients:

Children and adults who have had two or three seizures, unless there is either a long separation between seizures or the seizure is provoked by an injury or other specific causes. (In children, risk for recurrence after a single unprovoked seizure is rare. The risk even after a second seizure is low, even when the seizure is prolonged.)
Children and adults after a single seizure if tests reveal any brain injury, or if specific syndromes put a person at special risk for recurrence, for instance, in cases of myoclonic epilepsy.

There is some debate about whether to treat every adult patient with an AED after a single initial seizure. Some experts do not recommend treating adult patients after a single seizure if they have a normal neurologic examination, EEG, and imaging studies. A 2005 study of patients with single or infrequent seizures found that while early AED treatment reduced the risk of seizure for a few years, it had no effect on long-term outcomes. This study also suggested that delaying AED treatment does not increase the risk of developing lifelong epilepsy.

Some doctors believe, however, that any adult who has a first seizure should begin on-going AED treatment, since 30 - 70% of these patients are likely to experience a subsequent event. According to one study, when young adults were given a single drug (usually carbamazepine) after a first generalized seizure, only 22% had a subsequent seizure compared to about 70% of those who were not given treatment.

Most epileptic seizures can be controlled using a single-drug regimen. First-line AED drugs include phenytoin (Dilantin), carbamazepine (Tegretol, Carbatrol), and divalproex sodium (Depakote). Patients generally begin with low doses and build up until the seizures are controlled or a toxic reaction occurs. If a single drug fails to control seizures, other drugs are added on. The specific drugs and whether more than one should be used are determined by various factors, including the patient's age and the seizure's type, frequency, and cause.

Drugs fail to control epilepsy in about 30% of patients. For patients who have little or no benefit from their initial drug regimen the likelihood of good or complete control from different medications or multidrug regimens is not very high.

Reasons for Failure. An AED may fail to reduce seizures due to such factors as:

The wrong dose level.
Improper timing.
Introducing the medication too rapidly.
Not managing conditions that triggered the seizure.
Instability of the drugs. Many of the tablet forms disintegrate easily with moisture, so pills should be stored in a dry place, not in the bathroom, and kept away from heat.
Patients not taking medication as prescribed. Over 40% of patients experience toxic or bothersome effects from older AEDs, which often causes them to withdraw. Among the most distressing are sleepiness, problems in coordination, and weight gain.
Some evidence suggests that about a quarter of patients who do not respond to AEDs actually have nonepileptic seizures that in many cases are caused by psychiatric conditions (such as panic attack or personality disorders).

The doctor should first address these issues. If the patient still does not respond, the doctor will usually try a different drug. If this fails, one or even two additional drugs at a time may be used. When seizures do not respond to the first two or three drugs, the odds of a fourth or fifth working diminish greatly, despite a number of new medications on the market. In such cases, the patient should ask about surgical alternatives.

Healthy Behaviors. In young people, a positive attitude, continued support from family and health care providers, emotional well-being, and good treatment results can increase patient compliance. Unhealthful behaviors, such as smoking and alcohol use, can have a negative effect.

During the first few months of therapy, the doctor will probably order blood tests once or twice to monitor drug levels and, if necessary, adjust dosages. Monitoring is used to check for AED complications, and to be sure the patient is complying with the regimen. Many experts feel, however, that these blood tests are a less reliable indicator of problems than the patient's own self-observations of his or her responses to the drug. For instance, blood tests may suggest that the dosage levels are insufficient according to general standards, yet the individual patient may be seizure-free and leading a normal life. It is very important that women have AED levels monitored during pregnancy.

An estimated 60% of all patients treated effectively can stop taking AEDs within 5 - 10 years. Evidence suggests that medications in children should not be halted for at least 2 years after the last seizure, particularly if they have partial seizures and abnormal EEGs. It is not clear whether children who have been free of generalized seizures need to wait more than 2 years or if they can withdraw earlier.

Children who tend to relapse after withdrawal from treatment usually have the following conditions or situations:

A family history of epilepsy
Require multiple medications to control seizures
Abnormal EEG readings after treatment has started
Partial seizures

There is also no clear evidence on whether adults who are free of any seizure type can safely withdraw from their medications within 2 years of their last seizure of if they should wait.

In any case, attempts to halt drugs should be done during periods when seizures will cause the least harm. For instance, the best time to test the effects of drug withdrawal in teenagers might be about a year before they are eligible to drive.

Anti-epileptic drugs interact with many other drugs, and may cause special problems in older patients who use multiple medications for other health problems. Elderly patients should have liver and kidney function tests performed before starting antiseizure medication. Standard drugs are usually effective, while safe, newer ones (including gabapentin, lamotrigine, oxcarbazepine, and gamma-vinyl-GABA) may sometimes prove to be useful as a sole therapy. These newer drugs also increase patient compliance because they tend to have fewer side effects than the older ones.

Hormonal fluctuations affect epilepsy in about a third to a half of female patients. Estrogen appears to increase activity, and progesterone reduces it. The effect of pregnancy on women with epilepsy is complex. The following treatments may help or affect women with epilepsy:

Hormonal Drugs that Suppress Ovulation. When seizures in women are worsened by hormonal changes, such as during the menstrual cycle, suppressing ovulation may be recommended using drugs called gonadotropin-releasing hormone agonists.
Oral contraceptives. Antiseizure medications affect many oral contraceptives (OCs). Carbamazepine, phenytoin, phenobarbital, primidone, oxcarbazepine, and topiramate reduce the effects of OCs. Valproate does not, and may even increase hormonal levels. Gabapentin, lamotrigine, tiagabine, and vigabatrin may also prove to be safe with OCs, but more research is needed. Progestins may be the best contraceptive drugs for women with epilepsy at this time. Injected progestins may actually help prevent seizures in some cases.

More information on epilepsy and pregnancy can be found in this report under Outlook and Effects.

Medications

Many newer anti-epilepsy drugs (AEDs) are now available and are usually better tolerated than the older, standard AEDs. They often cause less sedation and require less monitoring. Although they are generally approved for use as add-ons to standard drugs that fail to control seizures, many doctors are now prescribing them as single drugs. Specific choices usually depend on the individual's particular condition and the specific side effects of the AED. None has emerged as being superior to either standard or newer drugs. All appear to offer some benefits, but, as with standard antiseizure drugs, they also have troublesome side effects.

Valproate (Depakene, valproic acid) and its delayed release form, divalproex sodium (Depakote), are anticonvulsants. Valproate is the most widely prescribed anti-epileptic drug worldwide.

Uses. Valproate is the first choice for patients with generalized seizures and is used to prevent nearly all other major seizures as well.

General Side Effects. These drugs have a number of side effects that vary depending on dosage and duration. Most side effects occur early in therapy and then subside. General side effects include:

Stomach and intestinal problems, which are experienced by nearly half of patients after starting the drugs and may still occur after several years of use. Divalproex sodium (Depakote) has a lower risk for these side effects than valproate (Depakene).
Increased appetite with significant weight gain often becomes a problem and can be a major reason for noncompliance, particularly in young people.
Hand tremors, irritability, and hyperactivity in children are fairly common.
Temporary hair thinning and hair loss have occurred. Taking zinc and selenium supplements may help reduce the effect.
Young girls may develop secondary male characteristics, and premenopausal women are at increased risk for menstrual irregularities and polycystic ovaries, due to elevated male hormones. The effects are reversible. (These side effects also appear in women using other anti-epileptic drugs, but the risk from valproate appears to be higher.)
Studies have reported symptoms of Parkinson's disease preceded by hearing loss in people who have taken it for more than a year, but they were reversible when the drug was withdrawn.
Valproate poses a higher risk for serious birth defects than many other AEDs. These birth defects include skull and limb deformities, and brain, heart, and lung problems. Experts recommend that women of child-bearing age use a different type of anti-epilepsy drug than valproate. If valproate is used, it should be prescribed at the lowest possible dose.
Cases of pancreatitis, a serious and even life-threatening inflammation in the pancreas, have been reported in children and adults taking valproate. (It is still very rare, however.)
Valproate and divalproex sodium are not usually recommended for young children because of an unusual, but potentially fatal, toxic effect on the liver. This very rare effect is most likely to affect children under 2 years of age who have birth defects and are taking more than one antiseizure drug. Some doctors recommend monitoring blood levels for liver function once prior to administering valproate or divalproex sodium, monthly during the first 6 months, and then periodically after that.
Children with epilepsy who take valproic acid may eventually develop some problems in the kidney, although they are generally not significant.

Symptoms of Toxic Side Effects in Liver or Pancreas.

Abdominal pain
Nausea or vomiting
Loss of appetite
Lethargy
Acute confusion
Water retention
Easy bruising
Yellowish skin coloring

Carbamazepine (Tegretol, Equetro, Carbatrol) is an effective anticonvulsant and specific analgesic when used alone or with other drugs. Carbamazepine also has the added benefit of relieving depression and improving alertness. An extended release form is available that allows twice-daily dosing rather than 3 times a day. A chewable form makes it easier for children to take.

Uses. This drug is used to prevent the following seizures or epilepsy syndromes:

Partial seizures. Patients tend to tolerate this drug better than others, although responses differ among individuals
Grand mal seizures
Combinations of grand mal and partial seizures
Autosomal dominant nocturnal frontal lobe epilepsy (an inherited disorder).

Side Effects. Different side effects may develop or resolve at different points in the treatment duration. Initial side effects may include:

Double vision, headache, sleepiness, dizziness, and stomach upset. These usually subside after a week and can be greatly reduced by starting with a small dose and building up gradually.
Some people experience visual disturbances, ringing in the ears, agitation, or odd movements when drug levels are at their peak. The extended-release form of carbamazepine (Carbatrol) may help reduce these symptoms.

Serious side effects are less common but can include:

Carbamazepine may increase the risk for birth defects, especially if it is taken during the first trimester of pregnancy.
Skin reactions, including toxic epidermal necrolysis and Stevens-Johnson syndrome, so severe the drug has to be discontinued develop in about 6% of patients. These skin reactions cause skin lesions, blisters, fever, itching, and other symptoms. People of Asian ancestry have a 10 times greater risk for skin reactions than other ethnicities. The FDA recommends that patients of Asian ancestry get a blood test prior to starting the drug to determine if they have the gene variant that increases this risk.
Water retention can be a problem in older people.
Hormonal changes, particularly higher levels of male hormones in both men and women, pose some risk for sexual dysfunction over time.
A decrease in white blood cells occurs in about 10% of those taking the drug. This is generally not serious unless infection accompanies it.
Other blood conditions can arise that are also potentially serious. Patients should be sure to inform the doctor if they have any sign of irregular heartbeats, sore throat, fever, easy bruising, or unusual bleeding.
Long-term therapy can cause bone loss (osteoporosis) in women, who should take preventive calcium and vitamin D supplements.
Children are at higher risk for behavioral problems.

Note: Citrus fruit, especially grapefruit, can increase carbamazepine's adverse effects and should be avoided by those taking this drug.

Uses. Phenytoin (Dilantin) is effective for adults who have the following seizures or conditions:

Grand mal seizures
Partial seizures
Status epilepticus
Can be effective for people with head injuries who are at high risk for seizures

This drug is not useful for the following seizures:

Petit mal seizures
Myoclonic seizures
Atonic seizures

Side Effects. Side effects are sometimes difficult to control. Some people may develop a toxic response to normal doses, while others, such as those with alcoholism, may require higher doses to achieve benefits. As with any drug, side effects generally rely on dosage and duration. Using phenytoin in combination with newer add-on drugs can allow lower doses and may reduce some of the risks. Side effects may include:

Excess body hair, eruptions and coarsening of the skin, and weight loss
Gum disease
Staggering, lethargy, nausea, depression, eye-muscle problems, anemia, and an increase in seizures can occur as a result of high doses.
Liver damage may develop in rare cases.
Bone loss from long-term therapy. Patients should take preventive calcium and vitamin D supplements and exercise regularly to improve bone mass.
Severe and even rare life-threatening skin reactions (Stevens-Johnson syndrome)
An increased risk for birth defects

Phenobarbital (Luminal), also called phenobaritone, is a barbiturate anticonvulsant and is often the initial drug prescribed for newborns and young children. It is a relatively inexpensive drug. Primidone (Mysoline) is converted in the body to phenobarbital, and has the same benefits and adverse effects. It is reported that primidone is not as well-tolerated as phenobarbital. Some experts believe that primidone has no advantage over the other drug.

Uses. Barbiturates are used to also prevent grand mal (tonic-clonic) seizures or partial seizures. They are no longer typically used as a first-line drug.

Side Effects. Phenobarbital has fewer toxic effects on other parts of the body than most anti-epileptic drugs, and drug dependence is unusual, given the low doses used for patients with epilepsy. Nevertheless, withdrawal is common because of side effects, and therefore it is less likely to be used over time than other drugs, including phenytoin, another relatively inexpensive but effective drug.

Patients sometimes describe their state as "zombie-like." The most common and troublesome side effects are:

Drowsiness
Memory problems
Problems with tasks requiring sustained performance
Problems with motor skills
Hyperactivity in some patients, particularly in children and the elderly
Depression in some adults

Some controversy has arisen over studies indicating that children taking phenobarbital score lower on intelligence tests, even for some months after going off the drug.

Uses. Ethosuximide (Zarontin) is used for petit mal (absence) in children and adults when the patient has experienced no other type of seizures. Ethosuximide succeeds in abolishing petit mal seizures in 60% of patients and controls them in up to 90%. Methsuximide (Celontin), a drug similar to ethosuximide, may be suitable as an add-on treatment for intractable epilepsy in children without causing serious or permanent side effects.

Side Effects. Use of this drug can cause stomach problems, dizziness, loss of coordination, and lethargy. In rare cases, it has caused severe and even fatal blood abnormalities. Periodic blood counts are recommended for patients taking this drug.

Uses. Clonazepam (Klonopin) is recommended for myoclonic and atonic seizures that cannot be controlled by other drugs and for Lennox-Gastaut (absence variant). It may be useful in newborns when other drugs are ineffective. Although clonazepam can prevent generalized or partial seizures, patients generally develop tolerance to the drug, and then seizures recur.

Side Effects. People who have had liver disease or acute angle glaucoma should not take clonazepam, and people with lung problems should approach the drug with caution. Clonazepam can be addictive, and abrupt withdrawal has been known to trigger status epilepticus. Side effects include the following: drowsiness, imbalance and staggering, irritability, aggression, hyperactivity in children, weight gain, eye muscle problems, slurred speech, tremors, skin problems, and stomach problems.

Uses. Lamotrigine (Lamictal) is approved as add-on (adjunctive) therapy for partial seizures, and generalized seizures associated with Lennox-Gastaut syndrome, in children aged 2 years and older and in adults. Lamotrigine is also approved as add-on therapy for treatment of primary generalized tonic-clonic (PGTC) seizures, also known as “grand mal” seizures, in children aged 2 years and older and adults. Lamotrigine can be used as a single drug treatment (monotherapy) for adults with partial seizures who have not responded to monotherapy with carbamazepine, phenytoin, phenobarbital, primidone, or valproate. Birth control pills lower blood levels of lamotrigine.

Side Effects. Common side effects include dizziness, headache, blurred or double vision, lack of coordination, sleepiness, nausea, vomiting, insomnia, and rash. Although most cases of rash are mild, in rare cases the rash can become very severe. The risk of rash increases if the drug is started at too high a dose or if the patient is also taking valproate. (Serious rash is more common in young children who take the drug than it is in adults.) Rash is most likely to develop within the first 8 weeks of treatment. Be sure to immediately notify your doctor if you develop a rash, even if it is mild.

Studies suggest that lamotrigine may cause fewer problems with sexual function in men than other antiseizure drugs. A 2006 study indicated that lamotrigine may cause fewer cognitive problems (such as confusion and difficulty concentrating) than topiramate.

Gabapentin (Neurontin) is an effective add-on drug for controlling complex partial seizures and secondarily generalized partial seizures and is approved for adults and children with these seizures. It has achieved response rates in patients with resistant partial epilepsy. It is not at all useful for generalized petit mal seizures.

Side Effects. Its toxicity is low, and side effects include sleepiness, headache, fatigue, and dizziness. Some weight gain has been reported. Gabapentin has no significant interactive effects when taken with other drugs. Children may experience hyperactivity or aggressive behavior. Long-term adverse effects are still unknown.

Pregabalin (Lyrica) is similar to gabapentin.

Uses. Approved as add-on therapy to treat partial-onset seizures in adults with epilepsy. In clinical trials, half of the patients who received pregabalin experienced a 50% reduction in seizure frequency.

Side Effects. These may include dizziness, sleepiness, dry mouth, swelling in hands and feet, blurred vision, weight gain, and trouble concentrating

Uses. Topiramate (Topamax, generic) is similar to phenytoin and carbamazepine and is effective and safe for a wide variety of seizures in adults and children. It is approved as add-on therapy for patients 2 years and older with generalized tonic-clonic seizures, partial-onset seizures, or seizures associated with Lennox-Gastaut syndrome. It is also approved as single therapy for patients 10 years and older with tonic-clonic seizures or partial-onset seizures. Studies have shown a 34 - 87% reduction in seizure frequency with some patients becoming seizure-free.

Side Effects. Most side effects are mild to moderate and can be reduced or even prevented by beginning at low doses and increasing dosage gradually. Serious side effects may include glaucoma, decreased sweating, increased body temperature, kidney stones, sleepiness, dizziness, confusion, and trouble concentrating. Patients should immediately tell their doctor if they have blurred vision or eye pain. Topiramate may have fewer interactions with oral contraceptives than other AEDs.

Oxcarbazepine (Trileptal, generic) is similar to phenytoin and carbamazepine but generally has fewer side effects.

Uses. Approved as single therapy or add-on therapy for partial seizures in adults and for children ages 4 years and older.

Side Effects. Serious side effects, while rare, include Stevens-Johnson syndrome and toxic epidermal necrolysis. These skin reactions cause a severe rash that can be life threatening. Rash and fever may also be a sign of multi-organ hypersensitivity, another serious side effect associated with this drug. Oxcarbazepine can also reduce sodium levels (hyponatremia). Your doctor may want to monitor the sodium level in your blood. This drug can also reduce the effectiveness of birth control pills. Women who take oxcarbazepine may need to use a different type of contraceptive.

Zonisamide (Zonegran) is a unique drug that blocks sodium and calcium channels and may have nerve-protecting properties.

Uses. It is approved as add-on therapy for adults with partial seizures, and studies indicate it is often effective against infantile spasms (West syndrome) and myoclonic seizures.

Side Effects. Zonisamide increases the risk for kidney stones, which can be reduced with increased fluid intake and citrate. It has also been associated with reduced sweating and a sudden rise in body temperature, especially in hot weather. Children are especially at risk for this side effect, which can be serious. (The drug has not been approved for children.) Other side effects tend to decrease over time and include dizziness, forgetfulness, headache, weight loss, and nausea.

Levetiracetam (Keppra) is known as a nootropic drug.

Uses. This drug is approved both in oral and intravenous forms as add-on therapy for:

Partial onset seizures in adults and children ages 4 years and older
Myoclonic seizures in adults and adolescents ages 12 years and older who have juvenile myoclonic epilepsy
Primary generalized tonic-clonic seizures in adults and children ages 6 years and older who have idiopathic generalized epilepsy

Some experts believe that levetiracetam represents a significant advance and will prove to be an important first-line drug. Levetiracetam appears to have fewer drug interactions than other anti-epileptic drugs and may be particularly useful for older patients.

Side Effects. These tend to occur mostly in the first month. They include sleepiness and fatigue, muscle weakness and coordination difficulties, headache, flu symptoms, dizziness, behavioral abnormalities, possible risk of a reduced white blood cell count, and a higher rate of infections. Caution is advised for patients with kidney dysfunction. There have been some reports of adverse effects on mood (irritability, depression, and anxiety), but recent studies have found fewer such effects than with other AEDs. Epilepsy, rather than the drug, is likely to be the cause of these mood changes. About 1% of patients report considerable weight loss.

Tiagabine (Gabitril) has properties similar to phenytoin and carbamazepine, and is also showing promise.

Side Effects. Evidence has reported some significant side effects with its use, including dizziness, fatigue, agitation, and tremor. At least one study suggested that it has more adverse effects than lamotrigine and is not as well tolerated. In February 2005, the FDA issued a warning advising that tiagabine may cause seizures in patients without epilepsy. Tiagabine is only approved for use with other anti-epilepsy medicines to treat partial seizures in adults and children 12 years and older.

Felbamate. Felbamate (Felbatol) is an effective antiseizure drug. However, after reports of deaths from a serious blood condition known as aplastic anemia or from liver failure, felbamate is recommended only under certain circumstances. They include severe epilepsy, such as Lennox-Gastaut syndrome or as monotherapy for partial seizures in adults when other drugs fail.

Vigabatrin. Vigabatrin (Sabril) is a chemical called gamma-vinyl GABA. It was designed to increase the brain levels of gamma aminobutyric acid (GABA), the enzyme that inhibits seizure activity. It has serious side effects, however, and is generally prescribed in the U.S. only in certain cases, such as in low doses for patients with Lennox-Gastaut syndrome. Overseas it is also used for partial seizures and as first-line therapy in children with infantile spasms (West syndrome). Between 10 - 30% of people on long-term treatment have developed irreversible visual disturbances, including reductions in acuity and color vision. Men are at higher risk for this side effect than are women. Further studies are needed to determine the extent and severity of this complication, particularly in children. There is a slight risk for depression or psychosis when vigabatrin is used as add-on therapy, and particularly if the drug is administered too quickly. These risks are far lower if the drug is used as sole therapy.

Older Drugs. Some older but less effective drugs may still play a role against epilepsy:

Acetazolamide (Diamox) is sometimes used against common types of seizures, but patients quickly develop a tolerance for it. Some experts suggest it still may be useful when drug interactions are a problem, when a rapid effect is required, or when an additional drug is needed for a short time.
Trimethadione (Tridione) is effective for petit mal seizures, but has very serious side effects, and its use is severely limited.

Infantile spasms are treated with vigabatrin, adrenocorticotropic hormone (ACTH), or valproate. Some experts recommend that vigabatrin be given first and ACTH administered 10 - 14 days later. In one small study, no infants who were given this combination relapsed after 4 months. Newer drugs may also be effective for this problem, but their effects on small children are not yet wholly known.

New AEDs. Retigabine is an investigational GABA enhancer that works in a different way from existing AEDs. It is currently in phase III trials for treatment of partial-onset seizures in patients who are receiving other AEDs. Talampanel is another new type of drug, known as an AMAP receptor antagonist, that is currently in early trials. Other drugs under investigation are related to existing AEDs. For example, brivaracetam and seletracetam are similar to levetiraceptam, fluorofelbamate is similar to felbamate, and eslicarbazepine is similar to oxcarbazepine.

Cannabinoids. Cannabinoids are compounds in marijuana (cannabis) that may have properties that protect nerve cells. Some patients claim a reduction in seizures while other active users of marijuana report no effect on seizures. No one has reported worse seizures from the drug. Animal studies further support some protection from cannabinoids against seizures. Clinical studies using humans have not been conducted.

Melatonin. Melatonin is a hormone found in the brain that is best known for its role in sleep. Some researchers believe that it might have properties that could benefit patients with epilepsy. Melatonin is a powerful hormone that can have major effects on all parts of the body. No one with epilepsy should experiment with this supplement except as part of a clinical trial. In some studies, melatonin has been found to cause seizures in children who have existing neurologic problems.

Surgery

Surgical techniques to remove injured brain tissue may be appropriate for many patients with epilepsy. The surgeon's goal is to remove only the damaged tissue in order to prevent seizures and to avoid healthy brain tissue. Surgical techniques for reaching these goals have improved significantly over the past decades due to advances in imaging and monitoring, new surgical techniques, and a better understanding of the brain and epilepsy.

A number of tests using imaging and electroencephalography (EEG) can determine if surgery is an option:

The general approach is to first use long-term EEG monitoring to locate the brain tissue that triggers the epileptic event.
Advanced imaging techniques can provide valuable additional information. They include functional magnetic resonance imaging (fMRI), positron emission tomography (PET), or single-photon emission computer tomography (SPECT) scans.

If the imaging tests indicate that more than one site is involved or their results conflict, then more invasive monitoring of the brain may be required, although the newer imaging tests are proving to be very accurate tools. If such tests pinpoint a specific area in the brain as the location for seizures, surgery is possible. MEG, for example, is now approved for imaging parts of the brain involved with motor control, sensation, and language function, and may become important in evaluating patients who are likely candidates for surgery. The doctor will also examine the test results to determine if the offending nerve cells perform vital functions and try to predict surgical outcome in certain cases.

The major areas of the brain have one or more specific functions.

The most common surgical procedure for epilepsy is temporal lobectomy, which is performed when epilepsy occurs in the temporal lobe. (Surgery is not as successful in epilepsies that occur in the frontal lobe.) It involves removing small portions from the hippocampus. The hippocampus is a part of the brain that is involved in memory processing. It is part of the limbic system, which controls emotions.

Click the icon to see an image of the limbic system of the brain.

Candidates. Candidates for this surgery usually have a history of seizures. Anti-epileptic drugs have not helped them. Young children may be more difficult candidates because they often have injured areas outside the temporal lobes. Nevertheless, surgery can be very successful in many children, even if more than one area is involved.

Success Rates. New imaging techniques are dramatically improving the success rates of temporal lobe surgery. Studies have shown that many patients remain seizure-free after temporal lobectomy. In a randomized controlled trial, around 60% of patients became free of disabling seizures after surgery versus only 8% of patients treated with medications. In general, around 60 - 80% of patients are seizure free 1 - 2 years after surgery.

Patients may still need to take medications after surgery, even if seizures are very infrequent. Cure is not always possible, and some patients may still experience some seizures. Double vision is very common after the operation, but it is typically temporary and resolves within a few months.

Studies also suggest that temporal lobe surgery improves quality of life and can help relieve depression and anxiety. Other studies indicate that surgery may even prolong survival. Some experts theorize that surgery stabilizes parts of the brain that influence heart rate and may reduce the risk of sudden death, a rare complication of epilepsy.

Effects on Mental Functioning. Although surgery on the left temporal lobe does not impair intelligence to any significant degree, some studies suggest negative effects of mental functioning and behavior. A risk of impairment of verbal memory is also present.

In general, surgical effects on mental functioning and behavior depend on the extent and location of the surgical area.

Lesionectomy is a procedure that removes abnormal tissues in certain conditions, such as:

Cavernous angiomas (abnormal clusters of blood vessels)
Low-grade brain tumors
Cortical dysplasias (these are abnormalities in fetal development in which the normal migration of nerve cells is altered for some reason)

This local surgery, which can cure the patient's epilepsy, has become possible with the advent of advanced imaging techniques such as MRI.

Other surgical procedures called hemispherectomy and corpus callosotomy offer hope for specific patients. They include infants and young children with catastrophic seizures that occur in one, or part of, a hemisphere and for patients whose seizures are due to specific structural brain abnormalities or tumors.

Hemispherectomy. Hemispherectomy is the removal of half the brain, leaving the deep structures intact. Surgery can take 12 hours and there is always some paralysis on one side of the body. There is also a small risk for hydrocephalus, coma, or even death. Quality of life is almost always improved, however, and the surgery does not reduce intelligence.

Corpus Callosotomy. Corpus callosotomy involves cutting the nerve fibers that connect one side of the brain to another. It does not remove brain tissue. It may be done in two stages. In the first, there is a partial separation. If seizures continue, the surgeon may perform a complete separation. This surgery can reduce (although not entirely stop) uncontrolled tonic clonic seizures. It has been used in patients with specific syndromes, such as Lennox-Gastaut syndrome. The procedure can have very severe complications, however.

Electrical stimulation of areas in the brain that affect epilepsy is helping many patients with refractory epilepsy. Vagus nerve stimulation (VNS), an electrical stimulation of the vagus nerve, is now an accepted therapy for severe epilepsy that does not respond to AEDs. The two vagus nerves are the longest nerves in the body. They run along each side of the neck, then down the esophagus to the gastrointestinal tract. They affect swallowing, speech, and many other functions. They also appear to connect to parts of the brain that are involved with seizures. The procedure is as follows:

Click the icon to see a depiction of epilepsy treatment.

A battery-powered device similar to a pacemaker is implanted under the skin in the upper left of the chest.
A lead is then attached to the left vagus nerve in the lower part of the neck.
The neurologist programs the device to deliver mild electrical stimulation to the vagus nerve. (Patients may also pass a magnet over the device to give it an extra dose if they sense a seizure coming on. This appears to help about 25 - 30% of patients.)
The batteries wear out after 3 - 5 years and need to be removed and replaced by a simple surgical procedure.

An investigational approach called deep brain stimulation (DBS) targets the thalamus, the part of the brain that produces most epileptic seizures. Early results have been promising. Researchers are also studying other implanted brain and nerve stimulation devices such as the responsive neurostimulator system (RNS), which detects seizures and stops them by sending electrical stimulation to the brain. A third investigational approach, trigeminal nerve stimulation (TNS), stimulates a nerve involved in inhibiting seizures.

Candidates. The American Academy of Neurology recommends VNS for:

Patients who are over 12 years old, and
Have partial seizures that do not respond to medication, and
Are not appropriate candidates for surgery

Evidence is accumulating, however, to indicate that VNS is effective and safe for many patients of all ages and for refractory epilepsy of many types.

Success Rates. Studies are reporting that the procedure reduces seizures within 4 months by up to 50% and even more in many patients. Studies report that it has been effective for longer than 7 years. In one study that followed patients for a year, the benefits of VNS appeared to increase over time.

Complications. Vagus nerve stimulation does not eliminate seizures in most patients and is still somewhat invasive. VNS can cause shortness of breath, hoarseness, sore throat, coughing, ear and throat pain, or nausea and vomiting. These side effects can be reduced or eliminated by reducing the intensity of stimulation. Some studies suggest that the treatment causes adverse changes in breathing during sleep and may cause lung function deterioration in people with existing lung disease. People who have obstructive sleep apnea also should be cautious about this procedure. Turning off the VNS (for example before an MRI or surgery) may increase the risk for status epilepticus. (However, VNS may also be helpful for treating status epilepticus in some patients.)

Stereotactic Radio Surgery. Focused beams of radiation are able to destroy lesions deep in the brain without the need for open surgery. Typically used for brain tumors, stereotactic radio surgery is also under investigation for temporal lobe epilepsy and for seizures due to cavernous malformations. It may be used for patients when an open surgical approach is not possible.

Lifestyle Changes

The best preventive measure is to comply strictly with the drug regimen as prescribed. Seizures cannot be prevented by lifestyle changes alone, but people can make behavioral changes that improve their lives and give them a sense of control.

In most cases, there is no known cause for epileptic seizures, but specific events or conditions may trigger them and should be avoided.

Inadequate or Fragmented Sleep. Inadequate or fragmented sleep can set off seizures in many people. In one study, the lowest risk for seizures was during REM sleep (when dreams occur). The highest risk was during light non-REM stages of sleep. Using sleep hygiene or other methods to improve sleep may be helpful.

Food Allergies. Food allergies may provoke seizures in children who also have migraine headaches, hyperactive behavior, and abdominal pains. Parents should consult an allergist if they suspect foods or additives might be playing a role in such cases.

Alcohol and Smoking. Alcohol and smoking should be avoided, although light alcohol consumption does not appear to increase seizure activity in people who are not alcoholics or sensitive to alcohol.

Flashing Lights. Patients should avoid exposure to flashing or strobe lights. Video games have been known to trigger seizures in people with existing epilepsy, but apparently only if they are already sensitive to flashing lights. Seizures have been reported in Japan among people who watched cartoons with rapidly fluctuating colors and quick flashes. The frequency of flashes per second is measured in hertz (Hz). Screens that emit a lower hertz (such as 50 Hz screens sold in Europe) are more likely to cause seizures in people with epilepsy than a higher-hertz screen (such as 100 Hz screens sold in the U.S.).

Relaxation methods include diaphragmatic rhythmic breathing, biofeedback, and meditation techniques. No strong evidence supports their value on reducing actual attacks (although some people have reported that they have), but they may be helpful in reducing anxiety in people who have positive experiences with them. There have been some reports that deep breathing (a common relaxation technique) triggers seizures in certain people.

Exercise is important for many aspects of epilepsy, although it can be problematic. Weight-bearing exercise helps maintain bone density, which can be reduced by many of the medications, particularly the older ones. Exercise can also help to prevent weight gain, which is a problem with some drugs. There have been some reports that exercise may trigger seizures in some patients, but this is uncommon. A number of studies have found no significant association between physical activity and a higher incidence of seizures in patients with epilepsy. Nevertheless, if patients are concerned they should discuss this issue with their doctors.

Some small studies have reported significant benefits from the practice of yoga, which employs weight bearing and balancing postures. In one study, a system of meditation called Sahaja yoga changed EEG readings of brain waves and reduced seizures. Other studies report a 50% reduction in seizures and an overall decline in the number of attacks per month. Still, well-controlled studies are needed to confirm these benefits.

All patients should maintain a healthy diet, including plenty of whole grains, fresh vegetables, and fruits. In addition, dairy foods may be important to maintain calcium levels. Fasting has been used to prevent seizures since ancient times. In the 1920s, a high-fat, no-sugar, low protein diet, known as a ketogenic diet, was used to prevent seizures. It lost popularity after the introduction of anti-epileptic drugs but is now proving to be effective with many children. Researchers are investigating whether the Atkins diet (high protein, low carbohydrate) may help people with epilepsy. Both the ketogenic diet and the Atkins diet can interfere with some anti-epileptic medications such as topiramate. Talk to your doctor before beginning any special diet or a weight loss program.

The ketogenic diet, which is very high in fat (90%), very low in carbohydrates, and low in protein, has been studied and debated for decades. It has proven to be helpful for many children with severe epilepsy that does not respond to AEDs. It is not clear why it works. The standard theory is that burning fat instead of carbohydrates causes an increase in ketones. Excess ketones (called ketosis) appears to alter certain amino acids in the brain and to increase levels of the neurotransmitter gamma aminobutyric acid (GABA), which helps prevent nerve cells from over-firing.

Benefits of the Ketogenic Diet. Studies report that about 10 - 15% of children who use the diet are seizure free after 1 year, while 30% are nearly seizure free. Some parents report that the diet helps improve their children’s alertness, even if seizures continue. Many children who try the ketogenic diet are able to stop or at least reduce their medications.

Candidates of the Ketogenic Diet. The Ketogenic Diet seems to be most helpful for children who have difficult-to-control seizures, in particular:

Generalized and partial seizures (the diet does not appear to be as helpful for children with partial-onset seizures)
Myoclonic-atastic epilepsy
Infantile spasm

Typical Ketogenic Diet. (This diet must be professionally monitored! Parents can endanger their children if they try the program on their own without consulting a doctor or trained health expert.) The child fasts for the first 1 - 2 days, then the diet is gradually introduced. The regimen uses small amounts of carbohydrates and large amounts of fats (up to 90%), with very few proteins and no sugar. Children generally consume 75% of their usual daily calorie requirements.

A typical dinner may include a chicken cutlet or piece of fish, broccoli with cheese, lettuce with mayonnaise, and a whipped cream sundae. Vegetables may include celery, cucumbers, or asparagus, cauliflower, and spinach. Breakfast might consist of an omelet, bacon, and cocoa with cream. (Artificial sweeteners are used for any desserts.)

The diet is difficult, as a slight deviation from the diet can provoke a seizure. Children cannot take medications that contain sugar (which is common in many drugs produced for children). Some sunscreens and lotions contain sorbitol, a carbohydrate that can be absorbed through skin. About 40 - 50% of patients find the diet too difficult or ineffective and stop it after 6 months.

Researchers are also investigating the Atkins diet, a popular weight-loss diet that has similar effects but is less restrictive than the ketogenic diet. Early results indicate that it might be helpful for some young people. Another alternative is a low glycemic index diet, which contains even fewer carbohydrates than the Atkins diet. Still, parents should not put their children on these diets without support from a doctor.

Side Effects and Complications. To prevent serious side effects, children need regular monitoring by a doctor, especially when the diet is first initiated.

Side effects or complications that may occur at the start of the diet include:

Acidosis, a build-up of acid in the blood and body
Low blood sugar (hypoglycemia)
Stomach upset
Dehydration
Lethargy

Side effects that may occur later on include:

Unhealthy cholesterol and lipid levels
Kidney stones, which may be a complication of acidosis, occur in about 5% of children on the diet. Patients should drink plenty of fluids. Oral potassium citrate (Polycitra K) may be protective.
Slowing of growth (tends to occur more in younger children than older children
Decreased bone density

Because most patients remain on the diet for only 2 years, the risks for potential long-term damage appear minimal.

Many patients with epilepsy and parents whose children have epilepsy can benefit from support associations. These services are usually free and available in most cities.

Tips for Helping Children. Some of the following tips may help the child with epilepsy:

Children should be treated as normally as possible by parents and siblings.
Children should be assured that they will not die from epilepsy.
Often children can be given the hope that they will outgrow the disorder.
Most children will not have seizures triggered by sports or by any other ordinary activities that are enjoyable and healthy.
As soon as they are old enough, children should be active participants in maintaining their drug regimens, which should be presented in as positive a light as possible.

Therapies for Children and Adults. Because of the risks for serious emotional consequences, psychological therapy may be beneficial and even necessary for some adults and children. In one study, cognitive behavioral therapy was helpful in lowering seizure rates in young people with juvenile myoclonic epilepsy. This approach offers a structured counseling program that helps people change behaviors that can reduce seizure risk factors such as anxiety and insomnia.

Resources

www.epilepsyfoundation.org -- Epilepsy Foundation
www.aesnet.org -- American Epilepsy Society
www.aan.com -- American Academy of Neurology
www.ninds.nih.gov -- National Institute of Neurological Disorders and Stroke

References

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Foldvary-Schaefer N, Wyllie E. Epilepsy. In: Goetz C, ed. Textbook of Clinical Neurology. 3rd edition. Saunders. 2007.

Freeman JM, Kossoff EH, Hartman AL. The ketogenic diet: one decade later. Pediatrics. 2007 Mar;119(3):535-43.

Johnson MV. Seizures in childhood. In: Behrman RE, ed. Nelson Textbook of Pediatrics. 17th edition. Saunders. 2004.

Krebs PP. Psychogenic nonepileptic seizures. Am J Electroneurodiagnostic Technol. 2007 Mar;47(1):20-8.

Krumholz A, Wiebe S, Gronseth G, et al. Practice Parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology. 2007 Nov 20;69(21):1996-2007.

Kwan P, Brodie MJ. Emerging drugs for epilepsy. Expert Opin Emerg Drugs. 2007 Sep;12(3):407-22.

Leone MA, Solari A, Beghi E; FIRST Group. Treatment of the first tonic-clonic seizure does not affect long-term remission of epilepsy. Neurology. 2006 Dec 26;67(12):2227-9.

Salanova V, Worth R. Neurostimulators in epilepsy. Curr Neurol Neurosci Rep. 2007 Jul;7(4):315-9.

Spencer SS. Seizures and epilepsy. In: Goldman L, ed. Cecil Medicine. 23rd edition. Saunders. 2007.

Tomson T, Hiilesmaa V. Epilepsy in pregnancy. BMJ. 2007 Oct 13;335(7623):769-73.

Review Date:
12/31/2007
Reviewed By:
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M. Copyright

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