About Epilepsy — Information for Patients
- What Is the Difference Between Seizures and Epilepsy?
- What Causes Epilepsy?
- Can Epilepsy Be Controlled?
- Is There More Than One Type of Seizure?
- What Can't People With Epilepsy Do?
- What Should I Know About My Anticonvulsants?
- Can I Drink Alcohol?
- Can Women With Epilepsy Have Children?
- How Can I Take Care of A Person Who Is Having a Seizure?
Seizures are characterized by a sudden change in movement, behavior, sensation or consciousness produced by an abnormal electrical discharge in the brain. It is estimated that 5 percent to 10 percent of people will experience at least one seizure during their lifetime. Epilepsy is a condition of spontaneously recurrent seizures, usually defined as two or more unprovoked seizures, which affects about 1 percent of the population.
In about half of all cases, the cause cannot be determined ("idiopathic epilepsy"). In the remainder, there has been evidence that some portion of the brain has been injured by infection, severe trauma, stroke or hemorrhage, tumor, lack of oxygen, or other causes. Epileptic seizures occur when large numbers of brain cells "fire" (send electrochemical messages) rhythmically and in unison. It is this simultaneous "firing" of large numbers of brain cells which disrupts normal behaviors and causes the shaking, confusion, and other signs and symptoms of seizures.
In some people, epilepsy is a chronic condition with seizures recurring at unpredictable times over many years. In the majority, however, epilepsy can be controlled completely with anti-epileptic medications. Many patients, especially children, can eventually "outgrow" their epilepsy and become seizure-free without the need for medication.
There are two major types of seizures. The first type, known as a generalized seizure, begins on both sides of the brain at about the same time. Full "grand mal" convulsions and brief staring episodes are examples of generalized seizures. The second type, known as a partial seizure, originates in one region of the brain.
In a simple partial seizure, the seizure-related electrical discharges remain very localized, so that one experiences a feeling, sensation, movement, or other symptom without any change in the level of awareness. In contrast, people who experience the most common type of a partial seizure, called a complex partial seizure, may suddenly become confused or unresponsive due to spread of the seizure to wider areas of the brain. If the seizure activity spreads still further, a complex partial seizure may lead to a "secondary" generalized seizure with complete loss of consciousness.
In general, most people who have seizures can lead normal and active lives — with only a few restrictions.
Driving is prohibited in people with uncontrolled seizures. Each state's motor vehicle administration has regulations stating what minimal period of freedom from seizures is required before you are allowed to drive. You should contact your state's motor vehicle bureau to notify them of your epilepsy and find out the process (i.e., forms, interview) involved in determining whether you can drive.
You should avoid working from heights or around dangerous machinery and under water. Showers are safer than tub bathing because of the risk of drowning during a seizure. If you are in a pool or lake, others around you should be aware of your seizures and be attentive to you while you are in the water. There should be someone present who can rescue you and perform first aid in the event of a seizure.
Anti-epileptic medications (also known as anticonvulsants) are the main form of treatment for epilepsy. There are a number of anticonvulsant drugs. The right drug, used in the right way can be very effective in treating seizures. It is important that you take the medication daily as prescribed in order to maintain a constant level in the blood. After starting an anticonvulsant, a blood test is done to measure the amount of drug in your bloodstream. If the medicine level is too high, you may have side effects (i.e. dizziness, blurred vision, upset stomach). If the level is too low, you may be at risk of seizures. It is important that you keep track of the frequency of your seizures and notify the doctor or nurse of medication side effects so that your medication can be adjusted properly.
There are some interactions that may occur between anti-epileptic medications and other prescription or over-the-counter medications. For example some anti-epileptic medications can lower the effectiveness of birth-control pills. There are many other examples. It is important to tell any doctor prescribing medication for you that you are also taking anticonvulsants.
In some people, alcohol can increase the risk of seizures. In others, alcohol and anticonvulsants can combine to make them less alert. However, in many people a small amount of alcohol (one beer, one glass of wine) will not cause a problem.
Most women with epilepsy can become pregnant and have healthy children. Planning for the pregnancy is the best thing you can do to help ensure that you have a healthy baby. Because of the effects of seizures and/or anti-epileptic medications, there is a mild increase in the risk of birth defects in children born to mothers with epilepsy. The amount and kinds of risk depend upon the medication(s) you are taking, and you should ask your doctor about your own situation.
The major risk of birth defects occur during the first three months of pregnancy. Therefore, your doctor may want to adjust or change your medication before you become pregnant. It usually is a good idea to begin taking at least 400 micrograms a day of folic acid before becoming pregnant; you should speak with your doctor about whether you may need a higher dose. Ideally you should start taking folic acid months before conception. Anticonvulsant medication does not seem to increase the risk of birth defects in the children of men with epilepsy.
For a tonic-clonic seizure (grand mal, convulsion): Help the person to a lying position and turn him or her onto one side. Place something soft under the head. Loosen tight clothing. Do not restrain the arms or legs. Do not put anything into the mouth. Forcing something in to the mouth may cause more harm than good.
The seizure itself should last less than one to two minutes. Afterwards the person may be very sleepy and confused and should be talked to in a calm and quiet manner. A trip to the hospital is recommended under the following circumstances: if the patient does not completely return to his or her normal state following the seizure or postictal period (which generally lasts less than 30 to 60 minutes); if the seizure itself lasts for more than a few minutes; if the patient experiences multiple seizures; or if any injury was sustained during the seizure.
For a complex partial seizure: Remain with the person, talk calmly, and protect him or her from self-injury. Do not restrain.