Complications & Diagnosis
Certain factors may increase your risk of developing epilepsy, such as:
• Your age—The onset of epilepsy is most common during early childhood and after age 65, but the condition can occur at any age.
• Your sex—Men are slightly at a higher risk of developing epilepsy than women.
• Family history—Those with a family history of epilepsy, may be at an increased risk.
• Head injuries—These injuries are responsible for many cases of epilepsy.
• Stroke and other vascular diseases—These can lead to brain damage that may trigger epilepsy.
• Brain infections—Such as meningitis, which causes an inflammation in the brain or spinal cord.
• Prolonged seizures in childhood—High fevers in childhood can be associated with prolonged seizures and subsequent epilepsy later in life, especially for those with a family history of epilepsy.
Depending upon when a seizure occurs, it can lead to instances that are dangerous to not only the person having the seizure but to others as well. Possible complications include:
• Falling—If a person falls during a seizure, he/she can injure his/her head or break a bone.
• Drowning—People with epilepsy are more than 15 times more likely to drown while swimming or bathing than the rest of the population because of the possibility of having a seizure while in the water.
• Car accidents—Seizures that cause either loss of awareness or control can be dangerous if the person is driving a car or operating other equipment.
• Pregnancy complications—Seizures during pregnancy pose dangers to both mother and baby, and certain anti-epileptic medications increase the risk of birth defects.
• Status epilepticus—This condition occurs if a person is in a state of continuous seizure activity lasting more than five minutes or he or she has frequent recurrent seizures without regaining consciousness in between them. People with this condition have an increased risk of permanent brain damage and death.
• Sudden unexplained death in epilepsy (SUDEP)—People with poorly controlled epilepsy also have a small risk of sudden unexplained death. Overall, less than one in 1,000 people with epilepsy die from SUDEP, but it's more common among people whose seizures aren't controlled by treatment. The risk of SUDEP is particularly elevated when generalized grand-mal seizures are frequent.
Tests and diagnosis
A number of tests can be used to diagnose epilepsy, from neurological exams to imaging techniques such as MRI scans. These include:
• Neurological and behavioral exam—Tests may be done to examine a person’s motor abilities, behavior and intellectual capacity to see the seizure’s affects.
• Blood tests—Doctors may take a blood sample to check for signs of infections, lead poisoning, anemia or diabetes, all of which can cause seizures.
• Neuropsychological tests—This group of tests includes IQ, memory and speech assessments, which help pinpoint where the seizures are deriving.
• Electroencephalogram (EEG) —This is the most common test to diagnose epilepsy. An EEG records the electrical activity of the brain by way of electrodes attached to the scalp.
• Computerized tomography (CT) —These scans can uncover abnormalities in the brain that may be causing seizures, such as tumors, bleeding and cysts. CT scans are generally done for those who go to an emergency room for an initial seizure, because it is usually a readily available test.
• Magnetic resonance imaging (MRI)—An MRI provides basically the same type of information as a CT scan, however it is in greater details. MRIs can reveal brain abnormalities that could cause seizures.
• Functional MRI (fMRI)—This measures the changes in blood flow that occur when specific parts of the brain are working. These tests can pinpoint exact locations of critical functions, such as speech.
• Positron emission tomography (PET) —PET scans use a small amount of low-dose radioactive material which is injected into a vein to help see active areas of the brain and detect abnormalities.
• Single-photon emission computerized tomography (SPECT)—This type of test is used mainly if an MRI and EEG didn't identify the location in the brain where the seizures are originating. A SPECT test uses a small amount of low-dose radioactive material that's injected into a vein to create a detailed, 3-D map of the blood flow activity in the brain during seizures.
Doctors generally begin treating epilepsy with medication, or they may propose surgery or another type of treatment, such as:
• Medication—Half of all people with epilepsy can become seizure-free by using a single anti-epileptic drug. Others can decrease the frequency and intensity of their seizures. Further, more than half the children with medication-controlled epilepsy can eventually stop medications and live a seizure-free life. Many adults also can discontinue medication after two or more years without seizures.
However, finding the right medication and dosage can be complicated. Doctors will usually first prescribe a single drug at a relatively low dosage, and then increase the dosage gradually until the seizures are well controlled. If a person has tried two or more seizure medications without success, a combination of two drugs may be recommended.
Recent studies show that seizures in up to 70% of children and adults with newly diagnosed epilepsy can be controlled with medications; however, many of these people experience treatment-related side effects.
Seizures in up to 30% of people with epilepsy do not respond to available medications.
• Surgery —Epilepsy surgery works best for people who have seizures that always originate in the same place in their brains. To even be considered for epilepsy surgery, a person must have tried at least two anti-seizure medications without success. If two have failed, it is highly improbable that any other anti-epileptic drug would help.
Surgery is most commonly done when tests show that the seizures originate in a small, well-defined area of the brain which does not interfere with vital functions such as speech, language or hearing. In these types of surgeries, called temporal lobe resections, doctors remove the portion of the brain (usually about the size of a golf ball) that is causing the seizures.
If the seizures originate in a part of that brain that cannot be removed, a different sort of surgery, called multiple subpial transaction, may be recommended. This would involve surgeons making a series of cuts in the brain to prevent seizures from spreading to other parts of the brain.
Another type of epilepsy surgery, called a corpus callosotomy, severs the network of neural connections between the right and left halves (hemispheres) of the brain. This surgery is used primarily in children who have severe seizures that start in one hemisphere and spread to the other side. This can help reduce the severity of seizures.
The most radical type of epilepsy surgery, called hemispherectomy, removes the outer layer of half the brain. This surgery is used in children who have seizures because of damage to just one half of the brain, which occurs in a few rare conditions that are present at birth or that appear in early infancy. The chance of a full recovery is best in younger children.
While many people continue to need some medication to help prevent seizures after successful surgery, they may be able to take fewer medications and reduce their dosages. In some cases, surgery for epilepsy can cause complications such as permanently altering cognitive abilities.
• Vagus nerve stimulation —This therapy involves a device called a vagus nerve stimulator that is implanted underneath the skin of the chest like a pacemaker. Wires from the stimulator are wrapped around the vagus nerve in the neck. The battery-powered device delivers short bursts of electrical energy to the brain through the vagus nerve. It's not clear how this prevents seizures, but the device can reduce seizures by 30 to 40 percent. Most people still need to take anti-epileptic medication. Side effects of vagus nerve stimulation include hoarseness, throat pain, coughing, shortness of breath, tingling and muscle pain.
• Ketogenic diet —Some children with epilepsy have been able to reduce their seizures by maintaining a strict diet that's high in fats and low in carbohydrates. This diet causes the body to break down fats instead of carbohydrates for energy. Some children can go off the ketogenic diet after a few years and remain seizure-free.
There is no known cure for epilepsy; however, advances in drug treatments can make epilepsy a manageable condition for approximately two-thirds of patients. The medicines can stop some seizures from occurring, but they do not actually "fix" the problems that cause the seizures. There are the additional one-third of patients with epilepsy who do not respond to drug treatments, to consider as well.
The more time that passes without seizures, the greater is the chance of staying seizure-free. More than 50 percent of children outgrow their epilepsy. Twenty years after the diagnosis, three-quarters of people will have been seizure-free for at least five years, although some may still need to take daily medication.
UPDATE April 2012
According to an article published in Science Daily, there is a new medication called Perampanel which shows promising results in people whose recurrent seizures may have been resistant to other medications. The drug, which is still being tested and evaluated, works by inhibiting a receptor in the brain called an AMPA receptor, and it appears to reduce seizures without causing major side effects. Read more about this latest research by clicking here.