Normal brain activity involves flow of electrical energy. When the energy flows in a controlled manner, you function well. When the brain cells malfunction and keep firing electrical signals, you experience an epileptic seizure. The energy surging through your brain causes the seizure. The electrical disturbance always begins in the brain, but may affect any part of your body.
Designated by the National Association of Epilepsy Centers, MedStar Health is home to D.C.'s first level-four epilepsy center—our doctors have the professional expertise and facilities to provide the highest level of medical and surgical evaluation and treatment for patients who have complex epilepsy.
Minor symptoms may include:
- Clouded awareness
- Difficulty communicating
- Symptoms that are more extensive may involve:
- Loss of consciousness
- Uncontrolled muscle movements
The severity of your symptoms depends on several factors, including where the disturbance is occurring in your brain and how long your seizure lasts. While most seizures last only a minute or two, you may experience lingering confusion afterwards. In order for you to be diagnosed with epilepsy, you must have had at least two unprovoked seizures.
If your seizures are epileptic, they fall into two main categories, each with several specific types:
- Generalized seizures involve the entire brain. Because of the extensive area affected, symptoms always include loss of consciousness.
- Absence seizures (formerly referred to as petit mal seizures) cause a brief (10-20 second) loss of consciousness and staring. Symptoms are so fleeting that they may go unnoticed for some time. This type of generalized seizure is more likely to affect children.
- Myoclonic seizures cause you to lose consciousness and experience rapid, brief muscle contractions. The affected muscles will usually contract on both sides of the body at the same time. To a bystander, it may look like sudden jerks or clumsiness.
- Atonic seizures can be particularly dangerous. Along with loss of consciousness, abrupt, sudden muscle weakness occurs without any warning. This can cause you to fall down suddenly, sometimes resulting in head or face injuries.
- Tonic-clonic seizures (formerly referred to as grand mal seizures) can cause you to cry out or fall as your seizure begins. You will lose consciousness for one to two minutes, and begin to experience stiffening of the limbs (the tonic phase), followed by jerking of the limbs and face (the clonic phase). Afterwards, you will have a recovery period. Do not be surprised if you experience amnesia regarding seizure events, confusion, and deep sleep.
- Partial seizures originate in a single area of the brain. Depending on the affected area, partial seizures can affect different physical, emotional, or sensory functions. While partial seizures can vary in their symptoms, they all tend to be brief, lasting at most a minute or two.
- Simple partial seizure does not involve loss of consciousness. You may experience sudden jerking, unusual sensations or movements.
- Complex partial seizures involve impaired consciousness or total loss of consciousness. You may experience an aura, have a period of staring (30-60 seconds), and be generally unaware of your environment. After the seizure is over, you may be somewhat confused and sleepy.
- Secondarily generalized tonic-clonic seizures: Occasionally, a partial seizure may lead to a generalized, full-blown tonic-clonic seizure. When this occurs, the resulting seizure is called a secondarily generalized tonic-clonic seizure. The symptoms are the same as if the tonic-clonic seizure occurred spontaneously.
Not all seizures are caused by epilepsy. These are known as non-epileptic seizures, or NES, and they are not caused by electrical discharges and do not show on an EEG. Non-epileptic seizures are very common. They are found in about 40 percent of the patients. They can affect adults, teens and children, but occur more often in females and people in their thirties and forties. Some NES can be caused by migraine headaches, drops in blood pressure, movement disorders, or other medical problems. The most common type of NES is the psychogenic seizure, which can be caused by mental or emotional stress or past trauma. This trauma can rest underneath the surface of a person's day to day life and come out in the form of these seizures—to stop the seizures, they must address the trauma.
An effective treatment for past trauma and stress is counseling and may include:
- Stress reduction
- Behavioral therapy
With proper treatment, seizures disappear in about 70 percent of adults. Children and adolescents have even higher rates of improvement after treatment.
The beginning stages of epilepsy diagnosis are very important. This is because treatment will largely depend on several factors, mainly:
- Where in the brain your seizure originated
- What type of seizure you have had
When one of our epilepsy specialists evaluates you, he or she may recommend that you receive a thorough evaluation in the Epilepsy Monitoring Unit (EMU).
Epilepsy Monitoring Unit
The Epilepsy Monitoring Unit (EMU) is a sophisticated diagnostic center for epilepsy not available at most hospitals. Staffed by specially trained neurologists, nurses, and technicians, the unit is designed to accommodate epileptic patients while they are video-recorded and monitored by EEG around the clock, for an extended period of time. This prolonged recording provides a more complete picture of brain activity before, during, and after seizures, which helps your neurologist better define the type of seizure and identify precisely the area in the brain where the seizure originates. This provides valuable information in determining and delivering the most effective treatment option.
Your doctors may determine that they want to perform a Phase I evaluation, which is a type of pre-surgical testing. You can expect to be admitted as inpatient for five to seven days. We will watch and analyze your seizures. Your doctors will be particularly interested in the specific area in your brain that is producing the seizure and will run the following tests:
- Single photo emission computed tomography (SPECT): When you begin to experience a seizure, injected radioactive isotopes will reveal the blood flow in your brain. The results will be superimposed onto a CT scan, thus highlighting the anatomical surgical target. The more doctors know about where the seizure is occurring, the more precisely they can plan your surgery.
- Positron emission tomography (PET): Doctors use this test in order to identify areas in your brain that display hypometabolism, or decreased sugar consumption. These areas are likely the focal point of the epileptic episodes and are responsible for the seizures.
- Magnetic Resonance Imaging (MRI): This imaging method uses magnets to produce pictures of your brain. These images will reveal any physical abnormalities in your brain structure that may have caused your seizures. An MRI is not a tool to diagnose epilepsy; it gives your doctors more information about your brain and its physical structures.
- Wada test: The Wada test is used to test your memory and language skills. Using medication, your doctors will try and isolate each hemisphere of your brain in order to establish where your language and memory skills originate.
Phase II Epilepsy Study
If your doctors have been unable to pinpoint the exact brain location that is producing seizures, they may need to do a Phase II study, which involves implanting electrodes in the area of your brain that your doctors' suspect may be responsible for the epileptic episodes.