Epilepsy is a complex neurological disorder in which bursts of electrical activity in the brain cause recurrent and unprovoked epileptic seizures. The condition affects 3.4 million people of all ages in the United States.
Seizures may impact thinking, muscle control, movement, speech, vision or awareness. They are usually brief, but can be frightening to patients and anyone around them.
Epilepsy is classified into two main categories:
- Generalized: Patients with generalized epilepsy typically have seizures that begin on both sides of the brain. Generalized epilepsy is primarily genetic and is usually treated with medications. However, some generalized epilepsy patients are treated with a surgical procedure known as vagus nerve stimulation (VNS).
- Localized (also known as focal): Patients with localized epilepsy experience seizures that develop in a particular region of the brain. Localized epilepsy is typically treated with surgery to remove, or intervene at, the region of the brain where seizures are originating.
Although the most common cause of seizures is epilepsy, not everyone who has a seizure has epilepsy. Non-epileptic seizures involve behavior that often presents as epilepsy, but turns out to be something different, such as sleep apnea, difficulties with breathing or psychologically triggered events. Be sure to consult with your health care professional if you experience any type of seizure to ensure proper treatment.
Diagnosing Epilepsy
Individuals who have experienced a seizure typically undergo comprehensive testing, beginning with a neurological exam, to accurately diagnose the condition. Additional tests may include:
- Positron emission tomography (PET): A low-dose radioactive material is injected into a vein to provide a view of active areas in the brain and help identify abnormalities.
- Magnetic resonance imaging (MRI): This magnetic scan provides a very detailed picture of the brain’s structure with special protocols for epilepsy patients.
- Functional MRI: This special type of MRI details neurological activity to help define areas of the brain involved in language and other functions.
- Magnetoencephalography (MEG): A magnetic scan detects the brain’s electrical activity and helps identify where seizures originate in the brain.
- Electroencephalography (EEG): Electrical activity of brain is recorded with the use of electrodes attached to the scalp to determine the area of the brain where seizures begin.
- Electrocorticography (ECoG): Similar to an EEG, this form of brain mapping also involves surgery to implant electrodes into the skull. The goal is to identify parts of the brain that perform vital functions as well as parts of the brain that might be most involved in generating seizures.
- Inpatient EEG and video monitoring: Some epilepsy patients have difficulty controlling their seizures with medications. When this happens, a patient is asked to stay in the hospital so episodes can be recorded with video and EEG monitoring. This includes monitoring language and memory and behavioral testing during episodes. It enables the health care team to identify where episodes originate and can be extremely helpful for planning future therapy. During monitoring, some patients find their diagnosis changes or becomes more specific. Some can stop taking medicines for epilepsy and be referred for other treatments and some can change epilepsy medications to ones that are more effective, or learn that they are candidates for surgical treatment.
- Single-photon emission computed tomography (SPECT): Patients being monitored as described above may also undergo single-photon emission computed tomography (SPECT). During this procedure, a technician injects low-dose radioactive material into a vein to provide a 3-D map of blood flow activity in the brain at the onset of a seizure.
Epilepsy Treatments
The goal of epilepsy treatment is to determine the best possible therapy to stop the seizures while minimizing side effects. The good news for epilepsy patients is that available treatment methods — including medical, dietary and surgical — are usually very effective at controlling seizures.
Medical treatment: The first and most common treatment for epilepsy is typically seizure medications. If the patient does not respond well to one medication, another may be tried until the right type is found. Medication proves successful in controlling epileptic seizures in roughly 70 percent of patients. There are more than 20 medications to treat seizures, and the use of these medicines is dictated by such factors as where the seizures originate, frequency of seizures and the patient’s age. Visit our Medical and Dietary Treatments for Epilepsy page for more information about epilepsy medications.
Dietary treatment: Dietitian-monitored therapy is a method of controlling seizures and is typically used in combination with seizure medication. Dietary treatment includes the high-fat, low-carbohydrate ketogenic diet or a modified Adkins diet. Traditionally used only in treating young epilepsy patients, these diets are now being recommended for patients of all ages. Visit our Medical and Dietary Treatments for Epilepsy page for more information about dietary treatments for epilepsy.
Surgical treatment: For epilepsy patients whose seizures cannot be controlled with medications, surgery may be indicated. There are two categories of surgical procedures: diagnostic and therapeutic. Diagnostic procedures include stereoelectroencephalography (SEEG) and grid implantation. Therapeutic surgery includes resection, in which the area of the brain where seizures originate is removed; modulation, in which devices — vagus nerve stimulation (VNS), responsive neurostimulation (RNS) and deep brain stimulation (DBS) — are implanted to deliver electrical impulses to the brain to stop seizures; and disconnection, a procedure that involves disconnecting the area of the brain where seizures originate to prevent them from spreading. Visit our Epilepsy Surgery page for more information about the various types of Epilepsy Surgery.
The Michigan Medicine Comprehensive Epilepsy Program
The Michigan Medicine Comprehensive Epilepsy Program is a designated Level 4 referral center by the National Association of Epilepsy Centers. This designation certifies that the Michigan Comprehensive Epilepsy Program provides the highest level of medical and surgical diagnostic and treatment options for epilepsy patients. In addition, our Comprehensive Epilepsy Program works to identify any medical, psychological or social complication that arises as a result of the seizure disorder. To learn more, visit the About the Michigan Medicine Comprehensive Epilepsy Program page.
Make an Appointment
To make an appointment to discuss treatment for epilepsy, contact our General Neurology Clinic at 734-936-9020.