Covers different types of epilepsy and its causes. Addresses complications of seizures and lists risk factors. Guides through decision regarding when to call doctor. Covers exams/tests, treatments, medicines, and surgeries. Provides home treatment tips.
What is epilepsy?
Epilepsy is a common condition
that causes repeated
seizures. The seizures are caused by bursts of
electrical activity in the brain that are not normal. Seizures may cause
problems with muscle control, movement, speech, vision, or awareness. They
usually don't last very long, but they can be scary. The good news is that
treatment usually works to control and reduce seizures.
is not a type of mental illness or
intellectual disability. It generally does not affect how well you
think or learn. You can't catch epilepsy from other people (like a cold), and
they can't catch it from you.
What causes epilepsy?
Often doctors do not know
what causes epilepsy. Less than half of people with epilepsy know why they have
Sometimes another problem, such as
a head injury, brain tumor, brain infection, or
stroke, causes epilepsy.
What are the symptoms?
The main symptom of
epilepsy is repeated seizures that happen without warning. Without treatment,
seizures may continue and become worse and more frequent over time.
There are different kinds of seizures. You may have only one type of
seizure. Some people have more than one type. Depending on what kind of seizure
Your senses may not work right. For example,
you may notice strange smells or sounds.
You may lose control of
You may fall down, and your body may twitch or
You may stare off into space.
You may faint (lose
Not everyone who has seizures has epilepsy. Sometimes
seizures happen because of an injury, illness, or another problem. In these
cases, the seizures stop when that problem improves or goes away.
How is epilepsy diagnosed?
Diagnosing epilepsy can
be hard. If you think that you or your child has had a seizure, your doctor
will first try to figure out if it was a seizure or something else with similar
symptoms. For example, a muscle tic or a migraine headache may look or feel
like a kind of seizure.
Your doctor will ask lots of questions to find out what happened to you just before, during, and right
after a seizure. Your doctor will also examine you and do some tests, such as
EEG. This information can help your doctor decide what
kind of seizures you have and if you have epilepsy.
How is it treated?
Medicine controls seizures in
many people who have epilepsy. It may take time and careful, controlled
changes by you and your doctor to find the right combination, schedule, and
dosing of medicine to best manage your epilepsy. The goal is to prevent
seizures and cause as few side effects as possible. After you find a
medicine that works for you, take it exactly as prescribed. The best way to
prevent more seizures is to keep the right amount of the medicine in your body.
To do that, you need to take the medicine in the right dose and at the right
times every day.
If medicine alone does not control your
seizures, your doctor may try one or more of these other treatments. They
Surgery to remove damaged tissue in the brain
or the area of brain tissue where seizures begin.
A special diet
called the ketogenic diet. With this diet, you eat a lot more fat and less
carbohydrate. This diet reduces seizures in some children who have
A device called a vagus nerve stimulator. Your doctor
implants the device under your skin near your collarbone. It sends weak signals
to the vagus nerve in your neck and to your brain to help control seizures.
How will epilepsy affect your life?
affects each person differently. Some people have only a few seizures. Other
people get them more often. Usually seizures are harmless. But depending on
where you are and what you are doing when you have a seizure, you could get
hurt. Talk to your doctor about whether it is safe for you to drive or swim.
If you know what triggers a seizure, you may be able to avoid
having one. Getting regular sleep and avoiding stress may help. If treatment
controls your seizures, you have a good chance of living and working like
But seizures can happen even when you do everything
you are supposed to do. If you continue to have seizures, help is available.
Ask your doctor about what services are in your area.
For parents, it is normal to worry about what will happen to your child
if he or she has a seizure. But it is also important to help your child live,
play, and learn like other children. Talk to your child's teachers and
caregivers. Teach them what to do if your child has a seizure.
There are many ways to lower your child's risk of injury and still let
him or her live as normally as possible. For example, learn about water safety
for children who have seizures.
develop even though you do not have any risk factors (things that increase your risk). A cause cannot always be
identified. This is especially true in many forms of childhood epilepsy. For
some people, epilepsy can result from a tumor, infection, or damage to the
Children and older adults are most likely to develop
epilepsy, but it can start at any age. It is possible that epilepsy may
run in families. But you do not have to have a family history to develop
Epileptic seizures occur when abnormal bursts of
electricity in the brain briefly upset normal brain function. It's not always
clear what triggers the bursts of abnormal electrical activity.
Conditions that can cause seizures include:
Stroke or conditions that affect the blood vessels
(vascular system) in the brain.
Hardening of the arteries (atherosclerosis) in the brain.
Brain infection, such as
Tumors, scar tissue from injury or disease, or abnormal
brain development may damage a specific area of the brain and cause
partial seizures. But you may not have any of these
conditions and still develop epilepsy.
Seizures are the only visible symptom of
epilepsy. There are different kinds of seizures, and
symptoms of each type can affect people differently. Seizures typically last
from a few seconds to a few minutes. You may be alert during the seizure or
lose consciousness. You may not remember what happened during the seizure or
may not even realize you had a seizure.
Seizures that make you
fall to the ground or make the muscles stiffen or jerk out of control are easy
to recognize. But many seizures do not involve these reactions and may be
harder to notice. Some seizures make you stare into space for a few seconds.
Others may consist only of a few muscle twitches, a turn of the head, or a
strange smell or visual disturbance that only you sense.
Epileptic seizures often happen without warning,
although some people may have an
aura at the start of a seizure. A seizure ends
when the abnormal electrical activity in the brain stops and brain activity
begins to return to normal. Seizures may be either partial or
begin in a specific area or location of the brain. The most common types of
partial seizures are:
Complex partial seizures.Complex partial seizures do affect level of consciousness. You may become
unresponsive or may lose consciousness completely.
Partial seizures with secondary generalization. Partial seizures with secondary generalization begin as
simple or complex
partial seizures but then spread (generalize) to the
rest of the brain and look like
generalized tonic-clonic seizures. These two types can
easily be confused, but they are treated differently. Most tonic-clonic
seizures in adults begin as partial seizures and are caused by partial
epilepsy. Generalized tonic-clonic seizures are more common in children.
Seizures that begin over the
entire surface of the brain are called
generalized seizures. The main types of generalized
Generalized tonic-clonic seizures
(grand mal seizures), during which the person falls to the ground, the entire
body stiffens, and the person's muscles begin to jerk or spasm
Absence seizures (petit mal seizures),
which make a person stare into space for a few seconds and then "wake up"
without knowing that anything has happened.
Atonic seizures, in which a sudden loss of muscle tone makes the person fall
down without warning.
Tonic seizures, in which the muscles
suddenly contract and stiffen, often causing the person to fall down.
People may refer to seizures as convulsions, fits, or
spells. But seizure is the correct term. Convulsions, during which the muscles
twitch or jerk, are just one characteristic of seizures. Some seizures cause
convulsions, but many do not.
Epileptic seizures are sometimes
psychogenic seizures, which are not due to abnormal
electrical function. A psychogenic seizure may be a psychological response to
stress, injury, emotional trauma, or other factors.
Types of epilepsy
There are many types of
epilepsy. All types cause seizures. It can be hard to determine what type
of epilepsy you have because of the numerous possible causes, because different
types of seizures can occur in the same person, and because the types may
affect each person differently.
Lennox-Gastaut syndrome, which causes frequent and
several different types of seizures to occur. This syndrome
can lead to falls during a seizure, which can cause an
Temporal lobe epilepsy (the most common type of
epilepsy in adults), which causes smacking of the lips or rubbing the hands
together, emotional or thought disturbances, and hallucinations of sounds,
smells, or tastes.
Epilepsy is not a form of
intellectual disability or mental illness. Although a few
forms of childhood epilepsy are linked with below-average intelligence and
problems with physical and mental development, epilepsy does not cause these
problems. Seizures may look scary or strange, but they do not make a person
crazy, violent, or dangerous.
Not everyone who has a seizure has epilepsy. Seizures that are not
epileptic may result from several different medical conditions such as poisoning,
fever, fainting, or alcohol or drug withdrawal. Seizures that
occur at the time of a disease, injury, or illness and stop when the condition
improves are not related to epilepsy. But if seizures occur repeatedly (become
chronic), occurring weeks, months, or even years after the injury or illness,
you have developed epilepsy as a result of the condition.
other conditions with similar symptoms, such as
fainting or seizures caused by high fevers.
epilepsy is one of the most common neurological
disorders involving the
nervous system, experts often cannot explain exactly
how or why the disease develops and how or why the abnormal electrical activity
in the brain occurs. Epilepsy does not always follow a predictable course. It
can develop at any age and may get worse over time or get better.
Although uncommon, epilepsy that begins in a specific area of the brain
may eventually affect another part of the brain. Some types of childhood
epilepsy disappear after the child reaches the teenage years. Other types may
continue for life. Epilepsy that started after a head injury may disappear
after several years or may last the rest of your life.
There is no
cure for epilepsy. But treatment can control
epileptic seizures, sometimes preventing them from
ever occurring again.
Quality of life
Epilepsy and uncontrolled seizures
can put limitations on your independence, self-esteem, and quality of life.
With epilepsy, you may have trouble getting or keeping a driver's
license. If you become pregnant, complications can occur. Your career choices
may be limited. Some people with epilepsy face discrimination at work or school
due to other people's fears and misconceptions about this condition.
news is that proper treatment may allow you to control seizures, which can lead
to improved quality of life and allow you to better cope with the
Finding out you have epilepsy can be hard. You may
not be able to do some of the things you used to take for granted (such as
driving a car). Epilepsy is also a disease that can be hard to treat for some
people, especially at first. You may need to try many different types of
medicines before you find one that works just right. All of these things may
make you feel sad or angry. It may help you to talk to a
counselor if you are feeling bad about having
Concerns about mental health or intelligence
Epilepsy does not cause and is not a form of mental illness. And in general it does not affect your ability to think and learn. Most people with
epilepsy have normal intelligence. Children with epilepsy may have a hard time performing in school, but this is usually not the result of below-normal
absence seizures, for instance, may explain why a
child seems to "zone out" or not pay attention during class. Some medicines
used to control seizures may affect a child's ability to stay focused at
epilepsy is often a lifelong (chronic) disease, it can be hard to understand
how much your life will change. Some people may have feelings of despair,
depression, or anxiety after hearing that they have epilepsy. In some studies,
adults with epilepsy had a higher risk of suicide, especially if they had also
been diagnosed with depression or another mental illness, and especially within
6 months of being diagnosed with epilepsy.1 For more information on depression, see the topic Depression.
If you or another adult friend or family member was just diagnosed with
epilepsy or just started a new treatment for epilepsy, you may want to watch for suicidal thoughts or threats. For more
information on what to watch for, see the topic
Suicidal Thoughts or Threats.
Complications of seizures
themselves usually cause no harm—the danger lies in where you are or what you
are doing when the seizure occurs. There is always a risk of head injury,
broken bones, and other injuries from falling or from drowning if you are swimming
or bathing at the time of the seizure. It can be dangerous to be operating
driving when you have a seizure. You cannot
swallow your tongue during seizures. But you can choke on food, vomit, or an object
in your mouth.
Some seizures may place temporary but severe stress
on the body and cause problems with the muscles, lungs, or heart. Choking, an
abnormal heartbeat, or other problems may cause sudden
death, though this is rare. Untreated seizures that become more severe or
frequent may lead to these problems. One of the most dangerous complications of
epilepsy is a prolonged seizure condition that can result in brain damage or
Epilepsy may develop even though you do not have any risk
factors. This is especially true of many forms of childhood epilepsy.
When To Call a Doctor
Seizures do not
always require urgent care. But call 911 or other emergency services immediately if:
The person having a seizure stops breathing for
longer than 30 seconds. After calling 911
or other emergency services, begin rescue breathing. For more information, see the topic
Dealing With Emergencies.
The seizure lasts longer than 3 minutes. (The person may have
entered a life-threatening state of prolonged seizure called
More than one seizure occurs within 24 hours.
person having a seizure does not respond normally within 1 hour after the
seizure or has any of the following symptoms:
Reduced awareness and wakefulness or is not
Inability to walk or
A seizure occurs after the person complains of a
sudden, severe headache.
A seizure occurs with
signs of a stroke, such as trouble speaking or
understanding speech, loss of vision, and inability to move part or all of one
side of the body.
A seizure follows a head injury.
pregnant woman or a woman who has recently had a baby has a seizure. This could
be a sign of
preeclampsia (toxemia of pregnancy).
diabetes has a seizure. Low blood sugar (hypoglycemia)
or very high blood sugar (hyperglycemia) can cause seizures in a person who has
A seizure occurs after eating poison or breathing
If you have a seizure for the first time or you witness
someone having a seizure, call a doctor immediately. For
more information, see the topic
If you have been diagnosed with
epilepsy, call your doctor if:
Your seizures become more frequent or more
A serious illness seems to be changing the normal pattern,
frequency, length, or other features of your seizures.
pattern or features of your seizures change. For example, you have never lost
consciousness during a seizure before, but now you do. Or you have never
fallen down during a seizure, but now this is happening.
taking antiepileptic medicine and the side effects seem more severe than
expected. When you begin taking a medicine, talk to your doctor about what side
effects you can expect and what problems might mean that your medicine levels
are too high (drug toxicity). You may start having seizures more often if
your medicine levels are too low.
You are pregnant or thinking
about becoming pregnant.
Watchful waiting is appropriate if you have
already been diagnosed with
epilepsy and you have a seizure. But call your doctor
right away if you have a second seizure within a short period of time or if
your seizures have become more frequent or more severe. Your doctor may need to
change the amount of medicine you take or try a different medicine.
If you or your child has a
seizure for the first time, contact your or your
child's doctor to discuss the event and its potential cause. Your doctor may
refer you to a
neurologist. Your regular doctor may be able to
epilepsy treatment after your seizures are under
People with epilepsy who have trouble controlling
seizures and need special care, tests, or surgery can get help at epilepsy
centers. The staff at epilepsy centers include doctors and other health
professionals trained in treating people with this disorder.
Making the correct diagnosis is vital
to identifying the appropriate treatment to control
epilepsy can be quite difficult. When you consult a
doctor after you or your child has had unexplained seizures, you and the doctor
will work together to answer three questions:
Was the event a seizure, or was it something that looked like a seizure? Several conditions can appear
to be seizures but are not in fact seizures. (These might include
migraine headaches, muscle twitches or
tics, sleep disorders, or
psychogenic seizures.) Taking antiepileptic medicines
to treat nonepileptic seizures can expose you or your child to unnecessary
If you are having seizures, are the seizures caused by epilepsy? Not everyone who has a seizure has epilepsy. The
seizure may have been caused by something else (such as fever, certain
electrolyte imbalance, or inhaling fumes). Taking
antiepileptic medicines when you do not have epilepsy may put you at
unnecessary risk from possible side effects.
If you have or may have epilepsy, what types of seizures are you having? The
different types of
epileptic seizures (partial and generalized) are not
treated in the same way or with the same medicines. For example, some medicines
that control complex partial seizures may make
absence seizures worse.
A physical exam and detailed
medical history often provide the best clues as to
whether you have epilepsy and what type of epilepsy and seizures you have.
Discussing what happens to you just before, during, and right after a seizure
can help the doctor make a diagnosis.
Your doctor may want to
rule out other possible causes for the seizures with other laboratory
tests, which may include:
Complete blood count (CBC) to check
for infection, and blood chemistry tests to check for abnormal
electrolyte levels (such as magnesium, sodium, and
calcium), signs of kidney or liver malfunction, and other common
Lumbar puncture (sometimes called a
spinal tap), which is an analysis of spinal fluid evaluated to rule out
infections, such as meningitis and encephalitis.
Toxicology screen, which examines blood, urine, or
hair to look for poisons, illegal drugs, or other toxins.
The most useful test in
support of a diagnosis of epilepsy is an
electroencephalogram (EEG). A computer records your
brain's electrical patterns as wavy lines. If you have epilepsy, the EEG may
show abnormal spikes or waves in your brain's electrical activity patterns.
Different types of epilepsy cause different patterns. But an
EEG is limited in its ability to diagnose epilepsy. And many people with
epilepsy have normal EEGs in between seizures.
Imaging tests (MRI and CT)
Magnetic resonance imaging (MRI) and
computed tomography (CT) are imaging tests that allow
a doctor to view the brain and evaluate the cause and location of
a possible source of epilepsy within the brain. The scans can reveal scar
tissue, tumors, or structural problems in the brain that may be the cause of
seizures or epilepsy. MRI is the more helpful test in most cases. Imaging tests
may not be done after a first seizure, but they are recommended in
many situations (such as after a first seizure in adults or after a head injury).
Treatment can reduce or prevent
seizures in most people who have
epilepsy. This can improve quality of life.
Controlling your epilepsy also lowers the risk of falling and other
complications that can happen when you have a seizure.
doctor will figure out what type of epilepsy and what kinds of seizures you
have. Treatment that controls one kind of seizure may have no effect on other
kinds. Your doctor will also think about your age, health, and lifestyle when
he or she plans your treatment.
It may take time for you and your doctor
to find the right combination, schedule, and dosage of medicines to manage your
epilepsy. The goal is to prevent seizures while causing as few side
effects as possible. With the help of your doctor, you can weigh the benefits
of a particular treatment against its drawbacks, including side effects, health
risks, and cost.
After you and your doctor figure out the treatment that works best for you, make sure to follow your treatment
exactly as prescribed.
Initial treatment for
epilepsy depends on the severity, frequency, and type
seizures and whether a cause for your condition has
been identified. Medicine is the first and most common approach. Antiepileptic
medicines do not cure epilepsy. But they help prevent seizures in well over
half of the people who take them.
It is not always clear whether to begin
treatment after a first seizure. It is hard to
predict whether you will have more seizures. Antiepileptic medicines are
not usually prescribed unless you have risk factors for having another seizure,
such as brain injury, abnormal test results, or a family history of
epileptic seizures continue even though you are being
treated, additional or other antiepileptic medicines may be tried.
In addition to medicines, other treatments, such as special diets and surgery, may be added
to help reduce the frequency and severity of epileptic seizures.
Surgery is not used just as a last resort to treat
epilepsy. Although brain surgery may sound frightening, it can successfully
reduce seizures that are harmful, severe, frequent, or do not respond to
medicines. Surgery can greatly improve the lives of some carefully screened
people who have epilepsy.
If you would like to know if surgery is a good choice for you, talk with your
What to think about
Early treatment may reduce the
risk of progressing to more frequent and severe seizures.
more likely to have additional seizures if you have had two or more seizures.
Doctors usually recommend treatment in these cases.
Since the cause of
epilepsy is often not clear, it generally is not
possible to prevent it.
Head injury, a common cause of epilepsy,
may be preventable. Always wear your seat belt in the car and a helmet when
riding a bike or motorcycle, skiing, skating, or horseback riding.
seizures caused by
epilepsy requires a daily commitment to following your
treatment plan. If you are using antiepileptic medicine, you must take your
medicine exactly as prescribed. Not following the treatment plan is one of the
main reasons why medicines fail to control seizures.
medicines will work only if you keep the right medicine level in your
body. Your doctor will set up a schedule of medicine dosages that keeps the
proper medicine levels in your body. Missing one or more doses can throw the
whole system off.
The same rule about following your treatment plan applies
if you or your child is on a special
ketogenic diet. The ketogenic diet can be hard to
follow, but it must be followed exactly.
As you follow
your treatment plan, also try to identify and avoid things that may make you more
likely to have a seizure, such as:
Not getting enough sleep.
drugs or alcohol.
Being emotionally stressed.
If you continue to have seizures despite treatment, keep a record(What is a PDF document?) of any seizures you have. Note the date, time of day, and any details
about the seizure that you can remember. Your doctor can use information about
your seizures to plan or adjust your medicine or other treatment. If you have
not been diagnosed with epilepsy, a record of your seizures can help your
doctor figure out whether you might have epilepsy and what kinds of seizures you
If you have epilepsy (or
your child has epilepsy):
Be sure that any doctor treating
you for any condition knows that you have epilepsy and knows what medicines you
are taking, if any.
medical identification bracelet. In the event of a seizure
or accident that leaves you unconscious or unable to speak for yourself, a
medical ID bracelet will let those who are treating you know that you have
epilepsy. It will also list any medicines you are taking to control your
seizures so that you are not given any medicines that will react badly with
those already in your body.
If you have a child with epilepsy, there are other
tips for parents that may be helpful.
Medicines to prevent
epileptic seizures are called antiepileptics. The goal
is to find an effective antiepileptic medicine that causes the fewest side
Although many people experience side
effects, medicine is still the best way to prevent epileptic seizures. The
benefits of treatment with medicine usually outweigh the drawbacks.
There are many antiepileptic medicines (called AEDs, anticonvulsants, or
antiseizure medicines). But they do not all treat the same types of seizures.
The first step your doctor takes in choosing a medicine to treat your seizures
is to identify the types of seizures you have.
It may take time
and careful, controlled adjustments by you and your doctor to find the
combination, schedule, and dosing of medicine to best manage your epilepsy. The
goal is to prevent seizures while causing as few side effects as
possible. After you and your doctor figure out the medicine
program that works best for you, make sure to follow your program exactly as
Using a single antiepileptic medicine is often better
than using more than one medicine. Single medicine use causes fewer side
effects and does not carry the risk of interacting with other medicines. The
chances of missing a dose or taking it at the wrong time are also lower with
just one medicine.
When treatment with one medicine doesn't help you enough, your doctor may suggest a second medicine to help improve seizure control. Also, if you
have several types of seizures, you may need to take more than one medicine.
Many medicines are used to treat epilepsy. Some are used
alone, and some are used only along with other medicines. Your medicine options
depend in part on what types of seizures you have. The medicines listed below are not the only medicines used for epilepsy, but they are the most common.
Medicines used for partial seizures, including those with secondary generalization
Carbamazepine (such as Carbatrol).
Oxcarbazepine (such as Trileptal).
Medicines used for primary generalized (tonic-clonic) seizures
(such as Depakene).
Medicines used for absence seizures
(such as Depakene).
Medicines used for atypical absence, myoclonic, or atonic seizures
Many of the medicines listed above control the same types
of seizures equally well. Most antiepileptic medicines can cause nausea,
dizziness, and sleepiness when you first start taking them. But these effects
usually go away after your body adjusts to the medicine. Liver and blood
problems are common to many of them. You may need to have regular blood tests
to watch for these side effects as long as you are taking the
Aside from these common problems, though, the medicines
have different side effects, health risks, and costs. A medicine that works for
someone else may not work for you.
When the more commonly used
medicines fail to control seizures or cannot be used for some other reason, you
may still have other medicine options.
Many new medicines are being
developed and tested in clinical trials but are not in regular use yet. One of
these might be an option. People with epilepsy who have not responded to
standard therapy sometimes choose to take part in these trials. To learn more
about clinical trials, talk to your doctor or visit the National Institutes of
Health clinical trials website at www.clinicaltrials.gov.
are also a few medicines that are only used for certain rare or severe forms of
epilepsy in children. Children with
infantile spasms, for instance, may respond to a
corticosteroid, vigabatrin, or adrenocorticotropic hormone (ACTH).
What to think about
All antiepileptic medicines have
some unpleasant side effects. Ideally, medicine works to prevent seizures
without causing intolerable side effects.
When choosing between
medicines that treat the same type of seizure, you and your doctor will
think about things such as:
How well the medicine works. How well a medicine works usually influences your willingness to take
Possible side effects of each medicine.
health risks of each medicine.
How often each medicine has to be
Your age. Side effects may not affect children and adults in
the same way. Medicines that can affect memory and thought processes may have a
more severe impact on older adults.
Your medical history and other
health concerns that might affect the use of a medicine. For instance, many
antiepileptic medicines can cause rare liver and blood problems and may be very
risky if you already have liver disease or a blood disorder.
doctor's own experience in treating people with each medicine.
cost of each medicine.
Building a medicine routine that works can be
hard. Finding the correct dosage of a medicine may take months. Some
people may have skin rashes, nausea, loss of coordination, and other short-term
problems when they first start taking medicine for epilepsy. When the first
medicine you try does not prevent seizures or you cannot tolerate its side
effects, the doctor may have to start the process all over again with a
different medicine. The chances of
medicine therapy failure increase as the number of
medicines tried increases.
If you or your child has epilepsy and
needs to begin or change a medicine routine, talk to your doctor about what to
expect from treatment with the medicine. You may or may not have a choice
between medicines, depending on the types of seizures you or your child has and
other factors. Thinking about and asking
questions about antiepileptic medicines will help you
prepare for the treatment.
special concerns for women who take antiepileptic medicines. Before you become
pregnant, be sure to talk to your doctor about how to
handle your treatment.
You may think about
stopping medicines if you have not had a seizure in
several years. About 6 to 7 out of 10 people in this situation are able to stop
taking antiepileptic medicines without having another seizure again for several
years.2 But do not stop taking your medicine without first talking with your doctor.
FDA Advisory. The U.S. Food and Drug Administration (FDA) has
issued an advisory on antiepileptic drugs (AEDs) and the risk of suicide. Talk
to your doctor about these possible side effects and the warning signs of suicide in adults and in children and teens.
Even though medicine is the most common
approach to treating epilepsy, it does not always work. In almost one-third of
people with epilepsy, medicine cannot control their seizures adequately (or at
all, in some cases). This number is even higher in
focal epilepsy. Surgery can greatly improve the lives
of some people who have
You may be a good candidate
for surgery if your seizures:
Occur often enough to severely disrupt your
Tend to result in injury or harm (for instance, if seizures
cause frequent falls).
Change or alter your
Are not controlled well with medicine, or you cannot
tolerate the side effects of the medicines.
Having frequent or severe seizures often restricts you from
driving, doing certain kinds of work, and other
activities. Medicine may fail to control these seizures. Or medicine may cause side
effects severe enough to disrupt your lifestyle.
Surgery is not an
"if all else fails" approach to treating epilepsy. It often may be a better
choice than trying each and every medicine. For
temporal lobe epilepsy, for instance, surgery may be
considered if two different first-line medicines are tried and neither controls
the seizures adequately. For certain types of childhood epilepsy—disorders
that children cannot outgrow and that do not respond to medicine—having surgery
at the youngest possible age may offer the greatest benefit for the child. The
younger brain is more adaptable and recovers better after surgery.
Epilepsy surgery removes an area of abnormal tissue in the brain, such as
a tumor or scar tissue, or the specific area of brain tissue where seizures
begin. Before surgery, you may have several tests (including an
magnetic resonance imaging [MRI], and video
monitoring) to find exactly where seizures begin in the brain. After the
area of abnormal tissue where your seizures begin has been located, doctors can
decide whether or not it can be removed safely.
usually done in a hospital that is associated with an epilepsy center. The
surgery usually takes a few hours, and you have to stay in the hospital for a
few days afterward. It may be several months or more before you feel fully back
The type of epilepsy surgery depends on the location in
the brain in which seizures start.
The most common surgery is
anterior temporal lobectomy, which is the removal of
part of one of the brain's temporal lobes. For many people with temporal lobe
epilepsy, this surgery offers a very good chance of becoming
Some types of surgery are usually only done on
Corpus callosotomy helps some children who have
Lennox-Gastaut syndrome by reducing falls that happen during seizures. These can happen often and often cause injury to the child.
Hemispherectomy during the first few years of life may
benefit children with other uncommon, severe forms of epilepsy (such as
Rasmussen syndrome or
What to think about
Surgery can be very effective
for some people with epilepsy. But surgery is not an option for everyone. If you or
your child has a type of epilepsy that might improve with surgical treatment,
you may want to think about some of these issues:
Surgery is not a last resort. It may be
considered after unsuccessfully trying two medicines.
surgery for some forms of childhood epilepsy may end seizures and prevent or
reverse developmental delays. Children make good surgical candidates. They tend to recover quickly with fewer problems
People who have temporal lobe epilepsy and whose seizures do
not get better with medicines may be good candidates for
Surgery is not always a cure for epilepsy. Some people
never have seizures again after surgery. But for many others, surgery only
reduces seizure frequency or severity.
You need to be healthy to
have the surgery and to benefit from it. People with severe illnesses,
psychiatric disorders, or neurological problems other than epilepsy may need
evaluations from more specialists to see if they are good candidates for
Epilepsy surgery involves removing part of your
brain. It can affect your brain function, although the effects may be less
bothersome than those caused by the epilepsy itself. Problems after surgery can
be mild to severe—such as less energy, visual defects, language and memory
problems, and weakness or partial paralysis on one side of the body—and may be
temporary or permanent.
Brain surgery is an expensive way to treat
epilepsy and carries with it many risks. Even if medicine does not prevent your
seizures, surgery may not be recommended if you only have seizures once in a
while or do not have severe seizures.
For many years, antiepileptic
medicine was the only treatment for people with
epilepsy. This is still true for many people, although
surgery is now an option for some. Seizures that cannot be controlled with
medicine or treated by surgery may sometimes respond to other
Other treatment choices
Treatments for epilepsy that can be used along with
medicines and surgery may include:
Special diets. For example, the ketogenic diet is a diet that
tries to force the body to use more fat for energy (instead of sugar) by
severely limiting carbohydrates—such as bread, pasta, fruits, and
vegetables—and total calories.
Nerve stimulation. For example, vagus nerve stimulation sends weak electrical signals to the
vagus nerve in your neck, which in turn sends the signals to your brain at
regular intervals to reduce seizures.
Other Places To Get Help
National Institute of Neurological Disorders and Stroke (U.S.)
Christensen J, et al. (2007). Epilepsy and the risk of
suicide: A population-based case-control study. Lancet Neurology. Published online July 3, 2007
Bazil CW, Pedley TA (2010). Epilepsy. In LP Rowland, TA Pedley, eds., Merritt’s Neurology, 12th ed., pp. 927–948. Philadelphia: Lippincott Williams and Wilkins.
Other Works Consulted
Bell GS, et al. (2008). Drowning in people with epilepsy: How great is the risk? Neurology, 71(8): 578–582.
Go CY, et al. (2012). Evidence-based guideline update:
Medical treatment of infantile spasms. Neurology, 78(24): 1974–1980.
Jentink J, et al. (2010). Valproic acid monotherapy in pregnancy and major congenital malformations. New England Journal of Medicine, 362(23): 2185–2193.
Krumholz A, et al. (2007). 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, 69(21): 1996–2007.
Liow K, et al. (2007). Position statement on the
coverage of anticonvulsant drugs for the treatment of epilepsy. Neurology, 68(16): 1249–1250.
Shneker BF, et al. (2009). Suicidality, depression screening, and antiepileptic drugs: Reaction to the FDA alert. Neurology, 72(11): 987–991.
How this information was developed to help you make better health decisions.