If you have ever attended a flashy concert or watched an effects-heavy music video, there is a good chance that you received an epilepsy warning before it started. Strobe lights and other visual effects trigger seizures in people who have epilepsy.
What exactly is epilepsy, and how is it treated?
Epilepsy is a neurological disorder that manifests with the development of seizures. When a person experiences a seizure, their brain is flooded with a sudden and uncontrollable rush of electrical energy, leading to various debilitating symptoms.
Epilepsy is a blanket term covering a wide range of seizure-based disorders. To be diagnosed with epilepsy, you must meet any of the following criteria:
Experience at least two unprovoked seizures more than 24 hours apart
Have at least one unprovoked seizure and a probability of further seizures similar to people who have had two seizures (which is between 60 and 90%)
Be diagnosed with an epilepsy syndrome (typically by EEG findings) even without having a seizure
People with epilepsy are at risk of experiencing mild to severe seizures at any time. Sometimes, these events are brought on by triggers, while most seizures occur for no apparent reason.
Epileptic seizures are classified into two groups: generalized and focal seizures.
Generalized seizure simultaneously affects both sides of the brain and is the most common form of the condition. Here are its specific subtypes:
Also known as “petit mal seizures,” this type appears as a brief period of loss of awareness, often paired with a blank and absent stare. During these episodes, you may experience mild, uncontrolled, and repetitive actions, such as lip-smacking or blinking.
These seizures are often difficult to identify because they last only a few seconds and may appear as just a brief pause in activity. Absence seizures are commonly seen in school-aged children but can occur at any time of life. They have a strong genetic component.
Atonic seizures cause a sudden loss of muscle control. Also referred to as “drop seizures,” the person loses control of their muscles and suddenly falls to the ground.
This type of epilepsy is often seen in people with other developmental delays and is difficult to control with medications. These episodes often result in injuries.
During a myoclonic seizure episode, you can experience seemingly random and rapid twitching movements in your arms and legs, lasting only for a few seconds. This type of epilepsy is relatively rare and is often seen along with other seizure types.
Juvenile myoclonic epilepsy occurs in adolescence and is one of the more common generalized epilepsy syndromes in children.
A person experiencing a tonic seizure will exhibit sudden body rigidity and stiffness, often in their arms, legs, and abdominal muscles.
Repetitive and strong jerking motions characterize clonic seizures. People experiencing this type of seizure can have these movements in the face, neck, and limbs.
Also known as “grand mal seizures,” this subtype is most commonly shown in movies and television shows. Characteristics include stiffness, shaking, tongue biting, losing control of the bladder and bowels, and losing consciousness.
Focal seizures (also called partial seizures) occur in one isolated part of the brain. Because of this, symptoms can vary wildly depending on the areas affected. Examples of focal seizure types include:
These seizures impact only a small section of the brain at a time. Depending on the affected area, symptoms can range from mild twitching to experiencing a change in your sense of smell or taste.
During a complex focal seizure, you may become confused and disoriented. You might be unable to answer questions or follow basic instructions throughout the seizure.
According to the Centers for Disease Control and Prevention, the number of children and adults living with epilepsy is rising¹. Over 3.4 million people in the US (3 million adults and 470,000 children) live with an active form of epilepsy. This accounts for 1.2% of the population.
The World Health Organization estimates that more than 50 million people² worldwide live with epilepsy.
Recent clinical data also show that 0.6% of all children aged 0–17 in the US live with active epilepsy. This means that 6 in every 1,000 children³ could have a seizure disorder.
Up to 80% of people with active epilepsy live in low- to middle-income countries. Without adequate access to quality healthcare and treatments, they are more likely to experience more profound and debilitating symptoms of the disorder.
While the specific epilepsy symptoms a person can experience will depend on the area(s) of their brain affected, some of the most common symptoms of tonic-clonic seizures¹ include:
Stiffness and rigidity throughout the body
Loss of muscle tone and control
Uncontrollable jerking motions of the limbs
Repetitive movements like lip smacking or blinking
Biting of the tongue
Frothing at the mouth
Loss of bowel and bladder control
Sudden onset of confusion and disorientation
Staring forward blankly
Loss of consciousness and lack of awareness of the event
Not all seizures require emergency medical attention. Depending on the type, location, duration, and the person’s epilepsy history, seizure episodes can often be managed in the home setting.
However, if you are with someone who has never had a seizure or has epilepsy and is experiencing an episode lasting longer than a few minutes, call emergency services for immediate support and medical attention.
If left untreated, epilepsy may cause significant health complications that can have a negative impact on your quality of life. Depending on the severity and quality of seizures that you experience, examples of epilepsy complications can include:
Lifelong difficulty learning and increased risk of being diagnosed with a learning disability
Mood irregularities, such as depression and anxiety
Injuries from seizure-related falls, including bruises, cuts, bone fractures, and self-inflicted bite wounds
Aspiration (inhaling food, water, or even saliva into the lungs) during an episode can result in a risk of developing aspiration pneumonia
Damage to areas in the brain from repeat seizures and increased risk of stroke
Unfortunately for many people with epilepsy, it has no clear identifiable cause in about half of all diagnosed cases. In the other 50% of cases, some of the most common causes can include the following:
Trauma to healthy brain tissue can increase your risk of experiencing recurrent seizures. You can develop epilepsy after a traumatic event like a car accident that causes a serious head injury.
Autoimmune epilepsy is a condition that arises due to changes in the immune system. Unable to discern the difference between foreign particles and our brain tissue, immune cells attack and damage your brain tissue, increasing your risk of experiencing a seizure.
Malformations of your brain tissue or blood vessels can increase the risk of developing epilepsy. Additionally, people who have previously suffered a stroke are at an increased risk of seizures.
Viral, bacterial, and parasitic infections are believed to be the most common cause of epilepsy worldwide. Infections such as malaria, HIV, and meningitis are also associated with an increased risk of developing this condition.
Life-changing injuries to brain tissue that can occur before a baby is born can increase their risk of developing epilepsy during their lifetime. Prenatal infections, poor nutrition, and lack of oxygen before or during delivery are all potential causes of epilepsy.
In some cases, epilepsy can be caused by genetic abnormalities.
However, it is important to emphasize that just because a person was born with a genetic predisposition for seizures does not mean they will develop epilepsy or that it was passed on from one of their parents.
Aside from your genetic makeup, other identifiable risk factors could increase your chances of developing a seizure disorder. Some of the most common epilepsy risk factors include:
Age (most prevalent in adolescents and young adults)
Stroke or other major vascular events
While people with epilepsy can experience a seizure without a specific trigger, it is also possible for people with this diagnosis to develop seizures due to changes in their surrounding environment or physical health.
People with epilepsy will often note patterns for when their seizures are more likely to occur. Some of the most common seizure triggers include:
A high fever
Flashing bright lights and repetitive patterns
Eating specific foods (dependent from person to person) or missing meals
Chronic high levels of stress
Hormonal changes (including changes due to the menstrual cycle)
Missing medication doses
Profound malnutrition or dehydration
If you suspect that you or someone you love has recently experienced a seizure for the first time, you should seek medical attention. Because various severe medical conditions can cause seizures, getting evaluated by a medical professional is essential for your health and safety.
Depending on your medical history and the specifics of your seizure, your doctor will run various diagnostic tests to determine the root cause.
After obtaining your history and performing a physical exam that includes a neurological assessment, your clinician may order blood work and other diagnostic tests to detect other causes of seizures.
Examples of common diagnostic studies used for evaluating seizures and diagnosing epilepsy include:
An EEG can record electrical patterns within the brain using small and painless electrodes placed on your head. This type of monitoring can identify abnormal electrical activity and is most frequently used in diagnosing epilepsy.
As one of the most common forms of neuroimaging used in evaluating seizures, MRI creates a detailed image of your brain tissue. This modality can be used to diagnose abnormalities that could increase your risk of developing epilepsy.
A CT scan is another form of neuroimaging performed after a seizure. It can be helpful to quickly rule out causes of seizures, such as a hemorrhagic stroke or bleeding in the brain from a head injury.
While various effective medications and surgical interventions are available to help manage symptoms, there is no definitive cure for epilepsy.
Despite this, getting access to the appropriate medical care needed to manage symptoms can dramatically impact your quality of life and overall health.
Receiving treatment for epilepsy can help you experience fewer seizures or may even stop them altogether.
When you meet with your primary care physician or specialist, they will create a treatment plan based on:
The type of epilepsy you have and its cause (if known)
The frequency and severity of your seizures
Your overall health and comorbidities
How well you respond to specific treatments
Currently, some of the most commonly used epilepsy treatment options include medications, vagus nerve stimulation, and surgery.
If you have been newly diagnosed with epilepsy, your doctor will likely start you on an antiseizure medicine as a first-line treatment. This medication is used to prevent the frequency and severity of seizure activity but not to stop an active seizure as it occurs.
Most antiseizure medicines are taken orally and absorbed through the stomach. You may be required to take more than one drug, depending on your epilepsy symptoms and response to the medicine.
Common antiseizure drugs include:
Valproic acid (Depakote)
Like all medications, antiseizure drugs can cause side effects that must be monitored and reported. Some more common and milder effects occur when you start taking the medicine but improve after a few weeks. Others are more severe or sustained.
You should speak with your prescribing physician if you develop any side effects while taking antiseizure medications. They may adjust the dosage or medication type to fit your needs.
Here are the side effects to look out for:
Dizziness and lightheadedness
Development of a skin rash
Additionally, a new area of research called pharmacogenetic testing¹ is being conducted to determine the effects of genetic factors on how effective medication can be. These tests are being done on people with known epilepsy to learn how to predict better the medications best suited to treat their condition.
Depending on how you respond to your prescribed medications, your neurologist may recommend this testing as part of your treatment plan.
For those with epilepsy who are considering becoming pregnant, it is crucial to understand that some antiseizure medications can impact the baby’s health in utero². Some examples of possible congenital disabilities that antiseizure drugs can cause include:
Cleft palate abnormalities
Neural tube defects
Congenital heart defects
Whenever possible, it is advised for women with epilepsy to speak with their clinician about the safety of their treatment plan before becoming pregnant.
While it may be essential for them to remain on some form of treatment, dosing changes and possible medication switches can be made to allow for the safest possible pregnancy for her and the baby.
For people who do not respond well to antiseizure medications and are not considered safe surgical candidates, vagus nerve stimulation is often tried as the next-in-line therapy option.
Electrical impulses are sent along the nerve to various brain areas using an implantable device connecting to the left vagus nerve. This has been proven to reduce the number of seizures and was approved by the FDA³ in 1997.
In more severe cases, when a person does not respond well to medications and vagus nerve stimulation, surgical interventions may be indicated to reduce seizure activity. Some of the most common surgical options for epilepsy include:
Surgical resection involves removing a portion of the brain where your seizure activity most commonly originates. Sometimes, patients remain awake during this procedure to collaborate with the surgical team.
If the primary seizure activity originates from an area of the brain that cannot be resected, the surgical team may conduct multiple subpial transections⁴. They will disconnect the nerve pathways and prevent seizure activity from spreading to other brain areas.
In addition to the abovementioned treatment options, your doctor may suggest various lifestyle changes to manage your epilepsy symptoms better. One of them is following a ketogenic diet.
Defined as a low-carbohydrate, high-fat diet, a ketogenic diet⁵ is challenging to maintain and requires constant monitoring. However, for those with drug-resistant epilepsy, the benefits may be worth the effort it takes to stay on a diet.
While the exact mechanism of action for the formation of many seizures is unknown, the ketogenic diet has proven to be an effective option for the long-term management of epilepsy. One large study showed a 50% reduction in seizure activity in up to 90% of patients⁶ who ate a ketogenic diet for 12 consecutive months.
If you or someone you know is interested in exploring the ketogenic diet as a treatment option for epilepsy, speak with your primary doctor or neurologist before making dietary adjustments.
If you happen to be with someone experiencing an active seizure, there are some things you can do to provide support and ensure their safety until it resolves.
If the individual is having a focal seizure, you should:
Stay with them
Ask them if they have experienced this type of seizure before or check for a medical emergency bracelet
Stay calm and keep those around you calm
Once it is completed, take them to a safe place
Ask if they want to be taken to a medical facility or need help getting home
If the person is having a more severe tonic-clonic seizure, you should:
Help the person to the ground as safely as possible
Clear the surrounding space of objects and people
Turn them on their side to help keep their airway clear
Loosen their clothing and remove accessories or glasses
Do not place anything in their mouth but monitor their breathing throughout the event
Time the seizure and call emergency services
It is important to know that you should never try to hold anyone down on the ground, offer mouth-to-mouth, or give them food or water while they are having a seizure.
Stay with the person until the episode resolves, and call emergency services if it does not stop after a few minutes, they have signs of difficulty breathing or low oxygen, or they don’t regain consciousness.
Pharmacogenomics in epilepsy (2018)
Ketogenic diet and epilepsy (2019)
For those living with epilepsy, staying in contact with your primary care clinician at least once a year and seeing your neurologist as often as recommended is essential to maintain your overall health and safety.
Between appointments, things that you can do to monitor and support your epilepsy include:
Keeping a diary of seizure events and medications
Monitoring for potential triggers and avoiding them when possible
Wearing a medical alert bracelet
Training those closest to you on how to identify and assist you during an episode
Living a healthy and balanced lifestyle