What to know about epilepsy
This article explains the many types of epilepsy, including their symptoms, treatment options, and prognoses.
The Centers for Disease Control and Prevention (CDC) describe epilepsy as "a common brain condition that causes repeated seizures."
A person with epilepsy may experience short blackouts or confused memory.
The main symptom of epilepsy is recurrent seizures. However, if a person experiences one or more of the following symptoms, they should seek medical attention, as it may indicate epilepsy:
- a convulsion with no fever
- short blackouts or confused memory
- intermittent fainting spells, during which they lose bowel or bladder control, frequently followed by extreme tiredness
- temporary unresponsiveness to instructions or questions
- sudden stiffness for no apparent reason
- sudden falling for no apparent reason
- sudden bouts of blinking without apparent stimuli
- sudden bouts of chewing without any clear reason
- temporarily seeming dazed and unable to communicate
- repetitive movements that seem involuntary
- fearfulness for no apparent reason
- panic or anger
- peculiar changes in senses, such as smell, touch, and sound
- jerking arms, legs, or body, which will appear as a cluster of rapid jerking movements in babies
It is vital to seek consultation with a doctor if any of these symptoms occur repeatedly.
The following conditions may cause similar symptoms to those above, so some people can mistake them for those of epilepsy:
- high fever with epilepsy-like symptoms
- narcolepsy, or recurring episodes of sleep during the day
- cataplexy, or periods of extreme muscle weakness
- sleep disorders
- panic attacks
- fugue state, a rare psychiatric condition in which a person forgets details about their identity
- psychogenic seizures, or seizures with a psychological or psychiatric cause
There is currently no cure for most types of epilepsy.
A doctor may prescribe antiepileptic drugs (AEDs) to help prevent seizures. If these drugs do not work, some other potential options include surgery, vagus nerve stimulation, or a special diet.
Doctors' objective is to prevent further seizures. They also aim to prevent side effects so that the person can lead an active and productive life.
AEDs appear to help control seizures in around 60–70% of cases, according to the American Epilepsy Society. The type of seizure a person has will decide which specific drug the doctor will prescribe.
People take the majority of AEDs by mouth. Common medications for treating epilepsy include:
- valproic acid
It is important to note that some drugs may prevent seizures in one person but not in another. Also, even when a person finds the right drug, it may take some time to find the ideal dosage.
If at least two medications have been ineffective in controlling seizures, a doctor may consider recommending epilepsy surgery. A 2013 study from Sweden found that 62% of adults and 50% of children with epilepsy had no seizures for around 7 years after epilepsy surgery.
According to the National Institute of Neurological Disorders and Stroke, some surgical options include:
- Lobectomy: During this procedure, a surgeon will remove the section of the brain in which seizures start. This is the oldest type of epilepsy surgery.
- Multiple subpial transection: During this procedure, a surgeon will make several cuts to limit seizures to one part of the brain.
- Corpus callosotomy: A surgeon will cut the neural connections between the two halves of the brain. This prevents seizures from spreading from one side of the brain to the other.
- Hemispherectomy: In extreme cases, a surgeon may need to cut out a hemisphere, which is one half of the cerebral cortex of the brain.
For some people, undergoing surgery may reduce the frequency and severity of their seizures. However, it is often important to continue taking antiseizure medication for several years following the procedure.
Another surgical option is the implantation of a device in the chest to stimulate the vagus nerve in the lower neck. The device sends preprogrammed electrical stimulation to the brain to help reduce seizures.
Diet may play a role in reducing seizures. A 2014 review of research that appeared in the journal Neurology suggested that high fat, low carbohydrate diets could benefit children and adults with epilepsy.
Five of the studies in the review used the ketogenic diet, while another five used a modified Atkins diet. Typical foods in these diets include eggs, bacon, avocados, cheese, nuts, fish, and certain fruits and vegetables.
The review found that 32% of study participants adhering to the ketogenic diet and 29% of those following the modified Atkins diet experienced at least a 50% drop in the regularity of seizures. However, many participants had difficulty maintaining these diets.
Specific diets may be beneficial in some cases, but more research is needed to confirm this.
Messaging systems in the brain control every function in the human body. Epilepsy develops due to a disruption in this system, which may result from brain dysfunction.
In many cases, healthcare professionals will not know the exact cause. Some people inherit genetic factors that make epilepsy more likely to occur. Other factors that may increase the risk include:
- head trauma, such as from a vehicle accident
- brain conditions, including stroke and tumors
- infectious diseases, such as viral encephalitis
- prenatal injury or brain damage that occurs before birth
- developmental conditions, including autism and neurofibromatosis
According to the CDC, epilepsy is most likely to develop in children under 2 years and adults over 65 years.
Is epilepsy common?
In 2015, the CDC stated that epilepsy affected around 1.2% of the United States population. That amounts to approximately 3.4 million people, including 3 million adults and 470,000 children.
The World Health Organization (WHO) estimate that epilepsy affects approximately 50 million people worldwide.
Doctors can sometimes identify the cause of a person's seizures. There are two main types of seizure based on whether or not they can determine the cause:
- Idiopathic, or cryptogenic: There is no apparent cause, or the doctor cannot pinpoint one.
- Symptomatic: The doctor knows what the cause is.
There are also three seizure descriptors — partial, generalized, and secondary generalized — depending on which area of the brain the seizure originates in.
A person's experience during a seizure will depend on the affected brain area and how widely and quickly the electrical activity in the brain spreads from that initial area.
The sections below discuss partial, generalized, and secondary generalized seizures in more detail.
A partial seizure occurs when the epileptic activity takes place in one part of a person's brain. There are two subtypes of partial seizure:
- Simple partial seizure: During this type of seizure, the person is conscious. In most cases, they are also aware of their surroundings, even when the seizure is in progress.
- Complex partial seizure: During this type, the seizure impairs a person's consciousness. They will generally not remember the seizure. If they do, their memory of it will be vague.
A generalized seizure occurs when the epileptic activity affects both halves of the brain. The person will usually lose consciousness while the seizure is in progress.
There are several subtypes of generalized seizure, including:
Tonic-clonic seizures: Perhaps the best-known type of generalized seizure, tonic-clonic seizures cause loss of consciousness, body stiffness, and shaking. Doctors previously called these grand mal seizures.
- Absence seizures: Previously known as petit mal seizures, these involve short lapses of consciousness wherein the individual appears to be staring off into space. Absence seizures often respond well to treatment.
- Tonic seizures: In tonic seizures, the muscles become stiff, and the person may fall.
- Atonic seizures: A loss of muscle tone causes the individual to drop suddenly.
- Clonic seizures: This subtype causes rhythmic, jerking movements, often in the face or one arm or leg.
- Myoclonic seizures: This subtype causes the upper body or legs to suddenly jerk or twitch.
Secondary generalized seizure
A secondary generalized seizure occurs when the epileptic activity starts as a partial seizure but spreads to both halves of the brain. As this seizure progresses, the person will lose consciousness.
A doctor will review an individual's medical history and the symptoms they have experienced, including a description and timeline of past seizures, to diagnose epilepsy.
They may also request tests to determine the type of epilepsy and the type of seizures the person has. Based on these results, the doctor will be able to recommend treatment options, such as antiseizure medications.
Testing for epilepsy
An EEG can help doctors test for epilepsy.
Several types of imaging test can help a doctor diagnose epilepsy. These tests include:
- an EEG, to look for abnormal brain waves
- CT and MRI scans, to detect tumors or other structural irregularities
- functional MRI scans, which can identify normal and abnormal brain function in specific areas
- single-photon emission CT scans, which may be able to find the original site of a seizure in the brain
- a magnetoencephalogram, which can identify irregularities in brain function using magnetic signals
The doctor may also use blood tests to identify any underlying conditions that could be causing the epilepsy. Neurological tests may also help a doctor determine the type of epilepsy the person has.
Is epilepsy genetic?
According to one 2015 research review, around 70–80% of epilepsy cases occur as a result of genetics.
A 2017 review of research linked over 900 genes to epilepsy. This number continues to grow as more studies take place.
Genes may link to epilepsy directly, to brain anomalies that can lead to epilepsy, or to other genetic conditions that can cause seizures.
Some people inherit genetic factors. However, certain genetic mutations may also cause epilepsy in people without a family history of the condition.
A doctor may sometimes request genetic testing to determine the cause of epilepsy.
A variety of factors can lead to seizures. One 2014 study identified stress, sleep deprivation, and fatigue as the most frequent triggers among 104 participants. Flickering lights and high levels of alcohol consumption can also cause seizures.
Stress is a common cause of seizures, but the reason is unclear. Research from 2016 in the journal Science Signaling focused on this trigger. The team found that the brain's stress response worked differently in rats with epilepsy than in those without.
The study also found that the molecule that typically suppresses brain activity in response to stress enhanced activity instead. This may contribute to seizures.
Epilepsy vs. seizures
Seizures are the main symptom of epilepsy. In fact, Johns Hopkins Medicine define epilepsy as having "two or more unprovoked seizures."
Some people may have a single seizure, or they may experience seizures that are not due to epilepsy.
It is even possible for doctors to misdiagnose nonepileptic seizures as epilepsy. However, nonepileptic seizures do not stem from abnormal electrical activity in the brain. The causes of these can be physical, emotional, or psychological.
There are also different types of seizure, which may vary among people with epilepsy. In two people with epilepsy, for example, the condition may look different.
For this reason, the CDC describe epilepsy as a spectrum disorder.
Is it a disability?
The Americans with Disabilities Act (ADA) prohibits discrimination against people with disabilities, including epilepsy. This applies whether or not the person is able to manage their seizures with medication or surgery.
People with epilepsy have certain employment-related protections under the ADA, including the following:
- Employers may not ask about job applicants' medical conditions, including epilepsy.
- Job applicants do not need to inform an employer that they have epilepsy unless they need reasonable accommodation during the application period.
- Employers may not cancel a job offer if the person can complete the primary functions of the job.
According to the Social Security Administration, people with epilepsy may be eligible for disability benefits. This requires that people document their seizure type and frequency while taking all the prescribed medications.
Some devices can monitor seizures and alert caregivers, potentially benefiting treatment and helping prevent sudden unexpected death in epilepsy (SUDEP).
A small 2018 study involving 28 participants, the results of which appeared in the journal Neurology, compared one such multimodality device, the Nightwatch, to an Emfit bed sensor. The Nightwatch detected 85% of all severe seizures, compared with 21% for the bed sensor. It also only missed one serious attack every 25 nights.
Nearly 70% of SUDEP cases occur during sleep, according to one 2017 study. This indicates that there may be potential benefits of using accurate nighttime warning systems.
Is it contagious?
Anyone can develop epilepsy, but it is not contagious. A 2016 review of research highlighted some misconceptions and stigma about epilepsy, including the false belief that epilepsy can transmit between people.
The study authors note that people with lower education levels and socioeconomic status had a high rate of misconceptions, as did those who did not know any people with epilepsy.
As a result, interventions and other educational efforts may be useful to reduce stigma around epilepsy and increase understanding of the condition.
Epilepsy can impair a person's life in multiple ways, and the outlook will depend on various factors.
Seizures can sometimes be fatal, depending on the circumstances. However, many people with epilepsy can manage their seizures using antiseizure medications.
More research is necessary to confirm the alleged relationship between seizures and brain damage.
Is epilepsy fatal?
Seizures can lead to drowning, falling, vehicle accidents, or other injuries that could be fatal. Although it is rare, SUDEP can also occur.
Cases of SUDEP typically occur during a seizure or immediately after it. For example, the seizure may cause the person to go too long without breathing, or it could result in heart failure.
After blocking acid from reaching the esophagus, SUDEP did not occur in the rats the researchers tested. It is not clear whether this has any relevance to humans, however.
According to the CDC, people are at more risk of SUDEP if they have had epilepsy for many years, or if they have regular seizures. Following these steps can help reduce the risk of SUDEP:
- taking all doses of antiseizure medication
- limiting alcohol intake
- getting sufficient sleep
Regularly taking prescribed medication may also help prevent status epilepticus, a condition wherein seizures last for longer than 5 minutes.
A 2016 study found that treating status epilepticus within 30 minutes reduced the risk of death.
Will seizures continue?
A 2013 review of research in the journal Brain indicated that 65–85% of people may experience long-term remission of seizures.
Seizures with an identifiable cause, however, are more likely to continue.
Other factors affecting the chances of remission include:
- access to treatment
- response to treatment
- other health conditions a person may have
With the correct use of antiseizure medications, the majority of people with epilepsy may be able to control their seizures.
Can epilepsy lead to brain damage?
Research into whether or not seizures can cause brain damage has shown mixed outcomes.
A 2018 study examined postsurgical brain tissue from people with recurrent seizures. The researchers found no brain damage markers in people with certain types of epilepsy.
However, several other studies have suggested that severe, long lasting seizures could lead to brain injury. For example, one 2013 study found that seizures could result in brain abnormalities, with status epilepticus causing irreversible brain lesions.
Other studies have looked at cognitive changes in children as they get older, either with or without epilepsy. Results suggest that epilepsy is associated with worse cognitive outcomes.
However, it is unclear whether:
- epilepsy causes the impairment
- a similar structural change causes both epilepsy and the impairment
- antiepileptic drugs have an effect
This is an area that needs further research.
Epilepsy can affect various aspects of a person's life, including their:
- emotions and behavior
- social development and interaction
- ability to study and work
The scale of impact on these areas of life will depend largely on the frequency and severity of their seizures.
Life expectancy of people with epilepsy
In 2013, researchers from the University of Oxford and University College London, both in the United Kingdom, reported that people with epilepsy are 11 times more likely to experience premature death than people without it..
The risk appears to be greater if the person also has a mental health condition. Suicide, accidents, and assaults accounted for 15.8% of early deaths. Most people affected by these had also received a diagnosis of a mental health condition.
Lead researcher Seena Fazel says, "Our results have significant public health implications, as around 70 million people worldwide have epilepsy, and they emphasize that carefully assessing and treating psychiatric disorders as part of standard checks in [people] with epilepsy could help reduce the risk of premature death in these patients."
"Our study," he adds, "also highlights the importance of suicide and nonvehicle accidents as major preventable causes of death in people with epilepsy."
Several factors may have links to an increased risk of epilepsy. According to a 2017 research review in the journal NeuroToxicology, these factors include:
- age, with new cases occurring more frequently in young children and older adults
- brain injuries and tumors
- genetics and family history
- alcohol consumption
- perinatal factors, such as stroke and preterm birth
- central nervous system infections, such as bacterial meningitis, viral encephalitis, and neurocysticercosis
Some risk factors, such as alcohol consumption, are modifiable when trying to prevent the development of epilepsy.
Is it curable?
There is currently no cure for epilepsy, but people with the condition can usually manage their symptoms.
According to the WHO, up to 70% of people with epilepsy can experience a reduction in their seizure frequency and severity with antiseizure medications. Around half of all people with epilepsy may be able to stop taking medications after 2 years without a seizure.
In some cases, surgery can also reduce or eliminate seizures when drugs are ineffective.
This can have long-term benefits. In one 2018 study, 47% of the participants reported no debilitating seizures 5 years after surgery, and 38% reported the same after 10 years.
The WHO explain that around 25% of epilepsy cases are preventable. People can reduce the risk of developing epilepsy by following these steps:
- wearing a helmet when riding a bicycle or motorcycle, to help prevent head injuries
- seeking perinatal care, to prevent epilepsy from birth injuries
- managing risk factors for stroke and heart disease, which could cause brain damage that results in epilepsy
- practicing good hygiene and preventative methods to avoid cysticercosis, an infection that is the most common cause of epilepsy around the world, according to the CDC.
A 2015 review of research in the journal Seizure also suggested that regular physical activity may help prevent the development of epilepsy and reduce how often seizures occur.
It is not possible to prevent all cases of epilepsy. However, taking the above steps may help reduce the risk.
Depending on the situation, seizures may lead to negative outcomes such as drowning or vehicle accidents. Long lasting seizures, or status epilepticus, may also cause brain damage or death.
People with epilepsy are eight times more likely than people without it to experience certain other chronic conditions, including dementia, migraine, heart disease, and depression. Some of these conditions could also make seizures worse.
Other complications may occur due to the side effects of antiseizure medications. For example, one 2015 study found that 9.98% of people taking the antiseizure drug lamotrigine (Lamictal) developed a skin rash.
Rash can also occur with other AEDs, including phenytoin (Dilantin) and phenobarbital. The rash usually disappears once the person stops taking the medication. However, 0.8%–1.3% of adults developed a serious rash that could be fatal.
Does a person with epilepsy typically experience one type of seizure, or multiple types?
Most people who have epilepsy will experience only one type of seizure. However, some people with epilepsy experience more than one type of seizure — especially those who have seizures caused by epilepsy syndromes, which usually begin during childhood.Heidi Moawad, M.D. Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.