Epilepsy is a brain disorder that causes people to have recurring seizures. The seizures happen when clusters of nerve cells, or neurons, in the brain send out the wrong signals. People may have strange sensations and emotions or behave strangely. They may have violent muscle spasms or lose consciousness.

Epilepsy has many possible causes, including illness, brain injury, and abnormal brain development. In many cases, the cause is unknown.

Doctors use brain scans and other tests to diagnose epilepsy. It is important to start treatment right away. There is no cure for epilepsy, but medicines can control seizures for most people. When medicines are not working well, surgery or implanted devices such as vagus nerve stimulators may help. Special diets can help some children with epilepsy. 

The epilepsies are chronic neurological disorders in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally and cause seizures. Neurons normally generate electrical and chemical signals that act on other neurons, glands, and muscles to produce human thoughts, feelings, and actions. During a seizure, many neurons fire (signal) at the same time – as many as 500 times a second, much faster than normal. This surge of excessive electrical activity happening at the same time causes involuntary movements, sensations, emotions, and behaviors and the temporary disturbance of normal neuronal activity may cause a loss of awareness.

Epilepsy can be considered a spectrum disorder because of its different causes, different seizure types, its ability to vary in severity and impact from person to person, and its range of co-existing conditions. Some people may have convulsions (sudden onset of repetitive general contraction of muscles) and lose consciousness. Others may simply stop what they are doing, have a brief lapse of awareness, and stare into space for a short period. Some people have seizures very infrequently, while other people may experience hundreds of seizures each day. There also are many different types of epilepsy, resulting from a variety of causes. Recent adoption of the term “the epilepsies” underscores the diversity of types and causes.

In general, a person is not considered to have epilepsy until he or she has had two or more unprovoked seizures separated by at least 24 hours. In contrast, a provoked seizure is one caused by a known precipitating factor such as a high fever, nervous system infections, acute traumatic brain injury, or fluctuations in blood sugar or electrolyte levels.

Anyone can develop epilepsy. About 2.3 million adults and more than 450,000 children and adolescents in the United States currently live with epilepsy. Each year, an estimated 150,000 people are diagnosed with epilepsy. Epilepsy affects both males and females of all races, ethnic backgrounds, and ages. In the United States alone, the annual costs associated with the epilepsies are estimated to be $15.5 billion in direct medical expenses and lost or reduced earnings and productivity.

The majority of those diagnosed with epilepsy have seizures that can be controlled with drug therapies and surgery. However, as much as 30 to 40 percent of people with epilepsy continue to have seizures because available treatments do not completely control their seizures (called intractable or medication resistant epilepsy).

While many forms of epilepsy require lifelong treatment to control the seizures, for some people the seizures eventually go away. The odds of becoming seizure-free are not as good for adults or for children with severe epilepsy syndromes, but it is possible that seizures may decrease or even stop over time. This is more likely if the epilepsy starts in childhood, has been well-controlled by medication, or if the person has had surgery to remove the brain focus of the abnormal cell firing.

Many people with epilepsy lead productive lives, but some will be severely impacted by their epilepsy. Medical and research advances in the past two decades have led to a better understanding of the epilepsies and seizures. More than 20 different medications and a variety of dietary treatments and surgical techniques (including two devices) are now available and may provide good control of seizures. Devices can modulate brain activity to decrease seizure frequency. Advance neuroimaging can identify brain abnormalities that give rise to seizures which can be cured by neurosurgery. Even dietary changes can effectively treat certain types of epilepsy. Research on the underlying causes of the epilepsies, including identification of genes for some forms of epilepsy, has led to a greatly improved understanding of these disorders that may lead to more effective treatments or even to new ways of preventing epilepsy in the future.

What Is Epilepsy?

Epilepsy is a disorder of the brain that causes seizures. These seizures are not caused by a temporary underlying medical condition such as a high fever.

Epilepsy can affect people in very different ways. This is because there are many causes and many different kinds of seizures. Some people may have multiple types of seizures or other medical conditions in addition to epilepsy. These factors play a major role in determining both the severity of the person’s condition and the impact it has on his or her life.

The way a seizure looks depends on the type of seizure a person is experiencing. Some seizures can look like staring spells. Other seizures can cause a person to collapse, shake, and become unaware of what’s going on around them.

Epilepsy can be caused by different conditions that affect a person’s brain. Many times the cause is unknown. Some causes include:

• Stroke.
• Brain tumor.
• Traumatic brain injury or head injury.
• Central nervous system infection.

A person with epilepsy is not contagious and cannot give epilepsy to another person.

Read answers to common questions about epilepsy.

Who Has Epilepsy?

Active Epilepsy

In 2015, 1.2% of the total US population had active epilepsy.

This is about 3.4 million people with epilepsy nationwide: 3 million adults and 470,000 children.

According to the latest estimates, about 0.6% of children aged 0-17 years have active epilepsy.Think of a school with 1,000 students—this means about 6 of them could have epilepsy.

Learn more about active epilepsy and find state-specific prevalence estimates on our Data and Statistics page.

Active epilepsy is defined as adults, participating in the 2015 NHIS, who reported a history of doctor-diagnosed epilepsy or seizure disorder and either were currently taking medication to control it, or had one or more seizures in the past year, or both.

How much do you know about epilepsy? Get the facts!

Epilepsy is a brain disorder that causes repeated seizures. There are many different types of epilepsy and many different kinds of seizures. Epilepsy can get in the way of life, especially when seizures keep happening. To control their seizures, people with epilepsy may take medicine, have surgery, use devices, or follow a special diet.

Here’s what you need to know:

#1 Epilepsy is common.

In fact, you probably know a few people with epilepsy. In 2015, about 3 million adults (age 18 and older) and 470,000 children (age 17 years or younger) had active epilepsy in the United States. That’s about 3.4 million people, which is about the same number of people living in Delaware, New Hampshire, and Rhode Island combined.

#2 Seizures may look different than you expect.

What comes to mind when you think of a seizure? In the movies and on TV, they often show a person falling to the ground, shaking, and becoming unaware of what’s going on around them. That’s one kind of seizure, but it’s not the most common. More often, a person having a seizure may seem confused, stare into space, wander, make unusual movements, or be unable to answer questions or talk. Sometimes it’s hard to tell when a person is having a seizure, so it’s important to learn how to recognize different types of seizures.

Seizures might not look like you’d expect. Learn to spot the signs of seizures and how to help.

#3 Seizure first aid is easy to give.

About 1 in 10 people may have a seizure during their lifetime. Because seizures are common, you may need to help someone one day. First aid for seizures involves keeping the person safe until the seizure stops on its own and knowing when to call 911 for emergency help.

Professionals such as school nurses and other school staff, law enforcement, first responders, and childcare workers should also understand epilepsy and how to offer first aid. CDC supports free training programs for these groups through a partnership with the Epilepsy Foundation.

#4 People with epilepsy can lead full lives.

Most people with epilepsy can do the same things as those without epilepsy. There are many successful people with epilepsy who work in medicine, sports, entertainment, government, and other professions.

People with uncontrolled seizures or severe types of epilepsy face more challenges and may find it harder to work or go to school regularly. Some adults with epilepsy have a hard time finding jobs, transportation, and affordable health care. Learn about resources that can help on CDC’s Find Support page.

#5 Some causes of epilepsy are preventable.

People with epilepsy need others to understand their condition. Get the facts!

Epilepsy can be caused by different conditions that affect a person’s brain. Many times, doctors don’t know the cause. Traumatic brain injuries, stroke, certain infections (such as cysticercosis, the leading cause of epilepsy worldwide), lack of oxygen during birth, and some birth defects are examples of preventable causes of epilepsy. Learn more about preventing epilepsy and reducing your risk.

Did you know that epilepsy is more likely to develop in older adults? Seizures can be easy to miss. Learn how to recognize the signs and how you can help.

Epilepsy is a brain disorder that causes repeated seizures. About 3 million US adults aged 18 or older have active epilepsy. Nearly 1 million of those adults are 55 or older. As our population ages, there will be even more older people with epilepsy in the coming years.

Epilepsy is more likely to develop in older adults because some risk factors for epilepsy are more common in older adults, such as:

• Strokes.
• Head injuries from falls.
• Diseases that affect brain function (such as Alzheimer’s disease).
• Brain tumors.

About half of older adults who are told they have epilepsy do not know the cause.

How Do I Know If It’s Epilepsy?

It isn’t always easy to tell when you or someone you care for develops epilepsy later in life. That’s because seizures may be hard to recognize in older adults and may go unnoticed. For example, memory problems, confusion, falls, dizziness, or sensory changes like numbness are often blamed on “getting older.” However, sometimes these can actually be signs of seizures.

There are many different signs of seizures because there are many types of seizures. In the movies and on TV, a person is often shown falling to the ground, shaking, and becoming unaware of what’s going on around them. That’s one kind of seizure, but it’s not the most common. More often, a person having a seizure may:

• Seem confused.
• Stare into space.
• Wander.
• Make unusual movements.
• Be unable to answer questions or talk.

When these signs occur more than once and often in the same pattern, they could be signs of seizures.

If an older adult is showing these signs, it’s important for them to talk to a health care provider. Most adults with epilepsy have good seizure control with medicines. Epilepsy specialists can help older adults find the right treatment. Find an epilepsy specialist near you at the Epilepsy Foundation website.

How Is Epilepsy Challenging for Older Adults?

Adults who develop epilepsy may have a hard time managing the disorder. Eight in 10 adults aged 65 or older have more than one chronic health condition. It can be hard to balance epilepsy treatment with taking medicines for other health problems. Many epilepsy medicines also have side effects such as bone loss or dizziness, which can make someone more likely to fall and become injured.

Epilepsy can also affect a person’s daily life if seizures limit their ability to drive or if they live alone. After a lifetime of being independent, losing the ability to drive or take care of themselves can be especially hard for older adults. Read more about the challenges faced by seniors with epilepsy.

How Can I Help?

Seizure first aid is easy to give and involves keeping the person safe until the seizure stops on its own and knowing when to call 911 for emergency help.

If you work at a senior center, long-term care facility, nursing home, in-home health care, or another senior-serving organization, you can take special training. Seniors & Seizures is a free course offered by the Epilepsy Foundation. You can also get free continuing education credits for participating.

The Epilepsy Foundation also has a free, online general training program anyone can take to become certified in seizure first aid.

Do I Call 911?

Seizures don’t usually require emergency medical attention. Only call 911 if one or more of these are true:

• The person has never had a seizure before.
• The person has trouble breathing or waking after the seizure.
• The seizure lasts longer than 5 minutes.
• The person has another seizure soon after the first one.
• The person is hurt during the seizure.
• The seizure happens in water.
• The person has a health condition like diabetes, heart disease, or pregnancy.

Caregivers should learn how to recognize seizures in older adults.

What is epilepsy?

Epilepsy is a medical condition that produces seizures that affect a variety of mental and physical functions. When a person has two or more seizures, they are considered to have epilepsy. These seizures are a result of sudden abnormal electrical activity in the brain. The exact type of seizure will depend on where it starts and then spreads within the brain.

What are seizures?

A seizure is a disturbance in the normal regulation pattern of the electrical activity of the brain. Although there are many causes and types of seizures, the common feature is a spreading wave of uncontrolled electrical activity. This abnormal activity within the brain will usually create outward changes in the person experiencing a seizure. Signs and symptoms may include muscle spasms, mental confusion, loss of consciousness and/or uncontrolled or aimless body movements. In general, seizures last a finite period of seconds to minutes, and then stop on their own.

There are two main types of seizures:

Generalized seizures begin with sudden abnormal electrical activity throughout the entire brain at once. These seizure types include: tonic-clonic convulsions ("grand mal" seizures) and absence seizures ("petit mal" or staring seizures).

Partial seizures begin with abnormal electrical activity in just one part of the brain. Although the activity starts in a specific area of the brain, this activity can spread to other parts as well. These seizures types include: simple partial seizures, complex partial seizures, and secondarily generalized seizures.

Epilepsy vs seizures?

Seizures are characterized by a sudden change in movement, behavior, sensation or consciousness produced by an abnormal electrical discharge in the brain. Epilepsy is a condition of spontaneously recurring seizures. Having a single seizure does not necessarily mean a person has epilepsy. High fever, severe head injury, lack of oxygen, or a number of other factors can cause a single seizure.

Epilepsy, on the other hand, tends to be a lifelong condition that affects how electrical energy and connections behave in the brain.

First Aid

Convulsive seizures

• When providing seizure first aid for generalized tonic-clonic (grand mal) seizures or partial seizures with secondary generalization, these are the key things to remember:
• Keep calm and reassure other people who may be nearby.
• Don't hold the person down or try to stop their movements.
• Time the seizure.
• Clear the area around the person of anything hard or sharp.
• Loosen ties or anything around the person's neck that may make breathing difficult.
• Put something flat and soft, like a folded jacket, under the person's head.
• Turn them gently onto one side. This will help keep their airway clear.
• Do not try to force their mouth open with any hard implement or with fingers. A person having a seizure CANNOT swallow their tongue. Efforts to hold the tongue down can injure teeth or the jaw.
• Don't attempt artificial respiration except in the unlikely event that a person does not start breathing again after the seizure has stopped.
• Stay with the person until the seizure ends naturally.
• Be friendly and reassuring as consciousness returns.
• Offer to call a taxi, friend or relative to help the person get home if they seems confused or unable to get home by themself.

Most generalized tonic-clonic (grand mal) seizures end by themselves. In a person with a history of seizures, they are not a medical emergency even though they can appear frightening. If the seizure stops naturally after a few minutes without injury, the person does not necessarily need to go to a hospital. In other circumstances, an ambulance might need to be called.

An ambulance should be called if:

• The person does not have a history of seizures.
• The seizure happened in water.
• The person is not wearing any medical ID, and there is no way of knowing whether or not the seizure is caused by epilepsy.
• The person is pregnant, injured, or diabetic.
• The seizure continues for more than five minutes.
• A second seizure starts shortly after the first has ended.
• Consciousness does not start to return after the shaking/convulsing has stopped.

If the ambulance arrives after the person has returned to consciousness, the person should be asked whether the seizure was associated with epilepsy and whether emergency care is needed.

What are some of the causes of epilepsy?

There are many causes of epilepsy. Some causes are hereditary, and can results in seizures starting in either childhood or as an adult. Other causes include head trauma, meningitis, brain tumors, stroke, or multiple sclerosis. However, if you have experienced a seizure, please note that many times, none of these diagnoses are made. In most cases, no clear cause of the seizure can be determined. Please consult with you physician about your personal situation.

How is epilepsy diagnosed?

Epilepsy is diagnosed by meeting with your neurologist and undergoing a series of basic tests. The first step is to review your medical history (including a detailed recounting of the seizures) with your physician. This physician will also conduct a thorough neurological examination. In most cases, an EEG (electroencephalogram) and MRI (magnetic resonance imaging) test will be performed as well. You will meet with the physician after these tests to discuss your overall personal health situation.

How is epilepsy treated?

The mainstay of epilepsy therapy remains anti-seizure medications. Various medications have been used for decades, and they remain very effective for the majority of patients with epilepsy. In more recent years, medications with better side effect profiles and safer long-term records have been introduced.

For patients who do not respond to medications, the vagus nerve stimulator and resective epilepsy surgery are also options. Finally, there are a number of investigational interventions currently in development. Please discuss these options and your personal situation with your neurologist.

What is an electroencephalography (EEG)?

An electroencephalogram (EEG) is a test to detect abnormalities in the electrical activity of the brain. Brain cells (or neurons) communicate by producing electrical signals. To perform an EEG test, electrodes are placed on the scalp to detect and record patterns of this electrical activity and check for abnormalities.

The test is performed by an EEG technician in a specially designed room that is located in the hospital. At the beginning of the test, you will lie on your back on a table or in a reclining chair. The technician will apply between 16 and 25 flat metal discs (the electrodes) in different positions on your scalp. The electrodes are affixed to your scalp with a paste and are connected by wires to an amplifier and a recording machine. There is no invasive part of this test, and you should feel no discomfort.

As the test begins, the recording machine converts the electrical signals into a series of wavy lines that are recorded on a computer. You will need to lie still with your eyes closed because any movement can alter these results. You may be asked to do certain things during the recording, such as breathe deeply for several minutes or look at a flickering light.

Your health care provider may want you to discontinue some medications before the test. Do not change or stop medications without first consulting your physician.

You should avoid all foods containing caffeine for 8 hours before the test.

Sometimes it is necessary to sleep during the test, so you may be asked to reduce your sleep time the night before. Please discuss this possibility with your physician.

The EEG test is used to help diagnose the presence and type of seizure disorders, to look for causes of confusion, and to evaluate head injuries, tumors, infections, degenerative diseases, and metabolic disturbances that affect the brain. It is also used to partly evaluate sleep disorders and to investigate periods of unconsciousness.

What is Magnetic Resonance Imaging (MRI)?

An MRI (magnetic resonance imaging) scan is a non-invasive procedure that uses powerful magnets to construct pictures of the body. Unlike conventional radiography, which uses potentially harmful radiation (X-rays), MRI imaging is based on the magnetic properties of atoms. A powerful magnet in the machine generates an intense magnetic field around the body, and some hydrogen atoms within the human tissue will align with this field. When radio wave pulses are directed at this tissue, the hydrogen atoms that have been affected by the magnet will return a signal. These signals are used to construct pictures of the part of the body being examined. In the case of epilepsy, the brain is the subject of interest.

The MRI scanner must be located within a specially shielded room to avoid outside interference. The patient will be asked to lie on a narrow table which slides into a large tunnel-like tube. If contrast is to be administered, an IV will be placed, usually in a small vein of the hand or forearm. A technologist will operate the machine and observe you during the entire study from an adjacent room. Several sets of images are usually obtained, each taking from 2 to 15 minutes. A complete scan may take up to one hour or more.

No preparatory tests, diets, or medications are usually needed before having an MRI performed. An MRI can be completed immediately after other imaging studies. Because of the strong magnets, certain metallic objects are not allowed into the room. Items such as jewelry, watches, credit cards, and hearing aids can be damaged, and must be removed prior to taking the test. Removable dental work should be taken out just prior to the scan. Pens, pocketknives, and eyeglasses can become dangerous projectiles when the magnet is activated and should not accompany the patient into the scanner area.

Because the strong magnetic fields can displace or disrupt the action of implanted metallic objects, people with cardiac pacemakers cannot be scanned and should not enter the MRI area. MRI also should not be used for people with metallic objects in their bodies, such as: inner ear (cochlear) implants, brain aneurysm clips, some artificial heart valves, older vascular stents, and recently placed artificial joints. Sheet metal workers, or persons with similar potential exposure to small metal fragments, will first be screened for metal shards within the eyes with X-rays of the skull.

The patient will be asked to sign a consent form confirming that none of the above issues apply before the study will be performed. A hospital gown may be recommended, or the patient may be allowed to wear "sweats" or similar clothing without metal fasteners.

There is no pain experienced during the scanning procedure. However, some people do have a claustrophobic. The table may be hard or cold, but you can request a blanket or pillow. The machine produces loud thumping and humming noises during normal operation. Ear plugs are given to the patient to reduce the noise. For people that have trouble with small spaces, a mild sedative may be used during the scan. If this is done, someone needs to be available to help get the patient home.

A technologist observes the patient during the entire procedure and may speak through an intercom in the scanner. Some MRI scanners are equipped with televisions and special headphones to help the examination time pass.

What is a Positron Emission Tomography (PET) scan?

A Positron Emission Tomography (PET) scan is a diagnostic exam that evaluates the energy activity of the brain. Positrons are tiny particles released from a low dose of radioactive substance administered to the patient prior to the exam.

The PET scan measures how intensely different parts of the brain use up glucose, oxygen, or other substances. A small amount of a radioactive substance is injected into one of the patient’s veins prior to the test. This substance attaches itself to glucose. Small objects (positrons) are released from the tagged glucose, which is detected by the PET scanner. The images that result are helpful in diagnosing a variety of conditions and diseases, including epilepsy.

The PET images are programmed to show different colors or levels of brightness. The possible area where a seizure occurs may appear darker in the brain tissue in comparison to other areas.

The actual PET scanner looks like a large doughnut. Around the central hole of the machine are rings of detectors that record the emission of positrons. As the patient lies on a cushioned table, the patient will be moved into the central hole of the machine. The test will take about 90 minutes. The patient should not eat for at least 6 hours before the PET scan. The patient will be encouraged to drink several glasses of water before the test.

The PET scan itself will cause no discomfort. The patient will lie in a cushioned examination table and be asked to remain still during the exam. Some patients who are claustrophobic may feel anxious while positioned in the PET scanner. Patients should talk with their physicians if they have a history of claustrophobia.

The PET scan allows physicians to better evaluate the functioning of different regions of the brain. It can show where seizures potentially start and help determine if a patient is a candidate for surgery.

For pregnant and nursing women, the radioactive substance may expose the fetus or infants who are breast-feeding to a small amount of radiation. The risk to the fetus or infant should be considered in relation to the potential information gained from the result of the PET examination. If the patient is pregnant or may be pregnant, the patient should inform the PET imaging staff before the examination is performed.

What is Video EEG Telemetry?

Inpatient video EEG monitoring enables the physicians to gather additional information about the specific types of seizures patients are having. The more accurately we are able to classify the seizure type, the better the chances are to achieve seizure control with medications.

Additionally, for people who are having spells without a clear diagnosis, video EEG telemetry can often be useful in characterizing such episodes. These spells may be diagnosed as epileptic seizures, but may also be determined to be psychogenic non-epileptic events, syncope, or cardiac-related spells.

Video EEG telemetry also assists physicians in localizing the seizure focus in the brain. This is critical if patients wish to know if they have the type of seizures that may be treated surgically. Seizure surgery is most successful when physicians are able to localize the precise area in the brain where seizures originate. Prolonged video EEG monitoring allows physicians to record a number of seizures, providing the best video and EEG data possible

The video EEG telemetry procedure has two parts:

1, EEG Telemetry: As during a routine EEG, electrodes are glued to the patient’s scalp. The electrodes then record for 24 hours per day. A computer monitors the EEG recording continuously so that seizure activity can be marked. This recording gives physicians an accurate count of seizures and allows the doctors to compare what is physically happening to the patient during a seizure with what is seen on the brain wave recordings.

2, Video: A camera is used to continuously film the patient while you are connected to EEG electrodes. By using the video, the physicians can see what happens to patients physically while they are having a seizure. Seeing what happens physically allows the physicians to better determine what type of seizures the patient is experiencing and where the seizure might be starting in the brain.

What is Magnetoencephalography (MEG)?

A magnetoencephalogram (MEG) is a test that identifies brain activity by measuring small electrical currents arising from the neurons of the brain. These currents produce magnetic fields. The MEG generates an accurate location of the magnetic fields produced by the neurons. The MEG test is somewhat related to the electroencephalography (EEG) test except that it is using magnetic fields as the primary information for determining where seizures might be originating.

The MEG test takes approximately two hours. An EEG is done at the same time as the MEG. Electrodes will be placed on the patient’s scalp using paste. All electronic items or items with a magnetic strip (cell phones, credit cards) will be removed. Also, all metal above the waist should be removed, such as under wire bra, shirts with zippers or snaps, jewelry and wrist watches. The patient will be in a specially shielded room during the test, and will lay in a bed with the head resting in the helmet-like MEG scanner. The MEG scanner does not emit radiation or magnetic fields. It only detects and amplifies magnetic signals produced by the brain.

There are video and intercom systems in the room. The technician can see, hear, and communicate with the patient at all times. During the scan, the patient must keep his/her head still. The head is immobilized by using cushions that are placed on both sides of the head.

The patient may be asked to arrive sleep-deprived in the hopes of recording brain activity in the awake, drowsy, and sleep states.

The MEG test causes no discomfort. The scanner does not make noise. The patient will be able to have someone in the room with you during the test, but they must also remove electronic and metallic objects.

What is Magnetic Resonance Imaging (MRI)?

An MRI (magnetic resonance imaging) scan is a non-invasive procedure that uses powerful magnets to construct pictures of the body. Unlike conventional radiography, which uses potentially harmful radiation (X-rays), MRI imaging is based on the magnetic properties of atoms. A powerful magnet in the machine generates an intense magnetic field around the body, and some hydrogen atoms within the human tissue will align with this field. When radio wave pulses are directed at this tissue, the hydrogen atoms that have been affected by the magnet will return a signal. These signals are used to construct pictures of the part of the body being examined. In the case of epilepsy, the brain is the subject of interest.

The MRI scanner must be located within a specially shielded room to avoid outside interference. The patient will be asked to lie on a narrow table which slides into a large tunnel-like tube. Once inside the machine, small devices may be placed around the head, arm, or leg, or adjacent to other areas to be studied. These are special coils which are designed to improve the quality of the images.

If contrast is to be administered, an IV will be placed, usually in a small vein of the hand or forearm. A technologist will operate the machine and observe you during the entire study from an adjacent room.

Several sets of images are usually obtained, each taking from 2 to 15 minutes. A complete scan may take up to one hour or more.

No preparatory tests, diets, or medications are usually needed before having an MRI performed. An MRI can be completed immediately after other imaging studies. Because of the strong magnets, certain metallic objects are not allowed into the room. Items such as jewelry, watches, credit cards, and hearing aids can be damaged, and must be removed prior to taking the test. Removable dental work should be taken out just prior to the scan. Pens, pocketknives, and eyeglasses can become dangerous projectiles when the magnet is activated and should not accompany the patient into the scanner area.

Because the strong magnetic fields can displace or disrupt the action of implanted metallic objects, people with cardiac pacemakers cannot be scanned and should not enter the MRI area. MRI also should not be used for people with metallic objects in their bodies, such as: inner ear (cochlear) implants, brain aneurysm clips, some artificial heart valves, older vascular stents, and recently placed artificial joints. Sheet metal workers, or persons with similar potential exposure to small metal fragments, will first be screened for metal shards within the eyes with X-rays of the skull.

The patient will be asked to sign a consent form confirming that none of the above issues apply before the study will be performed. A hospital gown may be recommended, or the patient may be allowed to wear "sweats" or similar clothing without metal fasteners.

There is no pain experienced during the scanning procedure. However, some people do have a claustrophobic. The table may be hard or cold, but you can request a blanket or pillow. The machine produces loud thumping and humming noises during normal operation. Ear plugs are given to the patient to reduce the noise.

A technologist observes the patient during the entire procedure and may speak through an intercom in the scanner. Some MRI scanners are equipped with televisions and special headphones to help the examination time pass.

About Pre-surgical Evaluation for Epilepsy

Many patients have similar questions about having seizure surgery and what tests may be needed before surgery. The following general information is intended to provide some answers. However, each epilepsy patient is unique and his or her care is always individualized. All patients should discuss their unique situation with their physician.

Seizure surgery is an operation aimed at removing the area of your brain that is causing the seizures. The goal of surgery is to improve seizure control and when possible, to stop seizures completely. There are several types of seizure surgery, and every patient is approached as a unique individual.

After several medications have failed to control a patient’s seizures that individual’s epilepsy is called refractory. Studies have shown that in cases of refractory epilepsy, medications are less likely to work. Surgery may help some of these patients, and seizures may come under control with the addition of surgery. For patients who are open to this option, a surgical evaluation may be initiated.

Results from the video EEG telemetry session give the doctors a better understanding of what part(s) of your brain the seizures may be arising from. If most of the seizures are coming from one specific area, it may be possible to safely remove this area (seizure focus) in an effort to control the seizures. However, there are additional tests that will be needed in order to help the epilepsy team determine exactly where the seizures arise from and whether surgery is a safe option.

The full epilepsy team consists of epileptologists (doctors specializing in epilepsy), brain surgeons (neurosurgeons), radiologists, neuropsychologists, an epilepsy nurse, a neurosurgery nurse practitioner, the EEG technologists, and the scheduling staff.

There are several types of additional tests that may be needed before being considered for surgery. Some of the tests include: Magnetic Resonance Imaging (MRI), Positron Emission Tomography (PET), Magnetoencephalography (MEG), Neuropsychological testing, and the Wada test.

The information gathered from the tests above is aimed at better defining and localizing your specific seizure focus and to help determine if that focus can be safely removed.

In some cases, however, the results of the tests may give the epilepsy team an idea as to where the seizures start but not enough information to be conclusive. If the initial scalp EEG or radiological testing doesn’t provide enough localizing information, the patient may need further evaluation using intracranial monitoring (Invasive Monitoring). Intracranial monitoring records brain wave activity using electrodes placed surgically in or on the surface of the brain.

If surgery is found to be an option, the last two tests are the neuropsychological evaluations and the Wada test. The neuropsychological evaluation will be done by a neuropsychologist. Extensive testing may determine the site of the seizures, as well as appraise the possible effects of the surgery on cognitive functioning.

The Wada test evaluates the location of speech and memory functions in the patient’s brain. This test is done in an angiography suite with the radiologist, neurologist and anesthesiologist. Sodium amytal, a short acting medicine, will be used to sedate one side of the brain while the other side is being tested by a neuropsychologist. The results of this test determine which side of the brain is the dominant area for crucial functions, such as language. It may determine whether the patient will be awake during part of the surgery. This test and its results should be discussed with the patient’s physician in detail.

Once the Epilepsy Team has obtained and reviewed all the necessary tests, they will present the results to the patient and together, the patient and physician team will make a decision about surgery.

What is Invasive Monitoring?

Invasive monitoring is a term that refers to recording brain waves using electrodes placed in or on the surface of the brain. In rare cases when scalp recordings do not localize your seizures, intracranial electrodes may be necessary to acquire further information. This procedure involves undergoing surgery to place the electrode at various places on the surface of the brain. These electrodes allow your physicians to get much higher quality information that what normal scalp-based electrodes can detect.

Ultimately, your physicians will determine if you are a candidate for having intracranial electrodes. In almost all cases, this is an advanced test that is only performed for patients who are being considered for epilepsy resective surgery.

If this decision is made, the epilepsy team will determine the number, the type and the exact placement of electrodes needed to further evaluate the seizure focus. There are different types of intracranial electrodes, including depth electrodes, subdural strips, and subdural grids all of which are placed by the neurosurgeon. You will get details about your particular situation if this intervention becomes necessary.

If you have this procedure, you will be admitted to the hospital at least a day before the placement of the intracrainal electrodes. You will need to wash your hair the night before the procedure. Part of your head will likely be shaved. This is done to prevent infection. Plan to stay in the hospital for at least 5 to 7 days after the electrodes are placed. After the electrodes are placed, you will be in a private monitored room such as the one you were in for video-EEG recordings. The overall test is very similar to routine video EEG monitoring, except that the electrodes are invasive.

You may experience scalp pain and headaches after the procedure. You may also experience some scalp or face swelling, especially with a grid set of electrodes. Your nurses and doctors will do all they can to make you comfortable.

Just as there are many different kinds of seizures, there are many different kinds of epilepsy. Hundreds of different epilepsy syndromes – disorders characterized by a specific set of symptoms that include epilepsy as a prominent symptom – have been identified. Some of these syndromes appear to be either hereditary or caused by de novo mutations. For other syndromes, the cause is unknown. Epilepsy syndromes are frequently described by their symptoms or by where in the brain they originate.

Absence epilepsy is characterized by repeated seizures that cause momentary lapses of consciousness. These seizures almost always begin in childhood or adolescence and tend to run in families, suggesting that they may be at least partially due to genetic factors. Individuals may show purposeless movements during their seizures, such as a jerking arm or rapidly blinking eyes, while others may have no noticeable symptoms except for brief times when they appear to be staring off into space. Immediately after a seizure, the person can resume whatever he or she was doing. However, these seizures may occur so frequently (in some cases up to 100 or more a day) that the person cannot concentrate in school or other situations. Childhood absence epilepsy usually stops when the child reaches puberty. Although most children with childhood absence epilepsy have a good prognosis, there may be long-lasting negative consequences and some children will continue to have absence seizures into adulthood and/or go on to develop other seizure types.

Frontal lobe epilepsy is a common epilepsy syndrome that features brief focal seizures that may occur in clusters. It can affect the part of the brain that controls movement and involves seizures that can cause muscle weakness or abnormal, uncontrolled movement such as twisting, waving the arms or legs, eye deviation to one side, or grimacing, and are usually associates with some loss of awareness. Seizures usually occur when the person is asleep but also may occur while awake.

Temporal lobe epilepsy, or TLE, is the most common epilepsy syndrome with focal seizures. These seizures are often associated with auras of nausea, emotions (such as déjà vu or fear), or unusual smell or taste. The seizure itself is a brief period of impaired consciousness which may appear as a staring spell, dream-like state, or repeated automatisms. TLE often begins in childhood or teenage years. Research has shown that repeated temporal lobe seizures are often associated with shrinkage and scarring (sclerosis) of the hippocampus. The hippocampus is important for memory and learning. It is not clear whether localized asymptomatic seizure activity over years causes the hippocampal sclerosis.

Neocortical epilepsy is characterized by seizures that originate from the brain's cortex, or outer layer. The seizures can be either focal or generalized. Symptoms may include unusual sensations, visual hallucinations, emotional changes, muscle contractions, convulsions, and a variety of other symptoms, depending on where in the brain the seizures originate.

There are many other types of epilepsy that begin in infancy or childhood. For example, infantile spasms are clusters of seizures that usually begin before the age of 6 months. During these seizures the infant may drop their head, jerk an arm, bend at the waist and/or cry out. Children with Lennox-Gastaut syndrome have several different types of seizures, including atonic seizures, which cause sudden falls and are also called drop attacks. Seizure onset is usually before age four years. This severe form of epilepsy can be very difficult to treat effectively. Rasmussen's encephalitis is a progressive form of epilepsy in which half the brain shows chronic inflammation. Some childhood epilepsy syndromes, such as childhood absence epilepsy, tend to go into remission or stop entirely during adolescence, whereas other syndromes such as juvenile myoclonic epilepsy (which features jerk-like motions upon waking) and Lennox-Gastaut syndrome are usually present for life once they develop. Children with Dravet syndrome have seizures that start before age one and later in infancy develop into other seizure types.

Hypothalamic hamartoma is a rare form of epilepsy that first occurs during childhood and is associated with malformations of the hypothalamus at the base of the brain. People with hypothalamic hamartoma have seizures that resemble laughing or crying. Such seizures frequently go unrecognized and are difficult to diagnose.

Seizures are divided into two major categories – focal seizures and generalized seizures. However, there are many different types of seizures in each of these categories. In fact, doctors have described more than 30 different types of seizures.

Focal Seizures

Focal seizures originate in just one part of the brain. About 60 percent of people with epilepsy have focal seizures. These seizures are frequently described by the area of the brain in which they originate. Many people are diagnosed with focal frontal lobe or medial temporal lobe seizures.

In some focal seizures, the person remains conscious but may experience motor, sensory, or psychic feelings (for example, intense dejà vu or memories) or sensations that can take many forms. The person may experience sudden and unexplainable feelings of joy, anger, sadness, or nausea. He or she also may hear, smell, taste, see, or feel things that are not real and may have movements of just one part of the body, for example, just one hand.

In other focal seizures, the person has a change in consciousness, which can produce a dreamlike experience. The person may display strange, repetitious behaviors such as blinks, twitches, mouth movements (often like chewing or swallowing, or even walking in a circle). These repetitious movements are called automatisms. More complicated actions, which may seem purposeful, can also occur involuntarily. Individuals may also continue activities they started before the seizure began, such as washing dishes in a repetitive, unproductive fashion. These seizures usually last just a minute or two.

Some people with focal seizures may experience auras – unusual sensations that warn of an impending seizure. Auras are usually focal seizures without interruption of awareness ( e.g., dejà vu, or an unusual abdominal sensation) but some people experience a true warning before an actual seizure. An individual’s symptoms, and the progression of those symptoms, tend to be similar every time. Other people with epilepsy report experiencing a prodrome, a feeling that a seizure is imminent lasting hours or days.

The symptoms of focal seizures can easily be confused with other disorders. The strange behavior and sensations caused by focal seizures also can be mistaken for symptoms of narcolepsy, fainting, or even mental illness. Several tests and careful monitoring may be needed to make the distinction between epilepsy and these other disorders.

Generalized Seizures

Generalized seizures are a result of abnormal neuronal activity that rapidly emerges on both sides of the brain. These seizures may cause loss of consciousness, falls, or a muscle’s massive contractions. The many kinds of generalized seizures include:

• Absence seizures may cause the person to appear to be staring into space with or without slight twitching of the muscles.
• Tonic seizures cause stiffening of muscles of the body, generally those in the back, legs, and arms.
• Clonic seizures cause repeated jerking movements of muscles on both sides of the body.
• Myoclonic seizures cause jerks or twitches of the upper body, arms, or legs.
• Atonic seizures cause a loss of normal muscle tone, which often leads the affected person to fall down or drop the head involuntarily.
• Tonic-clonic seizures cause a combination of symptoms, including stiffening of the body and repeated jerks of the arms and/or legs as well as loss of consciousness.
• Secondary generalized seizures.

Not all seizures can be easily defined as either focal or generalized. Some people have seizures that begin as focal seizures but then spread to the entire brain. Other people may have both types of seizures but with no clear pattern.

Some people recover immediately after a seizure, while others may take minutes to hours to feel as they did before the seizure. During this time, they may feel tired, sleepy, weak, or confused. Following focal seizures or seizures that started from a focus, there may be local symptoms related to the function of that focus. Certain characteristics of the post-seizure (or post-ictal) state may help locate the region of the brain where the seizure occurred. A classic example is called Todd’s paralysis, a temporary weakness in the part of the body that was affected depending on where in the brain the focal seizure occurred. If the focus is in the temporal lobe, post-ictal symptoms may include language or behavioral disturbances, even psychosis. After a seizure, some people may experience headache or pain in muscles that contracted.

While any seizure is cause for concern, having a seizure does not by itself mean a person has epilepsy. First seizures, febrile seizures, nonepileptic events, and eclampsia (a life-threatening condition that can occur in pregnant women) are examples of conditions involving seizures that may not be associated with epilepsy. Regardless of the type of seizure, it's important to inform your doctor when one occurs.

First seizures

Many people have a single seizure at some point in their lives, and it can be provoked or unprovoked, meaning that they can occur with or without any obvious triggering factor. Unless the person has suffered brain damage or there is a family history of epilepsy or other neurological abnormalities, the majority of single seizures usually are not followed by additional seizures. Medical disorders which can provoke a seizure include low blood sugar, very high blood sugar in diabetics, disturbances in salt levels in the blood (sodium, calcium, magnesium), eclampsia during or after pregnancy, impaired function of the kidneys, or impaired function of the liver. Sleep deprivation, missing meals, or stress may serve as seizure triggers in susceptible people.

Many people with a first seizure will never have a second seizure, and physicians often counsel against starting antiseizure drugs at this point. In some cases where additional epilepsy risk factors are present, drug treatment after the first seizure may help prevent future seizures. Evidence suggests that it may be beneficial to begin antiseizure medication once a person has had a second unprovoked seizure, as the chance of future seizures increases significantly after this occurs. A person with a pre-existing brain problem, for example, a prior stroke or traumatic brain injury, will have a higher risk of experiencing a second seizure. In general, the decision to start antiseizure medication is based on the doctor's assessment of many factors that influence how likely it is that another seizure will occur in that person.

In one study that followed individuals for an average of eight years, 33 percent of people had a second seizure within four years after an initial seizure. People who did not have a second seizure within that time remained seizure-free for the rest of the study. For people who did have a second seizure, the risk of a third seizure was about 73 percent by the end of four years. Among those with a third unprovoked seizure, the risk of a fourth was 76 percent.

Febrile Seizures

Not infrequently a child will have a seizure during the course of an illness with a high fever. These seizures are called febrile seizures. Antiseizure medications following a febrile seizure are generally not warranted unless certain other conditions are present: a family history of epilepsy, signs of nervous system impairment prior to the seizure, or a relatively prolonged or complicated seizure. The risk of subsequent non-febrile seizures is low unless one of these factors is present.

Results from a study funded by the National Institute of Neurological Disorders and Stroke (NINDS) suggested that certain findings using diagnostic imaging of the hippocampus may help identify which children with prolonged febrile seizures are subsequently at increased risk of developing epilepsy.

Researchers also have identified several different genes that influence the risks associated with febrile seizures in certain families. Studying these genes may lead to new understandings of how febrile seizures occur and perhaps point to ways of preventing them.

Nonepileptic Events

An estimated five to 20 percent of people diagnosed with epilepsy actually have non-epileptic seizures (NES), which can outwardly resemble epileptic seizures, but are not associated with seizure-like electrical discharge in the brain. Non-epileptic events may be referred to as psychogenic non-epileptic seizures (PNES). PNES do not respond to antiseizure drugs; instead, PNES are often treated by cognitive behavioral therapy to decrease stress and improve self-awareness.

A history of traumatic events is among the known risk factors for PNES. People with PNES should be evaluated for underlying psychiatric illness and treated appropriately. Two studies together showed a reduction in seizures and fewer coexisting symptoms following treatment with cognitive behavioral therapy. Some people with epilepsy have psychogenic seizures in addition to their epileptic seizures.

Other nonepileptic events may be caused by:

• Narcolepsy (sudden attacks of sleep)
• Tourette syndrome (repetitive involuntary movements called tics)
• Cardiac arrhythmia (irregular heartbeat)
• Other medical conditions with symptoms that resemble seizures

Because symptoms of these disorders can look very much like epileptic seizures, they are often mistaken for epilepsy.

The epilepsies have many possible causes, but for up to half of people with epilepsy a cause is not known. In other cases, the epilepsies are clearly linked to genetic factors, developmental brain abnormalities, infection, traumatic brain injury, stroke, brain tumors, or other identifiable problems. Anything that disturbs the normal pattern of neuronal activity – from illness to brain damage to abnormal brain development – can lead to seizures.

The epilepsies may develop because of an abnormality in brain wiring, an imbalance of nerve signaling in the brain (in which some cells either over-excite or over-inhibit other brain cells from sending messages), or some combination of these factors. In some pediatric conditions abnormal brain wiring causes other problems such as intellectual impairment.

In other persons, the brain's attempts to repair itself after a head injury, stroke, or other problem may inadvertently generate abnormal nerve connections that lead to epilepsy. Brain malformations and abnormalities in brain wiring that occur during brain development also may disturb neuronal activity and lead to epilepsy.

Genetics

Genetic mutations may play a key role in the development of certain epilepsies. Many types of epilepsy affect multiple blood-related family members, pointing to a strong inherited genetic component. In other cases, gene mutations may occur spontaneously and contribute to development of epilepsy in people with no family history of the disorder (called “de novo” mutations). Overall, researchers estimate that hundreds of genes could play a role in the disorders.

Several types of epilepsy have been linked to mutations in genes that provide instructions for ion channels, the "gates" that control the flow of ions in and out of cells to help regulate neuronal signaling. For example, most infants with Dravet syndrome, a type of epilepsy associated with seizures that begin before the age of one year, carry a mutation in the SCN1A gene that causes seizures by affecting sodium ion channels.

Genetic mutations also have been linked to disorders known as the progressive myoclonic epilepsies, which are characterized by ultra-quick muscle contractions (myoclonus) and seizures over time. For example, Lafora disease, a severe, progressive form of myoclonic epilepsy that begins in childhood, has been linked to a gene that helps to break down carbohydrates in brain cells.

Mutations in genes that control neuronal migration – a critical step in brain development – can lead to areas of misplaced or abnormally formed neurons, called cortical dysplasia, in the brain that can cause these mis-wired neurons to misfire and lead to epilepsy.

Other genetic mutations may not cause epilepsy, but may influence the disorder in other ways. For example, one study showed that many people with certain forms of epilepsy have an abnormally active version of a gene that results in resistance to anti-seizure drugs. Genes also may control a person's susceptibility to seizures, or seizure threshold, by affecting brain development.

Other Disorders

Epilepsies may develop as a result of brain damage associated with many types of conditions that disrupt normal brain activity. Seizures may stop once these conditions are treated and resolved. However, the chances of becoming seizure-free after the primary disorder is treated are uncertain and vary depending on the type of disorder, the brain region that is affected, and how much brain damage occurred prior to treatment. Examples of conditions that can lead to epilepsy include:

• Brain tumors, including those associated with neurofibromatosis or tuberous sclerosis complex, two inherited conditions that cause benign tumors called hamartomas to grow in the brain
• Head trauma
• Alcoholism or alcohol withdrawal
• Alzheimer's disease
• Strokes, heart attacks, and other conditions that deprive the brain of oxygen (a significant portion of new-onset epilepsy in elderly people is due to stroke or other cerebrovascular disease)
• Abnormal blood vessel formation (arteriovenous malformations) or bleeding in the brain (hemorrhage)
• Inflammation of the brain
• Infections such as meningitis, HIV, and viral encephalitis

Cerebral palsy or other developmental neurological abnormalities may also be associated with epilepsy. About 20 percent of seizures in children can be attributed to developmental neurological conditions. Epilepsies often co-occur in people with abnormalities of brain development or other neurodevelopmental disorders. Seizures are more common, for example, among individuals with autism spectrum disorder or intellectual impairment. In one study, fully a third of children with autism spectrum disorder had treatment-resistant epilepsy.

Seizure Triggers

Seizure triggers do not cause epilepsy but can provoke first seizures in those who are susceptible or can cause seizures in people with epilepsy who otherwise experience good seizure control with their medication. Seizure triggers include alcohol consumption or alcohol withdrawal, dehydration or missing meals, stress, and hormonal changes associated with the menstrual cycle. In surveys of people with epilepsy, stress is the most commonly reported seizure trigger. Exposure to toxins or poisons such as lead or carbon monoxide, street drugs, or even excessively large doses of antidepressants or other prescribed medications also can trigger seizures.

Sleep deprivation is a powerful trigger of seizures. Sleep disorders are common among people with the epilepsies and appropriate treatment of co-existing sleep disorders can often lead to improved control of seizures. Certain types of seizures tend to occur during sleep, while others are more common during times of wakefulness, suggesting to physicians how to best adjust a person’s medication.

For some people, visual stimulation can trigger seizures in a condition known as photosensitive epilepsy. Stimulation can include such things as flashing lights or moving patterns.

What is a Stroke?

A stroke happens when a clot blocks the blood supply to the brain or when a blood vessel in the brain bursts. Every year, about 795,000 people in the United States have a stroke. It is a leading cause of long-term disability and a leading cause of death.

Signs that someone is having a stroke are:

• Sudden numbness or weakness in the face, arm, or leg, especially on one side of the body.
• Sudden confusion, trouble speaking, or problems understanding speech.
• Sudden trouble seeing in one or both eyes.
• Sudden trouble walking, dizziness, loss of balance, or lack of coordination.
• Sudden severe headache with no known cause.

Call 911 right away if you or someone else has any of these symptoms. Learn more about acting F.A.S.T. to make sure someone having a stroke gets help quickly.

Strokes Can Cause Seizures and Epilepsy

Epilepsy is a broad term used for a brain disorder that causes repeated seizures. There are many types of epilepsy, and there are also many different kinds of seizures.

A single seizure may happen soon after a stroke. You may not have epilepsy if you have just one seizure, and you won’t necessarily develop it. Certain types of strokes, such as ones that cause bleeding, and more severe strokes, may be more likely to cause epilepsy.

One study found that among people who had strokes, 5% had one seizure and 7% developed epilepsy in the 30 months afterward.

Epilepsy caused by strokes can usually be controlled with anti-seizure medicines. It’s important to take medicine as prescribed to keep seizures under control.

Preventing Stroke

Lower your chance of having a stroke by:

• Controlling high blood pressure, diabetes, and high cholesterol.
• Having a healthy weight.
• Being physically active.
• Eating a healthy diet.
• Limiting alcohol.
• Avoiding smoking.

Older Adults Are More at Risk

Overall, adults with a history of epilepsy are much more likely to report that they’ve had a stroke compared to people who have never had epilepsy. This is especially true in people aged 45 or older, those with lower incomes, and those who have a history of high blood pressure. A CDC study found that about 23% of adults aged 65 or older with a history of epilepsy reported having had a stroke, compared to only about 5% of older adults without a history of epilepsy.

New epilepsy is also more likely to develop in older adults than younger adults. When examining causes for new-onset epilepsy in older adults, stroke accounts for up to half of these new cases of epilepsy. This makes stroke one of the most common reasons people develop epilepsy as they age.

Seizures may be hard to recognize in older adults and may be overlooked. For instance, trouble with memory, confusion, falls, dizziness, or numbness may be viewed as “normal” aging problems. However, these can actually be symptoms of seizures and are not normal. Older adults who have had a stroke, and their caregivers, should watch for these symptoms.

Do you know what to do if someone has a seizure? Review seizure first aid steps. Seizure first aid is easy to learn and to give.

Prevent epilepsy by preventing stroke!

A traumatic brain injury (TBI) happens when someone gets a bump, blow, or jolt to the head, or a penetrating injury to the head (such as a gunshot). TBIs can range from mild (such as concussions) to severe, life-threatening injuries. They can cause changes in:

• Thinking and remembering.
• Vision and balance.
• Emotions, such as anxiety, irritability, or sadness.
• Sleep.

TBIs can happen to anyone, but some groups are at greater risk of dying or having long-term health problems after the injury. These groups include racial and ethnic minorities, service members and veterans, people experiencing homelessness, people in correctional and detention facilities, survivors of intimate partner violence, and people living in rural areas.

TBIs can also cause epilepsy and seizures

Epilepsy is a broad term used for a brain disorder that causes repeated seizures. There are many types of epilepsy and there are also many different kinds of seizures. TBIs can cause a seizure right after the injury happens or even months or years later. Researchers agree that the more severe the TBI, the greater the chance the person may develop epilepsy. Age and other medical conditions may also play a role in whether or not a person may develop epilepsy after a TBI.

The terms post-traumatic epilepsy (PTE) and post-traumatic seizures (PTS) are both used to describe seizures that happen because of a TBI. In 2018, there were about 223,050 hospitalizations for TBI in the United States. A CDC-funded study found that among people aged 15 years and older hospitalized for TBI, about 1 out of 10 developed epilepsy in the following 3 years.

Everyone can:

• Learn the signs and symptoms of TBI and when to seek medical care.
• Take the CDC’s HEADS UP training to learn how to recognize, respond to, and minimize the risk of concussion or TBI – especially if you’re a parent, coach, child care provider, or school professional.

If you or someone you care for has a head injury, here’s what you need to know:

• Seek medical attention and share information about TBI signs and symptoms.
• Talk to the doctor about the risk for having seizures or developing epilepsy after a TBI.
• Learn to recognize the signs of a seizure. Sometimes it can be hard to tell. Some seizures cause a person to fall, cry out, shake or jerk, and become unaware of what’s going on around them. Other seizures can make a person appear confused, make it hard for them to answer questions, twitch, or cause the person to feel like they taste, see, or smell something unusual.
• Learn first aid so you are prepared if someone has a seizure.

To prevent TBIs that may cause epilepsy, protect your brain from injury. For example:

• Use seat belts and properly installed car safety seats every time you drive or ride in a motor vehicle.
• Never drive while under the influence of alcohol or drugs.
• Wear a helmet when playing certain sports and riding bikes, horses, motorcycles, or all-terrain vehicles.
• Prevent falls, especially in older adults and young children.

• Roll the person on his or her side to prevent choking on any fluids or vomit.
• Cushion the person’s head.
• Loosen any tight clothing around the neck.
• Don’t restrict the person from moving or wandering unless he or she is in danger.
• Do NOT put anything into the person’s mouth, not even medicine or liquid. These can cause choking or damage to the person’s jaw, tongue, or teeth. Remember, people cannot swallow their tongues during a seizure or any other time.
• Remove any dangerous objects the person might hit or walk into during the seizure.
• Note how long the seizure lasts and what symptoms occurred so you can tell a doctor or emergency personnel if necessary.
• Stay with the person until the seizure ends.

Call 911 if:

• The person is pregnant or has diabetes.
• The seizure happened in water.
• The seizure lasts longer than 5 minutes.
• The person does not begin breathing normally or does not regain consciousness after the seizure stops.
• Another seizure starts before the person regains consciousness.
• The person injures himself or herself during the seizure.
• This is a first seizure or you think it might be. If in doubt, check to see if the person has a medical identification card or jewelry stating that they have epilepsy or a seizure disorder.

After the seizure ends, the person will probably be groggy and tired. He or she also may have a headache and be confused or embarrassed. Try to help the person find a place to rest. If necessary, offer to call a taxi, a friend, or a relative to help the person get home safely.

Don't try to stop the person from wandering unless he or she is in danger.

Don't shake the person or shout.

Stay with the person until he or she is completely alert.

Accurate diagnosis of epilepsy is crucial for finding an effective treatment. Several tests are used to determine whether a person has epilepsy and, if so, what kind of seizures the person has. Generally, epilepsy is diagnosed after a person has had two or more unprovoked seizures separated by at least 24 hours.

Medical history

Taking a detailed medical history, including symptoms and duration of the seizures, is still one of the best methods available to determine what kind of seizures a person has had and to help determine what type of epilepsy the person has. The medical history should include details about any past illnesses or other symptoms a person may have had, as well as any family history of seizures.

Since people who have a seizure often do not remember what happened, accounts from people who have witnessed the seizures are very important. The person who experienced the seizure is asked about whether they felt anything unique (warning experiences) before the seizure started. The observers will be asked to provide a detailed description and timeline for the seizure.

Imaging and monitoring epilepsy

There are several scans and imaging techniques that can help diagnose and monitor a person's epilepsy. These include:

• An electroencephalogram (EEG), a test that measures electrical activity in the brain, can look for abnormalities in the person's brain waves and may help to determine if antiseizure drugs would help. Video monitoring may be used in conjunction with EEG to determine the nature of a person's seizures and to rule out other disorders that may look like epilepsy.
• SEEG (stereoelectoencephalograpy) is the surgical implantation of electrodes into the brain in order to better find where the seizures are located. SEEG can help determine if an individual is a candidate for epilepsy surgery. A magnetoencephalogram (MEG) measures the magnetic signals generated by neurons to help find unusual brain activity. MEG can help surgeons plan any appropriate surgeries to remove focal areas involved in seizures while minimizing interference with normal brain function.
• CT (computerized tomography) and MRI (magnetic resonance imaging) scans reveal structural abnormalities of the brain such as tumors and cysts, which may cause seizures. A type of MRI called functional MRI (fMRI) can be used to localize normal brain activity and detect abnormalities in brain function.
• PET (positron emission tomography)scans take pictures of the brain and show regions of the brain with normal and abnormal chemical activity. PET scans can be used to identify brain regions with lower-than-normal metabolism, which can indicate the focus of the seizure after it has stopped.
• Single photon emission computed tomography (SPECT) is sometimes used to find the location of focal seizures in the brain. In a person admitted to the hospital for epilepsy monitoring, the SPECT blood flow tracer is injected within 30 seconds of a seizure. The images of brain blood flow at the time of the seizure are compared with blood flow images taken in between seizures. The seizure onset area shows a high blood flow region on the scan.

Blood tests

Blood tests can screen for metabolic or genetic disorders that may contribute to the seizures. They also may be used to check for underlying health conditions such as infections, lead poisoning, anemia, and diabetes that may be causing or triggering the seizures.

Developmental, neurological, and behavioral tests

Tests to measure motor abilities, behavior, and intellectual ability often are used to determine how epilepsy is affecting an individual. These tests also can provide clues about what kind of epilepsy the person has.

Accurate diagnosis of the type of epilepsy a person has is crucial for finding an effective treatment. There are many different ways to successfully control seizures. Doctors who treat the epilepsies come from many different fields of medicine and include neurologists, pediatricians, pediatric neurologists, internists, and family physicians, as well as neurosurgeons. An epileptologist is someone who has completed advanced training and specializes in treating the epilepsies.

Once epilepsy is diagnosed, it is important to begin treatment as soon as possible. Research suggests that medication and other treatments may be less successful once seizures and their consequences become established. There are several treatment approaches that can be used depending on the individual and the type of epilepsy. If seizures are not controlled quickly, referral to an epileptologist at a specialized epilepsy center should be considered, so that careful consideration of treatment options, including dietary approaches, medication, devices, and surgery, can be performed in order to gain optimal seizure treatment.

Medications

The most common approach to treating the epilepsies is to prescribe antiseizure drugs. More than 20 different antiseizure medications are available today, all with different benefits and side effects. Most seizures can be controlled with one drug (called monotherapy). Deciding on which drug to prescribe, and at what dosage, depends on many different factors, including seizure type, lifestyle and age, seizure frequency, drug side effects, medicines for other conditions, and, for a woman, whether she is pregnant or will become pregnant. It may take several months to determine the best drug and dosage. If one treatment is unsuccessful, another may work better.

Seizure medications include:

In June 2018 the U.S. Food and Drug Administration approved cannabidiol (Epidolex, derived from marijuana) for the treatment of seizures associated with Lennox-Gastaut syndrome and Dravet syndrome for children age 2 and older. The drug contains only small amount of the psychoactive element in marijuana and does not induce euphoria associated with the drug. In November 2019 the FDA approved cenobamate tablets to treat adults with partial-onset seizures. FDA also has approved the drug tenfluramine to reduce the frequency of convulsive seizures associated with Dravet syndrome in children ages 2 years and older.

For many people with epilepsy, seizures can be controlled with monotherapy at the optimal dosage. Combining medications may amplify side effects such as fatigue and dizziness, so doctors usually prescribe just one drug whenever possible. Combinations of drugs, however, are still sometimes necessary for some forms of epilepsy that do not respond to monotherapy.

When starting any new antiseizure medication, a low dosage will usually be prescribed initially followed by incrementally higher dosages, sometimes with blood-level monitoring, to determine when the optimal dosage has been reached. It may take time for the dosage to achieve optimal seizure control while minimizing side effects. The latter are usually worse when first starting a new medicine.

Most side effects of antiseizure drugs are relatively minor, such as fatigue, dizziness, or weight gain. Antiseizure medications have differing effects on mood: some may worsen depression, where others may improve depression or stabilize mood. However, severe and life-threatening reactions such as allergic reactions or damage to the liver or bone marrow can occur. Antiseizure medications can interact with many other drugs in potentially harmful ways. Some antiseizure drugs can cause the liver to speed the metabolism of other drugs and make the other drugs less effective, as may be the case with oral contraceptives. Since people can become more sensitive to medications as they age, blood levels of medication may need to be checked occasionally to see if dosage adjustments are necessary. The effectiveness of a medication can diminish over time, which can increase the risk of seizures. Some citrus fruit and products, in particular grapefruit juice, may interfere with the breakdown of many drugs, including antiseizure medications – causing them to build up in the body, which can worsen side effects.

Some people with epilepsy may be advised to discontinue their antiseizure drugs after 2-3 years have passed without a seizure. Others may be advised to wait for 4 to 5 years. Discontinuing medication should always be done with supervision of a health care professional. It is very important to continue taking antiseizure medication for as long as it is prescribed. Discontinuing medication too early is one of the major reasons people who have been seizure-free start having new seizures and can lead to status epilepticus. Some evidence also suggests that uncontrolled seizures may trigger changes in the brain that will make it more difficult to treat the seizures in the future.

The chance that a person will eventually be able to discontinue medication varies depending on the person's age and his or her type of epilepsy. More than half of children who go into remission with medication can eventually stop their medication without having new seizures. One study showed that 68 percent of adults who had been seizure-free for 2 years before stopping medication were able to do so without having more seizures and 75 percent could successfully discontinue medication if they had been seizure-free for 3 years. However, the odds of successfully stopping medication are not as good for people with a family history of epilepsy, those who need multiple medications, those with focal seizures, and those who continue to have abnormal EEG results while on medication.

There are specific syndromes in which certain antiseizure medications should not be used because they may make the seizures worse. For example, carbamazepine can worsen epilepsy in children diagnosed with Dravet syndrome.

Diet

Dietary approaches and other treatments may be more appropriate depending on the age of the individual and the type of epilepsy. A high-fat, very low carbohydrate ketogenic diet is often used to treat medication-resistant epilepsies. The diet induces a state known as ketosis, which means that the body shifts to breaking down fats instead of carbohydrates to survive. A ketogenic diet effectively reduces seizures for some people, especially children with certain forms of epilepsy. Studies have shown that more than 50 percent of people who try the ketogenic diet have a greater than 50 percent improvement in seizure control and 10 percent experience seizure freedom. Some children are able to discontinue the ketogenic diet after several years and remain seizure-free, but this is done with strict supervision and monitoring by a physician.

The ketogenic diet is not easy to maintain, as it requires strict adherence to a limited range of foods. Possible side effects include impaired growth due to nutritional deficiency and a buildup of uric acid in the blood, which can lead to kidney stones.

Researchers are looking at modified versions of and alternatives to the ketogenic diet. For example, studies show promising results for a modified Atkins diet and for a low-glycemic-index treatment, both of which are less restrictive and easier to follow than the ketogenic diet, but well-controlled randomized controlled trials have yet to assess these approaches.

Surgery

Evaluation of persons for surgery is generally recommended only after focal seizures persist despite the person having tried at least two appropriately chosen and well-tolerated medications, or if there is an identifiable brain lesion (a dysfunctional part of the brain) believed to cause the seizures. When someone is considered to be a good candidate for surgery experts generally agree that it should be performed as early as possible.

Surgical evaluation takes into account the seizure type, the brain region involved, and the importance of the area of the brain where seizures originate (called the focus) for everyday behavior. Prior to surgery, individuals with epilepsy are monitored intensively in order to pinpoint the exact location in the brain where seizures begin. Implanted electrodes may be used to record activity from the surface of the brain, which yields more detailed information than an external scalp EEG. Surgeons usually avoid operating in areas of the brain that are necessary for speech, movement, sensation, memory and thinking, or other important abilities. fMRI can be used to locate such “eloquent” brain areas involved in an individual.

While surgery can significantly reduce or even halt seizures for many people, any kind of surgery involves some level of risk. Surgery for epilepsy does not always successfully reduce seizures and it can result in cognitive or personality changes as well as physical disability, even in people who are excellent candidates for it. Nonetheless, when medications fail, several studies have shown that surgery is much more likely to make someone seizure-free compared to attempts to use other medications. Anyone thinking about surgery for epilepsy should be assessed at an epilepsy center experienced in surgical techniques and should discuss with the epilepsy specialists the balance between the risks of surgery and desire to become seizure-free.

Even when surgery completely ends a person's seizures, it is important to continue taking antiseizure medication for some time. Doctors generally recommend continuing medication for at least two years after a successful operation to avoid recurrence of seizures.

Surgical procedures for treating epilepsy disorders include:

• Surgery to remove a seizure focus involves removing the defined area of the brain where seizures originate. It is the most common type of surgery for epilepsy, which doctors may refer to as a lobectomy or lesionectomy, and is appropriate only for focal seizures that originate in just one area of the brain. In general, people have a better chance of becoming seizure-free after surgery if they have a small, well-defined seizure focus. The most common type of lobectomy is a temporal lobe resection, which is performed for people with medial temporal lobe epilepsy. In such individuals one hippocampus (there are two, one on each side of the brain) is seen to be shrunken and scarred on an MRI scan.
• Multiple subpial transection may be performed when seizures originate in part of the brain that cannot be removed. It involves making a series of cuts that are designed to prevent seizures from spreading into other parts of the brain while leaving the person's normal abilities intact.
• Corpus callosotomy,or severing the network of neural connections between the right and left halves (hemispheres) of the brain, is done primarily in children with severe seizures that start in one half of the brain and spread to the other side. Corpus callosotomy can end drop attacks and other generalized seizures. However, the procedure does not stop seizures in the side of the brain where they originate, and these focal seizures may even worsen after surgery.
• Hemispherectomy and hemispherotomy involve removing half of the brain's cortex, or outer layer. These procedures are used predominantly in children who have seizures that do not respond to medication because of damage that involves only half the brain, as occurs with conditions such as Rasmussen's encephalitis. While this type of surgery is very excessive and is performed only when other therapies have failed, with intense rehabilitation, children can recover many abilities.
• Thermal ablation for epilepsy, also called laser interstitial thermal therapy, directs a set amount of energy to a specific, targeted brain region causing the seizures (the seizure focus). The energy, which is changed to thermal energy, destroys the brain cells causing the seizures. Laser ablation is less invasive than open brain surgery for treating epilepsy.

Devices

Electrical stimulation of the brain remains a therapeutic strategy of interest for people with medication-resistant forms of epilepsy who are not candidates for surgery.

The vagus nerve stimulation device for the treatment of epilepsy was approved by the U.S. Food and Drug Administration (FDA) in 1997. The vagus nerve stimulator is surgically implanted under the skin of the chest and is attached to the vagus nerve in the lower neck. The device delivers short bursts of electrical energy to the brain via the vagus nerve. On average, this stimulation reduces seizures by about 20 - 40 percent. Individuals usually cannot stop taking epilepsy medication because of the stimulator, but they often experience fewer seizures and they may be able to reduce the dosage of their medication.

Responsive stimulation involves the use of an implanted device that analyzes brain activity patterns to detect a forthcoming seizure. Once detected, the device administers an intervention, such as electrical stimulation or a fast-acting drug to prevent the seizure from occurring. These devices also are known as closed-loop systems. NeuroPace, one of the first responsive stimulation, closed-loop devices, received premarket approval by the FDA in late 2013 and is available for adults with refractory epilepsy (hard to treat epilepsy that does not respond well to trials of at least two medicines).

Experimental devices: not approved by the FDA for use in the United States (as of March 2015)

• Deep brain stimulation using mild electrical impulses has been tried as a treatment for epilepsy in several different brain regions. It involves surgically implanting an electrode connected to an implanted pulse generator – similar to a heart pacemaker – to deliver electrical stimulation to specific areas in the brain to regulate electrical signals in neural circuits. Stimulation of an area called the anterior thalamic nucleus has been particularly helpful in providing at least partial relief from seizures in people who had medication-resistant forms of the disorder.
• A report on trigeminal nerve stimulation (using electrical signals to stimulate parts of the trigeminal nerve and affected brain regions) showed efficacy rates similar to those for vagal nerve stimulation, with responder rates hovering around 50 percent. (A responder is defined as someone having greater than a 50 percent reduction in seizure frequency.) Freedom from seizures, although reported, remains rare for both methods. At the time of this writing, a trigeminal nerve stimulation device was available for use in Europe, but it had not yet been approved in the United States.
• Transcutaneous magnetic stimulation involves a device being placed outside the head to produce a magnetic field to induce an electrical current in nearby areas of the brain. It has been shown to reduce cortical activity associated with specific epilepsy syndromes.

Although most people with epilepsy lead full, active lives, there is an increased risk of death or serious disability associated with epilepsy. There may be an increased risk of suicidal thoughts or actions related to some antiseizure medications that are also used to treat mania and bipolar disorder. Two life-threatening conditions associated with the epilepsies are status epilepticus and sudden unexpected death in epilepsy (SUDEP).

Status Epilepticus

Status epilepticus is a potentially life-threatening condition in which a person either has an abnormally prolonged seizure or does not fully regain consciousness between recurring seizures. Status epilepticus can be convulsive (in which outward signs of a seizure are observed) or nonconvulsive (which has no outward signs and is diagnosed by an abnormal EEG). Nonconvulsive status epilepticus may appear as a sustained episode of confusion, agitation, loss of consciousness, or even coma.

Any seizure lasting longer than 5 minutes should be treated as though it was status epilepticus. There is some evidence that 5 minutes is sufficient to damage neurons and that seizures are unlikely to end on their own, making it necessary to seek medical care immediately. One study showed that 80 percent of people in status epilepticus who received medication within 30 minutes of seizure onset eventually stopped having seizures, whereas only 40 percent recovered if 2 hours had passed before they received medication. The mortality rate can be as high as 20 percent if treatment is not initiated immediately.

Researchers are trying to shorten the time it takes for antiseizure medications to be administered. A key challenge has been establishing an intravenous (IV) line to deliver injectable antiseizure drugs in a person having convulsions. An NINDS-funded study on status epilepticus found that when paramedics delivered the medication midazolam to the muscles using an autoinjector, similar to the EpiPen drug delivery system used to treat serious allergic reactions, seizures could be stopped significantly earlier compared to when paramedics took the time to give lorazepam intravenously. In addition, drug delivery by autoinjector was associated with a lower rate of hospitalization compared with IV delivery (see the NINDS news story).

Sudden Unexplained Death in Epilepsy (SUDEP)

For reasons that are poorly understood, people with epilepsy have an increased risk of dying suddenly for no discernible reason. Some studies suggest that each year approximately one case of SUDEP occurs for every 1,000 people with the epilepsies. For some, this risk can be higher, depending on several factors. People with more difficult to control seizures tend to have a higher incidence of SUDEP.

SUDEP can occur at any age. Researchers are still unsure why SUDEP occurs, although some research points to abnormal heart and respiratory function due to gene abnormalities (ones which cause epilepsy and also affect heart function). People with epilepsy may be able to reduce the risk of SUDEP by carefully taking all antiseizure medication as prescribed. Not taking the prescribed dosage of medication on a regular basis may increase the risk of SUDEP in individuals with epilepsy, especially those who are taking more than one medication for their epilepsy.

1. SUDEP is not well understood.

SUDEP stands for Sudden Unexpected Death in Epilepsy. It refers to deaths in people with epilepsy that are not from injury, drowning, or other known causes. Most, but not all, cases of SUDEP happen during or right after a seizure.

Researchers do not understand the exact cause of SUDEP, but these are possible reasons it happens:

• Breathing changes: A seizure may cause a person to have pauses in breathing. If these pauses last too long, they can reduce the oxygen in the blood to a dangerous level. Also, if a person’s airway gets blocked during a seizure, that can lead to suffocation.
• Heart rhythm changes: Rarely, a seizure may cause a dangerous heart rhythm or cardiac arrest.
• Other causes and mixed causes: SUDEP may happen because of a combination of breathing trouble and abnormal heart rhythm.

People with epilepsy are at increased risk of SUDEP if they have:

• Uncontrolled or frequent seizures.
• Generalized convulsive (what used to be called tonic-clonic or grand mal) seizures.

Other things that may increase a person’s risk of SUDEP include:

• Seizures that start at a young age.
• Many years of living with epilepsy.
• Missing doses of medicine.
• Drinking alcohol.

2. SUDEP is rare, but traumatic for families.

If you have epilepsy, it’s important to take your seizure medicine as prescribed. The chance of SUDEP is higher in people who have frequent seizures.

Researchers estimate that, for every 1,000 people with epilepsy, at least 1 person may die from SUDEP each year. This means that each year in the United States, there are about 3,000 deaths due to SUDEP. But counting SUDEP cases is hard because SUDEP is not always included on death certificates.

SUDEP occurs more often in people 21 to 40 compared to other age groups. Because SUDEP can happen unexpectedly to people who are so young, it can be very shocking for families and loved ones.

3. Managing seizures may help.

Research has shown that controlling seizures may lower the chance of SUDEP. If you have epilepsy, the most important way to do this is to take your seizure medicine as prescribed.

Other steps that might help lower the chance of SUDEP:

• Consider a seizure alert monitor if you often have seizures at night.
• Avoid seizure triggers if you know what they are.
• Don’t drink too much alcohol.
• Learn how to better control seizures and other symptoms with self-management programs.
• Get enough sleep.
• Make sure your family and friends know seizure first aid.

If you are taking medicine and still having seizures, talk to your doctor about changing your medicine or trying other things that might help. If seizures continue, consider seeing an epilepsy specialist.

4. Support is available.

Losing a loved one to SUDEP can be especially hard because it’s so unexpected. The Epilepsy Foundation’s SUDEP Institute provides information and support to families who are grieving.

Parents of children with epilepsy can learn more about SUDEP in children, including tips on how to talk to your child’s doctor.

5. Research continues.

CDC supports research to help us understand SUDEP better. Together with the National Institutes of Health, CDC funds the Sudden Death in the Young Case Registry. The goals of this project are to count the number of cases and to understand the causes of death in infants, children, and young adults who die suddenly and unexpectedly—including from SUDEP. Researchers will use this information to recommend ways to prevent these types of death in the future.

Sometimes we can prevent epilepsy. These are some of the most common ways to reduce your chances of developing epilepsy:

Prevent traumatic brain injuries

Brain injuries, also called traumatic brain injuries, are a frequent cause of epilepsy.

• Ride safely. Use safety belts, child passenger seats, airbags, bicycle helmets, and motorcycle helmets to reduce motor vehicle and traffic injuries.
• Step carefully. Falls are the leading cause of brain injury. Older adults and children have an increased chance of brain injuries from falls.
• Get help for traumatic brain injuries if they happen. The chance of epilepsy is high with severe brain injuries. Taking good care of the injury may help to avoid epilepsy.

Lower the chances of stroke and heart disease

Take steps everyday to lower your chances of stroke and heart disease. These include eating well, exercising, and not smoking. These health actions may prevent epilepsy later in life.

Get vaccinated

Protect yourself and your family from diseases. Immunizations (also known as vaccines or shots) lower your chances of infection that can sometimes lead to epilepsy. Read the CDC Recommendations for Vaccines and Immunizations.

Wash your hands and prepare food safely

An infection called cysticercosis is the most common cause of epilepsy world-wide. It is caused by a parasite and it is prevented through good hygiene and food preparation practices. Health screening and early treatment for cysticercosis can prevent epilepsy.

Stay healthy during your pregnancy

Some problems during pregnancy and childbirth can lead to epilepsy. Follow a prenatal care plan with your health care provider, like your doctor or nurse, to keep you and your baby healthy.

absence epilepsy – epilepsy in which the person has repeated absence seizures.

absence seizures –seizures seen in absence epilepsy, in which the person experiences a momentary loss in consciousness. The person may stare into space for several seconds and may have some twitching or mild jerking of muscles. An older term for absence seizures is petit mal seizures.

atonic seizures – seizures which cause a sudden loss of muscle tone, also called drop attacks.

auras – unusual sensations or movements that warn of an impending, more severe seizure. These auras are actually simple focal seizures in which the person maintains consciousness.

automatisms – automatic involuntary or mechanical actions.

clonic seizures – seizures that cause repeated jerking movements of muscles on both sides of the body.

convulsions –sudden severe contractions of the muscles that may be caused by seizures.

corpus callosotomy – surgery that severs the corpus callosum, or network of neural connections between the right and left hemispheres

déjà vu – a sense that something has happened before.

de novo- new, for the first time.

Dravet syndrome –a type of intractable epilepsy that begins in infancy.

drop attacks – seizures that cause sudden falls; another term for atonic seizures.

epilepsy syndromes – disorders with a specific set of symptoms that include epilepsy.

febrile seizures – seizures in infants and children that are associated with a high fever.

focal seizures – seizures that occur in just one part of the brain.

frontal lobe epilepsy – a type of epilepsy that originates in the frontal lobe of the brain. It usually involves a cluster of short seizures with a sudden onset and termination.

generalized seizures – seizures that result from abnormal neuronal activity in many parts of the brain. These seizures may cause loss of consciousness, falls, or abnormal movements such as convulsions.

grand mal seizures – an older term for tonic-clonic seizures.

hemispheres – the right and left halves of the brain.

hemispherectomy– surgery involving the removal or disabling of one hemisphere of the brain.

hemispherotomy – removing half of the brain’s outer layer (cortex).

hypothalamic hamartoma – a rare form of childhood epilepsy that is associated with malformations of the hypothalamus at the base of the brain.

infantile spasms – clusters of seizures that usually begin before the age of 6 months. During these seizures the infant may bend and cry out.

intractable – hard to treat; about 30 to 40 percent of people with epilepsy will continue to experience seizures even with the best available treatment.

juvenile myoclonic epilepsy – a type of epilepsy characterized by sudden muscle (myoclonic) jerks that usually begins in childhood or adolescence.

ketogenic diet – a strict diet rich in fats and low in carbohydrates that causes the body to break down fats instead of carbohydrates to survive.

Lafora disease – a severe, progressive form of epilepsy that begins in childhood and has been linked to a gene that helps to break down carbohydrates.

Lennox-Gastaut syndrome – a type of epilepsy that begins in childhood and usually causes several different kinds of seizures, including absence seizures.

lesion – damaged or dysfunctional part of the brain or other parts of the body.

lesionectomy – surgical removal of a specific brain lesion.

lobectomy – surgical removal of a lobe of the brain.

monotherapy – treatment with only one antiepileptic drug.

multiple subpial transection – a type of operation in which surgeons make a series of cuts in the brain that are designed to prevent seizures from spreading into other parts of the brain while leaving the person's normal abilities intact.

myoclonic seizures – seizures that cause sudden jerks or twitches, especially in the upper body, arms, or legs.

neocortical epilepsy – epilepsy that originates in the brain's cortex, or outer layer. Seizures can be either focal or generalized, and may cause strange sensations, hallucinations, or emotional changes.

nonconvulsive – any type of seizure that does not include violent muscle contractions.

nonepileptic seizures – any phenomena that look like seizures but do not result from abnormal brain activity. Nonepileptic events may include psychogenic seizures or symptoms of medical conditions such as sleep disorders, Tourette syndrome, or cardiac arrhythmia. Pseudoseizure is an older term for nonepileptic seizure.

post-ictal – post-seizure.

prodrome – a feeling that a seizure is imminent, which may last hours or days prior to the seizure.

progressive myoclonus epilepsy – a type of epilepsy that has been linked to an abnormality in the gene that codes for a protein called cystatin B. This protein regulates enzymes that break down other proteins.

Rasmussen's encephalitis – a progressive type of epilepsy in which half of the brain shows continual inflammation.

responsive stimulation – a form of treatment that uses an implanted device to detect a forthcoming seizure and administer intervention such as electrical stimulation or a fast-acting drug to prevent the seizure from occurring.

seizure focus – an area of the brain where seizures originate.

seizure threshold – a term that refers to a person's susceptibility to seizures.

seizure triggers –phenomena that trigger seizures in some people. Seizure triggers do not cause epilepsy but can lead to first seizures or cause breakthrough seizures in people who otherwise experience good seizure control with their medication.

status epilepticus – a potentially life-threatening condition in which a seizure is abnormally prolonged. Although there is no strict definition for the time at which a seizure turns into status epilepticus, most people agree that any seizure lasting longer than 5 minutes should, for practical purposes, be treated as though it was status epilepticus. Repeated seizures without regaining consciousness between the events is also considered a form of status epilepticus.

sudden unexpected deathin epilepsy (SUDEP) – death that occurs suddenly for no discernible reason. Epilepsy increases the risk of unexplained death about two-fold.

temporal lobe epilepsy – the most common epilepsy syndrome with focal seizures.

temporal lobe resection – a type of surgery for temporal lobe epilepsy in which all or part of the affected temporal lobe of the brain is removed.

tonic seizures – seizures that cause stiffening of muscles of the body, generally those in the back, legs, and arms.

tonic-clonic seizures – seizures that cause a mixture of symptoms, including loss of consciousness, stiffening of the body, and repeated jerks of the arms and legs. In the past these seizures were sometimes referred to as grand mal seizures.

vagus nerve stimulator – a surgically implanted device that sends short bursts of electrical energy to the brain via the vagus nerve and helps some individuals reduce their seizure activity.