Epilepsy & Seizure Facts
Definitions
Epilepsy is the general term for a variety of neurological conditions characterized by recurrent unprovoked seizures. A seizure is a brief disturbance in the electrical activity of the brain that causes temporary changes in movement, awareness, feelings, behavior, or other bodily functions.
 
Prevalence and Incidence
Epilepsy is the fourth most common neurological disorder in the United States after migraine, stroke, and Alzheimer’s disease. About one percent of Americans have some form of epilepsy, and nearly four percent (1 in 26) will develop epilepsy at some point in their lives. The number of Americans who have epilepsy is greater than the number who have multiple sclerosis, Parkinson’s disease, and cerebral palsy combined.  10% of Americans will have at least one seizure at some point in their lives.
                                   
Epilepsy is prevalent among other disability groups such as autism (25.5%), cerebral palsy (13%), Down syndrome (13.6%), and intellectual disability (25.5%). For people with both cerebral palsy and intellectual disability the prevalence of epilepsy is 40%.
 
Anyone can develop epilepsy at any time. Incidence is highest among the very young and the very old.
 
Causes
In about 70 percent of epilepsy cases, there is no known cause. Among the remaining 30 percent, the following causes are most frequent: traumatic brain injury, brain tumor, stroke, Alzheimer’s disease, poisoning (e.g. lead poisoning, alcohol or drug abuse, etc.), infection (e.g. meningitis, encephalitis, and others), prenatal or birth trauma, and developmental or congenital disabilities. Genetic factors also play a role in some types of epilepsy, but we still have a great deal to learn about this. 
 
Seizure Types and Epilepsy Types
There are about 20 different types of seizures and about 40 different types of epilepsy. It’s important for patients to ask their neurologists what type of seizures they are experiencing and what type of epilepsy is suspected. While most people are familiar with tonic-clonic or “grand mal” seizures, there are many types which are more subtle and can be easily confused with other conditions or behaviors. This can lead to misunderstanding or inappropriate reactions by onlookers and can also delay necessary diagnosis and treatment.
 
The following are some of the more common types of seizures:
                                                                               
  • Generalized Tonic-Clonic Seizure (formerly called grand mal): sudden fall and period of rigidity followed by muscle jerks, shallow breathing, pale or bluish skin, and possible vomiting or loss of bowel or bladder control; usually lasts a couple of minutes; normal breathing and complexion return promptly; some confusion and/or fatigue may occur, followed by a return of full consciousness.
  • Absence Seizure (formerly called petit mal): most common in children; looks like a blank stare; lasts for only a few seconds; may be accompanied by rapid blinking or chewing movements; person will be unaware of what happened during seizure, but will quickly return to full consciousness once the seizure has stopped; seizures often occur frequently throughout the day; atypical absence seizures begin and end more gradually and may last a bit longer; absence seizures may be mistaken for ADHD, behavior problems, or learning disabilities.
  • Drop Seizure: includes two distinct types of seizures, tonic and atonic—both of which frequently result in falling; in a tonic seizure, there is a sudden or gradual stiffening of the body, which often causes the individual to fall if standing; atonic seizures cause a sudden loss of muscle tone that may cause a drop of the head or fall to the ground; with both types of seizures, if consciousness is lost, the person usually regains it promptly with little or no confusion; because people with these seizures fall so suddenly, many have to wear helmets.
  • Myoclonic Seizure: seizure in which the primary symptom is one or more brief, shock-like bodily jerks caused by contractions of one or more muscles or muscle groups; often associated with childhood epilepsy syndromes.
  • Complex Partial Seizure: usually starts with blank stare, followed by chewing, walking about, random movements, vocalizations, picking at clothing, and other actions that the individual cannot control; person is unresponsive and awareness of surroundings is clouded; usually lasts 1-2 minutes; person will have no memory of what happened during the seizure and may be confused for several minutes after the seizure has stopped; in some cases, complex partial seizures may simply look like prolonged absence seizures; may be mistaken for mental illness, drug use, intoxication, aggression, or behavior problems.
  • Simple Partial Seizure: person is fully aware during the seizure; may involve jerking or other body movements, sensory distortions or hallucinations, unusual physical or emotional feelings, and other symptoms that are not obvious to the onlooker; may lead to another seizure.

For more information on seizure types, listen to our Learn & Share Conference Call on "Seizure Types: Implications for Diagnosis & Management" featuring Tyson Burghardt, MD.
 
Seizure First Aid
For tonic-clonic (grand mal) seizures...
  • check your watch or a clock once the seizure starts (to time the duration of the seizure)
  • if the person hasn’t already fallen, gently lower the person to the floor to prevent injury
  • clear the area of any sharp or dangerous objects
  • gently turn the person on one side to keep the airway open
  • place a soft object under the person’s head (e.g. a sweater or pillow) or cradle the head with your hand
  • gently loosen any restrictive clothing and remove glasses
  • If possible, cover the person with a blanket to maintain dignity (some people may lose bowel or bladder control during a seizure).
  • When the seizure ends, ask the person his or her name and location, and help to reorient. If disorientation or fatigue persists, allow the person to rest somewhere comfortable.
 
DO NOT…
  • place anything in the mouth of someone having a seizure or touch or hold the tongue.
  • restrain the person having a seizure.
  • administer liquids or foods until the person is fully conscious.
  • attempt to give oral medications during the seizure.
  • administer oxygen or CPR during the seizure.
 
CALL 911 IF…
  • the seizure lasts for more than 5 minutes.
  • the seizure stops and is followed by another seizure without the person fully regaining consciousness.
  • this is the person’s first seizure or if you don’t know whether or not the person has had a seizure before [NOTE: if the person has a medical ID or jewelry that says “epilepsy,” there is no need to call].
  • the seizure takes place in water.
  • the person is injured during the seizure (especially the head).
  • the person has diabetes or is pregnant.
  • normal breathing or complexion does not return after the seizure has stopped.
 
For complex partial seizures...
  • gently redirect from, block, or remove hazards.
  • explain what is happening to bystanders.
  • do not restrain forcefully.
  • when the seizure ends, ask the person his or her name and location, and help to reorient.
 
Treatment
Daily medication is the standard treatment for epilepsy. About 50 - 60% of people with epilepsy get complete seizure control through medication. Another 20 – 30% get improvement, but continue to have occasional seizures. The remaining 20 -30% get little or no improvement and continue to have frequent seizures. The goal of treatment should always be “no seizures and no side effects.” With this in mind, patients who continue to have seizures or side effects after having tried two to three medications should see an epileptologist (a neurologist who specializes in epilepsy) to review their current diagnosis and treatment regimen and to explore other treatment options.
 
Other treatment options include brain surgery, vagus nerve stimulation, and the ketogenic diet. There are also a number of complementary therapies that may be considered.
 
Risks
People with epilepsy are at increased risk of developing a number of physical and mental health conditions, including depression, memory problems, heart disease, stroke, arthritis, asthma, and cancer. Epilepsy also carries an increased risk of injury and death from a variety of causes. Most seizures are benign, but a prolonged seizure can evolve into status epilepticus, a condition that sometimes leads to brain injury and, occasionally, death. People with epilepsy also have a greater than average risk for suicide, sudden unexpected death in epilepsy (SUDEP), and accidental death, especially drowning. It’s important for patients to talk with their doctors about these risks and what can be done to reduce them.
 
Impact on Daily Life
Living with epilepsy is often associated with fear: fear of having a seizure in public, fear of injury, fear of losing one’s job, fear of dying, and many other legitimate fears. This feeling can be pervasive, even among those with well-controlled seizures. Persistent stigma and public misunderstanding about epilepsy only compound these fears.
 
Driving restrictions pose a major barrier to employment, independence, and social activity. Without a driver’s license, people who continue to have seizures are dependent upon family members, friends, walking, biking, or using public transportation to get around in their communities. In most cases, none of these options fully meet the individual’s needs. This lack of transportation, when combined with fear of seizures and other symptoms associated with epilepsy, often leads to social isolation.
 
Lack of transportation, along with cognitive problems, continued seizures, and employer misunderstanding, can also make finding and keeping a job very difficult. Without employment, people with epilepsy are often unable to get private health insurance, and in all too many cases, they are denied Medicaid, Medicare, and Social Security disability benefits. Without adequate insurance, seizure control gets worse, and epilepsy’s impact on daily life grows.
 
Most people with epilepsy are able to lead productive and fulfilling lives, but for many, epilepsy can be a devastating condition. Additional funding and support for research, improved public services and benefits, and increased awareness are all needed to minimize the impact of epilepsy.