Does epilepsy always cause seizures, and do they affect everyone the same?

Epilepsy is one of the most common neurological disorders in the world. In the United States, there are about 3.4 million people with some type of epilepsy — about 1 in 26 people.

While seizures are the main sign of the brain disorder, not everyone will experience seizures in the same way. Some people with epilepsy experience convulsions and lose consciousness. Others may have a brief lapse of awareness and stare into space for a short time.

Sometimes, someone might not completely realize after they’ve had a seizure that a seizure has even occurred. Or they might simply feel anxious, have a sense of déjà vu and/or notice that time has progressed but that they haven’t been “there” for this lost time.

During a seizure, a person might experience one or more of these symptoms:

• Blank stares that last only a few seconds
• Loss of consciousness
• Muscle spasms and uncontrollable movements for several minutes
• Having “strange” sensations or emotions
• Behaving differently or becoming disoriented
• Having a feeling of lost time, anxiety or a sense of déjà vu
• Flashing lights or certain noises

How is epilepsy diagnosed, and how long does diagnosis take?

In the U.S., 10% of people can have a one-time seizure. But of that 10%, only 30% will go on to develop epilepsy. That’s why it’s important to find a comprehensive epilepsy center to get an accurate diagnosis and to determine if the seizure was caused by epilepsy or something else.

The initial diagnosis process starts with looking at your medical history and getting a description of your seizures and potential triggers. You’ll then have specific tests done to find out if you’re at risk for continuous seizures or of developing epilepsy. Tests may include:

• Electroencephalogram (EEG) — a brief brain wave recording to look for activity showing how likely you are to have epilepsy.
• Magnetic resonance imaging (MRI) — uses a strong magnetic field and radio waves to create detailed images of the brain’s structure, so that we can look at whether structural lesions or other abnormalities could be causing your symptoms.
• Single photon emission computed tomography (SPECT) — a type of scan that detects blood flow changes in the brain and shows the “hotspot” in the brain where the seizure starts.
• A positron emission tomography (PET) scan — small amounts of radioactive material are injected into a vein, allowing us to study the brain’s use of oxygen or sugar (glucose).

A unique advantage of Ohio State’s Comprehensive Epilepsy Center is our state-of-the-art epilepsy monitoring unit (EMU) that’s designed to simulate everyday situations that could trigger seizures.

A stay in the EMU lasts three to five days and helps your treatment team learn about your seizures by triggering one in a controlled medical environment. This might seem overwhelming, but you can rest assured that you’ll be monitored and supervised closely during your stay to ensure your comfort and safety.

At the beginning of your stay, you’ll have a complete physical exam. We’ll also ask questions about your medications, medical history and seizures.

What should I look for in an epilepsy doctor?

The best way to manage your epilepsy is to understand how the disorder affects you. That’s why visiting a Level 4 epilepsy center early in your journey is crucial. A Level 4 epilepsy center offers the most advanced medical and surgical care for epilepsy.

At Ohio State, we conduct a specialized evaluation to examine how your epilepsy impacts your life and brain function. We also provide ongoing resources, education and support to help you manage the challenges that an epilepsy diagnosis can bring.

Our team approach brings together physicians, nurse practitioners, nurses, radiologists, neuropsychologists and neurosurgeons. Having multiple providers from different specialties on the treatment team allows us to provide the best care to each patient and their individual circumstances.

No single person knows everything about epilepsy, so with this team approach, we bring the best of all worlds together to get you the treatment you need to stop this progressive disease.

Another important aspect of being treated at a Level 4 epilepsy center is access to clinical trials. Our clinical trials enable us to offer the latest and greatest innovations in treatment to improve the lives of patients with epilepsy.

Can you outgrow epilepsy?

Some forms of epilepsy, such as childhood absence epilepsy, characterized by recurrent seizures, can be outgrown. About 60% of these patients will outgrow their disorder by their teenage years. Others could continue to have seizures into adulthood and will need lifelong treatment with medication.

People who are diagnosed with focal epilepsy are less likely to outgrow it. Focal epilepsy suggests that seizures are coming from a structural abnormality in the brain. Focal seizures can be due to head trauma, stroke, infection, cancer or other causes. Some genetic disorders can also cause focal seizures.

What are the treatment options for epilepsy?

The treatment options for epilepsy vary depending on the type of epilepsy you have and the frequency of your seizures. Here at the Ohio State Wexner Medical Center, we offer all these options:

Medications

There are more than 30 drugs approved for the treatment of epilepsy. Unfortunately, about a third of people with epilepsy don’t respond to medications and continue to have seizures. If you’ve tried two medications and they didn’t improve your epilepsy symptoms, it’s unlikely that a third or fourth medication will help.

If your epilepsy doesn’t respond to medication, your doctor will consider other treatment options based on the type of epilepsy and seizures you experience.

Dietary and lifestyle changes

Sometimes, when used in conjunction with medication, specific diets can help reduce and even eliminate seizures. Low-carb diets such as keto and modified Atkins can be useful for treating epilepsy.

Neuromodulation therapy

Neuromodulation is a non-invasive treatment that requires a short surgery to implant a device in either the chest or brain. Once implanted, the device stimulates nerves in your brain to help stop or control seizures. Neuromodulation therapies include deep brain stimulation, vagus nerve stimulation and responsive neurostimulation. These therapies can help with seizures and improve mood, memory, attention and energy.

Surgery

There are several types of epilepsy surgery options at Ohio State, depending on the type of epilepsy you have and what triggers your seizures.

Our designation as a Level 4 epilepsy center — the highest rating given by the National Association of Epilepsy Centers — means we have the expertise to perform even the most complicated surgeries.

New epilepsy treatment options currently being studied at Ohio State

We have multiple clinical trials currently running at Ohio State. For example, in one trial, scientists are studying patients with epilepsy using high- or low-frequency ultrasound to remove tissue to see if it helps the epilepsy and some of the other conditions that can go with epilepsy, such as anxiety and depression — which sometimes can be as debilitating as the seizures themselves.

Another clinical trial is exploring gene therapy for patients who have temporal lobe epilepsy, to see if an implanted gene therapy can help cure some of the damage in the hippocampus and stop a patient’s seizures.