Epilepsy

Epilepsy—also sometimes called a seizure disorder—can affect people of all ages, sexes, races, and backgrounds. The condition impacts around 50 million people globally, according to the World Health Organization (WHO). For every 1,000 people, between four and 10 have active epilepsy (in which seizures are present and treatment is necessary).

There are around 86 billion neurons (nerve cells) in the human brain. The brain, neurons, and spinal cord make up the nervous system. The nervous system helps the brain and body communicate and facilitates basic functions like breathing, thinking, walking, and talking.

Healthy neurons send chemical and electrical messages throughout your body. In epilepsy, neurons send abnormal signals or too many signals at the same time, essentially causing a burst of electrical activity. This burst can occur in various parts of the brain and cause a seizure, which may prompt a wide range of symptoms like loss of consciousness or involuntary movements, behaviors, sensations, or emotions.

Most seizures last between 30 seconds and two minutes. Though uncommon, it’s possible for seizures to last more than five minutes. (This is considered a medical emergency called status epilepticus.)

Having two or more unprovoked seizures at least 24 hours apart from each other is an indication of epilepsy. (An “unprovoked” seizure means there’s no obvious trigger.) Some people with epilepsy experience dozens of seizures daily, while others may only have one seizure every year or so.

Experiencing a seizure doesn’t necessarily mean you have epilepsy. According to WHO, as many as 10 percent of people worldwide experience one seizure in their lifetime. Other possible causes of seizures include:

• Low blood sugar  
• Withdrawal from use of drugs or alcohol
• Having a high fever (seizures related to high fever often occur in children)

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Epilepsy is a complex medical condition that can take many forms. The main types of epilepsy include:    

Generalized epilepsy  

This type of epilepsy causes seizures that affect both sides of the brain. Between 23 and 35 percent of epilepsy cases are generalized epilepsies. There are multiple subtypes of generalized epilepsy, many of which cause seizures that involve significant muscle contractions, jerks, or twitches. Such seizures may include:

Absence seizures  

Also known as a “petit mal” seizure, absence seizures typically last less than 10 seconds. They can pass so quickly that others may not realize the person is having a seizure. In severe cases, absence seizures can occur more than 100 times in a single day.

During an absence seizure, someone may appear like they’re staring off into space or “zoning out.” These seizures can also cause eye fluttering or unintended movements, like jerking of an arm. Typically, the person can return to normal activity immediately following the seizure. 

Another type of absence seizure is an atypical absence seizure, which can last 20 seconds or longer and involve automatisms (repetitive movements) like lip smacking, chewing motions, frequent blinking, or unusual hand movements, in addition to blank staring.

Tonic seizures

Tonic seizures are characterized by muscle stiffening, usually in the arms, legs, trunk, or back. Most of these seizures last around 20 seconds and take place during sleep. People who have tonic seizures while awake may fall and experience related injuries. They may also experience a brief loss of consciousness or awareness. Confusion and tiredness are common after a tonic seizure.

Often, tonic seizures affect people with Lennox-Gastaut syndrome, which is a severe type of epilepsy syndrome that begins in childhood (more on this type below).

Atonic seizures   

A person experiencing an atonic seizure may suddenly lose control of their muscles. This can result in falls and involuntary movements like slumping or their head dropping. (Atonic and tonic seizures are sometimes called “drop attacks,” because they tend to cause falls). Someone experiencing an atonic seizure may remain conscious or briefly lose awareness. Most atonic seizures last around 15 seconds or less.

Clonic seizures

Clonic seizures trigger repeated jerking muscle movements that occur on one or both sides of the body, sometimes along with numbness and tingling. They typically affect the face, neck, and arms and last for a minute or two. Generalized clonic seizures tend to cause loss of awareness or consciousness. Anyone of any age can experience a clonic seizure, including newborns.

Myoclonic seizures   

Myoclonic seizures can cause brief muscle twitches and jerking movements in the upper body, arms, or legs that may resemble electrical shocks. These seizures usually affect both sides of the body at the same time. Typically, myoclonic seizures last just a few seconds and can occur in bunches. Someone experiencing a myoclonic seizure may stay fully or partially conscious.

Tonic-clonic seizures

When people think of a stereotypically severe, dramatic seizure, they are likely picturing a tonic-clonic seizure. Sometimes referred to as a “grand mal” seizure, a tonic-clonic seizure can cause loss of conscious with falling, muscle stiffening (as in a tonic seizure), and jerking movements (as in a clonic seizure). It may also be accompanied by shaking, crying, drooling, tongue biting, or loss of bowel or bladder control. Tonic-clonic seizures usually last one to five minutes. Fatigue typically follows the seizure.

It’s possible for multiple myoclonic seizures to occur in a short amount of time and turn into a tonic-clonic seizure. These seizures may also take place in children with juvenile myoclonic epilepsy (JME, more information below).

Focal epilepsy   

Focal epilepsy occurs in just one part of the brain and causes focal seizures, which are sometimes called partial seizures. Around 60 percent of people with epilepsy experience focal seizures, according to the National Institute of Neurological Disorders and Stroke (NINDS). 

Focal seizures may be categorized as:

• Focal seizures with intact awareness: Formerly called simple focal seizures, these seizures impact a small portion of the brain and often cause twitching or unusual sensations that can impact smell or taste. The person remains alert and conscious during the seizure.
• Focal seizures with impaired awareness: Formerly called complex focal seizures, these seizures cause confusion or loss of awareness that can temporarily prevent the affected person from speaking or responding to questions.   

Focal seizures can also be categorized according to where they begin in the brain:

Temporal lobe seizures

Many focal seizures occur in one or both temporal lobes, which are located behind each ear.  The temporal lobes play a key role in maintaining short-term memory, processing emotions, interpreting sounds, and understanding language.

The most common symptoms associated with temporal lobe seizures are nausea, odd tastes or smells, and feelings of unease or déjà vu (the feeling that you’ve already experienced something happening to you). Someone who experiences this type of seizure may appear like they’re staring into space or are in a dreamlike state. Automatisms like lip smacking and finger rubbing can also occur. 

The frequent experience of temporal lobe seizures is linked to scarring and shrinkage in the hippocampus, which is the part of the brain that helps with learning and memory.

Frontal lobe seizures

Frontal lobe seizures occur in the brain’s frontal lobe. This is the part of the brain located behind the forehead that helps regulate emotions, decision making, problem solving, and movement. 

This type of seizure tends to come in bunches and often (though not always) occurs during sleep. The most common signs of frontal lobe seizures include grimacing, flailing of the arms or legs, twisting motions, eyes that move toward one side, or other uncontrolled movements."

Occipital lobe seizures  

The occipital lobe sits at the back of the brain and controls vision. Seizures that occur in the occipital lobe can trigger total or partial vision loss as well as unusual blinking or eye movements. Occipital lobe seizures may also cause visual hallucinations of bright, flashing lights. These seizures are uncommon, only accounting for around 5 percent of seizures among people with epilepsy.

Parietal lobe seizures

Parietal lobe seizures are also uncommon and make up around 5 percent of seizures experienced by people with epilepsy. They occur in the parietal lobe, which is situated at the top and sides of the brain and is the part of the brain that processes information regarding space and touch. Essentially, it’s where the brain assigns meaning to one’s interaction with the world.

Seizures that take place in the parietal lobe can cause sensory disruptions like numbness, weakness, electrical sensations, warmth, dizziness, and visual hallucinations.

Combined generalized and focal epilepsy  

Some people have both generalized and focal seizures and experience a wide range of seizure symptoms. This is known as combined generalized and focal epilepsy. People with Lennox-Gastaut syndrome and Dravet syndrome (a rare, treatment-resistant epilepsy syndrome) tend to experience combined generalized and focal epilepsy.

Unknown epilepsy 

Epilepsy is labeled as unknown if the origin or type of seizures a person experiences can’t be determined. This may happen if the results of diagnostic tests appear normal or there isn’t enough medical information to confirm a diagnosis.

Childhood epilepsy syndromes

An epilepsy syndrome is a type of epilepsy with a very specific set of symptoms. Several types of epilepsy syndromes can develop in infants or children, and many go into remission (a period without noticeable signs of disease) or resolve entirely during adolescence. Less commonly, epilepsy syndromes like Lennox-Gastaut syndrome and juvenile myoclonic epilepsy are chronic (long-term).

Examples of childhood epilepsy syndromes include: 

Childhood absence epilepsy: This is absence epilepsy that occurs in childhood. Most cases go away in adolescence, though it can sometimes continue into adulthood.

Developmental and epileptic encephalopathy (DEE): This is a severe group of epilepsy syndromes that can cause seizures in addition to encephalopathy (a condition that involves substantial delays in brain development). DEE is characterized by infantile spasms, which refers to repeated seizures that typically develop in infants younger than six months. Infantile spasms may cause a baby to cry, throw their arms up, drop their head, or bend over at the waist.

Hypothalamic hamartoma-associated epilepsy: This rare type of childhood epilepsy triggers seizures that may cause crying or laughing. It’s linked to structural abnormalities in the hypothalamus, which is located deep within the brain.

Juvenile myoclonic epilepsy (JME): This type of childhood epilepsy tends to develop in adolescence. JME typically causes seizures that occur within the first few hours after waking up from sleep. Seizures are characterized by jerky, electrical shock-like movements in the arms or fingers.

Lennox-Gastaut syndrome: This is a severe type of epilepsy that can cause sudden falls (drop attacks). Typically, children with Lennox-Gastaut syndrome start experiencing seizures by age 4. Intellectual disability may accompany this syndrome.

Rasmussen’s encephalitis: This is a gradually developing type of childhood epilepsy that triggers chronic inflammation in one half of the brain.   

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The most common symptom of epilepsy is recurrent seizures. A seizure caused by epilepsy is known as an epileptic seizure. Seizures can produce a broad spectrum of symptoms depending on what part of the brain they occur in and their severity. These seizure symptoms may range from hardly noticeable to severe.

Some of the most common signs of epileptic seizures include:

• Staring spells
• Loss of consciousness or awareness
• Muscle stiffness  
• Reduced muscle control
• Uncontrollable movements, including shaking or jerking motions of the arms or legs
• Sudden joy, sadness, anxiety, fear, déjà vu, confusion, warmth, coldness, or other sensations or emotions    
• Loss of bowel control or bladder control
• Unexplained changes in hearing, vision, smell, or taste
• Trouble speaking or understanding others  
• Upset stomach or nausea
• Automatisms such as increased blinking, lip smacking, twitching, chewing motions, finger rubbing, or even walking in an unusual fashion
• Psychosis (detachment from reality), including experiencing hallucinations or delusions

A person with epilepsy typically experiences just one type of seizure with the same general symptoms, though this isn’t always the case. They may remember only parts of the seizure, all of it, or none of it once the seizure is over.

What are the stages of a seizure?

Seizures tend to occur in stages, which includes the prodrome, aura, ictal, and post-ictal stage.

The prodrome stage

This stage signals that a seizure may occur in the upcoming hours or days. Some people with epilepsy notice the prodrome stage, while others don’t. A few common signs of this stage include:

• Trouble sleeping
• Increased anxiety
• Changes in mood or behavior
• Lightheadedness
• Difficulty concentrating

Aura (stage 1)

Aura is largely viewed as the very beginning of the seizure. It’s also known as the pre-ictal stage. Sometimes, an epileptic seizure doesn’t progress past this stage. Signs of aura may include: 

• Déjà vu 
• Jamais vu (feeling like you’re viewing something you’re already familiar with for the very first time)
• Changes in vision
• Dizziness
• Panic or fear
• Unusual tastes, sounds, or smells
• Headache
• Nausea 

Ictal stage (stage 2) 

The ictal (or middle) stage occurs when a burst of electrical activity takes place in the brain. It’s what many people view as the actual seizure, starting after the aura and ending once the seizure is complete. The signs of this stage can vary significantly from person to person, but may include:   

• Loss of consciousness or awareness
• Muscle twitches or convulsions
• Jerking movements 
• Automatisms like chewing motions, lip smacking, or finger rubbing
• Lack of muscle control
• Confusion
• Lapses in memory
• Trouble breathing
• Difficulty speaking, hearing, or understanding
• Unusual tastes, sounds, or smells

Post-ictal stage (stage 3)

The post-ictal stage is the recovery period following the seizure. How long it takes for someone to return to their normal state will vary according to the type of seizure and where in the brain it occurred. The post-ictal stage may involve:

• Reduced consciousness or awareness
• Fatigue
• Confusion
• Feelings of anxiety, fear, anger, shame, or embarrassment
• Nausea
• Loss of bowel or bladder control
• Headache
• Nausea
• Increased thirst
• Weakness or sore muscles  

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The cause of epilepsy is unknown in two out of three people with the condition, according to the CDC. This is called idiopathic epilepsy. For others, epilepsy can be linked to one or more of the following health issues:

Head injuries: Severe head injuries from traumatic events like collisions in sports, vehicle accidents, and falls can cause epilepsy.

Certain medical conditions: Some medical conditions can impact the brain and lead to epilepsy, including:

• Infections like meningitis, HIV, viral encephalitis, brain abscesses, neurocysticercosis and other parasitic infections. (It’s important to note that epilepsy and seizures are not contagious.)   
• Diseases and disorders that affect the brain, like brain tumors, stroke, and forms of dementia (including Alzheimer’s disease)
• Metabolic disorders, such as glucose transport deficiency syndrome, which disrupt how the body breaks down food and generates energy from nutrients  
• Autoimmune disorders that cause the immune system to mistakenly attack brain cells  
• Developmental disorders, such as cerebral palsy and autism spectrum disorder
• Mesial temporal sclerosis, which occurs when scar tissue forms in the innermost section of the temporal lobe of the brain

Abnormalities in the brain: Problems that develop in a fetus during pregnancy or childbirth can result in epilepsy. This might include uncommon conditions like:

• Tuberous sclerosis, which causes benign (noncancerous) tumors to form in the brain and other parts of the body, such as spinal cord and heart
• Focal cortical dysplasia, which is characterized by an area of abnormal brain cell development and organization
• Polymicrogyria, which is characterized by an excess of small folds on the surface of the brain
• Arteriovenous malformation, which occurs when an atypical bundle of blood vessels forms in the brain, potentially causing bleeding or damage to surrounding tissues

Genetics: Some people with epilepsy (particularly childhood absence epilepsy and juvenile myoclonic epilepsy) have a family history of the condition. Experts believe having certain genes or genetic syndromes (such as Down syndrome) can increase the risk of epilepsy, though environmental factors are also likely involved in the condition’s development.

What triggers epileptic seizures?  

Some people with epilepsy experience seizures in a set pattern, after certain events, or in specific situations. These are known as seizure triggers. 

A few of the most common seizure triggers in people with epilepsy include:

• Bright, flashing lights
• Mental and emotional stress
• Certain times of day or night
• Hormonal changes, such as those that occur with menstrual cycles  
• Not sleeping well
• Heavy alcohol use or alcohol withdrawal
• Illness, with or without a fever 
• Excess caffeine consumption 
• Use of recreational drugs like cocaine and ecstasy
• Taking certain medicines, including those with diphenhydramine (an active ingredient in allergy and cold medicines) 
• Missing medication dosages or taking too large of a dose  
• Vitamin or mineral deficiencies from a poor diet
• Not eating enough or skipping meals
• Low blood sugar
• Dehydration

Epilepsy with seizures that consistently occur in response to a specific trigger is sometimes called reflex epilepsy. One type of reflex epilepsy is photosensitive epilepsy, in which seizures are triggered by flashing lights.  

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While the cause of epilepsy is unknown in many cases, researchers have identified a few factors that can increase your risk of developing epilepsy. These epilepsy risk factors include: 

• Head injuries: Sustaining a head injury may leave you at a higher risk of epilepsy.
• Age: Anyone of any age can develop epilepsy, but it most often begins in older adults and young children.  
• Certain medical conditions: Having dementia, a brain infection such as meningitis, a stroke, or a blood vessel disease like arteriovenous malformation can increase your chances of epilepsy. (According to the CDC, 66 percent of adults with epilepsy have at least four other chronic conditions.)
• Childhood seizures: Experiencing seizures in childhood could mean you have a higher risk of epilepsy. 
• Family history: Some people with epilepsy have a family history of the disease. 

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Epilepsy is generally recognized as having two unprovoked seizures at least 24 hours apart from each other. If you’ve experienced a seizure or suspect you might have had a seizure, it’s important to visit a healthcare provider (HCP) for further evaluation. An HCP can confirm an epilepsy diagnosis and determine what type of epilepsy and seizures you’re experiencing.

The World Health Organization (WHO) estimates that 70 percent of people with epilepsy worldwide could avoid seizures with proper diagnosis and treatment.

Diagnosing epilepsy usually begins with a thorough review of your medical history, including any past illnesses, current medications and conditions, and unusual symptoms you may be experiencing. Your HCP will also ask about your experience with seizures, such as what you felt immediately before and during the episode (if you remember it) and how long it lasted.

Descriptions of your seizure from people who were around you are also important. Your HCP may also ask about your family medical history, such as if a first-degree blood relative (such as a parent or sibling) has epilepsy or seizures.

From there, your HCP may order one or more of the following tests to learn more about your health and make a diagnosis:

Blood tests

Several blood tests may be performed to check for signs of underlying illnesses that could be contributing to seizures, even if they’re unrelated to epilepsy. This might include infections, diabetes, lead poisoning, anemia, or certain genetic syndromes.

Imaging tests  

Certain brain imaging tests can help diagnose and monitor epilepsy, either by revealing structural causes of epilepsy (like a tumor) or pinpointing specific areas of seizure activity. Some of these imaging tests include:

Electroencephalogram (EEG): An EEG measures the electrical activity of the brain (brain waves). Someone with epilepsy may have abnormal brain waves, even when they’re not experiencing a seizure. During the test, a cap with small metal discs called electrodes is placed on the scalp to record brain waves. An EEG may be performed as you sleep or under video surveillance so your HCP can observe any seizures you may have.

There are a few variations of EEG tests that an HCP may order. One is an ambulatory EEG, which records brain waves over the course of a few days while you’re at home. Another is a magnetoencephalogram, which measures magnetic fields in the brain to pinpoint where seizures are taking place. A stereoelectroencephalography involves surgically placing electrodes in the brain to more accurately locate areas of seizure activity.

Computerized tomography (CT) scan: A CT scan uses X-rays to create a series of pictures of the brain. This can reveal physical abnormalities like cysts, atypical blood vessels, and tumors. 

Magnetic resonance imaging (MRI) scan: A brain MRI scan can also be used to check for abnormalities like brain tumors. Instead of X-rays, this test uses a magnetic field and radio waves to create detailed images of the brain.

A type of brain MRI called a functional MRI (fMRI) examines blood flow in the brain as you perform basic actions like talking or moving. This shows which parts of the brain are active during specific tasks, which tells a surgeon the areas to avoid during brain surgery to treat epilepsy (if recommended).    

Magnetic resonance (MR) spectroscopy: An MR spectroscopy uses an MRI scanner to compare the chemical composition of healthy brain tissue with unhealthy brain tissue. It may be used to identify brain tumors and check brain tissue for signs of epilepsy or stroke.

Positron emission tomography (PET) scan: A PET scan involves injecting a very small amount of radioactive material into a vein, which is then metabolized by the brain. Parts of the brain that appear to have lower metabolism rates on imaging results may indicate areas of seizure activity.  

Single photon emission computed tomography (SPECT) scan: Someone who is being monitored for epilepsy in an inpatient setting (like a hospital) may receive a SPECT scan at the very start of a seizure. This scan involves injecting a SPECT blood tracer that contains a very small amount of low-dose radioactive material into a vein, which shows how blood flows in vessels during the seizure. Areas of the brain with increased blood flow may indicate where the seizure originated. 

Other imaging techniques, such as statistical parametric mapping and electrical source imaging, may also be used to help identify where seizures start in the brain.

Other epilepsy tests  

Various other behavioral, neurological, and developmental tests may be used to assess brain function and health in someone with epilepsy. These tests usually focus on evaluating memory, speech, and thinking skills, in addition to reflexes and movement abilities. The results of such tests can help shed light on what type of epilepsy someone may have.

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Most epileptic seizures aren’t medical emergencies. Even so, it’s important to call 911 or go to the nearest hospital emergency department if you or someone around you has a seizure that:

• Is your or the person’s very first seizure
• Occurs in water 
• Lasts five minutes or longer
• Causes trouble breathing or walking
• Results in injury
• Is soon followed by another seizure  
• Causes loss of consciousness for more than a few minutes

You should also seek immediate medical care if you experience a seizure while pregnant or if you have diabetes or heart disease. Additionally, consult with your HCP if you continue to have seizures while taking antiseizure medication.

First aid for seizures

If you’re around someone who is experiencing a seizure, be sure to follow these seizure first aid tips from the CDC: 

• Remain with the person until the seizure is over and they’re fully alert.
• Stay calm and encourage others around you to do the same.
• Check for emergency medical information the person may be wearing, such as a medical bracelet or necklace.
• Once the seizure is over and the person is alert, take them to a safe place and calmly explain what happened in simple terms.
• Offer to arrange a taxi or call a loved one to ensure the person can get home safely.  

If someone around you is experiencing a seizure that involves convulsions, jerky movements, or loss of consciousness, try to:   

• Gently guide the person onto the floor and position them on their side, which helps them breathe more easily and keeps saliva from blocking their airway.
• Take off the person’s glasses (as needed) and loosen or remove any ties or necklaces to prevent airway obstruction.
• Place something soft under the person’s head, such as a folded jacket or towel.
• Remove any sharp or potentially dangerous items from the area.  
• Call 911 if the seizure continues for five minutes.  

It’s also important to know what not to do when a person is having a seizure:

• Never hold the person down in an attempt to stop seizure movements.
• Don’t try to give CPR (chest compressions or mouth-to-mouth breaths) during the seizure.
• Never put an object in the person’s mouth, as this can injure their jaw or teeth. (Contrary to popular belief, you cannot swallow your own tongue during a seizure.) 
• Don’t give the person any food or water until the seizure is completely over and they are fully alert.

What questions should you ask your healthcare provider?

Epilepsy is a complex condition that can affect people in various ways. If you’ve recently been diagnosed with epilepsy, you may have several questions about the condition and how to best manage it. Keeping a running list of questions to ask your HCP can help you get the most out of your medical appointments and make educated decisions about your care.

Here are a few common questions to get you started:

• What type of epilepsy do I have? What type of seizures do I have?
• What is causing my seizures? Are my seizures triggered by something specific? 
• What type of epilepsy treatments do you recommend and what are the risks and benefits of each?   
• Is my epilepsy curable?
• Are there any activities I should avoid? Am I allowed to drive a car if I have epilepsy? 
• How can I help prevent seizures? Are there any self-care measures I should try?
• How can I lower my risk of injury during a seizure?    
• When should I call an HCP? What epilepsy symptoms indicate an emergency?
• Should I speak with an epilepsy specialist? What kind of doctor specializes in treating epilepsy and seizures?

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Many types of HCPs can provide treatment for epilepsy, including primary care doctors like family medicine physicians and pediatricians. You may also be referred to a neurologist (a medical doctor who specializes in the brain and nervous system) or an epileptologist (a neurologist who focuses on treating epilepsy). Some hospitals and medical facilities feature epilepsy centers that are staffed with these specialists.

Epilepsy treatment differs from person to person. Your best course of treatment will depend on what type of epilepsy you have, the frequency and severity of your seizures, your overall health, and other factors.

In general, epilepsy treatment involves one or more of the following approaches:

Antiseizure medications

Antiseizure medication (sometimes called anti-epileptic medication) is the most common type of epilepsy treatment. Many people with epilepsy (as many as 70 percent globally) could avoid seizures entirely with proper use of antiseizure medications. 

There are currently more than 40 different antiseizure medications available. Your ideal antiseizure medication will depend on the type and severity of your seizures, along with what other conditions you may have and any medicines you’re taking. Typically, an HCP will recommend a low dose of one medication, then gradually adjust your dosage as necessary according to how you respond to the drug. Some people may need more than one antiseizure medication to control their epilepsy.

There are two general categories of antiseizure medications:

• Broad-spectrum antiseizure medications: These drugs can treat a wide range of seizures and are typically prescribed if the seizure’s type is unknown. Examples of broad-spectrum antiseizure medications include zonisamide, topiramate levetiracetam, and lamotrigine.
• Narrow-spectrum antiseizure medications: These drugs are usually prescribed to treat focal seizures, which impact just one part of the brain. Examples of narrow-spectrum antiseizure medications include ethosuximide, carbamazepine, gabapentin, and pregabalin.

As is the case with all prescription drugs, side effects are possible with antiseizure medications. Some of the most common side effects include:

• Dizziness
• Weight gain   
• Skin rashes
• Fatigue
• Reduced bone density  
• Problems with thinking, memory, or speech 
• Decreased coordination  

Depression and suicidal thoughts are less common though possible side effects of antiseizure medication. Inform your HCP right away if these occur.

Many people who respond well to antiseizure medication can stop taking it after two or more years without experiencing a seizure. When taking the medication, though, it’s important to consult with your HCP before stopping it, adjusting the dosage, or switching to a generic version of the drug. It’s also important to let your HCP know of other medicines, supplements, or essential oils you’re using.

Diet and lifestyle changes

If antiseizure medication proves ineffective, a ketogenic (“keto”) diet may help some people control their epilepsy and avoid seizures. The keto diet involves consuming large amounts of proteins and fats with very few carbohydrates. This initiates a state of ketosis, during which the body primarily breaks down fats for energy instead of carbohydrates.  

It’s unclear how the keto diet helps prevent seizures, but experts believe it may have something to do with associated chemical changes that could alter actions of brain cells. The diet has been shown to be especially beneficial among children with epilepsy.

Still, it should be noted that the keto diet comes with potential drawbacks. It isn’t right for everybody. Speak with your HCP before making any significant changes to your or your child’s eating plan. Your HCP may refer you to a registered dietitian or recommend a less-restrictive version of the keto diet, such as:

• A modified Atkins diet, which focuses on consuming proteins but allows a certain quantity of daily carbohydrates.
• A low-glycemic index diet, which focuses on consuming sensible portions of low-glycemic foods that raise blood sugar very slowly, if at all. Although it’s not understood why, low blood sugar levels control seizures in some people. Examples of low-glycemic foods include lean proteins, whole-grain pasta, sourdough bread, dairy milk, beans, lentils, apples, broccoli, and peas.

Maintaining an overall healthy lifestyle is an integral part of successfully managing epilepsy and controlling seizures in the long run. If you’re living with epilepsy, try your best to:

• Get a minimum of seven or eight hours of sleep every night.
• Stay active and exercise regularly. Speak with your HCP about what types of physical activity are best for your needs.
• Maintain a nutrient-rich diet to avoid vitamin and mineral deficiencies.  
• Avoid skipping meals. 
• Stay hydrated.
• Keep stress in check. Consider trying stress management techniques like deep breathing exercises, meditation, or journaling.
• Avoid smoking and recreational drug use.
• Maintain a healthy body weight.   
• Drink alcohol in moderation, if at all.

According to the CDC, people assigned female at birth should limit their alcohol consumption to one standard drink per day, while people assigned male at birth should consume no more than two standard drinks daily. A standard drink is defined as:

• 12 ounces of beer
• 8 to 10 ounces of malt beverages like hard seltzer
• 5 ounces of wine
• 1.5 ounces of whiskey, vodka, gin, rum, tequila, cognac, or brandy

Additionally, writing down when your seizures occur and how they respond to various changes in lifestyle or routine can provide insight on your condition and help your HCP recommend more effective treatments.

Surgery for epilepsy

If antiseizure medication and lifestyle changes aren’t enough to control epilepsy, surgery to remove the portion of the brain where focal seizures originate may be an option. This is sometimes referred to as a lobectomy or lesionectomy. It’s usually only recommended if the portion of the brain in question is small, clearly defined, and doesn’t control key functions like movement, memory, speech, and vision.

Other types of epilepsy surgery include:

• Corpus callosotomy: This procedure involves cutting the neuron connections between the right and left sides (hemispheres) of the brain. It’s generally recommended for children who have severe generalized seizures that start in one hemisphere and spread to the other. While seizures will continue in one side of the brain, they should stop in the other.
• Multiple subpial transection: This procedure may be used to address seizures that begin in a part of the brain that can’t be removed. It involves making several strategic cuts to prevent seizures from spreading to surrounding parts of the brain.
• Thermal ablation: This procedure involves delivering thermal energy to the precise area of the brain where seizures occur. This energy destroys brain cells in the targeted area, which can stop seizures.   
• Hemispherectomy and hemispherotomy: These procedures involve removing one half of the brain’s outer layer (cortex). They’re typically performed in children who have severe seizures that don’t respond to antiseizure medication. There are two types of hemispherectomies—an anatomic hemispherectomy removes more brain tissue, while a functional hemispherectomy removes less brain tissue.

Any type of surgery comes with risk. While epilepsy surgery can help some people achieve a seizure-free life, it may cause changes in thinking skills, personality, or physical abilities. Your HCP can carefully walk you through all your treatment options and explain the benefits and risks of each to help you make a confident decision about your care.

Other therapies and devices for epilepsy

Some people with epilepsy benefit from therapies that use special devices to reduce the number and severity of seizures. These therapies include:  

• Deep brain stimulation: This treatment involves surgically placing an electrode into a specific area of the brain, usually the thalamus (the structure that processes all the body’s senses except smell). The electrode is connected to a pulse generator that’s surgically placed in the chest. This pulse generator sends electrical stimulation to designated areas of the brain to help regulate electrical signals and reduce the likelihood of seizures.
• Vagus nerve stimulation: This treatment works by delivering electrical energy to the brain via the vagus nerve in the neck. It involves surgically placing a battery-powered device called a vagus nerve stimulator under the skin of the chest. This stimulator sends brief bursts of electrical energy to the vagus nerve through a wire. Experts aren’t sure how exactly this treatment subdues seizure activity, but it can reduce seizures by up to 40 percent.
• Responsive stimulation: This treatment uses an implantable device that examines brain wave patterns to detect when a seizure may be approaching. To help stop an upcoming seizure, the device sends electrical energy or a quick-acting drug to the brain.

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Epilepsy can cause a range of complications, especially if it’s poorly managed or left untreated. Some of the most common complications associated with epilepsy include:  

• Difficulty learning new things
• Injuries from falling, bumping into objects, or operating machinery during a seizure
• Aspiration pneumonia, which may occur after inhaling saliva or food into the lungs during a seizure
• Drowning, if a seizure occurs in the water. (People with epilepsy are 13 to 19 times more likely to drown when bathing or swimming than people without the condition.) 
• Pregnancy complications. (Most people with epilepsy can have healthy pregnancies and babies with appropriate medical care.)
• Mental health concerns like depression and anxiety  
• Brain damage

Two particularly notable complications of epilepsy are status epilepticus and sudden unexplained death in epilepsy (SUDEP). 

• Status epilepticus occurs when a person has a seizure that lasts for five minutes or longer, or experiences multiple seizures without fully regaining consciousness in between them. This is a potentially life-threatening emergency that requires immediate care, as medical intervention may be necessary to stop the seizure and avoid permanent brain damage. The Epilepsy Foundation reports that status epilepticus is responsible for 1.9 percent of deaths among people with epilepsy.
• Sudden unexplained death in epilepsy (SUDEP) causes death during or immediately after a seizure. It’s unrelated to injuries, drownings, or other obvious causes of death. There’s still much to learn about SUDEP and why it occurs, but it appears to be more common in people with seizures that are difficult to control. According to the Epilepsy Foundation, an estimated 1 out of every 1,000 people with epilepsy die of SUDEP each year. Taking antiseizure medication as prescribed by your HCP can help lower your risk of SUDEP.

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There’s no surefire way to prevent epilepsy. But according to WHO, up to 25 percent of epilepsy cases are potentially preventable. To minimize your risk of developing epilepsy, try to:

• Prevent head injuries. Head trauma increases epilepsy risk, so take steps to keep yourself safe. Use a seatbelt, wear appropriate head gear during physical activity, and implement some common-sense fall prevention techniques.     
• Maintain good heart health. Epilepsy can result from experiencing a stroke. To help improve your heart health and lower your risk of stroke, aim to lose excess weight, control your blood pressure, and quit smoking or never start.
• Reach out for help. Drinking alcohol in excess or using illegal drugs can cause brain damage that may lead to epilepsy. Consider seeking help from an HCP or a licensed mental health provider when life gets challenging.
• Prioritize perinatal care. Some birth injuries can cause epilepsy. Receiving sufficient perinatal care (care immediately before and after childbirth) can reduce the chances of birth injuries and associated epilepsy.

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The outlook for epilepsy varies from person to person. Many people with this condition can live seizure-free with adequate treatment, and some are able to stop taking antiseizure medications after several years without experiencing a seizure. Additionally, certain childhood epilepsy syndromes improve or resolve on their own with age, often in a person’s late teens or 20s. 

For others, epilepsy is a lifelong condition. Someone is more likely to have severe or difficult-to-control epilepsy if they have other serious health concerns, such as a brain tumor or history of stroke. The risk of premature death is as much as three times higher for people with epilepsy than for the general population, according to WHO.  

Still, there are reasons for optimism. Many research initiatives are focused on improving treatment options and outcomes for people with epilepsy. A few especially promising areas of research include:  

• Minimally invasive epilepsy surgery
• Electrical stimulation therapy that can be completed at home
• Nonsurgical magnetic stimulation for seizures that begin close to the brain’s surface
• Subthreshold stimulation for seizures that occur in the brain’s “eloquent” areas (those areas that can’t be surgically removed)
• Gene-sequencing technologies to better identify genetic mutations associated with epilepsy
• Artificial intelligence (AI) tools that can help locate where seizures begin in the brain

Can I drive if I've been diagnosed with epilepsy?

While many people with epilepsy can work and live independently, driving cars or operating other types of machinery isn’t always safe.

In most states in the U.S., someone with epilepsy must present documentation proving they haven’t had a seizure for a set period before they can be issued a driver’s license. This required seizure-free period ranges from a few months to a year or longer, depending on the state. To learn more about epilepsy driving laws by state, visit the Epilepsy Foundation website.  

In some cases, a person with epilepsy may also have to provide a letter from their HCP that states their seizures:

• Only occur when sleeping (nocturnal seizures)
• Are preceded by auras that can provide adequate warning
• Don’t interfere with driving abilities

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It’s very possible to live an independent, active life with epilepsy. Implementing healthy lifestyle habits, attending all scheduled medical appointments, and following your HCP’s treatment guidance can help you better control your epilepsy and limit or avoid seizures. Remember, no two cases of epilepsy are the same, so your prognosis and treatment plan will be unique to you.

In general, though, most people with epilepsy are advised to:  

• Stay clear of seizure triggers, if possible.
• Take someone with them when hiking, swimming, or doing other potentially dangerous activities.
• Inform friends, loved ones, and coworkers about the condition and seizure first-aid tips.   
• Wear a medical alert bracelet.
• Refill antiseizure medication several days before the prescription runs out.   
• Set a reminder on a phone or smart device to take medication.
• Reduce the risk of contagious illnesses by getting an annual flu shot, thoroughly washing hands, and avoiding contact with sick people, if possible.

Prioritizing mental health is also important if you have epilepsy. Many people with the condition deal with depression or anxiety over the possibility of future seizures or loss of independence. According to the CDC, up to 30 percent of adults with epilepsy contend with serious mental health concerns like severe depression and bipolar disorder. Research suggests the relationship between epilepsy and mental health goes both ways: Epilepsy can bring on or worsen mental health concerns, and mental health concerns can exacerbate epilepsy and trigger seizures.

Taking simple steps to keep stress in check can go a long way if you’re living with epilepsy. Many people find it helpful to implement stress management techniques like journaling, meditation, and gentle exercises such as yoga, tai chi, and qigong.

Sharing your thoughts with a trusted loved one or a licensed mental health provider such as a psychologist, psychiatrist, or counselor can help you cope with difficult emotions, as can attending an in-person or online epilepsy support group. Helpful resources like counseling and support groups are also available for caregivers and parents of people with epilepsy.

If you or someone you know is struggling with thoughts of suicide or needs immediate assistance for a mental health concern, contact the 988 Suicide & Crisis Lifeline by texting or calling 988. You can also chat with a professional online. This free service is available 24/7 and is completely confidential. 

To learn more about epilepsy self-management, support groups, and support for caregivers, talk to your HCP or browse resources from trusted organizations such as:

• Epilepsy Alliance America
• American Epilepsy Society  
• Centers for Disease Control and Prevention

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• Resources for Parents of Children With Epilepsy
• 7 Myths About Epilepsy You Should Stop Believing  
• The Surprising Link Between ADHD and Epilepsy