Epilepsy: Frequently Asked Questions

I started taking Zonegran over 2 weeks ago, and my hands and feet are freezing cold. Is this a normal side effect from Zonegran?
It is not a usual effect of Zonegran. If you are concerned, you should discuss it with your doctor.
How common is epilepsy?
Approximately six people out of 1,000 have epilepsy.
How does gamma knife surgery treat epilepsy? Is it still in research stages?
The gamma knife has primarily been used to treat irreparable vascular malformations and tumors, and if the seizures are being caused by those things then the gamma knife may help treat the seizures also. Research is being done on treating other forms of epilepsy with the gamma knife, but this is experimental at the present time. Resection surgery (removing the area where seizures come from) is still the most common surgical treatment of epilepsy.
How long can epilepsy last?
Epilepsy can last a few months, years, or be life-long. It varies among individuals.
What kinds of tests are necessary to determine if an epileptic patient requires surgery?
The tests are done to see where the seizures are coming from and if that area can be safely removed. Most centers perform an EEG recording of seizures (called video EEG) and MRI scan, and a test of brain function known as neuropsychological testing. Other tests include PET and SPECT scans, magnetoencephalography (MEG) and functional MRI (fMRI). These are tests that measure the brain's function.
At what age does epilepsy usually surface in most patients?
Epilepsy can begin at any age. It most commonly begins in children and in older adults.
What are common treatments of epilepsy other than surgery?
Most commonly we use medicine to treat epilepsy. If medicines fail, and epilepsy surgery is not an option, some patients opt for the vagus nerve stimulator, an electrical device implanted under the skin like a pacemaker.
What are infantile spasms and can they be prevented?
Infantile spasms are a type of seizure that occur in young children (6-12 months old). Most often they are treated with a medicine called ACTH, but they are often difficult to control and may evolve into other severe forms of epilepsy.
If absence seizures go undiagnosed what could happen?
The possibilities include 1) affecting school performance such as learning, 2) absence seizures are occasionally associated with other seizure types, such as convlusive seizures, and 3) absence seizures can go away on their own.
Is there a link between febrile convulsions as a child and adult epileptic seizures?
About 2% of children with febrile seizures will eventually develop epileptic seizures. The odds are slightly higher if the child has a long febrile seizure, the seizure primarily affects one side of the body or multiple seizures occur with a single febrile illness. Most children with febrile convulsions do not develop epilepsy.
Is it true that diet can play a role in epilepsy?
There is a diet known as the ketogenic diet that can treat certain types of epilepsy, mostly occurring in children. There has been some recent evidence from a small study that a modified version of the Atkins diet may help treat seizures, but this needs to be confirmed with a larger study. In general, I advise my patients to eat a healthy diet and not skip meals.
If a person has inherited epilepsy, could a sibling also have it but show no outward signs? Would the same patterns show up on an EEG?
If the sibling has not yet had a seizure then by definition they do not have epilepsy. I usually do not recommend doing an EEG on a family member that does not have seizures.
What is the chance of an infant outgrowing their seizures?
That is a tough one to answer because it depends on the type of seizures and what has caused them.
What should a bystander do if they see someone having a seizure?
First aid should include: 1) Helping the person lie down and taking them away from any dangerous objects like stoves; 2) Rolling them onto their side so they do not choke if they vomit; 3) Loosening any tight clothing such as neck ties; 4) Reassuring them as they are coming out of the seizure as they may be confused; and 5) Calling an ambulance if it is the person's first seizure or if it is significantly longer than their usual seizure.
Are nighttime seizures different than other types of seizures? What are the characteristics of nighttime seizures?
In some patients, it is the nature of their type of epilepsy to have nighttime seizures. In most cases we treat nighttime seizures the same as we treat daytime seizures. Nighttime seizures may also be a sign of an underlying sleep disorder, such as sleep apnea, that may need to be investigated.
What types of epileptic patients often opt for surgery in preventing future seizures?
Epilepsy surgery is indicated when: 1) the seizures are significantly impairing the person's quality of life, 2) the location of the seizures can be identified, 3) that area can be safely removed by the surgeon. In general there are no age limits to epilepsy surgery, although the person should be in generally good health.
My friend had a seizure at age 24. She had never had one before, is this common?
About 10 percent of all Americans will have a seizure sometime during their life. Most (about 60 percent) never have a second seizure.
Can antidepressants cause a seizure?
One particular antidepressant, Bupropion (Wellbutrin) is associated with a higher risk of seizures and should not be used in people with epilepsy. The medicine is also marketed under the name Zyban, and is used to help people stop smoking. The risk of seizures is less certain with other antidepressants. A physician prescribing antidepressants should be made aware that the person has epilepsy.
Does meningitis cause epilepsy?
Meningitis can cause epilepsy if it injures the brain but does not always cause epilepsy.
What are the symptoms of epilepsy?
The main symptom of epilepsy is seizures. Seizures can be of many different types in people with epilepsy, ranging from a simple sensory feeling or "aura," to staring and unresponsiveness, to convulsive activity.
Are there different kinds of seizures?
Yes, there are many different types of seizures. The two main types include 1) generalized seizures that affect the entire brain, and 2) partial seizures, that come from a part or region of the brain. There are many sub-types of generalized and partial seizures.
How is it diagnosed?
The most important factor in diagnosis is a description of the seizures, not only from the person, but also from a witness to the seizures. A neurological examination is performed to look for any signs of brain dysfunction. Then we often use tests like the EEG or MRI to help us with the diagnosis.
What drugs can help prevent seizures? Can any currently cure it?
There are a dozen medicines that are now used to control seizures. None of them, however, have been shown to cure epilepsy.
What can be done to help prevent epilepsy?
Risk factors for epilepsy include: brain infections like meningitis and encephalitis, head trauma, stroke, and brain tumors. Some of these, such as head trauma and stroke, are potentially preventable.
How does Oxcarbazepine work?
Oxcarbazepine works similarly to Carbamazepine (Tegretol, Carbatrol), but with fewer side effects. It acts on channels that let sodium into neurons, stabilizing the activity of the cells.
What about Myoclonic epilepsy-age 13?
Myoclonic seizures beginning at age 13 are usually caused by an epilepsy syndrome known as Juvenile Myoclonic Epilepsy. While the seizures usually respond to medication, the tendency to have seizures is life-long. For more information, I can refer you to the Epilepsy Foundation of America who may have more information. Their web page is www.EFA.org. I would recommend this site for any one who has epilepsy-related questions. I would like to thank everyone for participating and I hope the information that we talked about has been helpful. Neurologists and epilepsy specialists have a number of effective treatments for epilepsy. Please consult with your doctor or with your nearest specialized epilepsy center.

Mark Granner, MD
Associate Clinical Professor of Neurology