Epilepsy and Seizure Disorders
The team of skilled neurologists, neurosurgeons and neuropsychologists at the Comprehensive Epilepsy Care Center at North Shore-LIJ's Cushing Neuroscience Institute provides expert diagnosis and treatment for patients with all types of epileptic seizures.
What a person does or feels from a seizure depends upon what part of the brain is affected. There are basically two categories of seizures - focal onset and generalized onset.
Different types of seizures are treated by different medications effective for that type of seizure. Certain drugs can worsen some types of seizures, but be useful with other types. Different types of seizure conditions also follow different courses. People may "outgrow" certain types of childhood epilepsies, but typically do not "outgrow" epilepsies that begins after adolescence. If epilepsy seizures are not fully controlled by medications, then epilepsy surgery may be an option, with the particular type of surgery depending on the seizure type.
Types of Seizures
Focal Onset Epilepsy Seizures
Focal onset seizures begin with abnormal electrical activity that begins at a particular location in the brain and can spread to affect other parts of the brain. If there is little spread, then the seizure will involve a more subtle change in experience (e.g. strange smell, deja vu sensation, funny feeling in the belly, etc.). These types of experiences are often referred to as "auras.” If abnormal electrical activity spreads further, this is called a "complex partial seizure," which involves alteration of awareness. An affected person will often have a staring spell or exhibit strange behavior. As the abnormal electrical activity spreads and affects more of the brain, the person may have generalized tonic-clonic seizures (previously referred to as "grand mal" seizure). Even though the symptoms of focal onset seizure change, the underlying problem is the same; the way it looks can change, depending how much the abnormal electrical activity spreads.
Generalized Onset Seizures
Another major category of seizures is generalized onset seizures, where the abnormal electrical activity starts on both sides of the brain around the same time. These seizures are often caused by a genetic predisposition. Symptoms of generalized seizures may include:
- staring spells where the person can regain consciousness quite quickly
- generalized tonic-clonic convulsions
- brief jerks of the limbs (called myoclonus). The individual may spill liquids or drop things being held at the time of the seizure. These types of jerks often may be more noticeable in the morning and get worse with lack of sleep
The Comprehensive Epilepsy Care Center treats the following conditions:
- Absence seizures
- Atonic seizures
- Atypical absence seizures
- Epilepsy (convulsive and non-convulsive)
- Epilepsy (intractable and non-intractable)
- Epilepsy (partial and partial intractable)
- Essential tremor
- Myoclonic seizures
- Tonic seizures
- Tonic-clonic seizures
Types of Epilepsy
There are many types of epilepsy, and all types cause seizures. It can be difficult to determine what type of epilepsy you have because of the numerous possible causes. Different types of seizures can occur in the same person, and each type may affect each person differently.
Some specific types of epilepsy are:
- Benign Focal Childhood Epilepsy – causes muscles all over the body to stiffen and jerk. These usually occur at night.
- Childhood and Juvenile Absence Epilepsy – causes staring into space, eye fluttering and slight muscle jerks
- Infantile Spasms (West syndrome) – Symptoms include muscle spasms that affect a child's head, torso and limbs. Infantile spasms usually begin before the age of six months.
- Juvenile Myoclonic Epilepsy – causes jerking in the shoulders or arms
- Lennox-Gastaut syndrome – causes frequent episodes of several different types of seizures. This syndrome can lead to falls during a seizure, which can cause injury.
- Temporal Lobe Epilepsy (the most common type of epilepsy in adults) – Symptoms of temporal lobe epilepsy include smacking of the lips or rubbing the hands together, emotional or thought disturbances and hallucinations of sounds, smells, or tastes
Epilepsy is not associated with intellectual disability or mental illness. Although a few forms of childhood epilepsy are associated with below-average intelligence and problems with physical and mental development, epilepsy does not cause these problems.
Not everyone who has a seizure has epilepsy. The causes of seizures that are not epileptic may result from several different medical conditions such as poisoning, fever, fainting, or alcohol or drug withdrawal. Seizures that occur at the time of a disease, injury, or illness and stop when the condition improves are not related to epilepsy. However, if seizures become chronic and occur repeatedly weeks, months or even years after the injury or illness, you have developed epilepsy as a result of the condition.
There are several other conditions with similar symptoms of epilepsy, such as fainting or seizures caused by high fevers.
At the Comprehensive Epilepsy Care Center each person’s unique case is given careful consideration, and diagnostic testing is tailored to their goals. When a history of seizures is suspected, a person should see a specialist, especially when seizures or events are not well controlled or happening frequently. An epileptologist is a doctor who specializes in seizure disorders.
Making or confirming a diagnosis of epilepsy, pinpointing where seizures may originate, and finding a potential underlying cause for the seizures are all important aspects for determining the treatment options. Anti-epileptic drugs, drug combinations and surgical options may differ significantly depending upon patient’s individual needs.
Other medical and psychological conditions may be mistaken for epilepsy seizures based on their symptoms. Some examples of these conditions include:
- fainting spells
- stroke-like events
- movement disorders such as tics
- sleep disorders,
- anxiety attacks
- psychogenic non-epileptic attacks
Epilepsy Diagnosis Evaluation
- Clinical History and Physical Examination – This is the most important element of the evaluation during which the epileptologist (a neurologist with special training in epilepsy) gets a clear description of the events (epilepsy seizures), as well as their past medical, family and social history. Patients are often asked about the different events that they may experience, the duration of their events, how frequently the events occur, their impact on the individual’s life, and prior attempts at treatments. An examination will be performed to assess cognitive, motor and sensory function.
- CT Scan – A CT scan creates images of the brain using radiation and computer technology. This test is often used when seizures first begin and may be useful in detecting underlying non-epilepsy problems such as bleeding, tumor, infection or problems with the skull.
- Magnetic Resonance Imaging (MRI) – MRI provides a highly detailed picture of the brain. Certain brain structures are commonly abnormal in persons with epilepsy, but may be so subtle that a CT scan cannot reveal them. Subtle abnormalities can be best detected when high resolution MRI is performed with special epilepsy MRI protocols. These special types of MRIs are often only performed in certain epilepsy centers, and only when ordered specifically by the epileptologist. The strength of an MRI is measured in units called “Tesla.” The 3-Tesla MRI machine used by the Comprehensive Epilepsy Care Center is one of the most advanced units available.
- Electroencephalogram (EEG) – An EEG records electrical activity from the brain. The EEG shows patterns of normal or abnormal brain electrical activity. EEG may help the physician to understand the part of the brain where seizures originate, the specific areas of abnormal brain tissue, the risk for further seizures and whether seizures may be occurring that the individual may or may not be aware of. EEG is an excellent tool when the diagnosis of seizures is in question, when spells are occurring with uncertain causes or when other reasons for the episodes may be suspected. EEG may be done as a brief office study, as a prolonged portable home study, or in the hospital under close technical, nursing and physician observation in the Epilepsy Monitoring Unit (EMU) with video monitoring.
- Positron Emission Tomography (PET) – The PET procedure injects a small amount of radioactive sugar into a person to allow a radiation-detecting camera to record brain images. The pictures from Positron Emission Tomography show how and where the brain uses energy. Epilepsy can cause changes in the way the brain uses sugar, and a PET scan can help pinpoint a seizure focus.
- Single Photon Emission Computed Tomography (SPECT) – The SPECT procedure measures blood flow in the brain. An Ictal SPECT scan is a study performed on people with very frequent or predictable epilepsy seizures. "Ictal' means that the scan is performed during a seizure. This test is performed by injecting a radioactive substance immediately after a seizure begins. After the substance travels to the area of the brain where seizures originate, a special camera detects its location in the brain and produces a corresponding image.
- Magneto-Encephalography (MEG) – MEG is test that records brain activity by evaluating magnetic fields generated by the brain, and may be an adjunctive test to EEG. MEG is usually used in only certain cases.
- Neuropsychological Evaluation – A neuropsychologist conducts a number of tests to understand how well a person performs in different cognitive functions, such as memory, language and attention. In order to benefit the patient, these tests must be interpreted by a trained Neuropsychologist. Testing may serve to:
- diagnose a cognitive deficit
- identify relative strengths and weakness
- reveal areas of the brain which may be affected
- guide rehabilitation
- assess an individual’s level of functioning
- clearly document and track function over time
- Intracarotid Sodium Amobarbital Procedure (Wada Test) – Sometimes a Wada test is necessary prior to brain surgery. This test is performed by injecting a drug via a catheter to temporarily put one side of the brain to sleep in order to test the function of the other side that is still awake. This allows a neuropsychologist, working with a neuroradiologist, to test functions of the right and left sides of the brain individually. The Wada test can determine how each side of the brain performs important brain functions like language and memory. This test also helps to determine the safety of undergoing epilepsy brain surgery. Prior to undergoing a Wada test, patients meet with a neuropsychologist who explains the procedure in detail.
- Intracranial EEG – In special circumstances, where appropriate for individuals with epilepsy that is highly resistant to medications, inpatient intracranial EEG monitoring may be done to pinpoint the location where seizures begin. For this type of EEG, small electrodes are placed under the skull by a neurosurgeon. The electrodes may be used to both record electrical signals from the brain and stimulate the brain in order to map necessary brain function. Performing intracranial EEG requires a dedicated center with a highly specialized team of neurosurgeons, neurologists, nurses, technicians, and staff.
Video Electroencephalography (EEG) and the Epilepsy Monitoring Unit
Video EEG is a key diagnostic test that records brain waves while a person is videotaped for a period of time. Video EEG is also helpful in monitoring the effects of anticonvulsant medications, and in evaluating for subclinical or subtle events of concern for epilepsy seizures. This painless exam involves placing electrodes on the head with gauze and a special cream, which will harden after application to help prevent the electrodes from falling off. A device will then continuously record patients' brain wave activity from the electrodes and behavior on video.
Video EEG results can help the epileptologist:
- classify the event type
- confirm the diagnosis of epilepsy
- Identify the type of epilepsy syndrome the person may have
- localize the seizure related activity
- design a treatment plan
Video EEG is often performed over a few days for these main reasons:
- the diagnosis of epilepsy is not certain
- the type of epilepsy has to be classified
- seizures do not respond to medications
- patients are considering the possibility of surgical options
The Video EEG study usually takes between one to seven days, but depends on the specific goals of the admission and the individual’s circumstance. The epileptologist will determine, based on the patient’s goals, when it is most appropriate to be discharged.
What is the North Shore-LIJ Epilepsy Monitoring Unit?
Dedicated Epilepsy Monitoring Units are in place at both Long Island Jewish Medical Center and North Shore University Hospital. Both locations perform video EEG monitoring on an inpatient basis. They both provide a safe and comfortable environment for continued video EEG monitoring for those who are undergoing an evaluation for epilepsy or seizures.
In Fall 2012, the newly designed, state-of-the-art video EEG monitoring suite opened at North Shore University Hospital. This inpatient unit is staffed by 24/7 dedicated observation personnel, epilepsy-trained nurses and a team of compassionate and experienced certified EEG technologists. The new patient rooms also have comfortable accommodations for family members to stay with you.
Make an appointment at our Comprehensive Epilepsy Care Center
Cushing Neuroscience Institute’s Comprehensive Epilepsy Care Center makes it easy for you to take the first steps in ensuring the best neurological care for yourself or your family. Simply email us at email@example.com, call us at (516) 325-7060 or fill out our Request an Appointment form.