Epilepsy

Epilepsy is a brain condition where groups of nerve cells, or neurons, sometimes send the wrong signals and cause seizures. Our specialists offer prompt appointments, listen to your concerns, and provide treatments so you can live seizure-free.

Signs and Symptoms of Epilepsy

Epilepsy affects people of all ages. Symptoms can vary depending on the type of seizure. Symptoms may include:

• Temporary confusion
• Staring spells
• Stiff muscles
• Uncontrollable jerking or twitching movements of the arms and legs (convulsions)
• Biting your tongue, cheek, or lip (while sleeping)
• Loss of consciousness
• Abnormal mouth movements
• Memory loss
• Stop speaking mid-sentence
• Feelings of lost time, fear, anxiety, or déjà vu

If you experience a seizure, seek treatment at the nearest emergency room.

Types of Epilepsy

There are two main types of epilepsy.

Generalized Seizures:

Generalized seizures involve multiple areas of the brain, and include: 

• Tonic seizures: Muscles in your back, arms, and legs may stiffen, causing you to fall to the ground.
• Atonic (drop) seizures: Loss of muscle control in the legs causes you to drop to the ground
• Clonic seizures: Repeated or rhythmic jerking muscle movements affect your neck, face, and arms.
• Myoclonic seizures: Sudden, brief twitches affect your upper body, arms, and legs.
• Tonic-clonic (grand mal) seizures: The most dramatic type of seizure, you suddenly lose consciousness and experience body stiffening, twitching, and shaking, including tongue biting and loss of bladder control.
• Absence (petit mal) seizures: Typically occurring in children, symptoms include staring into space, with or without subtle body movements (like eye blinking, lip smacking, or brief loss of awareness).
  

Focal Seizures:

Focal seizures arise from electrical activity in one area of the brain. Symptoms of focal seizures, such as emotional changes or vision problems, may depend on the part of the brain where they originate. Focal symptoms may sometimes be confused with other neurological conditions, such as migraine headaches and narcolepsy. Testing is needed to determine a correct diagnosis. Focal seizures include: 

• Focal seizures without loss of consciousness (simple partial seizures): This type of seizure may cause changes in the way things look, smell, feel, taste, or sound; involuntary body part movement; or sensory symptoms like tingling, dizziness, and flashing lights.
• Focal seizures with impaired awareness (complex partial seizures): This type of seizure involves a loss of consciousness and may seem like you are in a dream. You may stare into space or perform repetitive movements such as hand rubbing, chewing, swallowing, or walking in circles.

Epilepsy Diagnosis at Virtua

As seizures may occur at any time, epilepsy can have a significant impact on your quality of life. Without proper evaluation, it can sometimes be mistaken for syncope, or fainting, caused by a sudden drop in blood pressure or a sleep-related condition.

Our team of neurologists has the epilepsy expertise to understand your concerns and work diligently with you to confirm your diagnosis and establish the best treatment for you.

How do you test for epilepsy?

Your neurologist will review your symptoms and medical history, conduct a neurologic exam to test your behavior, movements, and mental function, and order blood tests. You also may have brain imaging tests, including:

• Electroencephalogram (EEG): The most common test for epilepsy, an EEG uses electrodes attached to your scalp to record your brain’s electrical activity.
• Magnetic resonance imaging (MRI): Powerful magnets create a detailed view of your brain to see what may be causing your seizures.

Virtua offers EEGs at home or our Epilepsy Monitoring Unit at Virtua Voorhees Hospital. In the Virtua Epilepsy Monitoring Unit, our specialists will:

• Monitor you on video during an EEG to detect and record any seizures (with the ability to trigger a seizure in a safe environment if necessary).
• Analyze your brain activity and associated reactions—such as convulsions, confusion, or speech difficulties—which help identify seizure triggers as well as determine the type of epilepsy you have or if your symptoms may be caused by another condition.
• Temporarily and safely stop your medications to perform tests.
• Adjust or start medication to relieve your symptoms.

Appointments in the unit are typically available within a few weeks of the initial visit with your doctor.

Epilepsy Treatment at Virtua

Our epilepsy team, overseen by board-certified neurologists with subspecialty fellowship training in epilepsy, provides the expertise needed to determine the best treatment for you.

As epilepsy impacts people differently, we tailor your treatment based on your symptoms and medical history. We work collaboratively with a multispecialty team here at Virtua to ensure you receive the care you need for the best seizure control.

Treatments include:

• Anti-seizure medication: Anti-seizure medications effectively manage seizures in most epilepsy patients, though finding the right medicine (or combination of medicines) can be complex. There are many anti-seizure medicines available, and the type you take may depend on the type of epilepsy you have, your unique seizure triggers, and your age. Your doctor will seek to minimize the risk of any potential side effects and interactions with other drugs you may be taking.
• Surgery: If medicine does not provide enough control of your seizures, surgery may be an option. Procedures include removing a portion of the brain (resection) and MRI-guided stereotactic laser ablation to destroy tissue causing the seizures.
• Vagus nerve stimulation: A device implanted underneath the skin of the chest sends bursts of electrical energy to the vagus nerve and brain.
• Deep brain stimulation: Electrodes implanted in the brain are connected to a generator in your chest. The generator sends electrical pulses at timed intervals to reduce seizures.
• Responsive neurostimulation: An implanted device analyzes your brain patterns to detect and stop seizures.

What Is Drug-Resistant Epilepsy and How Is It Treated?

People whose seizures do not improve with two or more medications are referred to as having “drug-resistant,” “refractory,” or “uncontrolled” epilepsy. If you have drug-resistant epilepsy, you may require closer monitoring and coordination of your anti-seizure medications. A growing number of anti-seizure medications are available that can be used alone or in combination to treat seizures that are resistant to standard treatment.

Surgery is another option if medication does not provide adequate control of your seizures. Procedures include brain resection, MRI-guided stereotactic laser ablation and neurostimulation devices.

You and your doctor will discuss options best for you.