Michael Frucht, M.D
Epilepsy is a condition many have heard of, but few realize just how common the seizure disorder is. The Centers for Disease Control (CDC) reports nearly three million Americans are living with active epilepsy. An estimated five million people have a history of epilepsy.
Dean & St. Mary’s neurologist Dr. Michael Frucht specializes in epilepsy. As an epileptologist, he treats and advises many patients living with the seizure disorder. He says the condition is very treatable.
Are seizures and epilepsy the same?
A seizure happens when something causes a surge of electrical activity in a patient’s brain. This change in electrical activity causes a change in behavior or appearance for a short time. Dr. Fucht says physical signs of a seizure can be hard to spot.
“Most seizures do not include convulsions,” says Dr. Frucht. “Sometimes seizures comes across as confusion, motor or sensory problems. I’ve seen patients whose only physical indicator of seizure is a chewing motion.”
Seizures fall into two categories: Generalized seizures which affect both sides of the brain, or focal seizures which are located in one area of the brain.
Within both categories are types of seizures that can cause different behavioral changes. Generalized seizures include:
• Absence seizures. Sometimes called petit mal seizures, a patient will begin blinking rapidly or stare into space.
• Tonic-clonic seizures. Sometimes called grand mal seizures, a patient may cry out, lose consciousness, fall to the ground or have convulsions or muscle spasms.
Focal seizures include:
• Simple focal seizures. Affect a small part of the brain, may cause twitching or a change in sensation like a strange taste or smell.
• Complex focal seizures. May make a patient confused or dazed and they will be unable to respond to questions or directions for up to a few minutes.
• Secondary generalized seizures. These seizures begin in one area of the brain but spread to both sides of the brain.
According to the Epilepsy Foundation, one in 26 people in the United States will develop epilepsy at some point in their lifetime.
Beyond the types of seizures, you may also hear certain words used to describe the way the muscles in the body act during seizures:
• Tonic. During a tonic seizure, muscles in the body become stiff.
• Atonic. During an atonic seizure, muscles in the body relax.
• Myoclonic. During a myoclonic seizure, parts of the body will jerk for short periods of time.
• Clonic. During a clonic seizure, parts of the body will shake or jerk for a period of time.
Seizures can last for several minutes. Patients with seizure disorders, including epilepsy, can experience more than one type of seizure. The frequency and severity of the seizures can also widely vary.
While all cases and types of epilepsy include seizures, it is important to remember that not all seizures are epilepsy. For seizure activity to be diagnosed as epilepsy, a patient must experience recurrent, spontaneous seizures. That means a patient experiences more than one seizure with an unknown cause.
What causes seizures and epilepsy?
Seizures and epileptic conditions can be caused by a variety of things. Strokes, tumors and brain injuries can cause seizures. Some seizures can be caused by medical conditions like diabetes or stroke. Some patients experience non-epileptic seizures because of a high fever. Some seizure disorders are genetic and sometimes the cause of a seizure or seizure disorder like epilepsy is unknown.
How is epilepsy diagnosed?
If you think you’ve had a seizure or if people tell you they suspect you’ve had a seizure, tell your doctor.
“A clinical diagnosis is made with brain imaging tests like a CT scan, brain wave testing called electroencephalogram – called an EEG for short – and a description of the patient’s events,” says Dr. Frucht.
Testing starts with your primary care physician. From there, if a seizure is detected, your doctor will look at what caused it. If another medical condition like diabetes or a high fever caused your seizure you will be treated for that condition. If epilepsy is suspected, medication can be prescribed to help prevent additional seizure activity.
Patients diagnosed with epilepsy are then referred to a neurologist, often with special training in epilepsy. These doctors, like Dr. Frucht, are called epileptologists. They can help you find the right treatment to best manage your epilepsy.
How is epilepsy treated?
For most patients, treatment includes medication and lifestyle changes. Things like reducing your stress and getting regular sleep can reduce the risk of future seizure activity. For most people living with epilepsy – 70 percent – medication works well in controlling seizures. Others are able to manage the condition by avoiding known seizure triggers. When seizures are caused by an abnormality in the brain, such as a tumor or cyst, surgical removal can be an option.
“When they’re doing well, most patients just need relatively infrequent checks to make sure everything is fine,” says Dr. Frucht.
Dr. Frucht also notes that modern seizure medications are better and cause fewer side effects than medications from the past. It’s also important to remember that each person is different, so one medication might treat your seizures better than other medications. It’s important to work with your health care team to find the best treatment.
Can epilepsy be cured?
Because the causes of epilepsy are varied or unknown, there is no cure for epilepsy. But Dr. Frucht advises patients to remember that epilepsy is very treatable.
“Most of my patients do very well on medications,” he says. “Epilepsy very rarely limits a person’s lifestyle or quality of life.”
The importance of self-managing epilepsy
Maintaining a normal lifestyle with epilepsy does require patients to manage their condition. Self-management skills like developing a seizure first aid plan and learning how to record seizure activity are important to epilepsy management.
These skills can also help managing your condition easier by:
• Making it easier for you to talk to your health care team and understand the information they give you;
• Teaching others how to best respond to your seizures;
• Changing your lifestyle or environment to lessen seizure triggers;
• Living a healthy lifestyle;
• Preventing seizure emergencies;
• Providing extra information to your health care team about your seizures, seizure triggers and other factors that could improve the success of your treatment.
It can help to know that you aren’t alone. Your doctor and health care team is there to ensure your treatments are successful. They can also help you find other medical support. Your family and friends can help by taking detailed notes when a seizure happens, by learning what to do when you have a seizure and offering other support you may need.
Epilepsy support groups can also help. These groups provide a safe place for you to talk about epilepsy with other patients and their caretakers. For more information on support groups in Wisconsin, go to epilepsywisconsin.org.
Epilepsy First Aid
If you witness someone having a seizure, Dr. Frucht says it is important to know how to help. Here are some things you should do if you recognize someone having any kind of seizure:
• Stay with them until the seizure ends.
• Once they are fully awake, help the person sit in a safe place.
• Once they are alert and able to communicate, tell them in simple terms what happened.
• Comfort the person and speak calmly.
• Check for a medical bracelet or other emergency information.
• Keep yourself and others calm.
• Offer to call a taxi or another person to make sure they get home safely.
If you recognize someone having a tonic-clonic seizure – where they cry out, fall, shake or jerk – these steps can help keep them safe from injury until the seizure ends:
• Ease them to the floor.
• Turn the person onto one side.
• Clear the area of anything hard or sharp that may cause injury.
• Put a soft flat object, like a folded jacket, under their head.
• Remove eyeglasses.
• Loosen ties or anything around the neck that could make it hard to breathe.
• Time the seizure and call 911 if the seizure lasts longer than five minutes.
It is equally important to know what NOT to do when someone is having a seizure:
• Do not hold the person down or try to stop their movements.
• Do not put anything in the person’s mouth – a person having a seizure cannot swallow their tongue.
• Do not give mouth-to-mouth breaths like CPR – people typically breathe again on their own following a seizure.
• Do not offer food or water until the person is fully alert.
*Seizure First Aid tips provided by the CDC.