Seizures and epilepsy care

Epilepsy is a disease of the brain that occurs when an individual has two or more unprovoked seizures or a single seizure and risk factors that make it likely that more seizures will occur. An unprovoked seizure is a seizure that is not caused by a reversible medical condition, such as low blood sugar or alcohol withdrawal.

More than 2.2 million Americans have epilepsy. In fact, epilepsy is the fourth most common neurological disorder in the United States, after migraine, stroke and Alzheimer’s disease. Epilepsy can affect people at any age or stage of their life but occurs more frequently in children under the age of 1 and older adults. Seizures and epilepsy can be serious and lead to injuries, life-threatening emergencies and even death.

If you or someone you know has epilepsy, we can help. 

Allina Health offers comprehensive evaluation and treatment options for children and adults with seizures, including new onset or first-time seizures, and spells of altered consciousness. Patients receive care from specialists with expertise in treating epilepsy, physiological and psychological non-epileptic events, and brain tumors.

Most people can achieve good seizure control through medication or other treatment. If seizures haven’t been controlled after 12 months of treatment, or after trying a second medication, patients are advised to see a specialist.

Seizure

A seizure is a disruption of the brain’s normal function caused by abnormal electrical activity that affects the neurons (nerve cells) of the brain. Seizures can cause loss of consciousness, abnormal sensations, movements or behaviors. A seizure is a temporary event that may indicate that there is a problem or disease involving the brain.

There are many types of seizures, but they are generally classified as either focal or generalized. Focal seizures begin with abnormal electrical activity in one area of the brain and are sometimes described by people as “strange” spells or episodes. Focal seizures can involved no loss of consciousness or loss of consciousness.

Generalized seizures begin with abnormal electrical activity involving the whole brain. Seizures vary greatly in their appearance and can affect different people in different ways. There are a number of different types of generalized seizures:

• Absence seizures are often referred to as petit mal seizures. These seizures are subtle and may involve a brief loss of awareness. A person with this type of seizure may stare blankly or have rapid blinking movements of their eyes and appear to be daydreaming.
• Tonic seizures cause the muscles in your back, arms and trunk to suddenly stiffen uncontrollably. These seizures may cause a person to fall suddenly to the ground.
• Clonic seizures cause rhythmic jerking of muscles, usually muscles in the hand, arms face and head.
• Myoclonic seizures usually appear as large, brief jerks of the upper body, arms or legs. These seizures may cause a person to drop objects.
• Atonic seizures, or drop seizures, cause a loss of muscle control and muscle tone. These seizures will cause an individual to suddenly collapse or fall to the ground.
• Tonic-clonic or convulsive seizures are often referred to as grand mal seizures. These seizures involve stiffening and shaking of the body and may involve a loss of bladder control and tongue biting. Following the seizure the person is confused and sleepy.

It is important to be evaluated by a doctor even if an individual has experienced just one seizure. Seizures can cause injury and even death, or they can be a symptom of an underlying problem with the brain. Your doctor will try to determine if a seizure has occurred and whether or not treatment is needed to prevent more seizures. 

There are several kinds of tests or assessments that will help your doctor to determine if you have had a seizure and if you need treatment to prevent further seizures. Some of the assessment may include:

• Medical history
• Neurological examination
• Electroencephalogram (EEG) 
• MR
• Other neuroimaging, positron emission tomography (PET), magnetoencephalography or magnetic source imaging (MEG or MSI) and single photon emission computed tomography (SPECT)

The goal of epilepsy treatment is to stop seizures or control them as best as possible. 

For a majority of individuals with epilepsy, seizures can be controlled by taking one or more antiepileptic medications. The primary treatment approach is to control seizures with medications. Currently, there are more than 20 anti-epileptic medications available. However, approximately one third of people with epilepsy will not have their seizures controlled by medications alone.

Seizures that are not controlled within the first 12 months of treatment or after trying a second antiepileptic medication could mean that a person has what is known as refractory or difficult to control epilepsy. For these individuals, brain surgery or an implanted device may help to control seizures. New advances in technology and surgical techniques are improving outcomes for individuals that have difficult to control epilepsy.

Medications

Medicines used to treat seizures are referred to as anticonvulsant medications, antiepileptic drugs (AEDs) or anti-seizure medications. Medication is the primary method of treatment for epilepsy. It is important to understand that medications can help to control seizures or prevent them from happening but they do not cure or correct the problem that caused the seizures. 

Approximately 70 percent of individuals with epilepsy will have their seizures controlled after trying one or two antiepileptic drugs (AEDs). There are different types of anticonvulsant medications and certain types of medications are more effective for certain types of seizures. As with most other medications, AEDs can potentially cause side effects.

Epilepsy surgery

For approximately 30 percent of individuals with epilepsy, seizures are not controlled with AEDs alone. For these individuals, epilepsy surgery may be an option. Epilepsy surgery can dramatically improve seizure control; in many cases, seizures may be completed controlled following surgery. Some individuals who are not candidates for epilepsy surgery may be helped by implanted devices.

• Vagus nerve stimulation – In this procedure, an implantable device works by stimulating the vagus nerve with a mild electrical charge. No brain surgery is involved.
• Responsive neurostimulation – Responsive neurostimulation is a new approach to treating uncontrolled seizures. A device is implanted under the scalp and in the skull. This device continually monitors the brain for abnormal electrical activity. When the device senses the abnormal activity, it delivers a mild electrical stimulus to disrupt the abnormal activity before a seizure occurs. 

Allina Health, along with our independent physician partners, offers comprehensive evaluation and treatment options for children and adults with seizures, including new onset or first-time seizures.

Comprehensive, state-of-the-art inpatient treatment for epilepsy, physiological and psychological non-epileptic seizures and brain tumors is available at Abbott Northwestern Hospital in Minneapolis and United Hospital in St. Paul. The National Association of Epilepsy Centers has designated Abbott Northwestern Hospital as a level 4 epilepsy center and United Hospital as a Level 3 center. The inpatient facilities offer long-term video-EEG monitoring units with 24-hour monitoring to record and localize seizure onset, allowing for development of an individualized treatment plan to best control seizures. Neurosurgeons perform both surgical re-sectioning of the brain and new, less-invasive laser ablation surgery.