Epilepsy

Epilepsy is usually diagnosed if

at least two seizures have occurred,

there was a period of at least 24 hours between the seizures, and

there is nothing to suggest that the seizures were caused by certain factors (provoked seizures).

Epilepsy can also be diagnosed if the risk of having a second seizure is considerably higher after the first seizure.

There are special (rarer) types of epilepsy too, known as epilepsy syndromes. These include absence epilepsy and infantile spasms (West syndrome), which can occur in children.

Your medical history is important for making a diagnosis: For instance, when and under what circumstances did the seizure occur? What happened during the seizure? People who have seizures often can’t remember much about what happened themselves. Then it makes sense to take someone along who saw the seizure and can describe exactly what happened.

Physical and neurological examinations are done, and a blood sample is taken.

An electroencephalogram (EEG) is also usually done to measure the electrical activity of your brain. Certain EEG patterns indicate that you are more likely to have seizures. But an EEG alone isn’t enough to diagnose epilepsy.

An MRI (magnetic resonance imaging) scan is usually done too. This helps to find out whether there are changes in the brain that could be causing the seizures.

In rare cases the cerebrospinal fluid is tested – typically if doctors think that you might have an inflammation in your brain or in the membranes surrounding the brain and spinal cord (meningitis). The fluid is taken from the lumbar (lower back) region of the spine, using a needle. This procedure is known as a lumbar puncture or spinal tap

The most suitable kind of treatment for a specific person will depend on the type of epilepsy they have and the course of their disease so far. Epilepsy is usually treated with medication known as anti-epileptic drugs (AEDs). Various kinds of medications – from different groups of drugs – can be used as AEDs. If a certain medication doesn’t work at a low dose, the dose can be increased. If that doesn’t work, a medication from a different group of drugs can be tried out or several medications can be used together.

Seizures are often one-off events, so you can usually wait before having any treatment. People typically only start treatment if they have a second seizure. But if you have a higher risk of further seizures, for example if you have a brain disease, then it may be a good idea to already start with treatment after the first seizure. It's important to discuss your personal situation with your doctor.

People who decide to take medication usually take it for several years. If they don't have any seizures during that time, some people can stop taking the medication and see what happens. Others have to take medication for the rest of their lives.

Anti-epileptic drugs can have side effects like tiredness or dizziness. There are also sometimes specific risks, for example ones affecting an unborn baby during pregnancy. Then it's especially important to discuss the options in detail with your doctor.

If seizures can’t be prevented with medication, other options may be considered. These include the following:

Surgery: If someone has partial seizures and it's clear which part of the brain is triggering them, that part of the brain can be surgically removed. But that's not always possible.

Vagus nerve stimulation: In this procedure, a device that produces electrical signals is implanted in your chest area. It is connected to the vagus nerve in the neck by wires and is meant to prevent the nerve cells from being too active. The vagus nerve is an important part of the vegetative nervous system and is involved in regulating the body's internal organs. There’s currently a lack of good-quality research on the benefits of this treatment. As a result, statutory health insurers in Germany only cover the costs of vagus nerve stimulation in very specific cases, under special circumstances.

The treatment is overseen by a neurologist. Children are treated by child neurologists (pediatric neurologists). One part of the examination and treatment is usually done in a hospital. There are outpatient facilities and clinics that specialize in treatments for people with epilepsy (e.g. epilepsy centers, epilepsy outpatient hospital departments, and specialized doctors’ practices). These are particularly suitable if you have a specific problem, if the diagnosis is not clear, or if you keep on having seizures despite treatment.

The most important thing that helpers can do during an epileptic seizure is stay calm and prevent injury. If the seizure lasts longer than five minutes or if several seizures occur within a short space of time, the emergency services should be informed (e.g. by calling 112 in Germany and most European countries, or 911 in the U.S.). People who have a severe epileptic seizure sometimes have to stay in hospital for a bit.

It may be helpful to have psychological treatment too. This can help you to cope with the effects of epilepsy and improve your quality of life. It is not yet clear from scientific research whether this can also lower the number of seizures.