Severe and Uncontrolled Epilepsy
A seizure happens when there are certain types of abnormal electrical activity in the brain. During a seizure, you may:
- Lose consciousness
- Stare into space
- Have convulsions—abnormal jerking of the muscles
- Experience abnormalities of sensation or emotion
If you have 2 or more seizures that are not due to an illness or other trigger, then it is considered a seizure disorder. This condition is also known as epilepsy. Seizure disorders may be classified by the part of the brain they affect and the kinds of symptoms they cause. One way to categorize into two important groups is:
- Generalized seizure disorder—onset is throughout the brain, not from a single focal location
- Partial seizure disorder (focal seizure)—begins within certain areas of the brain
|Brain Cells (Neurons)|
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Seizures are caused by abnormal brain function. For many people, it is not known what causes the malfunction. Some known causes include:
- Congenital conditions
- Head trauma—common cause, such as concussion , skull fracture , bleeding inside of the skull, and oxygen deprivation due to near-drowning
- Infections, such as encephalitis , cerebritis, brain abscess
- Brain tumor
- Immune-mediated diseases
In older adults:
- Brain tumor
- Degenerative diseases, such as Alzheimer disease
Factors that may increase your chance of developing seizures or a seizure disorder include:
- Previous brain injury—seizure disorder usually develops within one year of injury
- Previous brain infection
- Abnormal blood vessel that has formed in the brain
- Brain tumor
- History of stroke
- History of complex febrile seizures
- Use of certain medications or recreational drugs
- Stopping the use of medications, recreational drugs , or alcohol
- Drug overdose
- Exposure to toxins, such as arsenic , lead , or carbon monoxide
- Family history of seizure disorders
- Alzheimer disease
- Toxemia during pregnancy
- Chemical abnormalities—decreased or excess blood sodium or glucose, low blood calcium
- Liver or kidney failure
- Severe, untreated high blood pressure
- Chronic diseases, such as lupus, polyarteritis nodosa , porphyria , sickle cell disease , and Whipple disease
- Cysticercosis—an infection caused by a pork tapeworm
If you already have a seizure disorder, the following factors can increase your chance of having a seizure:
- Sleep deprivation
- Hormonal changes, such as those that occur at points during the menstrual cycle
- Flashing lights, especially strobe lights
- Use of certain medications
- Missing doses of anti-epileptic medications
There are many kinds of seizure disorders with a variety of symptoms, such as:
- Aura—a sensation at the start of a seizure, may involve the perception of an odd smell or sound, visual symptoms, or unusual stomach sensations
- Loss of consciousness
- Repeated jerking of a single limb
- Generalized convulsion with uncontrollable jerking of muscles throughout the body
- Hand rubbing
- Lip smacking
- Picking at clothing
- Perception of an odor, sound, or taste
- Loss of bladder or bowel control
- Postictal state—a state of drowsiness, alteration in responsiveness, and/or confusion that commonly occurs after a generalized tonic-clonic seizure; may last minutes, hours, or days
Symptoms of generalized seizure disorders include:
- Generalized tonic-clonic seizures—loss of consciousness, stiffening, uncontrollable jerking of muscles throughout the body
- Absence seizures—staring, eye blinking, or eye rolling
Symptoms of partial seizure disorder include:
Complex partial or temporal lobe seizures:
- May lose contact with reality, stop purposeful activity, and begin a series of automatic gestures, such as lip smacking, hand-wringing, or picking at clothing
- May appear as a brief moment of confusion or loss of attentiveness
- May have a perception of unusual sights, sounds, or smells
Simple partial seizures:
- Does not involve a loss of contact with reality or a loss of consciousness
- Single area of the body may move uncontrollably, such as leg or arm shaking
- May include the perception of an odor, sound, or taste, or an unrelated emotion
You will be asked about your symptoms and medical history. A physical exam will be done. You may need to see a neurologist. These doctors specialize in the nervous system and brain.
Your bodily fluids may be tested. This can be done with:
- Blood tests
- Lumbar puncture
Images may be taken of your bodily structures. This can be done with:
- MRI scan
- CT scan
- Magnetoencephalography (MEG)
- Positron emission tomography (PET)
- Single photon emission computed tomography (SPECT)
Your brain activity may be evaluated. This can be done with an electroencephalogram (EEG).
The goals of treatment are to:
- Treat the underlying cause (if known)
- Prevent seizures—may be done through medications, surgery, or special therapies
- Avoid factors that stimulate seizure activity
There are wide varieties of medications that may be used. These drugs may be given alone or in combination. Each drug may have particular side effects and interactions. Talk to your doctor about which medication is right for you.
Talk to your doctor if you are or plan to become pregnant.
If medication does not work or the side effects are too severe, you may need surgery. Surgery involves the removal of the seizure focus. This is the area of the brain that has been identified as starting the seizure. Surgery is only an option for people who have very localized areas of the brain involved.
A brain responsive neurostimulator, an intracranial implanted device, can stop seizures in those with medically refractory epilepsy as they begin.
Vagus Nerve Stimulation (VNS)
A device is implanted in the chest. It will provide intermittent electrical stimulation to the vagus nerve. It is not clear how this works. Somehow it prevents or decreases the frequency of seizures. You may still require medication. The dosage may be less.
This is a strict diet. It is high in fat and low in carbohydrates and proteins. This diet keeps the body’s chemical balance in ketosis. Ketosis decreases the frequency of seizures. The reason is unknown. Following a ketogenic diet is most successful in children. It is less successful in adults.
Modification of Activity
If you have a seizure disorder, you can take the following steps to try to decrease the chance of a seizure:
- Get enough sleep.
- Avoid excessive alcohol intake. Alcohol can make seizures more likely.
- Avoid hyperventilating.
- Avoid places where flashing or strobe lights are in use.
- Wear a medical alert bracelet. That way, if you have a seizure, people around you will understand what is happening. They will be able to take appropriate steps to be helpful.
- Consider keeping a seizure log. Record things that were happening around the time of a seizure. This will help to identify a seizure trigger.
- Take your seizure medications according to the prescription.
There are no known ways to prevent every type of seizure disorder. You can take steps to prevent brain injuries that could lead to seizures:
- Always wear a helmet when using bikes, rollerblades, skateboards, or scooters.
- Wear protective headgear when playing contact sports.
- Dive in safe depths of water.
- Always wear a seatbelt.
- Avoid using street drugs.
- If your baby or child has a high fever, get treatment right away.
- Get prenatal care. If you have high blood pressure during pregnancy, get proper treatment.
- If you have a chronic condition, get proper care.
If you have a severe seizure disorder, some changes may be needed to prevent serious injuries, such as:
- Avoid driving, if advised to do so by your doctor.
- Do not swim or bathe alone.
- Do not work on ladders or ledges.
- Avoid or modify athletic activities.
Talk to your doctor about these kinds of issues.
This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.
Edits to original content made by Denver Health.
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- Seizure Disorder—Child
Epilepsy Foundation http://www.efa.org
National Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov
Center for Epilepsy and Seizure Education http://www.esebc.ca
Epilepsy Ontario http://www.epilepsyontario.org
Antiepileptic drugs (AEDs) for seizure disorders. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114575/Antiepileptic-drugs-AEDs-for-seizure-disorders . Updated August 10, 2017. Accessed November 10, 2017.
Epilepsy in Adults. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115086/Epilepsy-in-adults . Updated October 16, 2017. Accessed November 10, 2017.
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