What is epilepsy?
Epilepsy is a neurological disorder that occurs when nerve cell activity in the brain is disturbed, causing seizures. These seizures may cause behavioral changes, convulsions or loss of consciousness.
Epilepsy can develop at any age — some people experience their first seizure as an adult, and others as a child. Every person with epilepsy experiences something different, which makes epilepsy a “spectrum condition.” We’ll work with you so that you, your family and your friends understand your or your child’s epilepsy.
The first step in an epilepsy evaluation is determining whether someone has epilepsy. Epileptic seizures are then typically categorized into two larger categories: focal seizures or generalized seizures. Determining the type of seizure helps to guide the best possible treatment path.
Generalized seizures occur when abnormal electrical brain function is recorded from the entire brain. These seizures cause a loss of consciousness and feelings of nausea, hypertension, headache, migraine, tiredness and confusion.
Generalized seizures include:
- Generalized tonic-clonic seizures (grand mal seizures), which are characterized by loss of consciousness and muscle jerking.
- Absence seizures (petit mal seizures), which can cause a person to stare into space for a few seconds.
- Atonic seizures (drop attacks), which are characterized by complete or partial loss of muscle tone.
- Clonic seizures, which cause muscle jerking and can involve either no impact on consciousness or a loss of consciousness.
- Myoclonic seizures, which are characterized by brief jerks of a group of muscles.
- Tonic seizures, which usually last less than one minute and are characterized by sudden stiffness of the body, arms or legs.
Focal seizures occur when abnormal electrical brain function is recorded in one or more areas on one side of the brain. Also called partial seizures, focal seizures may cause an aura (experience of visual change, hearing abnormalities or strange smells) before the person has a seizure.
Focal seizures include:
- Motor seizures, an uncontrolled movement caused by seizures. There are many types of motor seizures. For example, a motor seizure can be a brief twitch, a rhythmic jerking of one limb or half of the body, a sudden fall with quick recovery, a brief stiffening of the whole body that is not followed by shaking, a drop of the head or a sudden flailing of the arms and legs.
- Non-motor seizures, sometimes called absence seizures, often involve staring, a brief lapse in awareness and last a few seconds. Other non-motor seizures can last longer and may involve changes in vision, hearing taste or smell. They can involve feeling nauseated or “out of it.” There may be changes in a person’s breathing and heart rate.
Symptoms of epilepsy
While each person experiences something different with epilepsy, there are some key symptoms to look for. Symptoms of epilepsy may include:
- Confusion
- Fear, anxiety or déjà vu
- Loss of or impaired consciousness or awareness
- Repetitive movements (automatism)
- Staring spells
- Stiffening
- Uncontrollable jerking in arms or legs
Your epilepsy care team
From common to complex epilepsy conditions, you’ll have an entire neurology team behind you. Your epilepsy care team will consist of:
- Epileptologist, a highly trained neurologist with additional, specialized training for treating epileptic seizures and seizure disorders.
- Neuropsychologists, who specialize in understanding the relationship between behavior and the brain.
- Nutritionists, who will partner with you and/or your child to create a nutrition plan to help manage and improve epilepsy symptoms. Learn more about pediatric nutrition.
- Pediatric neurologists, specialists who help diagnose and treat children with conditions related to their nervous system.
- Neurosurgeon, a surgeon who holds advanced training in surgery to treat neurological conditions.
- Pediatric epilepsy surgeon, who specializes in pediatric neurosurgery to treat epilepsy. Learn more about pediatric neurosurgery.
- Case management nurses, who are trained to answer any questions you may have during your or your child’s care.
- Neurophysiology technician, who administers tests that can diagnose neurological disorders including epilepsy, seizure disorders and strokes.
- Nurse care coordinators, who are trained to answer questions you may have at any step, including those about your or your child’s treatment and healthcare.
- Advanced practice providers, including physician assistants and advanced practice registered nurses.
- Genetics specialists, who can analyze genes to determine if symptoms are caused by genetic factors. Learn about MyCode.
- Neurodevelopmental pediatricians, who specialize in the care and treatment needed to support healthy brain development.
- Nurses, who will assist with your or your child’s care while you’re in for checkups and appointments.
Diagnosing epilepsy
If you suspect that you or your child may have epilepsy, your doctor may recommend certain tests to help with a proper diagnosis. These tests may include:
- Magnetic resonance imaging (MRI): An MRI uses safe, powerful radio waves and magnets to create detailed 2D images of the brain.
Most MRIs operate at a strength of 1.5 Tesla (a unit that measures the strength of a magnetic field). Our team uses 3 Tesla MRI technology, which operates at twice the strength of traditional MRI scanners.
This technology provides highly detailed images of the brain, which allows us to treat conditions more accurately and better than ever.
- EEG (electroencephalography): An EEG is a noninvasive test that records the brain’s electrical activity. Electrodes (small metal disks) are placed on your or your child’s head to continuously read and record brain wave activity. A video is recorded during this test, which is used to evaluate you or your child for seizures or the risk of having seizures.
- Long-term EEG monitoring (LTM): LTM is a continual video recording, day and night, that is taken in a controlled environment during an EEG and used to help determine if a person is having epileptic seizures. These tests take place in a safe, monitored space that allows us to study seizures and determine where seizures are originating.
- Genetics: Sending your child's blood samples for analysis can help determine whether they have a genetic-based disorder or disease. Learn about MyCode.
Treating epilepsy
Our epilepsy specialists use some of the latest technology available to treat epilepsy. Your doctor may recommend any of the following to treat epilepsy:
Medication is the first step in treating epilepsy and can often completely control seizures. Epileptologists are experienced with the broad range of medications available to treat people with epilepsy, including FDA-approved cannabidiol (CBD) and the latest pharmaceuticals.
There are also opportunities to participate in clinical trials for new and developing medications to treat epilepsy. Participating in a trial may help improve your condition, even if standard approaches haven’t worked. Find a clinical trial near you.
The ketogenetic diet and its modifications (low glycemic, Atkins and modified Atkins) can help reduce the number of seizures, as well as their severity.
If your child has epilepsy, they will work with a pediatric nutritionist who is specially trained to create a nutrition plan that best meets their needs.
For those whose epilepsy is not controlled by medications (known as drug-resistant or intractable epilepsy), surgery may be recommended. Surgery can lead to better control of seizures and in some cases completely resolve them.
Several surgical options are available depending on the type of seizure and clinical history:
- The seizure-causing part of the brain can be surgically removed using a laser (LITT).
- Our surgeons can insert a neuromodulator — a small, implanted device that works like a pacemaker to disrupt the signals that are causing seizures. This can also be used as a diagnostic technique. There are several types of neuromodulators, including responsive neurostimulation (RNS), vagal nerve stimulation (VNS), transcranial magnet stimulation (TMS) and deep brain stimulation for epilepsy.
If you need surgery, we will follow an advanced, multi-stage surgical planning process so that the most personalized treatment is offered. This includes:
- A surgical procedure known as stereoelectroencephalography (SEEG), where electrodes can be placed within the brain to target specific seizure-causing areas deep in the brain.
- Neuropsychological testing and advanced imaging techniques – such as functional MRI (fMRI), positron emission tomography (PET) and transcranial magnetic stimulation – help minimize risk from any procedure and promote the best possible outcome.
Epilepsy care at Geisinger
Whether you’re looking for care for yourself, a family member or your child, our entire team is here to support you throughout epilepsy diagnosis and treatment. We offer:
- A nationally-accredited team – We’ve been accredited by the National Association of Epilepsy Centers (NAEC) as a Level IV Epilepsy Center – the highest level of epileptic patient care available. Your care team is powered by surgeons, doctors and specialists with years of training and experience with epilepsy care.
- Care from all sides – Your care team is multidisciplinary, which means it has many physicians from different specialties who come together to create a personalized treatment plan for you. That means you can see your care team in one location, all during the same visit.
- Care designed for you, where you live – With locations throughout northeast, central and south-central Pennsylvania, our experienced team provides consultations and comprehensive care. We offer leading-edge treatment options and tailored-to-you care backed by the expertise and innovation of a nationally recognized health system.
- Genetic testing and counseling programs – Special research programs such as MyCode® are only available at Geisinger. Participating in MyCode allows you to contribute to genetic research. By participating, you may also receive information about your own genetic risks. Learn about MyCode.