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Webinar Recap: Seizures: What You Need to Know

Learn what causes seizures, how they’re diagnosed, and which treatment options get the best results with minimal side effects.

 

About 1 in 10 people will have a seizure in their lifetime. Despite how common they are, seizures are often misunderstood. We recently hosted a webinar to explore what people should know about this complex neurologic phenomenon, including common causes, diagnostic methods, and effective treatments.

American Brain Foundation board member Jacqueline French, MD, was joined by two Mayo Clinic neurologists and seizure experts, Alyx Porter, MD, a neuro-oncology specialist, and Greg Cascino, MD, an expert in drug-resistant epilepsy. Dr. Porter and Dr. Cascino provide valuable insights and foster a deeper understanding of the challenges of living with seizure disorders.

What are Seizures?

A seizure is an uncontrolled burst of electrical activity between neurons (brain cells). It causes temporary changes in movements, sensations, and states of consciousness. Some people confuse the terms seizure and epilepsy, but seizures are a symptom, and epilepsy is a disorder. When an individual has recurrent and unprovoked seizures, they have a seizure disorder or epilepsy (the terms are synonymous). “It’s one of the most common chronic neurologic disorders,” explains Dr. Cascino. “Perhaps one in 26 Americans will develop a seizure disorder during their lifetime.”

Seizures are divided into categories based on how they originate: generalized onset seizure (affects both sides of the brain at the same time), focal onset seizure (starts in one area of the brain), and unknown onset seizure (undetermined origin).

What Causes Seizures?

Dr. Cascino estimates that about one-third of individuals experiencing seizures have a symptomatic lesion (an abnormal area of tissue) in their brains as the cause. Tumor, stroke, blood vessel malformation, and traumatic brain injury (TBI) can all lead to symptomatic lesions that cause seizures. As a neuro-oncologist, Dr. Porter encounters many individuals who experience seizures due to brain tumors. She explains, “It really does depend on where in the brain the mass arises as to whether or not a patient may present with a seizure or may experience seizures as part of their experience.” Dr. Porter notes that younger people with brain tumors often experience seizures as their first noticeable symptom. Focal Cortical Dysplasia (FCD) is another condition that causes seizures, often leading to a diagnosis when individuals are younger. FCD involves abnormal brain cell development and organization and is a common cause of treatment-resistant epilepsy. 

Unfortunately, it’s more challenging to determine the cause of seizures for the majority of people experiencing them. Ongoing research is starting to provide valuable insight into cases like these. Researchers are discovering that a number of these individuals have genetic epilepsy—even without a family history of seizures. There are also some interesting connections between epilepsy and other disorders affecting the brain. “We now know that a number of autoimmune neurologic diseases may be associated with focal and generalized seizures,” notes Dr. Cascino.

How are Seizure Disorders Diagnosed?

Identifying that a seizure has occurred is always the first step in getting a diagnosis. That’s why it’s important to remember that seizures present in many different ways—and they’re not always obvious. “Sometimes, there might be tingling sensations. Sometimes, people might have difficulty getting the words out. There are all kinds of presentations,” explains Dr. Porter. Remembering the phrase “short, sudden, sometimes strange, and similar spells” can help people recognize when seizures may be occurring.

After experiencing a seizure, individuals should visit their primary care physician or a neurologist to begin a comprehensive and multidisciplinary evaluation. The doctor will try to determine the type of seizure and what caused it. They will first evaluate medical history, asking many questions to gather as much information as possible. This is often followed by a neurologic exam assessing the individual’s thinking, function, and senses.

Brain imaging is the next step to look for abnormalities in brain structure. CT scans, CAT scans, and MRI scans are all used to identify anatomical issues that lead to seizures, including tumors, TBI, and abnormal brain development. These scans don’t always tell the whole story, so doctors might order an electroencephalogram (EEG) to monitor the individual at a clinic or in their home. An EEG is a test that shows patterns of brain activity, revealing whether it is abnormal or normal. Abnormal patterns can occur due to various conditions, but doctors can identify a distinctive type of pattern associated with epilepsy.

What are Effective Treatments for Epilepsy?

The cause determines some treatment options, but seizures can still be controlled even if the cause has not been identified. The goal is always to reduce seizure activity, improve quality of life, and reduce the likelihood of emergency events.

Dr. French explains that there are several effective anti-seizure medications on the market. Some medicines are designed to work for different types of seizures, and individuals may have to try a few options before they find what works for them. “Fortunately, two-thirds of the time, that does control all the seizures, and an individual can go about their life as they had before,” she says.

People with drug-resistant seizures may require additional medical and surgical care. Electrical stimulation is a treatment option that involves implanting a device that delivers electrical stimulation to inhibit or control seizures. Vagus nerve stimulation, responsive neurostimulation, and deep brain stimulation are all types of electrical stimulation. Surgery is another treatment option for some people with drug-resistant seizures. It works best for those whose seizures consistently start in the same place in the brain. Thermal ablation, which destroys pinpointed brain cells, and lobectomy, which removes the area where seizures begin, are two surgical options.

Dr. Cascino also wants to ensure that all people with epilepsy are aware of and have immediate access to rescue treatments. Different from daily seizure medications, rescue treatments are fast-acting drugs used as needed to avoid emergencies. They can be easily administered by a caregiver and should be used if a seizure occurs in a more intense, longer-lasting, or more frequent pattern.

Why More Epilepsy Research is Crucial

The past few decades have seen many advancements in uncovering the causes of epilepsy and in the use of exciting new treatments. However, much more work must be done to understand the underlying mechanisms responsible for the disorder. There’s also a need for more medication options with fewer side effects and new therapies for people with drug-resistant epilepsy.

The American Brain Foundation is currently funding epilepsy research exploring the potential shortening of clinical trials and the role of the microbiome in drug-resistant epilepsy. “In the last ten years, we’ve granted over a million dollars to epilepsy research, and we will certainly be providing more investment in epilepsy research in the future,” shares Dr. French. 

Because brain diseases are interconnected, research breakthroughs have a magnified impact. Discovering a cure for one disease or disorder often leads to cures for many more. That’s why it’s so important to support more research. “We can’t do our work and improve the lives of people with epilepsy and other brain diseases without the support of our donors,” says Dr. French.

The American Brain Foundation is dedicated to funding research on epilepsy and other brain conditions. Join us in our mission to find cures for all brain diseases and disorders—donate today to make a difference.