Epilepsy - The Brain's 'Electrical Storm'

Today’s medications and other new treatments help most people with epilepsy live seizure-free

When Someone Has a Seizure

The vast majority of seizures stop safely and naturally in a minute or two. However, you can help the person by following these guidelines:
• If he collapses to the floor, position him on his side to prevent food or fluids being breathed into the lungs.
•Don’t put anything in his mouth. People having seizures do not swallow their tongue.
• If he is sitting upright, make sure his head is supported and protected.
• If the seizure doesn’t stop in several minutes, call 911.

It came as a shock to her college classmates when Mary* collapsed one day, lost consciousness and began shaking all over. They didn’t know she had epilepsy. Although Mary had been diagnosed with the disorder at age 14, medication allowed her to live seizure-free for five years. Recently, her doctor had tried taking her off the drug in the hope she’d outgrown her seizures. (She went back on medication and was fine.)

Mary is among 2 million people in the United States who have epilepsy, the diagnostic term used for recurring seizures, says neurologist John Margraf, M.D., of Lehigh Valley Hospital and Health Network. Seizures occur in all age groups. Those that begin in childhood often are controlled well by medication and may stop by adulthood. Some people, like Mary, may require medication lifelong.

“Seizures occur when there is a sudden change in the normal electrical activity in your brain cells, triggering a brief ‘electrical storm’ in the brain,” Margraf says. This change in electrical activity may be the result of a head injury, stroke, tumor or illness such as meningitis, but most often the cause is unknown.

There are many different types of epileptic seizures, Margraf says:

• Partial seizures begin in a small area of the brain and cause uncontrolled shaking of an arm or leg, staring, memory loss or repetitive movement such as hand rubbing or lip smacking. Sometimes partial seizures spread to both sides of the brain and create more serious symptoms.
• Primary generalized seizures affect the whole brain. At the mild end of the spectrum are petit mal seizures, a common type in children that includes staring, subtle body movement and brief lapses of awareness. Grand mal seizures are the most intense type, resulting in loss of consciousness and convulsions.

Today’s treatment options

About 70 percent of people with epilepsy control their seizures well by taking a medication, Margraf says. For others, a combination of drugs is required. Side effects may include dizziness and confusion, but new medications give doctors more choices to help limit these effects.

In some cases, seizures can be controlled with surgery or a new treatment called vagus nerve stimulation, says P. Mark Li, M.D., chief of neurosurgery at Lehigh Valley Hospital and Health Network. Surgery is an option when seizures begin in one specific area in the side or front regions of the brain. Surgeons remove this area and eliminate the seizures, although medication still may be necessary.

“For people who are not candidates for this surgery and do not respond well to medication, vagus nerve stimulation is a new alternative,” Li says. “It reduces seizures in 30 to 50 percent of patients and often improves a person’s overall feeling of well-being.”

Surgeons implant a small generator similar to a cardiac pacemaker in the upper left side of the chest, running a connecting wire under the skin to the vagus nerve in the left side of the neck. The wire carries impulses 24 hours a day that stimulate the nerve at regular intervals, inhibiting seizures. People who feel some sense of warning (or “aura”) before a seizure often can stop the seizure by activating the stimulator, Li says.

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