What is a Seizure? What is Epilepsy?

Let’s start with a couple definitions.

Seizures are sudden episodes of excessive discharge of electrical activity in the brain that usually cause a change in behavior. Seizures may be related to a brain injury or a family tendency, but most seizures occur for no known reason. There are different types of seizures and what occurs during a seizure will depend on the area of brain involved.

Epilepsy is a neurological condition which affects the nervous system. The term seizure disorder is often used to mean the same thing. Epilepsy usually is diagnosed after a person has had two or more seizures that are not provoked or caused by a specific medical illness. When epilepsy is present, a person has a tendency to have recurring seizures.

Medical History

When something happens to you for the first time that might have been a seizure, you should see a doctor or nurse as soon as possible.

The doctor or nurse should first ask you or your family member about your history. This is important because it may indicate whether or not it was a seizure, and if it was, the history may point to the possible cause and indicate the chances another seizure could occur.

The doctor or nurse will ask for a complete description of what happened. Often it is important to bring along a family member or someone else who saw the seizure and can tell the doctor what happened, since the person who had the seizure may have been unconscious at the time and unable to remember it. Even if the patient thinks that he or she was aware during it, there may be important aspects that the patient can not recall. The doctor or nurse will want to hear not only a description of the seizure itself, but also the details about the events leading up to it and the after-effects that followed it.

You might be asked questions like:

• Could the episode have been provoked by sleep deprivation, excessive use of alcohol or drugs, or some other factor?
• What was the setting?
• Did the episode occur shortly after standing?
• Was there a warning?
• Exactly what happened during the episode?
• How long did it last?
• Was the person tired or confused after the episode?
• Has there been more than one episode in the past? If so, were they all alike?
• Has the person seen a doctor before about this kind of event?
• If so, what tests were done? Was any medication prescribed? What effect did it have?
• Does anyone in the family have seizures or epilepsy?

Some other things that the doctor or nurse should ask you include:

• Did you ever hit your head so hard you lost consciousness?
• Did you ever have a stroke?
• Do you drink alcohol or take drugs, and if yes, how much?

Physical and Neurological Examinations

After the history, the doctor should conduct physical and neurological examinations. Because certain medical disorders involving other organ systems of the body can cause seizures, your doctor will perform a general medical examination as an important part of your first visit for seizures. A physical examination along with some laboratory tests can tell the doctor whether your liver, kidneys, and other organ systems are working properly.

Some people have both epilepsy and a medical disorder such as kidney disease or an overactive thyroid gland. If you have a disorder of this kind, both your neurologist and your primary care doctor should know about it. Your medical disorder may be involved in causing your seizures. Even if it is not, the presence of another disorder may affect the seizure medicines that may be prescribed for you. Either the disorder itself may affect the way the medicine works in your body, or the medicine prescribed to treat it may interact with your seizure medicine.

The neurological examination evaluates how well your brain and the rest of your nervous system are functioning. It checks the functioning of your muscles, your senses, and your reflexes. It also monitors how well you walk and checks your coordination. Another important part of the neurological exam is a test of your mental functions, such as the ability to remember words, do arithmetic, and name objects.

Lab Tests

The doctor usually orders a variety of tests to help determine if the event was a seizure, and if so, whether it was indicative of epilepsy or another problem. These tests include:

• A brain wave test, also called an EEG (electroencephalogram), to look for changes in the brain's electrical patterns that are related to seizures
• Blood tests, to look for certain medical disorders that could have triggered a seizure
• A special x-ray of the brain – either a CT scan (sometimes called a CAT scan), or an MRI scan (magnetic resonance imaging), to look for abnormal areas in the brain that could have caused a seizure.

Depending on the urgency of the situation, other tests also might be recommended, such as a lumbar puncture (also called a spinal tap), EKG (electrocardiogram, to check the heart), or a sleep test.

The results of these tests often appear completely normal in people with epilepsy. Normal test results do not necessarily mean that the seizures are not real or that epilepsy is not present.

If the primary care physician can’t be sure if you had a seizure, or can’t find a reason for the seizure, then he or she should refer you to a doctor who specializes in neurology (general neurologist) or to a neurologist who specializes in the treatment of epilepsy (an epileptologist).

Education and Counseling

If the doctor or nurse concludes that you had a seizure, you should receive information on safety issues that are important for you to know, such as first aid for seizures, driving restrictions and how to be prepared in case another seizure occurs.

Beginning Treatment After a First Seizure

In special situations, your doctor may recommend that treatment with epilepsy medications be started after one seizure if he or she believes you are likely to have more seizures. Some of these situations include:

• if you have weakness on one side of the body
• if your EEG shows abnormalities that are typically seen in persons with epilepsy
• if your MRI or CT scan shows an abnormality of the brain
• if you are over 60 years
• if you or your family members think that the risks of having another seizure are greater than the potential side effects from trying an epilepsy medication. For example, some people are worried about losing their driving privileges, and would rather begin epilepsy medications than have another seizure and be unable to legally drive for a long time.

The doctor chooses a particular seizure medication based on the type of seizure you may have had, your age, and whether you have any other medical conditions. The doctor then should then discuss with you how to take the medicine, what side effects to look for, and when to come back for a follow-up visit.

For more information:

• Why See a Doctor?
• What Will the Doctor Do?
• Diagnosis 101: The Basics
• Medical History
• Physical Exam
• Neurological Exam
• What Tests are Needed?
• EEG
• Developing Preparedness Plans
• Responding to Seizures
• Treatment 101: The Basics

Topic Editor: Mary Jo V. Pugh, PhD, RN and Steven C. Schachter, MD.
Last Reviewed: 3/25/08

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