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Epilepsy : Causes, Types, Symptoms, Diagnosis and Treatment


Lily Wong-Kisiel M.D., a pediatric neurologist, responds to some of the most common questions about epilepsy.

Epilepsy is a syndrome that is made up of different symptoms. These symptoms describe changes in the electrical activity of the brain. An MRI of the brain can help identify any structural abnormalities, and an EEG can help identify certain characteristics of the brainwave activity. Based on this information, the physician can determine which type of epilepsy the person has. There are many causes of seizures in children. Some are due to genetic causes, neuromagnetic causes, or autoimmune causes.

A seizure action plan is a roadmap for nurses and teachers at school in the event that your child has a seizure. It includes information about what kind of seizure your child has and whether there is any anti-seizure medication that should be used while the seizure is happening. If seizures do not stop after attempting the treatments listed above, it is important to contact the family or emergency services.


Most seizures are brief. Some patients have absence seizures that last five to six seconds. Other patients may have generalized tonic-clonic seizures that last two to three minutes. These brief seizures, although they may seem like a lifetime for parents, don't actually cause any lasting damage. There can be a negative impact on growth and development if a child has frequent seizures. However, if seizures last longer than five minutes or are generalized (everybody in the seizure goes crazy), your doctor may discuss a seizure action plan with you.

This will depend on the type of seizure your child has. For seizures that are subtle and don't always happen, it is helpful to keep track of how often this happens to your child. If it's not possible or practical for you to watch every moment, you should talk to your doctor about this. EEG monitoring will be ongoing in order to detect subtle seizures. This could be helpful for those patients who have sporadic seizures that are difficult to detect by visual inspection. For patients who have nocturnal seizures, video EEG monitoring can also be very helpful. Doctors can determine the seizure frequency by looking at the number of movements a patient makes during a seizure. There are FDA-cleared devices that can detect generalized tonic-clonic seizures based on movement.

About a third of patients with epilepsy can continue to have seizures despite appropriate treatment. In those patients, evaluation for surgery may be an option. Epilepsy surgery can be an option for patients who have a focal epilepsy where a focus can be identified and safely removed. There are a variety of epilepsy surgery options, including surgery to disconnect certain areas of the brain that may be causing seizures.

You should be prepared with questions when you visit your clinic. Be familiar with the different seizure types that you've seen, and know the duration of each seizure. Also, keep a seizure calendar to help your physician and care team understand your seizures better. Make sure to review the frequency of your seizures.

 Diagnosing your condition

To diagnose your condition, your doctor will review your symptoms and medical history. Your doctor may order several tests to determine if you have epilepsy and to determine the cause of seizures. Your evaluation may include:

  • A neurological exam.Your doctor will test your behavior, mental function, and other areas in order to diagnose your condition and determine the type of epilepsy you may have.
  • Blood tests.Your doctor may take a blood sample to check for signs of infections, genetic conditions, or other health conditions that may be associated with seizures.

Your doctor may suggest tests to detect brain abnormalities such as: -An MRI scan to see if there are any abnormalities in the brain -A blood test to measure levels of neurotransmitters (chemicals that help nerve cells communicate with each other)

  • Electroencephalogram (EEG).This is a test that is used to diagnose epilepsy. electrodes are attached to your head with a sticky substance or cap. The electrodes will record the electrical activity of your brain.

    If you have epilepsy, it's common for your normal brain waves to change even when you're not having a seizure. Your doctor may use an EEG (electroencephalogram) to monitor your brain waves while you're awake or asleep to detect any seizures. Knowing about the seizures may help your doctor treat them. The doctor will determine what kind of seizures you are having or rule out other conditions.

    The test may be done in a doctor's office or the hospital. If the test is appropriate, you may also have an ambulatory EEG (a device that records seizure activity over a few days), which you wear at home.

    Your doctor may tell you to do something that might cause a seizure, such as getting a little sleep beforehand.

  • High-density EEG.Your doctor may recommend high-density EEG testing, which places the electrodes closer together than conventional EEG tests. This type of test may help your doctor more precisely determine which areas of your brain are affected by seizures.
  • A computerized tomography (CT) scan is a type of imaging test that uses x-rays to create pictures of the inside of your body.A CT scan uses X-rays to view the inside of your brain. This scan can reveal abnormalities that might be causing your seizures, such as tumors and cysts.
  • Magnetic resonance imaging (MRI).MRI scans use powerful magnets and radio waves to create a detailed view of your brain. Your doctor may be able to see abnormalities in your brain that are causing your seizures.
  • Functional MRI (fMRI).Doctors use an MRI to measure the changes in blood flow that occur when different parts of your brain are working. This information can be used to help surgeons plan operations by identifying which parts of your brain are involved in specific functions.
  • Positron emission tomography (PET).A PET scan uses a very small amount of low-dose radioactive material to help visualize metabolic activity in the brain and detect abnormalities. If areas of the brain have low activity, this may indicate where seizures occur.
  • A computerized tomography scan uses one photon of light to create a detailed image of the inside of the body.This type of test is used if an MRI and EEG have not found the source of your seizures.

    A SPECT test uses a small amount of radioactive material to map the activity of blood flow in your brain during seizures. Areas with higher blood flow during a seizure may indicate where seizures occur.

    Doctors may also perform a form of SPECT called subtraction ictal SPECT combined with an MRI scan (SISCOM). This could provide even more detailed results by overlapping the SPECT results with a patient's brain scan.

  • Tests that measure how the brain works.Doctors use tests to assess your thinking and speech skills. The test results help doctors determine which areas of your brain are affected.

Your doctor will use a variety of analysis techniques to help determine where seizures start in your brain. These might include tests that measure different aspects of your brain activity.

  • Statistical parametric mapping (SPM).SPM is a method of comparing areas of the brain that have had an increase in blood flow during seizures to normal brains in order to find out where seizures start.
  • Electrical source imaging (ESI).EEG data is collected and projected onto an MRI to show doctors where seizures are happening.
  • Magnetoencephalography (MEG).MEG measures the magnetic fields produced by brain activity to determine where seizures might begin.

If you know the type of seizure you are having and where seizures begin, it will help you find an appropriate treatment.

More Information

  • Epilepsy care at Mayo Clinic
  • CT scan
  • EEG (electroencephalogram)
  • MRI
  • Positron emission tomography scan
  • SPECT scan
  • Epilepsy FAQs
  • An infographic about epilepsy shows where seizures generally take place in the body.
  • Infographic: Epilepsy and Brain Mapping


Doctors generally try to treat epilepsy with medication before considering other treatments. If medications don't work, doctors may propose surgery or another approach.


Many people with epilepsy can become seizure-free by taking one anti-seizure medication. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications.

Many children who don't have epilepsy symptoms can eventually stop taking their medications and live seizure-free lives. Many adults can stop taking their medications after two or more years without seizures. Your doctor will advise you when the appropriate time to stop taking medications is. medications are medicines.

There is a lot to consider when choosing the right medication for your seizure disorder. Your doctor will consider your condition, how often you have seizures, and other factors when selecting a medication. They will also take into account any other medications you are taking. These ingredients will not interact with each other.

Your doctor may start you on a low dosage of a single medication and gradually increase the dosage until your seizures are under control.

There are many different types of seizure medications available. The medication your doctor chooses to treat your epilepsy depends on the type of seizures you have as well as other factors such as your age and health conditions.

These medications may cause some side effects. Some mild side effects may include:

  • Fatigue
  • Dizziness
  • Weight gain
  • Loss of bone density
  • Skin rashes
  • Loss of coordination
  • Speech problems
  • Memory and thinking problems

Some side effects are more severe, but they are not common. These side effects include:

  • Depression
  • Suicidal thoughts and behaviors
  • Severe rash
  • Inflammation of certain parts of your body can lead to organ problems, such as liver inflammation.

To get the best seizure control possible with medication, follow these steps:

  • Take medications exactly as prescribed.
  • Before changing to a generic version of your medication or taking other prescribed medications, always call your doctor. This is especially important if you are switching from a prescription medication to an over-the-counter drug, or from one over-the-counter drug to another.
  • Always talk to your doctor if you stop taking your medication.
  • If you notice any new or increased feelings of depression, suicidal thoughts, or changes in your mood or behaviors that are not normal, please tell your doctor right away.
  • If you have migraines, let your doctor know. Some of the anti-epileptic medications can help prevent your migraines and treat epilepsy.

A majority of people newly diagnosed with epilepsy will become seizure-free with their first medication. If anti-epileptic medications don't work, your doctor may suggest surgery or other therapies. You will have regular check-ups with your doctor to make sure that the treatment is still helping. Talk to your doctor about your condition and medications.


 Epilepsy surgery

If medications do not control seizures well, surgery may be an option. A surgeon will remove the area of your brain that's causing seizures.

Doctors usually do surgery when tests show that it is the best course of action.

  • Your seizures are likely caused by a small area in your brain.
  • The surgery will not interfere with your vital functions such as speaking, moving your arms and legs, seeing, or hearing.

For some people with epilepsy, less invasive procedures such as MRI-guided stereotactic laser ablation may be effective when an open procedure would be too risky. In these procedures doctors direct a thermal laser probe at the specific area in the brain causing seizures. Doctors try to control seizures by using tissue.

After successful surgery, many people still need medication to help prevent seizures. However, you may be able to take fewer drugs and reduce your dosage.

Some surgeries for epilepsy can have complications, such as permanently altering your thinking abilities. Talk to your surgeon about the success rates and complication rates of the procedure you're considering.


There are many potential therapies for treating epilepsy. Some of these treatments include medications and surgery, but other options include therapies that don't involve medications or surgery.

  • Stimulating the vagus nerve.Doctors can implant a device called a vagus nerve stimulator beneath the skin of your chest. The device receives electrical stimulation from wires that are connected to the vagus nerve in your neck.

    The device sends bursts of electrical energy through the vagus nerve, which is a nerve in your neck. This might reduce seizures by 20 to 40%.

    Almost everyone will still need to take anti-epileptic medication, but some people may be able to lower their dose. You may experience side effects from vagus nerve stimulation, such as throat pain, hoarseness, shortness of breath, or coughing.

  • Ketogenic diet.Some children with epilepsy have been able to reduce their seizures by following a diet that includes a lot of fats and few carbohydrates.

    The ketogenic diet is a diet that the body breaks down fats instead of carbohydrates for energy. After a few years some children may be able to stop the ketogenic diet - under close supervision of their doctors - and remain seizure-free.

    Make sure to consult a doctor if you or your child are considering a ketogenic diet. This diet can be dangerous if not followed carefully, so make sure your child is getting the right amount of food.

    Some side effects of a ketogenic diet may include dehydration, constipation, slowed growth, because of nutritional deficiencies, and a build-up of uric acid in the blood, which can cause kidney stones. These side effects are uncommon if the diet is properly supervised.

    A ketogenic diet can be difficult. Low-glycemic index and modified Atkins diets offer less restrictive alternatives that may still provide some benefit for seizure control.

  • Deep brain stimulation is a treatment for certain medical conditions. There are surgical procedures that involve implanting electrodes into a specific part of your brain. These electrodes are then connected to a generator implanted in your chest. This generator sends electrical pulses to your brain at specific intervals, which may reduce your seizures. Brain stimulation is sometimes used to treat people who have seizures that don't improve with medication.
  • Responsive neurostimulation. These implantable devices can help reduce the number of seizures you have. These responsive stimulation devices watch your brain activity and when they detect a seizure starting, they give you an electric shock or drug to stop it before it becomes harmful. This therapy has few side effects and is effective in providing long-term seizure relief.

Potential future treatments

Researchers are testing many new treatments for epilepsy. Some potential treatments include:

  • Continuous stimulation of the area near the seizure onset.Subtle stimulation to the brain below a level that can be seen or felt may improve seizure outcomes and quality of life for some people with seizures. This helps prevent seizures from happening.The treatment approach might work for people who have seizures that start in an area of the brain that cannot be removed because it would affect speech and motor functions (an eloquent area). Or it may be beneficial for people whose seizure characteristics mean their chances of successful treatment with responsive therapy are high.The amount of stimulation needed is low.
  • Minimally invasive surgery.There are new surgical techniques that show promise at treating seizures without any risks greater than traditional open-brain surgery for epilepsy.
  • Transcranial magnetic stimulation (TMS).TMS uses focused magnetic fields to treat seizures by targeting areas of the brain where they occur. It may be used for patients who have seizures that occur near the surface of the brain, and surgery is not an option.
  • External trigeminal nerve stimulation. This device would reduce the frequency of seizures by stimulating specific nerves. It would not require surgery like vagus nerve stimulation, which is done inside the body. In studies, external trigeminal nerve stimulation has been successful in reducing seizure frequency. The use of CBD oil can result in improvements in seizure control and mood.

Pacemaker for epilepsy

Mayo Clinic has the latest information about epilepsy. You can receive this information by email.

Join our mailing list to receive updates on epilepsy treatment and management.

We will use your email and website usage information to provide you with the most relevant and helpful information. We may also combine this information with other information about you, such as your medical history. If you are a patient at the Mayo Clinic, this could include your protected health information. We will combine this information with your protected health information, and we will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the link in our email message. There is a link in the e-mail that will let you unsubscribe from the mailing list.

More Information

  • Epilepsy care at Mayo Clinic
  • What are the side effects of Neurontin? How can I manage them?
  • Epilepsy surgery
  • Vagus nerve stimulation
  • Pacemaker for epilepsy
  • An infographic about electrical brain stimulation for epilepsy.

Clinical trials

There are studies being conducted at the Mayo Clinic that test new treatments and interventions in an effort to prevent, diagnose, or manage this condition.

Lifestyle and home remedies

If you know your condition, you can better manage it:

  • Take your medication correctly.Don't change your dosage before consulting with your doctor. If you feel that your medication needs to be changed, talk to your doctor first.
  • Get enough sleep.If you are not getting enough sleep, that can lead to seizures. Make sure to get enough rest each night.
  • Wear a medical alert bracelet.This will help emergency personnel understand how to treat you correctly.
  • Exercise.Exercising can keep you physically healthy and reduce depression. Make sure to drink plenty of water and rest if you get tired during exercise.

Make healthy life choices, such as limiting your intake of alcohol and cigarettes.

Coping and support

Seizures and their effects on your life can at times be overwhelming or lead to depression. It's important not to let epilepsy keep you from living an active full life. There are ways to cope:

  • Learn about decoupage and how to do it yourself. Talk to your friends and family about it so that everyone can have a fun activity to do together.This information is about epilepsy so that you will understand the condition.
  • Do not let negative reactions from people bother you.It is important to know about epilepsy in order to dispel myths about the disease. And it is helpful to maintain a sense of humor about it.
  • Live as independently as possible.If you can't drive because of your seizures, try to continue working. If you can't drive and live in your current city, investigate public transportation options near you. If you're not allowed to drive and live in your current city, consider moving to a city with good public transportation options.
  • Find a doctor you like and with whom you feel comfortable.
  • Try not to constantly worry about having a seizure.
  • Find an epilepsy support groupTo have friends who understand what you are going through is helpful.

If you have seizures that prevent you from working outside of your home, there are still ways to be productive and connected to people. You may consider working from home.

Make sure people you work and live with know the correct way to respond if they are present when you have a seizure. You may suggest things such as:

  • If someone is choking, be sure to roll them over so they are not breathing in vomit or food.
  • Place something comfortable under his or her head.
  • Loosen tight neckwear.
  • Don't try to help the person during a seizure by putting your fingers in their mouth. That has never happened – and it's physically impossible.
  • Do not try to restrain someone who is having a seizure.
  • If the person is leaving dangerous objects behind.
  • Stay with the person until medical personnel arrive. Do not leave them alone.
  • Watch the person closely so that you can provide more specific details about what happened.
  • Time the seizures.
  • Be calm during the seizures.

Preparing for your appointment

You may visit your family doctor or a general practitioner first. However, if you call to set up an appointment you may be referred immediately to a specialist, such as a doctor who is trained in brain and nervous system conditions (neurologist) or a neurologist who is specifically trained in this area. A person who has epilepsy is an epileptologist.

Make sure to be prepared for your appointment. Appointments are often brief, so it's important to have plenty of questions ready. Here is some information about what to expect during your visit with the doctor.

What you can do

  • Keep a detailed seizure calendar.Every time a seizure occurs, write down the time it happened and how long it lasted. Also note any factors that may have contributed, such as missed medications, sleep deprivation, increased stress, or menstruation.

    You should talk to family friends and co-workers about your seizures so that they can record information about them.

  • Please be aware of any pre-appointment restrictions.When you make your appointment, be sure to ask if there are any restrictions on what you can eat in advance.
  • Write down key personal information,The more stressed or recent life changes a person has experienced, the more likely they are to have a mental health condition.
  • Make a list of all medications,Some of the vitamins or supplements that you're taking.
  • Take a family member or friend along.If you forget something important during your appointment, someone who is with you may remember it for you.

    Your doctor may want to ask questions of someone who has witnessed you having a seizure. This is because you may not be aware of everything that happens during one.

  • Write down questions to askMake a list of questions to ask your doctor. This will help you get the most out of your appointment.

Some basic questions to ask your doctor if you have epilepsy include:

  • What is likely causing my seizures?
  • What kinds of tests do I need?
  • Can my epilepsy be considered temporary or chronic?
  • What kind of treatment do you think would be best?
  • What are some alternative ways to approach the problem you're describing?
  • How can I prevent another seizure from happening?
  • What are some of the other health conditions I have? How can I best manage them together?
  • Do I need to follow any specific rules when decorating with decoupage?
  • Should I see a doctor? How much will it cost and is my insurance likely to cover it?
  • Can I substitute a different medicine for the one you're prescribing?
  • Can I take any printed material home with me? Do you have any websites that I can visit?

Do not hesitate to ask questions during your appointment. You may also have questions during the visit that you don't understand.

What to expect from your doctor

Your doctor may ask you a number of questions, such as:

  • When did your seizures first start happening?
  • Do you think your seizures are somehow related to certain things?
  • Can you describe the feeling you have just before a seizure happens?
  • Do you have seizures frequently or only occasionally?
  • What are the symptoms of a seizure?
  • What might help improve your seizures?
  • What are the possible side effects of taking this medicine?

What you can do in the meantime

If you are worried about seizures, it might be helpful to:

  • Do not drink too much alcohol. Drinking too much alcohol can be harmful to your health.
  • Avoid using nicotine
  • Get enough sleep
  • Reduce stress

It is important to keep a record of your seizures before visiting your doctor.

Epilepsy : Causes, Types, Symptoms, Diagnosis and Treatment

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