Frequently Asked Questions

Seizures and Epilepsy 101

A seizure is a sudden electrical storm that occurs in your brain, that temporarily affects your brain’s normal functioning and can cause a variety of different symptoms. 

Provoked seizures happen because of a clear reason, such as a very low blood sugar level; alcohol or drug withdrawal; and certain medications. Unprovoked seizures happen without any obvious cause.

 

Seizures can occur in many different forms. 

Auras are unusual feelings or symptoms that occur at the very beginning of a seizure, such as: a sudden rising or dropping feeling in your stomach; feeling warm and flushed all over; feeling scared or anxious; feeling déjà vu (the feeling that you’ve already seen or done something before); or seeing, hearing, tasting, or smelling things that aren’t there.

Focal aware seizures are seizures that do not affect someone’s thinking or their level of consciousness at the time of the seizure.  People who have focal aware seizures know when they are having a seizure, are aware of everything that is going on around them during the seizure, and can recall all of these events after the seizure has ended.  Focal aware seizures can sometimes consist of unusual feelings, similar to those described in the “Auras” section above.  Other times, they might involve shaking or stiffening of one side of the body; or sudden numbness or tingling of one side of the body.  

Focal seizures with impaired awareness are seizures that can cause someone to become confused or lose awareness of the world around them.  Someone who is having a focal seizure with impaired awareness may appear as if they are daydreaming or zoned out.  They are awake, but may not react or respond when you talk to them, or they may seem very confused. They might stare blankly, make unusual chewing or lip smacking movements with their mouth, or pick at their clothing or other things with their hands without meaning to.  Afterwards, they often do not remember what happened or what was said to them while they were experiencing the seizure.  Sometimes they may not even be aware that they had a seizure.

Generalized tonic-clonic seizures are a type of seizure where someone loses consciousness (passes out) and their whole body stiffens and then shakes all over.  These seizures are also called “grand mal” seizures or “generalized convulsions.”   People may injure themselves, bite their tongue, or lose control of their bladder or bowels during these kinds of seizures.  Afterwards, they are often very tired and confused, it may take them hours to days to recover back to their baseline.  

Epilepsy is a diagnosis that means that someone’s brain is likely to have repeated seizures without any clear cause. You can be diagnosed with epilepsy if:

  • You have had two or more unprovoked seizures that occurred more than a day apart.
  • You have had one seizure, but your doctor thinks you have a high chance of having another seizure in the future, based on your test results or other risk factors you might have.

Most seizures last anywhere from a few seconds to a few minutes.

Rarely, seizures can be quite prolonged, lasting many minutes to hours. 
When this occurs, it is called “status epilepticus” and is a medical emergency.

Seizures can cause injuries when they occur, because they can make you confused, cause you to lose awareness of the world around you, or cause you to fall.  They might result in injuries such as burning or cutting yourself (if a seizure occurs while you are cooking), or crashing your car (if a seizure occurs while you are driving).

The most dangerous kind of seizure, a generalized tonic-clonic seizure, can sometimes cause broken bones, dislocated shoulders, or serious abnormalities in your heart rhythm or breathing.  Sometimes (though rarely) seizures can lead to death. 

Stay calm, and remain with the person during the seizure and afterwards, until they have recovered. 

Time the seizure.   If a seizure lasts longer than 5 minutes, call 911.  If the person has multiple repeated seizures without recovery in between, call 911.

If the person has lost consciousness and is lying on the ground, roll the person onto their side, to prevent them from choking on their saliva.   Cushion their head with a soft object such as a pillow, blanket, or a shirt.  If there are sharp or hard objects nearby that they could injure themselves on, move these out of the way or place cushioning around them, to prevent injury.

Do NOT place any objects in the person’s mouth. Do NOT try to hold the person down to prevent them from shaking.  These actions are likely to cause injury, rather than helping. 

Monitor their breathing and check their pulse.

After the seizure is over, the person should be monitored to make sure that they are recovering from their seizure and are returning to their baseline.

In some cases, the doctor might prescribe emergency medications to be given during the seizure, to help stop the seizure.  

For more information, see the Epilepsy Foundation’s First Aid for Seizures

It is helpful to have someone who knows you well and who has seen your seizures join the visit or be available by phone.

Bring a list of all your current medications and the doses you take. 

Make a list of questions that you would like to discuss with the doctor.

Inform your doctor if you have been having any usual spells or sensations that have occurred repeatedly, even if they seem subtle to you.  

Let your doctor know if you have concerns about your memory (forgetfulness), language (word finding difficulties), or concentration difficulties.

Tell your doctor if you are having issues with sleep, such as waking up feeling fatigued or whether your bed partner has witnessed snoring or any periods where you stop breathing.

Discuss with your doctor what your alcohol consumption is like, whether you take any vitamin or nutritional supplements, and whether you smoke or vape substances such as marijuana.

Inform your doctor about any anxiety or depression symptoms, and whether there are ongoing stressors in your life.

 

Late-Onset Seizures and Epilepsy

A late-onset seizure is a first-time seizure that occurs later in life, typically after the age of ~ 55 or 60 years old.  

The most common causes of late-onset seizures include: stroke, bleeding in or around the brain, brain tumors, neurodegenerative diseases, and head trauma.

In 30-50% of individuals with late-onset seizures, there is no identifiable cause for their seizures.

Undiagnosed seizures can result in significant injury, as well as a decline in a person’s thinking and memory.  It is important to diagnose seizures early, so that appropriate medications can be started to prevent further seizures and their consequences.  

Studies have also shown that people with late-onset seizures have a higher risk of developing stroke and dementia, compared to people their age who do not have seizures.  Therefore, diagnosing late-onset seizures can provide an opportunity to assess whether there are specific medical conditions (such as high blood pressure and diabetes) that should be optimized, and/or lifestyle changes that can be made (such as exercising, eating a healthier diet), to reduce a person’s risk for stroke and dementia.

Late-onset seizures can be challenging to diagnose, because the symptoms associated with seizures in older adults can be quite subtle.  The most important tests are brain imaging scans such as a brain MRI (Magnetic Resonance Imaging), and brain wave testing with an EEG (electroencephalogram). Your doctor may also order blood tests, urine tests, cognitive testing, a spinal tap, or a sleep study, depending on your medical history and risk factors.

Late-onset seizures are typically treated using anti-seizure medications. There are several anti-seizure medications approved by the FDA, and most work equally well to prevent seizures, with the main differences being the side effect profiles. You should discuss with your doctor which anti-seizure medications would be a good fit for you, after taking into account your other medical problems.

It is also important to identify potential seizure triggers (such alcohol consumption, poor sleep, stress), so that these can be avoided if possible.  

Finally, it can be helpful to identify other medical conditions that could be contributing to more frequent seizures.  For example, some studies suggest that obstructive sleep apnea that goes untreated can result in worse seizure control.  

Overall, an individual with late-onset epilepsy who starts an anti-seizure medication has an 80-90% chance of being seizure-free, if they take their medication consistently.

Older adults have the highest risk of developing epilepsy compared to any other age group.  Late-onset seizures are very common and occur in around 1% of the population.  There is an urgent need to better understand why people are more likely to develop seizures as they grow older.  We also need to understand why people with late-onset seizures have a 3-times higher risk of developing a stroke or diseases like Alzheimer’s disease, compared to people their age who don’t have seizures.  Similarly, we need to identify new treatments that can be used to prevent stroke and dementia from occurring in people with late-onset seizures.  Older adults have the highest risk of developing epilepsy compared to any other age group.