What Are Causes of Epilepsy and Treatments? (video/podcast)

Many people associate epilepsy with someone lying helplessly on the ground, arms and legs jerking uncontrollably. While this certainly can be one symptom of epilepsy, others may be more subtle or even barely noticeable. With treatment, epilepsy is manageable.

In this video, San Diego Health host Susan Taylor talks with Michelle Van Noord, MD, a neurologist at Scripps Clinic Torrey Pines, about epilepsy symptoms and treatments.

Epilepsy is a type of seizure disorder — a medical condition that causes a temporary, uncontrolled surge of electrical activity in your brain. Think of it as a spontaneous electrical storm in the brain, says Dr. Van Noord, who has expertise in epilepsy.

“Seizures can start in one focal area of the brain as something small, and then spread from there,” she says. “Other types of seizures can actually happen in both halves of the brain at the same time right from the onset, and that can change the way the seizure looks.”

Epilepsy symptoms can vary widely depending on the part of the brain affected. In addition to uncontrollable jerking movements of the arms or legs, epilepsy may cause fainting, temporary confusion or the inability to respond to things a person sees or hears — they may seem to be staring off into space. Some people experience strange physical sensations or emotions. Generally, people do not remember what happened during a seizure, or even having one.

In about 50% of epilepsy cases, the cause is unknown. Brain trauma, stroke and infection may trigger a seizure. Other types of epilepsy are associated with neurodevelopmental disorders or genetics. If you have a first-degree relative, such as a parent or sibling who has epilepsy, you likely have an increased risk of the disorder.

“Epilepsy is a clinical diagnosis, which means the story of what’s happening tells your physician more than any other test,” says Dr. Van Noord. “That’s where having somebody who witnessed the episode is really important. The description of a seizure helps us tell the difference between that and other types of neurologic disorders like strokes.”

The Scripps Memorial Hospital La Jolla Epilepsy Monitoring Unit (EMU) continuously monitors patients with epilepsy for up to five days using video and electroencephalogram (EEG) equipment with the goal of capturing a seizure. This information helps an epileptologist — a neurologist who specializes in caring for people with epilepsy — develop a treatment plan.

Medication is usually the first step in treating epilepsy.

“Medications can control seizures in up to 70% of patients,” says Dr. Van Noord. “Sometimes that takes more than one medication, but that’s not really different than people who use medications to control other chronic medical problems like high blood pressure or diabetes.”

If medication is not effective, surgery may be an option. Temporal lobe resection surgery may be recommended for patients who have epilepsy that starts in one part of the brain; the surgery removes that part of the brain. Another procedure, laser ablation surgery, uses a laser to destroy the part of the brain causing the seizures. Both surgeries are generally very effective at eliminating or reducing seizures. 

Several devices that are implanted into the body also can help control seizures:

Vagus nerve stimulator (VNS) is a small device placed in the chest and connected to a small, flexible wire that goes over the vagus nerve along the side of the neck. The VNS delivers electronic impulses that can help reduce seizure activity in the brain. VNS surgery is typically an outpatient procedure with no hospital stay.

Responsive neurostimulation (RNS) uses electrodes implanted in the brain and a device implanted into the skull beneath the scalp to control seizures. RNS is a type of deep brain stimulation (DBS) therapy, often used to control tremors caused by Parkinson’s disease. RNS usually requires an overnight hospital stay.

“Epilepsy is a very treatable disorder. We have new medications and treatments to help our patients control their seizures and live the life that they want to live,” says Dr. Van Noord. “So make sure you seek care for any loss of consciousness or strange symptoms that you can’t explain, and get the care that you need.”

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