What are seizures & Epilepsy? How is it treated? [Simple explanation!]

This concise information about the cause of epilepsy, diagnosis and treatment is from a handout that I give to my clinic patients.

I hope it helps you.

You can download the original PDF by clicking here: [Epilepsy Patient Information Handout]. Its free for use and distribution.

For more extensive information, you can read the complete Epilepsy Patient Guide.

What does Electricity Do Inside the Brain?

Each part of our brain communicates with other parts using electric currents.

These electric currents are strictly regulated.

Normal electricity in the brain

For example, when you want to move a small current is sent to the brain area that controls the hand.

So, your hand only moves when you want it to move.

What is A Seizure?

Sometimes, a small part of the brain starts producing too much electric current.

When there is too much electric current, abnormal things start happening.

How a seizure starts in the brain

For example, your hand may start shaking without reason. Or you may become unresponsive. This is a “small seizure”.

Later, this abnormal current can spread. It can involve the entire brain.

How a seizure spreads in the brain

At this stage the entire body starts shaking violently. This is a “Big seizure”.

What should I do if someone has a seizure?

The most important thing is to avoid injury.

What should you do during a seizure

  1. Be calm
  2. Move hard furniture away from the person.
  3. Prevent the head from hitting the ground.
  4. Turn the person to one side. If he/she vomits, the vomit should fall to the ground.
  5. Do not put anything inside the mouth. It can go into the lungs.
  6. Wait. The seizure should get over in 1-2 minutes. After the seizure is completely over, clean the mouth with your finger.
  7. Wait for the patient to wake up. Do not give any water or food until completely awake.

What is a Seizure called in India?

A seizure has many different names:

  • आकड़ी–Akdi (Marathi)
  • ऐपिलेप्सी– Mirgi (Hindi)
  • ખેંચ – Khench (Gujurati)
  • फिट – Fit (Many languages)

What is Epilepsy?

A seizure is one event.

If the person has a tendency to have seizures again and again, then he is said to have Epilepsy.

So, you can say that “A person with Epilepsy has Seizures”. There is no matching word for “Epilepsy” in the Indian languages.

When can you say That Someone has Epilepsy?

The first way is very simple to understand.

If a person actually has seizures again and again, then he has Epilepsy (a tendency to have seizures).

Which tests can be used to TEST if a person has Epilepsy?

Two tests are commonly done:

  1. MRI – This can show abnormal spots in the brain.
    A “3 Tesla (3T)” MRI can show very small abnormalities. But even a 3T MRI does not show very minute abnormalities. This means the abnormal parts are too small to be seen even with the best MRI.
    MRI Brain
  1. EEG – This can show electrical sparks.
    If the electrical sparks only occur sometimes, the EEG may be normal. Long EEGs can detect sparks more easily.
    EEG brain

I may ask you to do a very long EEG (4 hours) & sleep less before the test (4 hours only) so that we are able to detect sparks.

If the MRI or EEG are abnormal, there is a chance the patient may have more seizures (Epilepsy).

Why is the MRI & EEG sometimes normal?

If the MRI is normal, its actually good news! It means the abnormality is so small that it is not seen on the MRI.

7 Tesla (7T) MRIs in the USA may be able to show even smaller abnormalities.

Even long EEGs may not detect sparks that occur very rarely. Also, an EEG cannot detect sparks that occur deep inside the brain.

What is EEG Monitoring?

EEG Monitoring is an EEG that is done for 1 or more days.
video EEG mointoring Epilepsy Monitoring Unit

Usually it is done in a hospital, so that a video recording and ECG can be done as well.

Not all patients need EEG monitoring. But in some patients it is very helpful:

  1. EEG monitoring can find a different reason for your attacks such as excessive stress or heart problems.
    cardiac problems detected during video eeg monitoring
  1. It determines the kind of seizures you have (e.g. focal versus generalized), so that the correct medications can be selected.
    Correct medications for seizures
  1. EEG monitoring quantifies seizure activity. For example, if you (or your child’s) EEG is very active at night, steroids may need to be given to prevent brain damage.
  2. It identifies the bad part of the brain. If medications are not effective, this bad part can be removed (Epilepsy Surgery).

Can Medications Control Seizures?

There are more than 30 anti-seizure medications.

Your symptoms, life-style, the MRI and EEG help us to choose the right medications.

Sometimes, EEG monitoring may be needed to choose the right medications.

After the right medications are given, about 70-80% of patients stop having seizures.

Seizure freedom with medications

Is there a Medication that cures Epilepsy Permanently?

There is no medication that cures Epilepsy permanently. But don’t be disappointed.

I wear spectacles. I cannot see clearly without them! I didn’t like them at first but now I am not disturbed by my need to wear spectacles.

Spectacles

Many patients need daily medications for high cholesterol or high blood pressure. They are not disturbed by the need to take medications.

In the same way, most people with epilepsy feel better when they take their medications.

Perhaps, it would help you to think of them as spectacles or routine tablets. Epilepsy or the tablets are not your life.

Your life is much more wonderful than Epilepsy!

Can the brain learn to control itself and stop having seizures?

Sometimes, the brain heals itself. It stops having seizures.

We don’t know why this happens.

The chances of this happening depends on the type of Epilepsy.

For example, patients with a kind of epilepsy called JME frequently need long-term medications.

Short term versus long term seizure medications

This “self-healing” is more likely to happen for other epilepsies such as Focal Epilepsy.

Therefore, if you have focal epilepsy AND have absolutely no seizures for 3 years, your doctor may advise reducing or stopping medications.

3 years how long should seizure medications be continued

50% of patients with Focal Epilepsy do not have seizures after this point.

The chances of “self-healing” is very high for Epilepsy types such as Childhood Absence.

 

What if seizures are not controlled with medications?

20% to 30% of patients may have keep having seizures even after taking medications.

It is important to confirm 2 things here:

  1. There is no other cause for the events – such as heart problems.
  2. The correct medications for the type of epilepsy & the correct dose is being given.

If the patient continues to have seizures, Epilepsy surgery should be considered.

What is  “Resective” Epilepsy Surgery?

Resective epilepsy surgery is removing the part of the brain that is causing seizures.

Resective epilepsy surgery

The chances of seizure-freedom after this surgery can be as high as 70%.

What is Vagus Nerve Stimulation (VNS)?

A Vagus Nerve Stimulator (VNS) is a device that provides modulation currents to the brain, through a nerve below the skin.

Vagus Nerve stimulation for epilepsy seizures

The surgery is minor. Effectiveness is modest. VNS decreases seizures by about 50%.

 

What other options are available?

There are many other options:

  1. Ketogenic diet
  2. Deep Brain Stimulation (DBS)
  3. Responsive Neurostimulation (RNS)
  4. Corpus Callosotomy

Deep brain stimulation DBS for epilepsy seizures

And so on…

You can discuss these options with your neurologist.

Keywords – what causes epilepsy, seizure symptoms, what is a seizure, types of epilepsy and symptoms, seizure vs epilepsy, seizure treatment, epilepsy diagnosis

Caution: This information is not a substitute for professional care. Do not change your medications/treatment without your doctor's permission.
Dr. Siddharth Kharkar

Dr. Siddharth Kharkar

Dr. Siddharth Kharkar has been recognized as one of the best neurologists in Mumbai by Outlook India magazine and India today Magazine. He is a board certified (American Board of Psychiatry & Neurology certified) Neurologist.

Dr. Siddharth Kharkar is a Epilepsy specialist in Mumbai & Parkinson's specialist in Mumbai, Maharashtra, India.

He has trained in the best institutions in India, US and UK including KEM hospital in Mumbai, Johns Hopkins University in Baltimore, University of California at San Francisco (UCSF), USA & Kings College in London.

Call 022-4897-1800

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  • Avatar Paras Prabhu ★★★★★ 6 months ago
    Out patient is epileptic from about 10 years and her seizure gotten worse during the past year with the frequency of about 3-4 times a week.So we consulted … More Dr. Kharkar. He tried a few medicines, and within 1.5-2 months now the patient is feeling very well now. There are no seizures for 14 days currently.Dr. tried to keep medicines as minimum as possible. He also tried to keep the cost of the treatment minimum.When some of the medicines started showing side-effects, he was quick to switch the medicines to the better options.Overall I think we are getting a best of the available treatments. We thank you very much Dr. Kharkar.
  • Avatar Dr Shobha Sankhe ★★★★★ a month ago
    Dr Kharkar is gem of a doctor with tremendous patience, empathy, genuine concern for his patients .He guides them very methodically & scientifically … More for their neurological ill healthOur epilepsy patient is extremely happy with his treatment , Patient feels better by just visiting him too!May his selfless service to humanity flourish to reach all the needy patients!!
  • Avatar shrruti khanna ★★★★★ a month ago
    I consulted Dr Sidharth for my sister who has become very hyper and aggressive and we could not understand the issue. Keeping in mind she is someone with … More special needs Dr Sidharth was extremely understanding of the situation and did not put her through unnecessary investigation and avoided a very long stay at the hospital. He was infact more keen on her returning home to her natural environment. We highly appreciate Dr Sidharth for his effort and for looking into the matter with utmost care. It was a very difficult decision for my family to get my sister admitted but we are glad we did it under his care.Thankyou Doc.
  • Avatar Prashant Purohit ★★★★★ a month ago
    my name is prashant purohit. I m become completely bed ridden from last 9 months and was unable to walk. I couldnt find out the cause even after visiting … More many doctors and many hospital in Ahmedabad nd jodhpur.started losing hope. A good friend of mine suggested to visit a neurologist. After searching a lot, I came to know about Dr. Siddharth Kharkar and took his appointment in Nanavati Hospital. He examined and said that he suffered from \u201cPKD(PAROXYSMAL KNESIGENIC DYSKNESIA\u201c. He assured us to reverse this in 5 days time. And indeed this happened. I started recovering miraculously. today I am fully well fit I m walking as normal . Many Many thanks to Dr. Siddharth Kharkhar sir for giving me a new life.
  • Avatar Sanjay Pradhan ★★★★★ 7 months ago
    Dr. Kharkar is truly exceptional. He is extremely knowledgeable. But simultaneously, he is extremely patient and kind - taking the time and care to respond … More to all the questions. It is rare to come across a doctor who is not in a hurry to get on to the next patient, but instead, focuses on the one in front with full attention, expertise and compassion. A great experience.
  • Avatar N N ★★★★★ 11 months ago
    We visited Dr. Kharkhar for treatment regarding my mum - who is a multi-stroke patient and has aphasia. Certain medications were creating complications … More with her condition and Dr. Kharkhar was able to help mitigate the issue. We found him and his approach to be incredibly compassionate, considerate, individualized and patient-friendly. He advice is astute, up-to-date and empathetic. His treatment always comes from a deeply human place and is about seeing how to help the patient and their caregivers feel more at ease. Something that is quite rare and refreshing within the medical community.We feel that he genuinely cares about the patients that he is treating and is always kind and respectful in his communication. Moreover, his admin team is very efficient and prompt and it's a pleasure to deal with them.Would highly recommend Dr Kharkhar himself - though we must say our experience with Nanavati hospital itself has been less than ideal.Hope this helps.
  • Avatar Manish Ranjan ★★★★★ a year ago
    I have been visiting Dr Kharkar for treatment of my father. He is a very friendly doctor. He listens to our concerns with lot of patience. He also explains … More the issue in much greater details. He has really been of great help. My father is much better now.
  • Avatar Pinakin Shah ★★★★★ 9 months ago
    One of the best Dr. Gives complete attention and time to listen to patient's history, issues. Explains various options of treatment with pros and … More cons.
  • Avatar Lawrence Castellino ★★★★★ 11 months ago
    Exceptional experience with an expert,Dr. Kharkar is a knowledge house. It is rare nowadays to find doctors with patience, knowledge, and a flair for … More handling patient’s questions, besides Dr. Kharkar’s bedside manners are exemplary. I am privileged to be treated by such an amazing soul. I have told him and will repeat it here that “I am advancing my move back to India although I am a US Citizen, because I know I am in good hands and will be well taken care of. Thanks Dr. Kharkar for your selfless service!
  • Avatar Hemant Kansara ★★★★★ a year ago
    Great doctor!! Really appreciate.The doctor diagnosed to my sister correctly and start treatment, she has good improvement after taking medicine prescribed … More by doctor as no epilepsy attake. We have good experience with the doctor. Thank you

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