An Overview of Epilepsy

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Epilepsy is a neurological condition that's caused by electrical disturbances in your brain, resulting in seizures, which can cause atypical behavior, movements, or experiences, and sometimes a lack of awareness or loss of consciousness. It's diagnosed when you've had two or more seizures and there's no medical condition behind them, such as alcohol withdrawal or low blood sugar. Epilepsy can affect anyone, at any age, sometimes runs in families, and can be the result of a brain injury. However, often the cause is unknown.

Types

Understanding the different types of epilepsy begins with learning more about the different types of epileptic seizures.

Focal Seizures

Focal seizures involve just one area of your brain and are the most common type of seizures that people with epilepsy experience. They are divided into two categories:

  • Focal aware seizures: During these seizures, which used to be called simple partial seizures, you're awake and aware. Some people may not be able to respond during the seizure, but they're still aware of what's going on. Focal aware seizures can last from just seconds up to a couple of minutes and may involve muscle jerking, stiffening, or limpness; only one area or side of your body is affected. They can also result in symptoms such as changes in the way you experience things around you, dizziness, tingling, or visual disturbances like flashing lights. This type of seizure is also commonly referred to as an aura.
  • Focal impaired awareness seizures: As the name implies, during these seizures, you are either unaware or your awareness is impaired. These used to be called complex partial seizures. Normally lasting from one to two minutes, these seizures are sometimes preceded by an aura, which is a sort of warning sign that's different for everyone and is actually a type of focal aware seizure itself. You may have a blank stare and repeat the same action over and over like chewing, rubbing your fingers together, or lip smacking, known as an automatism, or you may simply freeze.

    Generalized Seizures

    Generalized seizures may involve your entire brain, or they may involve just certain areas on both sides of your brain. There are six different types of generalized seizures, including:

    • Absence seizures: Historically known as petit mal seizures, absence seizures involve a short period of time in which you lose a sense of awareness or "space out." This type is most common in children between the ages of 4 and 14 and usually lasts less than 10 seconds.
    • Tonic seizures: These seizures cause your muscles to suddenly stiffen, which can prompt you to fall if you're standing up. Tonic seizures often happen during sleep and usually involve a loss of consciousness.
    • Atonic seizures: When you have an atonic seizure, your muscles lose tone and control, becoming limp, and you may collapse. These are often referred to as "drop seizures."
    • Myoclonic seizures: If you've ever been asleep and suddenly woken up because one of your muscles suddenly jerked, you know what a myoclonic seizure feels like. These seizures involve sudden, quick jerks in your arms or legs. You may have a number in a row or just one on occasion.
    • Clonic seizures: Similar to myoclonic seizures, clonic seizures involve sudden, jerky muscle movement, only in this case, it's repetitive. Usually, clonic seizures are involved in a tonic-clonic seizure.
    • Tonic-clonic seizures: Previously called grand mal seizures, these seizures are the type that most people associate with epilepsy. First, in the tonic stage, your muscles stiffen, then you lose consciousness and fall to the ground. Next is the clonic stage, in which your arms and sometimes your legs begin jerking or twitching quickly and repeatedly. These seizures typically last for a few minutes.

    In 2017, the International League Against Epilepsy (ILAE) made significant changes in the classification systems for seizures and types of epilepsy. While epilepsy used to be classified by type as either generalized or focal, two new categories have been added as well: generalized and focal epilepsy and unknown epilepsy. Here's what they mean:

    • Generalized epilepsy: If you have generalized seizures, your epilepsy is classified as generalized.
    • Focal epilepsy: If you have focal seizures, your epilepsy is classified as focal.
    • Generalized and focal epilepsy: If your seizures consist of both generalized and focal, your epilepsy is classified as generalized and focal epilepsy. Several epilepsy syndromes are included in this category (see below).
    • Unknown epilepsy: If it's unclear whether your seizures are focal or generalized, or if no one has witnessed them, they will likely be categorized as unknown. Later on, with tests and observation, your seizures may end up being reclassified as either focal or generalized.

    Epilepsy Syndromes

    Epilepsy syndromes are conditions characterized by patterns of seizures and other associated features like where in the brain the seizures begin, what type they are, the age at which they begin, causes, genetic components, the severity and frequency of the seizures, and the way they show up on an electroencephalogram (EEG). Most of these syndromes begin in childhood.

    Having your epilepsy classified even further as a syndrome is helpful for your medical team because of the specific diagnostic, treatment, and sometimes genetic approaches that have been found to work best for each of them. However, many epilepsies don't fit any specific syndrome.

    There are more than 20 syndromes recognized by the ILAE. Here are some of the most common ones:

    • Juvenile myoclonic epilepsy: This generalized syndrome is one of the most common and is characterized by three types of seizures that begin in childhood and evolve over time. Children with this syndrome may start having absence seizures between the ages of 5 and 16 years. Because these seizures are brief, they can go unnoticed. Myoclonic seizures generally begin to occur one to nine years later after waking up, and usually within a few months after this, generalized tonic-clonic seizures start. People with juvenile myoclonic epilepsy may have episodes in which more than one of the seizure types occur sequentially within a few minutes. Medication usually keeps the seizures under control, but it may need to be taken for life. Juvenile myoclonic epilepsy often runs in families.
    • Benign rolandic epilepsy: Also called childhood epilepsy with centrotemporal spikes, around 15 percent of children with epilepsy have this syndrome and almost all of them outgrow it by the age of 15. Seizures typically begin between the ages of 6 and 8 years, but they can start anytime between the ages of 3 and 13. These seizures are a focal aware type that involves twitching, tingling, or numbness in the face or tongue, which can cause drooling and interfere with speech. This may then lead to a tonic-clonic seizure. For many kids, the seizures happen infrequently, often at night, and only last a minute or two. This syndrome has a complex genetic component.
    • Lennox-Gastaut syndrome: This syndrome only affects 2 percent to 5 percent of children with epilepsy, but the seizures are hard to control and require lifelong treatment. Intellectual development is usually impaired and people with Lennox-Gastaut syndrome have two or more types of seizures, including atonic, tonic, tonic-clonic, and atypical absence seizures. These seizures don't tend to respond well to seizure medications, but other medications and treatments can help.
    • Myoclonic-astatic epilepsy (Doose syndrome): This syndrome makes up 1 percent to 2 percent of epilepsy that starts in childhood and is more common in boys than girls. Seizures usually start between the ages of 7 months and 6 years and are hard to control because they don't respond well to medication. Genetics seem to play a role in this syndrome, but it's not clear exactly how. Everyone with Doose syndrome has myoclonic and myoclonic followed by atonic seizures. Around three in four people have generalized tonic-clonic seizures; two out of three people have absence seizures, and generalized tonic-clonic seizures that occur with fever are seen in one out of three people. Nearly two in three children may eventually have no seizures at all.
    • Panayiotopoulos syndrome: Typically showing up in kids between the ages of 3 and 10 years, this syndrome consists of focal seizures that may be accompanied by vomiting, nausea, and paleness, and can become generalized seizures with eyes rolled to the side and/or tonic-clonic movements. Over half of these seizures occur during sleep and they tend to be long, lasting from 20 to 60 minutes. Some kids have the seizures infrequently while others may need medications to help control their seizures. Almost all children with Panayiotopoulos syndrome stop having seizures two to three years after the initial seizure.
    • West syndrome: Also known as infantile spasms, the seizures associated with West syndrome typically involve a sudden jerk and then stiffening, usually with the arms out and the knees pulled up as the body bends forward. These spasms begin between 3 and 12 months of age and usually stop by age 2 to 4 years. Most kids end up with another type of epilepsy later. Though seizures only last for a second or two each, they tend to occur in clusters, one right after another, most often after waking up. This is a serious, rare syndrome and needs to be treated right away for the best outcomes. Around two-thirds of these cases are caused by conditions or injuries that change the way the brain forms or works, but the rest are of unknown origin.

      Symptoms

      The symptoms of epilepsy vary according to what type of seizure you have, but in general, they may include jerking of the muscles, loss of awareness or consciousness, weakness, aura, staring, or repetitive movements. Most people tend to have the same type of seizures every time, so your symptoms will generally be consistent unless you experience more than one type.

      Causes

      In approximately half of the people who are diagnosed with epilepsy, the cause is unknown. For the other half, the cause may be due to one or more factors including genetics, developmental disorders, structural changes in the brain, brain damage, and certain illnesses. These potential causes are all risk factors that can increase your risk of developing epilepsy as well.

      Diagnosis

      Diagnosing epilepsy often involves some testing to verify that you had a seizure and to check for any underlying condition that may have caused it, such as stroke, a tumor, or any structural change in the brain that you may have been born with. Your doctor will do likely do a medical history, family history, physical exam, and neurological exam. You may also have tests to look at your brainwave patterns such as an EEG or magnetoencephalography and an imaging scan like magnetic resonance imaging (MRI) to look at the structure of your brain. These tests give your doctor clues about where your seizures may be originating in your brain so that your treatment can be targeted appropriately.

      Treatment

      There are several different treatment approaches that can be used depending on the type of seizures you have. The number one goal of epilepsy treatment is to get your seizures under control with the least amount of side effects possible.

      Putting you on an anti-seizure medication is the first step your doctor will take to control your seizures. Most people's seizures can be controlled with just one drug, but you may need more. If medications don't work, your doctor may discuss surgery, a nerve stimulation device, or a special diet.

      Your doctor will likely also talk to you about lifestyle management since there are some lifestyle factors that can exacerbate seizures. The most common triggers for seizures include sleep deprivation, skipping your medication, and severe stress. Avoidance of these lifestyle triggers is an important component of seizure prevention.

      Coping

      Being diagnosed with epilepsy can make you feel like your whole world has been turned upside down at first. With time, you'll learn how to cope with the practicalities such as making sure you take your medicine regularly and get enough sleep and talking to your friends and family about your diagnosis and what to do if you should have a seizure. Educating yourself about your condition and talking to others who also have epilepsy are great ways to help you deal with your diagnosis too.

      A Word From Verywell

      It can be scary to get a diagnosis of epilepsy, whether it's you or your child. Epilepsy can cause stress, uncertainty, and worry for you and your family. Living with epilepsy requires some lifestyle adjustments, including avoiding seizure triggers, consistently taking your medications as prescribed, being on the lookout for side effects when starting new medications, and awareness of safety precautions that affect driving and fall hazards. This will all soon become second nature.

      Fortunately, many people's seizures are completely controlled with medication. Around six out of every 10 people who are diagnosed with epilepsy can even eventually become seizure-free within a few years of beginning treatment, and many never have a seizure—or need medication—again. 

      If your epilepsy does end up being a lifelong condition, however, you'll need to keep taking medication for the rest of your life. If your seizures remain uncontrolled on medication, there are a variety of available treatments you can look into to help get them under control and new treatments on the horizon that are being researched and developed.

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      Article Sources
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