Absence Seizures

Absence Seizures

Absence seizures involve brief, sudden lapses of consciousness. They're more common in children than adults. Someone having an absence seizure may look like he or she is staring into space for a few seconds. This type of seizure usually doesn't lead to physical injury.

Absence seizures usually can be controlled with anti-seizure medications. Some children who have them also develop other seizures. Many children outgrow absence seizures in their teens.

An indication of simple absence seizure is a vacant stare, which may be mistaken for a lapse in attention that lasts 10 to 15 seconds, without any subsequent confusion, headache or drowsiness. Signs and symptoms of absence seizures include:

• Sudden stop in motion without falling
• Lip smacking
• Eyelid flutters
• Chewing motions
• Finger rubbing
• Small movements of both hands

Absence seizures generally last 10 to 15 seconds, followed immediately by full recovery. Afterward, there's no memory of the incident. Some people have dozens of episodes daily, which interfere with school or daily activities.

A child may have absence seizures for some time before an adult notices the seizures, because they're so brief. A decline in a child's learning ability may be the first sign of this disorder. Teachers may comment about a child's inability to pay attention.

When To See a Doctor

Contact your doctor:

• The first time you notice a seizure
• If this is a new type of seizure
• If the seizures continue to occur despite being placed on anti-seizure medication

Seek immediate medical attention:

• If you observe prolonged automatic behaviors — activities such as eating or moving without awareness — or prolonged confusion, possible symptoms of a condition called absence status epilepticus
• After any seizure lasting more than five minutes

Often, no underlying cause can be found for absence seizures. Many children appear to have a genetic predisposition to them. Rapid breathing (hyperventilation) can trigger an absence seizure.

In general, seizures are caused by abnormal electrical impulses from nerve cells (neurons) in the brain. The brain's nerve cells normally send electrical and chemical signals across the synapses that connect them.

In people who have seizures, the brain's usual electrical activity is altered. During an absence seizure, these electrical signals repeat themselves over and over in a three-second pattern.

People who have seizures may also have altered levels of the chemical messengers that help the nerve cells communicate with one another (neurotransmitters).

Absence seizures are more prevalent in children. Many children gradually outgrow them over months to years. Some children with absence seizures may also experience full seizures (tonic-clonic seizures).

Certain factors are common to children who have absence seizures, including:

• Age. Absence seizures are more common in children between the ages of 4 and 10.
• Sex. In general, most seizures are more common in boys, but absence seizures are more common in girls.
• History of febrile seizures. Infants and children who have seizures brought on by fever are at greater risk of absence seizures.
• Family members who have seizures. Nearly half of children with absence seizures have a close relative who has seizures.

While most children outgrow absence seizures, some:

• Have seizures throughout life
• Eventually have full convulsions, such as generalized tonic-clonic seizures

Other complications can include:

• Learning difficulties
• Behavior problems
• Social isolation

You're likely to start by seeing your family doctor or a general practitioner. However, you'll probably be referred to a doctor who specializes in nervous system disorders (neurologist).

Here's some information to help you get ready for the appointment.

What You Can Do

• Write down any symptoms your child is experiencing, including any that may seem unrelated to seizures.
• Make a list of all medications, vitamins and supplements you or your child takes.
• Write down questions to ask the doctor.

Preparing a list of questions will help you make the most of your time with your doctor. For absence seizure, some basic questions to ask your doctor include:

• What's the most likely cause of these symptoms?
• Are there other possible causes?
• What tests are needed? Do these tests require special preparation?
• Is this condition temporary or long lasting?
• What treatments are available, and which do you recommend?
• What side effects might I expect from treatment?
• Are there alternatives to the treatment you're suggesting?
• Is there a generic alternative to the medicine you're prescribing?
• Can my child also develop the grand mal type of seizure?
• How long will my child need to take medication?
• Do I need to restrict activities? Can my child participate in physical activities, such as soccer, football and swimming?
• Do you have brochures or other printed material I can take? What websites do you recommend?

Don't hesitate to ask any other questions you have.

What To Expect From Your Doctor

Your doctor is likely to ask you a number of questions, such as:

• When did the symptoms begin?
• How often have the symptoms occurred?
• Can you describe a typical seizure?
• How long do the seizures last?
• Is your child aware of what happened after the seizure?

Your doctor will ask for a detailed description of the seizures and conduct a physical exam. Tests may include:

• Electroencephalography (EEG). This painless procedure measures waves of electrical activity in the brain. Brain waves are transmitted to the EEG machine via small electrodes attached to the scalp with paste or an elastic cap.

Your child may be asked to breathe rapidly or look at flickering lights, an attempt to provoke a seizure. During a seizure, the pattern on the EEG differs from the normal pattern.

• Brain scans. Tests such as magnetic resonance imaging (MRI) can produce detailed images of the brain, which can help rule out other problems, such as a stroke or a brain tumor. Because your child will need to hold still for long periods, talk with your doctor about the possible use of sedation.

Your doctor likely will start at the lowest dose of anti-seizure medication possible and increase the dosage as needed to control the seizures. Most children can taper off anti-seizure medications, under a doctor's supervision, after they've been seizure-free for two years.

Drugs prescribed for absence seizure include:

• Ethosuximide (Zarontin). This is the drug most doctors start with for absence seizures. In most cases, seizures respond well to this drug.
• Valproic acid (Depakene). Because this drug has been associated with higher risk of birth defects in babies, doctors advise women against using it while trying to conceive or during pregnancy. Women who can't achieve seizure control on other medications should discuss potential risks with their doctors.
• Lamotrigine (Lamictal). Some studies show this drug to be less effective than ethosuximide or valproic acid, but has fewer side effects.

A person with absence seizures may elect to wear a medical bracelet for identification for emergency medical reasons. The bracelet should state whom to contact in an emergency and what medications you use. It's also a good idea to let teachers, coaches and child care workers know about the seizures.

Even after they've been controlled with medication, seizures may affect areas of your child's life, such as attention span and learning. He or she will have to be seizure-free for reasonable lengths of time (intervals vary from state to state) before being able to drive.

You may find it helpful to talk with other people who are in the same situation as you. Besides offering support, they may have advice or tips for coping that you haven't considered.

The Epilepsy Foundation has a network of support groups, as well as online forums for teens and adults who have seizures and parents of children who have seizures. You can call the Epilepsy Foundation at 800-332-1000 or visit its website. Also, your doctor may know of support groups in your area.

Medicines Two Choices for You

References

1. Korff CM. Childhood absence epilepsy. http://www.uptodate.com/home. Accessed April 3, 2014.
2. Absence seizures. The Epilepsy Foundation. http://www.epilepsy.com/learn/types-seizures/absence-seizures. Accessed April 3, 2014.
3. Stafstrom CE, et al. Pathophysiology of seizures and epilepsy. http://www.uptodate.com/home. Accessed April 3, 2014.
4. Glauser TA, et al. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy. New England Journal of Medicine. 2010;362:790.
5. Jentink J, et al. Valproic acid monotherapy in pregnancy and major congenital malformations. New England Journal of Medicine. 2010;362:2185.
6. Safety information: Stavzor (valproic acid) delayed release capsules. http://www.fda.gov/safety/medwatch/safetyinformation/ucm360495.htm. Accessed April 3, 2014.

Frontal Lobe Seizures

Frontal Lobe Seizures

Overview

• Frontal lobe seizures are a common form of epilepsy, a neurological disorder in which clusters of brain cells send abnormal signals and cause seizures. These types of seizures originate in the front of the brain.
• Frontal lobe seizures may also be caused by abnormal brain tissue, infection, injury, stroke, tumors or other conditions.
• Because the frontal lobe is large and has many important functions, frontal lobe seizures may produce a number of unusual symptoms that can appear to be related to a psychiatric problem or a sleep disorder.
• Frontal lobe seizures often occur during sleep and may feature bicycle pedaling motions and pelvic thrusting. Some people scream profanities or laugh during frontal lobe seizures.
• Medications usually can control frontal lobe seizures, but surgery or an electrical stimulation device may be options if anti-epileptic drugs aren't effective.

Medicines Two Choices for You

Grand Mal Seizures

Grand Mal Seizure

A grand mal seizure — also known as a generalized tonic-clonic seizure — features a loss of consciousness and violent muscle contractions. It's the type of seizure most people picture when they think about seizures in general.

Grand mal seizure is caused by abnormal electrical activity throughout the brain. Most of the time grand mal seizure is caused by epilepsy. In some cases, however, this type of seizure is triggered by other health problems, such as extremely low blood sugar, high fever or a stroke.

Many people who have a grand mal seizure will never have another one. However, some people need daily anti-seizure medications to control and prevent future grand mal seizure.

Grand mal seizures have two stages:

• Tonic phase. Loss of consciousness occurs, and the muscles suddenly contract and cause the person to fall down. This phase tends to last about 10 to 20 seconds.
• Clonic phase. The muscles go into rhythmic contractions, alternately flexing and relaxing. Convulsions usually last for less than two minutes.

The following signs and symptoms occur in some but not all people with grand mal seizures:

• Aura. Some people experience a warning feeling (aura) before a grand mal seizure. This warning varies from person to person, but may include feeling a sense of unexplained dread, a strange smell or a feeling of numbness.
• A scream. Some people may cry out at the beginning of a seizure because the muscles around the vocal cords seize, forcing air out.
• Loss of bowel and bladder control. This may happen during or following a seizure.
• Unresponsiveness after convulsions. Unconsciousness may persist for several minutes after the convulsion has ended.
• Confusion. A period of disorientation often follows a grand mal seizure. This is referred to as postictal confusion.
• Fatigue. Sleepiness is common after a grand mal seizure.
• Severe headache. Headaches are common but not universal after grand mal seizures.

When To See a Doctor

If you see someone having a seizure:

• Call for medical help.
• Gently roll the person onto one side and put something soft under his or her head.
• Loosen tight neckwear.
• Don't put anything in the mouth — the tongue can't be swallowed and objects placed in the mouth can be bitten or inhaled.
• Don't try to restrain the person.
• Look for a medical alert bracelet, which may indicate an emergency contact person and other information.
• Note how long the seizure lasts.

A grand mal seizure lasting more than five minutes, or immediately followed by a second seizure, should be considered a medical emergency in most people. This is also a medical emergency if the person is pregnant, injured or diabetic. Seek emergency care as quickly as possible.

Additionally, seek medical advice for you or your child:

• When the number of seizures experienced increases significantly without explanation
• When new signs or symptoms of seizures appear

Grand mal seizures occur when the electrical activity over the whole surface of the brain becomes abnormally synchronized. The brain's nerve cells normally communicate with each other by sending electrical and chemical signals across the synapses that connect the cells.

In people who have seizures, the brain's usual electrical activity is altered. Exactly what causes the changes to occur remains unknown in about half the cases.

However, grand mal seizures are sometimes caused by underlying health problems, such as:

Injury or Infection

• Traumatic head injuries
• Infections, such as encephalitis or meningitis, or history of such infections
• Injury due to a previous lack of oxygen
• Stroke

Congenital or Developmental Abnormalities

• Blood vessel malformations in the brain
• Genetic syndromes
• Brain tumors

Metabolic Disturbances

• Very low blood levels of glucose, sodium, calcium or magnesium

Withdrawal Syndromes

• Using or withdrawing from drugs, including alcohol

Risk Factors For Grand Mal Seizures Include:

• A family history of seizure disorders
• Any injury to the brain from trauma, stroke, previous infection and other causes
• Sleep deprivation
• Medical problems that affect electrolyte balance
• Illicit drug use
• Heavy alcohol use

Certain activities could be dangerous if you have a seizure while doing them. Activities include:

• Swimming. If you go in water, wear a life preserver and don't go alone.
• Bathing. Bathing also can pose a risk of drowning. Shower instead.
• Driving a car or operating other equipment. Most states have licensing restrictions for driving for people with a history of seizures.

The force of a seizure or falling as a result of a seizure can cause injury. In extreme cases, seizures can be fatal, particularly if medication is not taken consistently or properly.

Types of injuries that can occur with seizures include:

• Joint dislocations
• Head injuries
• Bone fractures

Repeated Seizures

Whether repeated seizures can cause brain damage has been studied extensively, but there's no simple answer.

The longer a seizure lasts, the more likely it is to lead to changes in brain function and structure. Repeated brief seizures also can lead to brain changes, sometimes causing a normal brain to become epileptic, a process known as kindling.

The seriousness of repeated seizures underscores the need for control with medication.

You're likely to start by seeing your family doctor or a general practitioner. However, you'll probably be referred to a doctor who specializes in nervous system disorders (neurologist).

It's good to be prepared for your appointment. Here's some information to help you get ready for your appointment, and to know what to expect from your doctor.

What You Can Do

• Write down any symptoms you or your child has experienced, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Make a list of all medications, vitamins and supplements you're taking and the dosages used. Also, write down the reasons you stopped taking any medications, whether this was because of side effects or lack of effectiveness.
• Ask a family member to come with you to the doctor, because it's not always easy to remember everything you've been told during your appointment.

Also, since memory loss can happen during seizures, many times an observer is able to better describe the seizure than is the person who's had the seizure.

• Write down questions to ask your doctor.

Preparing a list of questions will help you make the most of your time with your doctor. For grand mal seizure, some basic questions to ask your doctor include:

• Do I have epilepsy?
• Will I have more seizures?
• What kinds of tests do I need? Do these tests require any special preparation?
• What treatments are available and which do you recommend?
• What types of side effects can I expect from treatment?
• Are there any alternatives to the primary approach you're suggesting?
• Do I need to restrict any activities?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

Don't hesitate to ask any other questions that occur to you.

What To Expect From Your Doctor

Your doctor is likely to ask you a number of questions, such as:

• When did you or your child begin experiencing symptoms?
• How many seizures have you or your child had?
• How often do the seizures occur?
• Can you describe a typical seizure?
• How long do the seizures last?
• Do the seizures occur in clusters?
• Do they all look the same, or are there different seizure behaviors you or others have noticed?
• What medications have you or your child tried? What doses were used?
• Have you tried combinations of medications?
• Have you noticed any seizure triggers, such as sleep deprivation or illness?

Medical History

Your doctor will ask for a detailed description of the seizure, which is crucial for diagnosis. Because people who have grand mal seizures lose consciousness and don't remember their seizures, the description needs to come from people who have witnessed the seizures.

Your doctor may try to determine whether a particular trigger, such as intense exercise, loud music, flashing lights (such as those caused by video games or television) or lack of sleep, preceded your seizure. However, most people have no identifiable or consistent trigger.

Neurological Exam

If you've had a seizure, your doctor usually will perform a neurological exam that tests:

Muscle Condition

• Reflexes
• Muscle tone
• Muscle strength
• Sensory function

Motor Symptoms

• Gait
• Posture
• Coordination
• Balance

He or she may also ask questions to assess your thinking, judgment and memory.

Blood Tests and Scans

Blood tests may be ordered as appropriate to check for problems that could be causing or triggering the seizures.

Your doctor may also suggest scans or tests designed to detect abnormalities within the brain.

• Electroencephalogram (EEG). An EEG displays the electrical activity of your brain via electrodes affixed to your scalp. People with epilepsy often have changes in their normal pattern of brain waves, even when they're not having a seizure.

In some cases, your doctor may recommend video-EEG monitoring, which may require a hospital stay. This allows your doctor to compare — second by second — the behaviors observed during a seizure with your EEG pattern from exactly that same time.

This comparison can help your doctor pinpoint the type of seizure disorder you have, which helps identify the most appropriate treatment options, and it can help make sure that the diagnosis of seizures is correct.

• Brain imaging. Computerized tomography (CT) scan and magnetic resonance imaging (MRI) produce detailed images of your brain and may reveal tumors, cysts and structural abnormalities.

During a CT scan or an MRI, you will lie on a padded table that slides into a machine. Your head will be immobilized in a brace, to improve precision while images of your brain are taken.

Not everyone who has one seizure will have another one, and because a seizure can be an isolated incident, your doctor may decide to not start treatment until you've had more than one. Treatment usually involves the use of anti-seizure medications.

Medications

Many medications are used in the treatment of epilepsy and seizures, such as:

• Carbamazepine (Carbatrol,Tegretol, others)
• Phenytoin (Dilantin, Phenytek)
• Valproic acid (Depakene)
• Oxcarbazepine (Trileptal)
• Lamotrigine (Lamictal)
• Gabapentin (Gralise, Neurontin)
• Topiramate (Topamax)
• Phenobarbital
• Zonisamide (Zonegran)
• Levetiracetam (Keppra)
• Tiagabine (Gabitril)
• Pregabalin (Lyrica)
• Felbamate (Felbatol)
• Ethosuximide (Zarontin)
• Lorazepam (Ativan)
• Clonazepam (Klonopin)
• Clobazam (Onfi)
• Rufinamide (Banzel)
• Perampanel (Fycompa)

Finding the right medication and dosage can be challenging. Your doctor likely will first prescribe a single drug at a relatively low dosage, and then increase the dosage gradually until your seizures are well-controlled.

Many people with epilepsy are able to prevent seizures by taking only one drug, but others require more than one. If you've tried two or more single-drug regimens without success, your doctor may recommend trying a combination of two drugs.

To achieve the best seizure control possible, take medications exactly as prescribed. Always call your doctor before adding other prescription medications, over-the-counter drugs or herbal remedies.

And never stop taking your medication without talking to your doctor.

Mild side effects of anti-seizure medications can include:

• Fatigue
• Dizziness
• Weight gain

More-troubling side effects that need to be brought to your doctor's attention immediately include:

• Mood disruption
• Skin rashes
• Loss of coordination
• Speech problems
• Extreme fatigue

In addition, the drug Lamictal has been linked to an increased risk of aseptic meningitis, an inflammation of the protective membranes that cover the brain and spinal cord that's similar to bacterial meningitis.

Pregnancy and Seizures

Women who've had previous seizures usually are able to have healthy pregnancies. Birth defects related to certain medications can sometimes occur.

In particular, valproic acid has been associated with cognitive deficits and neural tube defects, such as spina bifida. The American Academy of Neurology recommends that women avoid using valproic acid during pregnancy because of risks to the baby.

Discuss these risks with your doctor. Because of the risk of birth defects, and because pregnancy can alter medication levels, preconception planning is particularly important for women who've had seizures.

In some cases, it may be appropriate to change the dose of seizure medication before or during pregnancy. Medications may be switched in rare cases.

Contraception and Anti-seizure Medications

It's also important to know that some anti-seizure medications can alter the effectiveness of oral contraceptive (birth control) medication. If contraception is a high priority, check with your doctor to evaluate whether your medication interacts with your oral contraceptive, and if other forms of contraception need to be considered.

If you have a seizure disorder, wear a medical bracelet to help emergency medical personnel. The bracelet should state whom to contact in an emergency, what medications you use and what drugs you're allergic to.

Even after they're under control, seizures can affect your life. Grand mal seizures can be frightening to those around you.

Children may get teased or be embarrassed by their condition, and both children and adults may be frustrated by living with the constant threat of another seizure. Poor self-esteem, depression and suicide are increased in people who have repeated seizures.

Most states restrict those who've had seizures from driving until they've gone a long time without a seizure. Even recreational activities can be affected, because you can't do certain activities, such as swimming, alone.

You may find it helpful to talk with other people who are in the same situation you are. Besides offering support, they may also have advice or tips for coping that you'd never considered.

The Epilepsy Foundation has a network of support groups, as well as online forums, for teens and adults who have seizures and for parents of children who have seizures. You can reach the Epilepsy Foundation at 800-332-1000 or through its website.

You can also ask your doctor if he or she knows of any support groups in your area.

Medicines Two Choices for You

References

1. Seizures and epilepsy: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/epilepsy/detail_epilepsy.htm. Accessed March 11, 2014.
2. Tonic-clonic seizures. Epilepsy Foundation. http://www.epilepsyfoundation.org/aboutepilepsy/seizures/genconvulsive/tonicseizures.cfm. Accessed March 11, 2014.
3. Schachter SC. Evaluation of the first seizure in adults. http://www.uptodate.com/home. Accessed March 11, 2014.
4. Seizure disorders. The Merck Manuals: The Merck Manual for Health Care Professionals. http://www.merckmanuals.com/professional/neurologic_disorders/seizure_disorders/seizure_disorders.html. Accessed March 11, 2014.
5. Schmidt D, et al. Drug treatment of epilepsy in adults. British Medical Journal. 2014;348:g254.
6. FDA Drug safety communication: Aseptic meningitis risk with use of seizure drug Lamictal. U.S. Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm221847.htm. Accessed March 12, 2014.
7. Ahmed R, et al. Epilepsy in pregnancy. Australian Family Physician. 2014;43:112.

Temporal Lobe Seizures

Temporal Lobe Seizures

Temporal lobe seizures originate in the temporal lobes of your brain, which process emotions and are important for short-term memory. Some symptoms of a temporal lobe seizure may be related to these functions, including having odd feelings — such as euphoria, deja vu or fear.

During a temporal lobe seizure, you may remain aware of what's happening. During more-intense seizures, you might look awake but be unresponsive. Your lips and hands may make purposeless, repetitive movements.

Temporal lobe seizures may stem from an anatomical defect or scar in your temporal lobe, but the cause is often unknown. Temporal lobe seizures are treated with medication. For some people who don't respond to medication, surgery may be an option.

An unusual sensation (aura) may precede a temporal lobe seizure, acting as a warning. Not everyone who has temporal lobe seizures has auras, and not everyone who has auras remembers them.

The aura is actually a simple partial or focal seizure — one that doesn't impair consciousness. Examples of auras include:

• A sudden sense of unprovoked fear
• A deja vu experience — a feeling that what's happening has happened before
• A sudden or strange odor or taste
• A rising sensation in the abdomen

Sometimes temporal lobe seizures impair your ability to respond to others (partial complex or focal dyscognitive seizures). This type of temporal lobe seizure usually lasts 30 seconds to two minutes. Characteristic signs and symptoms include:

• Loss of awareness of surroundings
• Staring
• Lip smacking
• Repeated swallowing or chewing
• Unusual finger movements, such as picking motions

After a temporal lobe seizure, you may have:

• A period of confusion and difficulty speaking
• Inability to recall what occurred during the seizure
• Unawareness of having had a seizure
• Extreme sleepiness

In extreme cases, what starts as a temporal lobe seizure evolves into a generalized tonic-clonic (grand mal) seizure — featuring convulsions and loss of consciousness.

When To See a Doctor

Seek medical advice in these circumstances:

• If you think your or your child is having seizures
• When the number or severity of seizures increases significantly without explanation
• When new signs or symptoms of seizures appear

Seek emergency medical care if:

• A seizure lasts more than five minutes
• The person doesn't recover completely or as quickly as usual after the seizure is over
• Seizures keep repeating in a single day

Often, the cause of temporal lobe seizures remains unknown. However, they can be a result of a number of factors, including:

• Traumatic brain injury
• Infections, such as encephalitis or meningitis, or history of such infections
• A process that causes scarring (gliosis) in a part of the temporal lobe called the hippocampus
• Blood vessel malformations in the brain
• Stroke
• Brain tumors
• Genetic syndromes

During normal waking and sleeping, your brain cells produce varying electrical activity. If the electrical activity in many brain cells becomes abnormally synchronized, a convulsion or seizure may occur.

If this happens in just one area of the brain, the result is a focal seizure. A temporal lobe seizure is a partial seizure that originates in one of the temporal lobes.

Over time, repeated temporal lobe seizures can cause the part of the brain that's responsible for learning and memory (hippocampus) to shrink. Brain cell loss in this area may cause memory problems.

You'll likely start by seeing your family doctor or a general practitioner, then you'll likely be referred to a doctor who specializes in nervous system disorders (neurologist).

Here's some information to help you prepare for your appointment.

What You Can Do

• Write down symptoms you or your child has had, including those that may seem unrelated to seizures. Note the kinds of seizures. For example, do some affect the left side of the body more than the right or vice versa? Do some affect speech and others not?
• Make a list of all medications, vitamins and supplements you or your child is taking and the dosages. Write down the reasons — whether side effects or lack of effectiveness — you stopped taking any.
• Ask a family member to accompany you to help you remember what you're told during your appointment. Also, since memory loss can happen during seizures, an observer may be able to describe the seizures better than you can.
• Have a family member or friend video record the seizure with a cellphone or other video recorder, if possible.
• Write down questions to ask your doctor.

Preparing a list of questions for your doctor will help you make the most of your time together. For temporal lobe seizure, some questions to ask include:

• Is the diagnosis epilepsy?
• Will more seizures occur? Will different types of seizures occur?
• What tests are needed? Do these tests require special preparation?
• What treatments are available, and which do you recommend?
• What types of side effects can I expect from treatment?
• Is surgery a possibility?
• Should I restrict activities? What safety issues do I face?
• Is my condition potentially fatal? How do I minimize the risks caused by my condition?
• Is there a generic alternative to the medicine you're prescribing?
• Do you have brochures or other printed materials I can take? What websites do you recommend?

Don't hesitate to ask any other questions.

What to Expect From Your Doctor

Your doctor is likely to ask you a number of questions, such as:

• When did you or your child begin having symptoms?
• Did you notice any unusual sensations before the seizures?
• How often do seizures occur?
• Can you describe a typical seizure?
• How long do the seizures last?
• Do the seizures occur in clusters?
• Do they all look the same or are there different seizure behaviors you or others have seen?
• Does your or your child's head or body turn in one direction during a seizure?
• Does the seizure affect speech during its early phase?
• Have you or your child been injured during a seizure?
• How would you describe you or your child right after the seizure?
• What medications have you or your child tried? What doses were used?
• Have you tried combining medication?
• Have you noticed seizure triggers, such as sleep deprivation or illness?

Medical History

Your doctor will need a detailed description of the seizures, preferably from a witness, because most people who have temporal lobe seizures don't remember the episodes.

Neurological exam

If you or your child has had a seizure, your doctor likely will perform a neurological exam that tests:

• Reflexes
• Muscle tone
• Muscle strength
• Sensory function
• Gait
• Posture
• Coordination
• Balance

He or she may also ask questions to assess your thinking, judgment and memory.

Blood Tests and Scans

Blood tests may be ordered to check for problems that could be causing or triggering the seizures.

Your doctor may also suggest scans or tests designed to detect abnormalities within the brain.

• Electroencephalogram (EEG). An EEG displays the electrical activity of your brain as recorded by electrodes attached to your scalp. People with epilepsy often have changes in their brain wave patterns, even when not having a seizure. The EEG sometimes can help indicate the type of seizures you're having.

In some cases, your doctor may recommend video-EEG monitoring in the hospital. This allows your doctor to compare — second by second — the behaviors observed during a seizure with your EEG pattern. This can help your doctor pinpoint the type of seizure disorder you have, which helps to identify appropriate treatments, and can help ensure that the seizure diagnosis is correct.

• Magnetic Resonance Imaging (MRI). An MRI machine produces detailed images of your brain. Although many people with seizures and epilepsy have normal MRIs, certain MRI abnormalities may provide a clue to the cause of the seizures.

During the test, you will lie on a padded table that slides into the MRI machine. Your head will be immobilized in a brace, to improve precision. The test is painless, but some people experience claustrophobia inside the MRI machine's close quarters. If you think you may have this reaction, tell your doctor before the study.

• Single-Photon Emission Computerized Tomography (SPECT). Sometimes used when the area of seizure onset is unclear, SPECT imaging requires two scans — one during a seizure and one during a non-seizure period, each performed on separate days. Radioactive material is injected for both scans.

The scans are then compared to find the area of the brain with the greatest activity during the seizure. The resulting image is then superimposed onto the MRI. This is used with EEG information to help guide the surgeons.

Medications

Numerous medications are available to treat temporal lobe seizures. However, many people don't achieve seizure control with medications alone, and side effects, including fatigue, weight gain and dizziness, are common.

Discuss possible side effects with your doctor when deciding about treatment options. Also ask what effect your seizure medications and other medications you take, such as oral contraceptives, may have on each other.

Surgery

If you have temporal lobe seizures that don't respond to medication, you may be evaluated for surgery. For some people, surgery eliminates or greatly reduces the number of seizures.

However, as with any surgery, surgery for seizures carries risks. It may not be successful, and it can result in neurological problems. Discuss the possible risks with your neurologist and surgeon.

Surgery is generally not an option if:

• Your seizures come from a region of the brain that performs vital brain functions
• Your seizures come from more than one area
• Your seizure focus can't be identified

Preparing for surgery

Talk to your surgeon about his or her experience, success rates and complication rates with the procedure you're considering. You may also want to request a second opinion before having surgery.

Before surgery, you'll need:

• A comprehensive evaluation
• MRI scans of your brain
• Observation of your seizures in a hospital-based monitoring unit using video recordings and EEG

After Surgery

Most people need to continue taking medication to help ensure that seizures don't recur. However, if surgery appears successful, medications can sometimes be reduced and occasionally discontinued.

Vagus Nerve Stimulation

A device called a vagus nerve stimulator may be an option if medications are ineffective or cause serious side effects. The stimulator is implanted into your chest under the collarbone. Wires from the stimulator are attached to the vagus nerve in your neck.

The device turns on and off according to an adjustable program and can be activated with a magnet. The device doesn't detect seizures. It's usually well-tolerated, but it's not a replacement for medication.

Responsive Neurostimulation

The Food and Drug Administration (FDA) has approved a device for treating seizures that don't respond to medication. The device detects seizure activity and delivers an electrical stimulation to the detected area. The device is implanted on the surface of the brain or within the brain tissue, and attached to a battery-powered generator, which is implanted in the skull, close to the brain.

Deep Brain Stimulation

Deep brain stimulation involves implanting electrodes into a part of the brain called the thalamus. This treatment is not currently FDA-approved for treatment of seizures. In highly selected cases, it may be beneficial in treating seizures that don't respond to medication. More study is needed.

Pregnancy and Seizures

The most important thing to remember is to plan pregnancy. Women who are on medications for seizures usually are able to have healthy pregnancies. However, certain medications, such as valproic acid (Depakene), taken during pregnancy are known to increase the risk of birth defects.

Seizures pose a risk to a developing baby, so it's generally not recommended to stop medications during pregnancy. Discuss these risks with your doctor. Because pregnancy can alter medication levels, preconception planning is particularly important for women with seizures.

If you take medication for seizures and might become pregnant, taking prescription folic acid daily before you become pregnant can help prevent birth defects related to seizure medication.

The risk of birth defects is considered to be higher in women taking more than one drug. If your seizures can't be well-controlled with other medication, discuss the potential risks with your doctor.

Contraception and Anti-seizure Medications

Some anti-seizure medications can alter the effectiveness of oral contraceptive (birth control) medication. If contraception is a high priority, check with your doctor to evaluate whether your medication interacts with your oral contraceptive, and if you should consider other forms of contraception.

Certain activities can be dangerous if you have a seizure while doing them. Activities include:

• Swimming. If you go in water, don't go alone and be sure to wear a life preserver.
• Bathing. Bathing also can pose a risk of drowning. Shower instead.
• Working high up. You could fall during a seizure.
• Driving a car or operating other equipment. All states have licensing restrictions for driving for people with a history of seizures. The rules differ from state to state.

Consider wearing a medical alert bracelet to help emergency medical personnel. The bracelet should state whom to contact in an emergency, what medications you use and your medication allergies.

Even after they're under control, seizures can affect your life. Temporal lobe seizures may present even more of a coping challenge because people may not recognize the unusual behavior as a seizure. Children may get teased or be embarrassed by their condition, and living with the constant threat of another seizure may frustrate children and adults.

You may find it helpful to talk with others in similar situations. Besides offering support, they may have advice or tips for coping you haven't thought of.

The Epilepsy Foundation has a network of support groups, as well as online forums for teens and adults who have seizures and for parents of children who have seizures. You can reach the foundation at 800-332-1000 or visit the foundation website. You can also ask your doctor if he or she knows of any support groups in your area.

Medicines Two Choices for You

References

1. Temporal lobe epilepsy. Epilepsy Foundation. http://www.epilepsy.com/learn/types-epilepsy-syndromes/temporal-lobe-epilepsy. Accessed April 9, 2014.
2. Benbadis SR. Localization-related (partial) epilepsy: Causes and clinical features. http://www.uptodate.com/home. Accessed April 9, 2014.
3. Seizures and epilepsy: Hope through research. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/epilepsy/detail_epilepsy.htm?css=print. Accessed April 9, 2014.
4. Schachter SC. Surgical therapy of epilepsy in adults. http://www.uptodate.com/home. Accessed April 9, 2014.
5. Tzatha E, et al. Responsive neurostimulation for the treatment of seizures that do not respond to medication. Neurology 2011;77:e79.
6. FDA approves responsive stimulation therapy by Neuropace. Epilepsy Foundation. http://www.epilepsy.com/release/2014/3/fda-approves-responsive-neurostimulation-therapy-neuropace. Accessed April 23, 2014.
7. Calpern CH, et al. Deep brain stimulation for epilepsy. Neurotherapeutics. 2008;5:59.

Dr. Huntoon's Alternative Medicine Perspective

Seizures, from an Alternative Medicine Perspective are looked at completely different.  

Information that Dr. Huntoon learned early on in his career from one of his mentors demonstrated that seizures and seizure disorders were due to a brain imbalance resulting from poor communication and nutritional reserves within the Cerebellum and the Cerebrum.  He was taught that the Cerebellum was the battery of the brain and that it holds electricity for the body in reserve so it is available on demand.  When a person has seizures, it is due to the cerebellum being low in stored energy.  As a result, the electricity of the brain shorts out and the person will have seizures of any type.

Some of the specific nutrition that has demonstrated a huge reduction and even elimination of seizures is a supplement called RNA-Ribonucleic Acid.  Given at a large dosage, this supplement acts as a computer chip to the brain and helps to regulate the electrical capacity of the brain.  It helps to retain memory and it is also an electrolyte that helps the brain hold its charge.  

Appreciate that if your car was running out of gas, before the car would stop altogether, the engine would "sputter" and "hesitate" causing the car to "buck" until the fuel was completely empty.  The brain, when it is running out of fuel will do the same thing.  The result is a seizure.

We also want to add a second supplement, either Min-Tran or MinChex, depending on the specifics of the person.  Min-Tran is a supplement that supplies minerals to the brain and helps to create a general calming effect on the functioning of the brain.  

Working with a Holistic Chiropractor who understands this and has experience helping people lead a normal life without seizures is important.  

Dr. Huntoon has helped practice members in the past go from having 14 seizures a day while on their medication to having one seizure every 2 - 3 weeks using nutrition alone.  Your ability to follow through and restore your overall health will determine the outcomes you experience.  

Having a Consultation and Examination with Dr. Huntoon would prove valuable if you are willing to consider that life-time medication, while still having seizures, is not an ideal solution.  

Others have benefited from Acupuncture, Homeopathy and Naturopathy.

Your Solution

Do You Have Seizures?

Working with a Holistic Chiropractor who understands the basis for seizures and has experience helping people lead a normal life without seizures is important.  

Dr. Huntoon has helped practice members in the past go from having 14 seizures a day while on their medication to having one seizure every 2 - 3 weeks using nutrition alone.  Since those successes, Dr. Huntoon has studied and learned more about proper brain nutrition and normal brain function.  Your ability to follow through and restore your overall health will determine the outcomes you experience.  

Having a Consultation and Examination with Dr. Huntoon would prove valuable if you are willing to consider that life-time medication, while still having seizures, is not an ideal solution.  

Others have benefited from Acupuncture, Homeopathy and Naturopathy.