Seizures

Diagnosis

After a seizure, your healthcare professional reviews your symptoms and medical history and performs a physical exam. Tests may be done to determine the cause of the seizure and assess the likelihood of future seizures.

Tests may include:

Neurological exam

• Evaluates behavior, motor abilities, and brain function.

Blood tests

• Check blood sugar levels, electrolyte balance, and signs of infections or genetic conditions.

Spinal tap (lumbar puncture)

• Collects spinal fluid to detect infections that may have triggered a seizure.

Electroencephalogram (EEG)

• Electrodes placed on the scalp record electrical activity in the brain.

• Helps identify patterns indicating seizure likelihood and can rule out conditions with similar symptoms.

• Can be done in a clinic, overnight at home, or over several nights in a hospital.

Imaging tests

• MRI: Uses magnets and radio waves to provide detailed brain images, detecting changes that may lead to seizures.

• CT scan: X-rays provide cross-sectional brain images to detect tumors, bleeding, or cysts.

• PET scan: Low-dose radioactive material highlights active areas in the brain.

• SPECT scan: Maps blood flow in the brain during seizures.

• SISCOM: A specialized SPECT test combined with MRI for detailed results, usually done in a hospital with overnight EEG.

Treatment

Not everyone who experiences one seizure requires treatment. Therapy aims to stop seizures while minimizing side effects.

Medications

• Antiseizure medicines are the main treatment.

• Finding the right medicine and dosage may require trying multiple options.

• Side effects can include weight changes, dizziness, fatigue, mood changes, and rarely liver or bone marrow issues.

Dietary therapy

• Ketogenic diet: High fat, very low carbohydrate diet that can improve seizure control.

• Other high-fat, low-carb diets, such as low glycemic index or Atkins diets, may help but are less studied.

Surgery

• Considered if two or more antiseizure medicines fail and seizures consistently start in the same brain area.

• Types include:

  • Lobectomy: Removal of the seizure-originating brain region.

  • Thermal ablation (laser interstitial thermal therapy): Destroys targeted brain tissue with concentrated energy.

  • Multiple subpial transection: Cuts in brain areas to prevent seizure spread.

  • Corpus callosotomy: Cuts connections between brain hemispheres to limit seizure propagation.

  • Hemispherotomy: Separates one brain hemisphere from the rest of the brain and body; used when seizures affect only one side.

Electrical stimulation

• Vagus nerve stimulation: Device under the chest stimulates the vagus nerve to reduce seizures.

• Responsive neurostimulation: Device placed in the brain detects seizure activity and delivers electrical impulses to stop it.

• Deep brain stimulation: Electrodes in the brain deliver controlled impulses via a chest-implanted device to manage seizure activity.

Pregnancy and seizures

• Many people with seizures can have healthy pregnancies.

• Some antiseizure medicines, like valproic acid, may cause birth defects and cognitive issues.

• Planning with a healthcare professional is essential before and during pregnancy.

• Folic acid supplementation may reduce risks associated with antiseizure medicines.

Birth control considerations

• Certain antiseizure medications may reduce the effectiveness of hormonal birth control.

• Alternative contraceptive methods may be recommended.

Potential future treatments

• MRI-guided focused ultrasound: Targets and destroys brain tissue causing seizures without surgery, reaching deep brain structures while sparing surrounding tissue.