Epilepsy and Seizures
Expert Care for Epilepsy in New Jersey
Epilepsy is a neurological disorder that causes repeated, unpredictable seizures. A seizure is a sudden change in the brain’s electrical activity. It can change how you move, feel, act, or think for a short time. Some seizures cause convulsions or loss of consciousness, while others may cause a brief staring spell, unusual sensation or change in behavior.
RWJBarnabas Health provides coordinated care across the lifespan for adults and children with epilepsy and other seizure disorders. Board-certified neurologists, neurosurgeons, radiologists and other specialists work together to identify the cause of seizures and create a personalized treatment plan. Several facilities also offer epilepsy monitoring to record brain activity and help diagnose seizure disorders.
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What Is Epilepsy?
A person may be diagnosed with epilepsy after having two unprovoked seizures more than 24 hours apart. Epilepsy may also be diagnosed after one seizure if the person is likely to have another, or if testing shows a specific type of epilepsy. One seizure does not always mean a person has epilepsy. Because seizures can have many causes, it is important to see a health care provider after a first or suspected seizure.
What Is a Seizure?
A seizure is a sudden burst of abnormal electrical activity in the brain. Symptoms depend on where the seizure begins and how much of the brain is involved. Seizures may be obvious or very subtle, and the same person often has similar symptoms from one episode to the next.
Types of Seizures
Seizures are commonly grouped by where they begin in the brain.
Focal Seizures
Focal seizures, or focal onset seizures (FOS), begin in one area of the brain. A person may remain aware or may have impaired awareness. Symptoms can include unusual sights, smells or tastes; nausea; fear or déjà vu; repetitive movements; or jerking that starts in one part of the body, leading to more widespread effects.
Generalized Seizures
Generalized seizures involve networks on both sides of the brain. Types include:
- Absence seizures. Brief periods of staring or reduced awareness, sometimes with blinking or small repetitive movements.
- Generalized tonic-clonic seizures. Stiffening followed by rhythmic jerking, usually with loss of consciousness and a period of confusion or fatigue afterward.
- Atonic seizures. A sudden loss of muscle tone that may cause a fall.
- Clonic seizures. Repeated rhythmic jerking movements.
- Tonic seizures. Sudden muscle stiffening, often during sleep.
- Myoclonic seizures. Very brief, shock-like muscle jerks that may occur alone or in clusters.
Epilepsy Syndromes and Related Conditions
- Self-limited epilepsy with centrotemporal spikes (formerly called benign Rolandic epilepsy)
- Childhood and juvenile absence epilepsy
- Febrile seizures
- Frontal lobe epilepsy
- Hypothalamic hamartoma
- Infantile epileptic spasms syndrome (infantile spasms)
- Landau-Kleffner syndrome
- Lennox-Gastaut syndrome
- Mitochondrial disorders
- Progressive myoclonic epilepsies
- Rasmussen encephalitis reflex epilepsies
- Ring chromosome 20 syndrome
- Temporal lobe epilepsy
Epilepsy Causes
For many people, the cause of epilepsy is not known. When a cause can be identified, it may involve genetics or a condition that affects the brain. Possible causes and risk factors include:
- Alcohol consumption
- Brain injury before or around birth
- Genetic or neurodevelopmental conditions
- Infections affecting the brain
- High fever
- Metabolic or immune disorders
- Neurodegenerative conditions, including some forms of dementia
- Psychoactive substance use (for example, cocaine or amphetamines)
- Structural changes from stroke, brain tumors, vascular malformations or developmental brain abnormalities
- Traumatic brain injury
- Very low blood sugar
A specialist can help determine whether an event was a seizure and whether an underlying condition needs treatment.
Epilepsy Symptoms
Seizure symptoms vary. Possible signs include:
- A staring spell or brief period of unresponsiveness
- A blackout, loss of awareness or loss of consciousness
- Confusion before or after an episode
- Drooling or teeth clenching
- Repetitive movements, such as blinking, lip smacking, swallowing or tugging at clothing
- Sudden muscle stiffening, spasms or uncontrollable jerking
- Tingling or numbness
- Unusual tastes, smells, sights or sounds
- Sudden fear, anxiety or a feeling of déjà vu
Some people notice warning symptoms before a seizure, such as dizziness, nausea, anxiety or flashing lights. If possible, note what happened before, during and after the event. A witness’s description or video may also help the care team understand what occurred.
Epilepsy Diagnosis
An epilepsy evaluation begins with a detailed medical history and a description of the suspected seizure. A neurological exam checks brain and nervous system function, including reflexes, muscle function and coordination. If the person lost awareness, it may help to bring someone who saw the event.
Testing may include:
- Electroencephalogram (EEG), including routine, ambulatory, high-density or prolonged video EEG, to record electrical activity in the brain
- Electrocardiogram (EKG) to check your heart and rule our fainting
- Magnetic resonance imaging (MRI) to look for structural causes
- Computed tomography (CT) in urgent or selected circumstances
- Functional MRI for presurgical mapping when appropriate
- Positron emission tomography (PET) or single-photon emission computed tomography (SPECT), for selected patients, often as part of a presurgical evaluation
- Magnetoencephalography (MEG), when appropriate, usually as part of a presurgical evaluation
- Blood tests when metabolic, infectious, genetic or other systemic causes are suspected; testing for sugar, salt levels, and organ health
- Neuropsychological testing, particularly when cognitive effects or epilepsy surgery are being evaluated
- Other tests, such as a lumbar puncture, electrocardiogram or sleep study, when medically indicated
Normal test results do not always rule out epilepsy.
Conditions that could be mistaken as epileptic seizures include: fainting, psychogenic/functional seizure-like events, anxiety/panic attacks, movement disorders, acute symptomatic (provoked) seizures.
The care team considers the full history, exam and test results when making a diagnosis.
Epilepsy Treatments
Treatment depends on the seizure type, cause, age, overall health and how seizures affect daily life. A personalized epilepsy management plan may include anti-seizure medication, nutrition therapy, or epilepsy surgery.
Anti-Seizure Medication
Medication is often the first treatment. The neurologist selects a medicine based on the specific seizure type and monitors how well it works and whether it causes side effects. Daily medicine can lower the risk of having more seizures by 30 to 70 percent. Do not stop anti-seizure medicine without guidance from the prescribing clinician.
Nutrition Therapy
A medically supervised ketogenic or other specialized diet may help some patients, especially children whose seizures are difficult to control. These diets should be managed by an experienced clinical team.
Epilepsy Surgery
Patients whose seizures remain uncontrolled after adequate trials of two appropriately selected and tolerated anti-seizure medications should be referred to a comprehensive epilepsy center. Referral does not necessarily mean surgery; it allows the team to confirm the diagnosis and consider medication, dietary, surgical and neuromodulation options. Epilepsy surgery may be considered when seizures are drug resistant and evaluation shows that a procedure can be performed safely and is likely to improve seizure control. Depending on the patient, procedures may include open or minimally invasive approaches. RWJBarnabas Health neurologists and neurosurgeons work together to select the safest, most effective option for each patient.
For some patients, an implanted device may deliver electrical stimulation to help reduce seizures. Vagus nerve stimulation (VNS) is one form of neuromodulation; other neuromodulation approaches may be considered by a comprehensive epilepsy team when clinically appropriate. The epilepsy team can determine whether this type of treatment is appropriate.
Highest Levels of Epilepsy Care
Cooperman Barnabas Medical Center and Robert Wood Johnson University Hospital are home to comprehensive, Level 4 epilepsy programs that provide multidisciplinary evaluation and medical and surgical care for adults and children in New Jersey. The programs are accredited as Level 4 Epilepsy Centers by the National Association of Epilepsy Centers (NAEC), reflecting the highest level of specialized epilepsy care available. Community Medical Center is accredited as a Level 3 Adult Epilepsy Center. The Bristol-Myers Squibb Children’s Hospital at RWJUH is accredited as a Level 3 Pediatric Epilepsy Center.
A Level 3 or Level 4 epilepsy center should be considered when seizures remain uncontrolled, the diagnosis is uncertain, treatment causes significant side effects, or specialized testing or treatment may be needed.
Epilepsy Support Services
Epilepsy can affect safety, school, work, driving and quality of life. Support may include:
- Education for patients and caregivers
- Long-term medication management
- Nutrition guidance
- Neuropsychological testing
- Surgical evaluation
- Coordinated follow-up
Patients may also be advised to wear medical identification and teach family, friends or caregivers how to respond to a seizure.
Depending on individual needs, counseling may also address mental health, memory, driving, bone health, reproductive health, pregnancy and sudden unexpected death in epilepsy (SUDEP).
What to Do During a Seizure
- Stay calm and stay with the person.
- Help the person to the ground if they are falling.
- Move hard or sharp objects away and place something soft under the person’s head.
- Keep track of how long the seizure lasts.
- Do not restrain the person and do not put anything in the person’s mouth.
- Turn the person gently onto one side, with the mouth pointing toward the ground, if it is safe to do so. Stay nearby until the person is fully alert or help arrives.
- Do not give food, water or medication until the person is fully alert.
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Emergency guidance: Call 911 for a first known seizure, a seizure lasting five minutes or longer, repeated seizures without recovery, trouble breathing, serious injury, a seizure in water, or if the person is pregnant or has diabetes and loses consciousness. Follow the person’s seizure action plan when one is available. |
Epilepsy Clinical Trials
Clinical trials may offer access to new ways to diagnose, monitor or treat epilepsy. Availability and eligibility can change.
Patients and families can search current RWJBarnabas Health clinical trials or ask the epilepsy care team whether a research study may be appropriate.
Epilepsy Prevention and Screening
There is no routine screening test for epilepsy in people without symptoms, and epilepsy cannot always be prevented. Prompt care for head injuries, stroke, infections and other conditions that affect the brain may help reduce some risks. People with epilepsy can lower the chance of breakthrough seizures by taking medication as prescribed, keeping medical appointments and following an individualized plan for sleep, illness, stress and other known triggers.
Anyone who has a first or suspected seizure should receive a medical evaluation. Ongoing or uncontrolled seizures should be reviewed by an epilepsy specialist.
Epilepsy Precautions
People who have epilepsy should consider the following precautions to stay safe:
- Driving: One may need to stop driving for a period of time. This is NJ law. Ask your doctor when it is safe to drive again.
- Sleep: Try to get enough sleep each night. Being very tired can trigger seizures.
- Water: Take showers, not baths. Do not swim alone. Wear a life jacket when on open water.
- Home/work: Be careful with heights, heavy machines, open flames and holding a baby for long periods until your seizures are controlled.
Make an Appointment
If you or a loved one needs evaluation or treatment for epilepsy or another seizure disorder, connect with the RWJBarnabas Health neuroscience team.
