Epilepsy is a neurological disorder caused by abnormal and unpredictable electrical and chemical activity of neurons. During normal brain function, electrical and chemical information is passed from nerve cells in the brain to other parts of the body in a coordinated, orderly fashion.

However, in patients with epilepsy, this pattern is interrupted by sudden and synchronized bursts of electrical energy, which, if intense enough, may briefly affect a person's consciousness, bodily movements or sensations. These physical changes are called epileptic seizures. 

Some people with epilepsy will have only an occasional seizure, while others will have many on a daily basis. Epilepsy is estimated to affect one percent of the U.S. population -- approximately 3 million people. Seizures usually occur without warning and without the person's awareness of what is happening.

Drug therapy, brain surgery, the vagal nerve stimulator or the ketogenic diet can all be used to treat epilepsy, depending on the underlying cause. Of these options, antiepileptic drugs, which prevent or control seizures, remain the cornerstone of treatment.

Most epilepsy can be treated successfully with medications. It is only cases where disabling seizures cannot be stopped with medication where surgery is considered an appropriate option. Improved technology has made it possible to identify more accurately where seizures originate in the brain (epileptogenic regions), and advances in surgery have made the operations safer. Surgery may involve removing brain areas that are causing seizures, or implanting a vagal nerve stimulator, a device about the size of a silver dollar, which is placed under the skin in the chest, with thin wires that stimulate the vagus nerve in the left side of the neck.

Whether patients would benefit from surgery depends on the type of epilepsy they have and requires a comprehensive evaluation by experts.

In more than half of all patients with epilepsy, no cause can be found. In the other group of patients, head injuries, brain tumors, genetic disorders, structural abnormalities in the brain and certain genetic, vascular, and infectious illnesses can serve as underlying causes.

Neurological Evaluation: The main way that to diagnosis epilepsy is with a careful history and examination by a health care provider. The most important part is the description of the episodes. Because patients may not be aware, and may not remember what happened during many seizures, it is important to interview a family member or witness if available.

EEG Recording: An EEG records brain waves through electrodes that are placed on the scalp to detect abnormalities in the brain's electrical activity. An outpatient EEG takes about 2 hours, and can help diagnose epilepsy if it shows spikes or sharp waves, which are momentary electrical discharges which indicate irritability of the brain. 
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Video EEG Monitoring: The purpose of this test is to record brain waves and also videotape what happens during a patient’s actual seizures. Usually this requires admission to the hospital. Sometimes the antiepileptic medications are reduced or stopped to bring on seizures. Most of the time this is done with 21 or more electrodes glued on the scalp. This type of monitoring can be done to clarify the diagnosis when someone’s seizures are not responding to treatment, and also can be done, in other patients, to determine where seizures start, to see if a patient with uncontrolled seizures should be considered for brain surgery.

Dense Array EEG Monitoring: This is a special EEG monitoring procedure done with 256 electrodes placed with a net over the head to record seizures. The extra electrodes allow better identification of where in the brain electrical signals are generated. This technique is usually only used in patients being evaluated for brain surgery, where the standard video EEG monitoring study fails to adequately locate where the seizures arise.
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Invasive EEG Monitoring: Sometimes EEG and scans cannot determine exactly where seizures arise in the brain. If there is a very strong possibility that the patient is a candidate for epilepsy brain surgery, invasive monitoring is done. This involves surgically placing electrodes directly over the surface of the brain (subdural strip and grid electrodes) to record seizures. In certain situations, depth electrodes, small needle like probes, are used to record from deeper brain regions.

Neuroimaging (scans): The most important test is the MRI (magnetic resonance imaging) to look for brain abnormalities that could be causing the epilepsy. Sometimes special MRI methods are used, because in some patients, these abnormalities are hard to see. CT (computed tomography) is typically less useful than MRI.

Some specialized methods are only useful for patients being evaluated for epilepsy surgery. PET (positron emission tomography) looks at brain metabolism and can help to locate where seizures start. Ictal SPECT studies are done in the hospital. This test identifies where seizures start by measuring blood flow in the brain. A nurse sits by the bedside and, when a seizure occurs, quickly makes an injection of a special isotope into the patient’s intravenous line. Functional MRI (fMRI) is a special MRI method used to find areas of the brain that support certain functions, such as movement, sensation, vision or language, and is sometimes used to plan operations to help make sure that the brain area to be removed won’t affect important normal functions.

Neuropsychological Testing: This is used to assess how a person’s epilepsy affects their memory, mental abilities and emotions. Sometimes certain patterns of results from this testing can help to diagnose a patient’s condition or locate where in the brain the seizures come from. 
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Wada test:  The intra-carotid amobarbital "Wada" test is performed primarily on epilepsy surgical candidates to determine which side of the brain speech and memory functions reside.  Learn more ...

In a small number of cases, epilepsy is caused by a serious underlying condition, for example, a brain tumor, and complications can be due to progression of the underlying problem.

In most cases, however, the effects of epilepsy are due to the seizures, and consist of disability—inability to work or progress in school, or risk of injury or even death if the seizures are not controlled. Patients with uncontrolled seizures that cause loss of responsiveness are at risk for motor vehicle accidents, and cannot safely or legally drive a vehicle. They are also at risk for drowning, falls, and other injuries. They should avoid heights, and swimming or bathing without supervision. Rarely, prolonged, uncontrolled seizures can cause brain injury or even death without prompt intervention.

There is a very small risk (less than 1%/year) of sudden death in patients with uncontrolled epilepsy. This is called SUDEP (sudden unexpected death in epilepsy) and typically is unwitnessed. The cause is an issue of controversy.

The best way for most people with epilepsy to avoid any of these complications, is to work closely with their health care providers to control the seizures.”