Epilepsy & Seizures Overview

Dr. Alim Akhtar Bhuiyan Consultant Neurologist and Epilepsy Specialist Apollo Hospitals ,Dhaka
Overview of Epilepsy & Seizures Epilepsy is a recurrent seizure disorder caused by abnormal electrical discharges from brain cells, often in the cerebral cortex. It is not a distinct disease, it is a group of disorders for which recurrent seizures are the main symptom. Different forms of epilepsy are either secondary to a particular brain abnormality or neurological disorder, or are said to be "idiopathic," without any clear cause. Normally, nerve transmission in the brain occurs in an orderly way, allowing a smooth flow of electrical activity. A seizure occurs when these neurons generate unco-ordinated electrical discharges that spread throughout the brain. This can occur with both normal and abnormal nerve cells. Epilepsy Incidence Seizure disorders are a common neurological problem. In the United States alone, it has been estimated that more than 4 million people have some form of epilepsy.. The prevalence of epilepsy (defined as the total of the population suffering from a disorder at a particular time) has been estimated to be about 5 to 8 in every 1000 people, The number of patients with Epilepsy is more common in developing countries including Bangladesh .

Epilepsy & Seizure Physiology

Physiology of Seizures In order to understand the process of electrical transmission within nerve cells, it is important to review the structure and function of a nerve. A nerve cell can be thought of as a tube, having an inner section, and bounded by a cell wall (membrane). Importantly, the chemical composition of the inside of the cell and the outside of the cell are very different. Specifically, there is a difference in the concentration of sodium and potassium salts, with sodium being much higher on the outside, and potassium being much higher on the inside. In a normal resting state, special pumps (called membrane pumps) are continually at work to maintain each salt in its proper location. When a nerve is called upon to transmit an electrical signal, a sudden movement of these salts from one side of the cell's membrane to the other occurs. This movement spreads like a wave from one end of the nerve to the other, until it reaches the end. At this point, the nerve's signal may be transmitted to the next nerve cell either by a direct extension of this process, or, more commonly, by releasing a special chemical called a neurotransmitter. Neurotransmitters generally have one of two special functions. One type is responsible for encouraging cellto-cell communication and is referred to as an "excitatory" neurotransmitter. The second type is able to slow down, or even stop cell-to-cell communication and is called an "inhibitory" neurotransmitter. In some cases, overactivity of excitatory neurotransmitters or underactivity of inhibitory neurotransmitters may lead to seizure activity by allowing an uncoordinated flow of electrical activity in the brain. Interestingly, certain areas of the brain are more likely than others to be the source of a seizure. These include the motor cortex (responsible for the initiation of body movement) and the temporal lobes

(including a special deep area called the hippocampus, which is involved in memory). The reason for this likelihood may be that nerve cells in these areas are particularly sensitive to certain situations that can provoke abnormal electrical transmission. Examples include sensitivity to decreased oxygen levels, metabolic changes, and infection, any of which may lead to a seizure. Many types of brain abnormalities can be responsible for producing seizure activity. Abnormal discharges may spread to other cells in a local area or to remote areas of the brain, resulting in intermittent disturbance in the brain's normal functions. Changes in brain biochemistry and communication between brain cells occur. These basic neurofunctional abnormalities that lead to epilepsy produce the clinical symptoms that are seen. In turn, recurrent seizures or prolonged seizures can cause injury to the brain. Seizures that last longer than 20 to 30 minutes can damage the brain's neurons. A seizure is often divided into different parts. The aura is a period or warning prior to a seizure. Patients may experience unusual smells, visual symptoms, or feelings. The seizure itself is known as the ictus. The period of time after the seizure is called the postictal state. Seizures were depicted by prehistoric man in cave paintings. Hippocrates wrote of epilepsy and of its relationship to the brain. Epilepsy also is described in the Bible. Writings from 4000 years ago depict epileptics as possessed by demons. Julius Caesar, the great Russian novelist Dostoyevsky, and King Charles II all are said to have had seizures.

Types of Seizures
Seizure Types There have been many attempts to categorize seizures, based on both the causes of seizures as well as the different seizure subtypes. A well-recognized classification system is the International Classification of Epileptic Seizure. This divides seizure types by the location in the brain that they originate from. The two main categories of seizures include partial seizures and generalized seizures Partial seizures are those that begin in a focal or discreet area of the brain. This type can be further subdivided into:

Simple partial: No change in consciousness occurs. Patients may experience weakness, numbness, and unusual smells or tastes. Twitching of the muscles or limbs, turning the head to the side, paralysis, visual changes, or vertigo may occur. When motor symptoms spread slowly from one part of the body to another, this "epileptic march" has been termed jacksonian epilepsy (first described by Hughlings Jackson). Complex partial seizures (temporal lobe): Consciousness is altered during the event. Patients may have some symptoms similar to those in simple partial seizures but have some change in their ability to interact with the environment. Patients may exhibit automatisms (automatic repetitive behavior) such as walking in a circle, sitting and standing, or smacking their lips together. Often accompanying these symptoms are the presence of unusual thoughts, such as the feeling of deja vu (having been someplace before), uncontrollable laughing, fear, visual hallucinations, and experiencing unusual unpleasant odors. These interesting symptoms are thought to be caused by abnormal discharges in the temporal lobe.

Generalized seizures involve larger areas of the brain, often both hemispheres (sides), from the onset. They are further divided into many subtypes. The more common include:

Tonic-clonic (grand mal): This subtype is what most people associate with seizures. Specific movements of the arms and legs and/or the face may occur with loss of consciousness. A yell or cry often precedes the loss of consciousness. Prior to this, patients may have an aura (an unusual feeling that often warns the patient that they are about to have a seizure). The person will abruptly fall and begin to have jerking movements of their body and head. Drooling, biting of the tongue, and

incontinence of urine may occur. When the jerking movements stop, the patient may remain unconscious for a period of time. The seizure usually lasts 5 to 20 minutes. They often awaken confused and may sleep for a period of time. The patients may experience prolonged weakness after the event; this is termed Todds paralysis.

Absence (petit mal): Loss of consciousness only occurs, without associated motor symptoms. Usually there is no aura, or warning. The loss of consciousness is brief; the patient may appear to be involved with the environment and briefly stop what they are doing, stare for 5 to 10 seconds, and then continue their activity. No memory of the event exits. Subtle motor movements may accompany the alteration in consciousness. Myoclonic: Myoclonic seizures are characterized by a brief jerking movement that arises from the central nervous system, usually involving both sides of the body. The movement may be very subtle or very dramatic. There are many different syndromes associated with myoclonic seizures, including juvenile myoclonic epilepsy, West syndrome and Lennox-Gastaut syndrome. Most cases of myoclonic epilepsy occur during the first 5 years of life.

West Syndrome West syndrome involves a group of symptoms including infantile spasms, retardation of psychomotor development, and a particular abnormality on the electroencephalogram (EEG) known as hypsarrhythmia. Infantile spasms are characterized by a particular posturing of the infant's body, in which the child assumes a jack-knife, or folded, position. These spasms may occur frequently in the course of the day or may be continuous. Neurological problems are ultimately found in most of these children. The hypsarrhythmia pattern seen on the EEG is a grossly disorganized pattern of electrical brain activity. It is often difficult to control the seizures in this syndrome because they usually respond poorly to most anticonvulsant medications. Lennox-Gastaut Syndrome Lennox-Gastaut syndrome is characterized by the early onset of a common seizure type called minor motor seizures. These seizures include the aforementioned myoclonic seizures, atypical absence seizures, and atonic seizures. Atypical absence seizures may involve staring and brief episodes of unconsciousness. They may occur in cycles and are associated with EEG findings different from those seen in typical absence seizures. Atonic seizures may be associated with sudden loss of muscle tone. Status Epilepticus Status epilepticus is prolonged, repetitive seizure activity that lasts more than 20 to 30 minutes, during time which the patient is unconscious. Status epilepticus is a medical emergency with a significantly poor outcome; it can result in death if not treated aggressively. Its causes include improper use of certain medications, stroke, infection, trauma, cardiac arrest, drug overdose, and brain tumor.

Epilepsy & Seizures Causes

Causes of Epilepsy & Seizures Epilepsy is not associated with any particular disease. Many abnormalities of the nervous system can result in seizure activity. Seizures can also occur in the normal nervous system when its metabolic balance is disturbed. The etiology (cause) of epilepsy may be idiopathic (not clearly known) or related to a particular disease state. About 35% of all cases of epilepsy have no clearly definable cause. The following summarizes some of the more common factors leading to seizure activity.

Genetic factors: It is now accepted that some persons may have a genetic predisposition to the development of seizures. There is also an increased incidence of epilepsy in relatives of those with a seizure disorder. Head injury: Seizures may develop at or around the time of injury or years after (usually not more than two years later). They may occur with either an "open" or "closed" head injury. Stroke/cerebrovascular disorders: Seizures can occur at the time of a stroke or many years later. They may occur with strokes that result in lack of blood flow to the brain or with those that involve bleeding into or around the brain. Metabolic disturbances: This group of disorders changes levels of various metabolic substances in the body. These disease states sometimes result in seizures.

Electrolyte disturbances (altered levels of sodium, calcium, or magnesium) Hypoglycemia (low blood sugar) or hyperglycemia (elevated blood sugar) Renal failure (kidney disease) with uremia (increased urea in the blood) or changes that occur around the time of kidney dialysis Hepatic failure (severe liver disease) and elevation of associated toxins Hypoxia (lowered oxygen delivery to the brain)

Toxic causes: The presence of certain drugs can cause seizure activity. In addition, abrupt withdrawal of some substances can lead to seizure activity. These substances that may induce seizures include the tricyclic antidepressants, lithium, antipsychotic medications, aminophylline, and high doses of penicillin. Illicit drug use, particularly cocaine, heroine, amphetamines, and PCP, can cause seizures. Alcohol withdrawal can be associated with seizure activity. These seizures usually occur 12-24 hours after the last drink but can occur up until 48 hours or more after binge drinking. Withdrawal from prescription drugs and agents such as barbiturates and narcotics can result in seizure activity. Infections: Infections of the nervous system may result in a lowered seizure threshold. These may include meningitis (infections of the coverings of the brain and spinal fluid), encephalitis (infection of the brain itself), and HIV (human immunodeficiency virus), and related infections. Tumors and space-occupying lesions: Brain tumors, both malignant (cancerous) and benign, may be associated with seizures. The anatomic location of the abnormality influences the likelihood of having seizures. Degenerative disorders: There are many neurodegenerative disorders that are accompanied by seizures. These include tuberous sclerosis, neurofibromatosis, Tay-Sachs disease, phenylketonuria (PKU), and Sturge-Weber syndrome. Brain damage in infancy: Cerebral palsy secondary to lack of oxygen, infection, or trauma is associated with epilepsy. Febrile seizures: These are an age-associated form of epilepsy that may present as a single seizure or may be recurring. They are associated with a high fever in children 3 months to 4 years of age and occur in 3% 4% of children.

Epilepsy & Other Seizure Disorders

Disorders That Mimic Seizure Disorders True seizure disorders must be differentiated from a variety of problems whose symptoms approximate or closely resemble those of epilepsy. These include other conditions include cerebrovascular (stroke-related) disorders, migraine, narcolepsy, syncope (fainting), and anxiety and other psychiatric disorders. Another type of spell well known to physicians is the so-called pseudoseizure, or more properly nonepileptogenic seizure. These spells are not triggered by nerve cell discharges that cause true epilepsy, although the patient may experience muscle twitching and even apparent loss of consciousness. These spells have a psychiatric component and often coexist in persons who have true epilepsy. EEG monitoring can help distinguish disorders that mimic epilepsy from true seizures.

Epilepsy & Seizures Diagnosis

Diagnosis of Epilepsy & Seizures Patients should be evaluated thoroughly after an initial seizure. It is imperative that the clinician take a complete and detailed patient history, including details of birth, childhood, family history, and medication regimen; and a thorough medical history, including any illnesses of the nervous system. In some cases, other conditions (e.g., irregular heartbeat) must be ruled out. A thorough history of drug and alcohol use is equally important.

also is helpful to distinguish seizure subtypes, partial or generalized; time of day of the event, including whether the seizure occurred during wakefulness or sleep; and any known triggers, such as a flickering light, severe sleep deprivation, or dehydration. Thorough general physical and detailed neurological examinations also should be performed. Diagnostic Testing for Epilepsy Laboratory data utilized in the diagnostic evaluation of patients with seizure disorders may include CAT scan imaging, magnetic resonance imaging (MRI), and electroencephalography (EEG). A complete blood laboratory panel, including drug-toxic screening, and urinalysis are usually performed. CAT scan brain imaging is often the first radiological study obtained, especially in the emergency room setting. It can indicate pathology such as a brain tumor, stroke, brain hemorrhage, acute or remote trauma, and infection. Limitations include inability to evaluate certain structures in the brain in detail, particularly the temporal lobes of the brain, often the first sites of seizure activity. MRI brain imaging is performed for many patients with seizure disorders. It has the ability to visualize in great detail much of our brain anatomy. Subtle asymmetries in relevant structures, as well as undetected mass lesions, small strokes, and evidence of trauma may be uncovered. The use of a contrast agent (injected into the vein) can enhance the ability to show underlying abnormalities. EEG (also known as "brain wave") provides information about the electrical activity in the brain. Unlike CAT or MRI, it does not produce an image of the brain, but supplies information about the function or dysfunction of parts of the brain. Multiple small electrodes are placed at specific points on the scalp on both sides of the head to record activity generated mainly by the cerebral cortex. Brain wave activity is usually recorded for 30-45 minutes. Many patients will also be tested while hyperventilating (breathing rapidly and deeply), when flashing lights are flashing, while sleeping, or when sleep deprived. The brain normally exhibits particular patterns on the EEG during wakefulness, drowsiness, and sleep. The duration and character of normal brain-wave activity can be used as a baseline for comparison with abnormal waves on an EEG.

Some of the findings on EEG are specific to particular disorders and subtypes of epilepsy. Activity during a seizure can be identified by a pattern on the graph indicating epilepsy called epileptiform. Correlating this type of data with clinical symptoms of seizures often helps make an accurate diagnosis. The EEG recording between seizures is often abnormal in patients with epilepsy, and so can be helpful in this setting. EEG can be combined with video monitoring to record activity both electrically and visually. EEG can also be performed in a long-term care setting with a portable ambulatory unit, to monitor patients for up to many days at a time. Other uses of the EEG include evaluation of altered states of consciousness, brain damage, metabolic-toxic injury, and suspected brain death.

Epilepsy & Seizures Treatment

Treatment for Epilepsy & Seizures The medications used to treat patients with epilepsy are called anticonvulsants. Many of these drugs are available and each has a different mechanism of action, but all serve to reduce the frequency of epileptic seizures. These medications can be given for long periods of time. Treatment options are evaluated initially based on seizure subtype, as certain anticonvulsants may be indicated for treating some forms of epilepsy and contraindicated for others. When making decisions about treatment with a particular agent, the physician should always take into account the patient's entire medical and medication histories, age and gender, and side-effect profile. It is important to evaluate the risks and benefits of treatment for each individual. That said, some general principles apply to treatment. Monotherapy, treatment with a single agent, is the goal. Seizures can be controlled with one agent in approximately 75% of patients. Management becomes complicated when patients are given medications in combinations. This also risks increasing the number and frequency of side effects, making it less likely that patients will take their medication appropriately. For medications to work effectively, a relatively constant level of medication must be maintained in the body. This is accomplished by taking medication regularly as directed, without missing doses. The consequences of missed doses may be a single seizure, more devastating multiple seizures, or status epilepticus. Divided doses may be preferable with some medications, ensuring a more constant level of medication in the bloodstream. Appropriate dosing levels depend on many factors, including the patient's body weight, concomitant medications, and reaction to treatment. Many neurologists believe brand-name medications are preferable to generic products. Generic medications may be produced by different companies without rigorous standards regarding adequate drug level at a particular dose. Patients who use these medications may therefore be exposed to fluctuating levels of medication. For some people with epilepsy, this can result in loss of seizure control. Brand-name anticonvulsants, meeting stringent standards, provide more confidence in the dose-blood level relationship. Any medication can cause an allergic reaction. Dermatological problems, including rashes, are not uncommon. Life-threatening reactions, such as the Stevens-Johnson syndrome, can occur. It is essential that patients report any suspected reactions to their physician. When medications are to be discontinued, it is almost always recommended that they be slowly tapered down in dosage strength because abrupt withdrawal can produce seizures. Kidney and liver function testing should be performed to evaluate the ability of these organs to metabolize the medication; some drugs will require changing the dosage if function is impaired.

There is still some controversy over whether to treat a patient who has had only a single seizure. Approximately 75% of seizure sufferers have only one seizure and no reoccurrence. In making treatment decisions, it is helpful to look at risk factors that may predict a second seizure. These include lesions of the brain, an abnormal EEG, or a family history of seizure disorders. Anticonvulsants can reduce the risk of further seizure activity. People who have had more than one seizure should probably be treated with anticonvulsants.

Epilepsy & Seizures First-Generation Anticonvulsants

First-Generation Anticonvulsants to Treat Epilepsy It is convenient to divide some of the existing medications into first-generation anticonvulsantsolder medicationsand second-generationmore recently developeddrugs. Pharmaceutical research of new drugs is ongoing, with exciting developments in progress. The following medications are first-generation anticonvulsants commonly prescribed for epilepsy. Phenytoin (Dilantin) was first used in the late 1930s. It has become one of the more commonly used agents and often is considered the first-line drug to treat seizures. It is thought to work by suppressing electrical activity in brain nerve cells. It can be given orally or intravenously (IV), and a newer form of the drug, fosphenytoin (Cerebryx) can be injected into muscle. The oral form has the benefit of once-a-day dosing. Phenytoin is a first-line agent for treating partial and generalized tonic-clonic (grand mal) seizures. It is also one of the main agents used with patients who present with status epilepticus. Phenytoin drug levels need to be monitored with laboratory testing. The therapeutic concentration recommended is between 1020mg/L. In addition, liver function testing and a complete blood count (CBC) need to be followed. Phenytoin has many interactions with other medications, and its own level can fluctuate when other drugs are taken. Some of the side effects associated with its use include gingival hyperplasia (overgrowth of the gums), hirsuitism/hypertrichosis (excessive hair growth), imbalance, lethargy, anemia, and, in long-term use, peripheral neuropathy (weakness). Carbamazepine (Tegretol/Carbatrol) has been in use for over 30 years. It is commonly prescribed for the treatment of partial and generalized tonic-clonic (grand mal) seizures. The mechanism by which it works is not well understood. In oral form, it can be taken 2 to 3 times a day; a recent development of the drug in sustained-release form allows for twice-a-day dosing. Carbamazepine levels need to be followed with laboratory testing. The recommended therapeutic level is between 812mg/L. Liver function tests and CBC also need to be checked routinely. Carbamazepine can affect the levels of a number of other drugs in the body, and its own level can fluctuate when other agents are taken. Recognized side effects include drowsiness, imbalance, nausea, anemia, and neutropenia (low, white blood cell count). Carbamazepine is also used to treat trigeminal neuralgia, or tic douloureux, a painful nerve disorder of the face, and other neuropathic pain syndromes. Phenobarbital is the oldest of this group of anticonvulsants. It can be used to treat both partial and generalized seizures. It also is used as part of the protocol after phenytoin use in status epilepticus as well as in neonatal epilepsy. It is available in oral and intravenous forms. Levels need to be monitored. The recommended therapeutic level is 1540mg/L. A complete blood analysis also should be routinely conducted. Phenobarbital can cause changes in the metabolism of other drugs through its actions on liver enzymes. Side effects may include drowsiness, cognitive impairment, and irritability.

Valproate (Depakote) has been in use for more than 20 years. It can be prescribed for a broad spectrum of anticonvulsant needs, including partial seizures, generalized tonic-clonic (grand mal) seizures, absence (petit mal), and myoclonic epilepsy. Its mechanism of action is thought to be related to the effect of a brain substance known as GABA (gamma-aminobutyric acid). It is available in oral form and must be taken 2 to 3 times per day for adequate dosing. Drug levels must be monitored, as well as liver function, and blood count. The drug's suggested therapeutic window is 50100mg/L. Side effects include hepatotoxicity (liver damage), nausea, weight gain, allopecia (hair loss), and tremor.

Epilepsy & Seizures Second-Generation Anticonvulsants

Second-Generation Anticonvulsants to Treat Epilepsy Topiramate (Topamax) is used with other anticonvulsant drugs in the treatment of partial seizures and generalized tonic-clonic seizures in adults and children aged 2 to 16. Although its precise mechanism of action is unknown, one theory suggests that its anticonvulsant activity may be due in part to increasing GABA (gamma-aminobutyric acid), a neurotransmitter that inhibits excitation of nerve cells in the brain. It is available in oral form, including sprinkles for children, and should be taken twice daily. Major side effects include drowsiness, nausea, dizziness, and coordination problems. Children may have difficulty concentrating and may become agressive. Acute glaucoma and visual abnormality, a potentially very serious complication, has been reported in a small number of patients. If any abnormal visual symptoms occur, patients should notify their physician immediately. There are few drug interactions between Topamax and other medications or other anticonvulsants. Gabapentin (Neurontin) is indicated for the adjunctive treatment of partial seizures, with or without secondary generalization. Although it is structurally related to the substance GABA (gamma-aminobutyric acid), it does not interact with GABA receptors in the brain, and its mechanism of action is unknown. It is available in oral form and should be taken three times daily. No laboratory monitoring of liver, kidney, or hematologic (blood) function is necessary with Neurontin. Its major side effects are fatigue, dizziness, and imbalance. Neurontin also has been used successfully in patients with neuropathic pain syndromes. Lamotrigine (Lamictal) is used for the adjunctive treatment of partial seizures. Its precise mechanism of action is unknown. It is presently available in oral form. Lamictal should be taken twice daily. No laboratory monitoring of Lamictal levels are necessary. Its major side effect is the appearance of a potentially lifethreatening skin rash, particularly for patients who also are taking valproate (Depakote). Any patient taking Lamictal who develops a rash should immediately report it to his or her physician. Other side effects include headache, nausea, and dizziness. Tiagabine (Gabitril) is indicated for adjunctive therapy in adults with partial seizures. Its mechanism of action may be related to its effect on the brain substance GABA (gamma-aminobutyric acid). It is available in oral form and should be given in divided doses two to four times daily. No laboratory monitoring of Gabitril levels are necessary. Some interaction likely exists when Gabitril is taken with other anticonvulsants, in that its metabolism may be altered. Side effects include dizziness and somnolence. Keppra (levetiracetam) Keppra is approved for use in adults as adjunctive therapy for the treatment of partial seizure disorders. The side effects can include fatigue, imbalance and behavioral changes, which often dissipate after the first month of treatment.

Trileptal (oxcarbazepine) is indicated for monotherapy (used alone) in adults who have partial seizures and can be used in children as add-on therapy for partial seizures. The most common side effects include dizziness, sleepiness, nausea, and imbalance, but these do not warrant clinical observation. Zonegram (Zonisamide) is approved for use in adults as adjunctive therapy for partial seizures. It has however, been used fairly extensively in other countries for use in other seizure types including generalized seizures, myoclonic seizures and absence seizures. Side effects can include dizziness, imbalance and fatigue. Individuals who are allergic to sulfonamide drugs should not use Zonisamide since it is a derivative of this class of drug

Epilepsy & Seizures Surgery

Surgery to Treat Epilepsy Surgical resection of epileptogenic areas of the brain in patients with partial seizures sometimes is considered when seizure activity fails to respond to even the most aggressive medical management. Patients considered for these procedures are those with intractable seizures, even when given high levels of anticonvulsant drugs. Video-EEG monitoring on a long-term basis is used to determine where in the brain the seizures occur. In some patients, placing electrodes beneath the scalp may help to define epileptogenic areas of the brain. Specialized centers throughout the country have multidisciplinary teams to aid in the evaluation of potential candidates for these procedures

Epilepsy & Seizures Precautions

Precautions for Patients with Epilepsy & Seizure Disorders The word epilepsy is used when more than one seizure has occurred, and, if someone has a single seizure, they usually are not said to have epilepsy. Unfortunately, epilepsy connotes something very negative to many people. The terms epilepsy and seizure disorders are often used interchangeably. Psychosocial Aspects of Seizure Disorders Seizure disorders can have a profound effect on many aspects of normal daily living. An individual's perception of his or her own health or illness may be dramatically changed when they have a seizure disorder. For some patients, epilepsy carries a stigma that may cause them to alter plans regarding their future educational, employment, or social opportunities. Awareness of these issues is key to developing a treatment and counseling plan for patients and their families. Important issues to address and include when educating patients about managing epilepsy are:

what seizures are, and what symptoms may warn of their onset when to notify a physician about any change in symptoms details of medication dosing, side effects, and importance of medication compliance (taking medications exactly as they are directed and not missing doses) importance of laboratory monitoring tests with some drugs advice on living a healthy lifestyle and avoiding things that may trigger seizure activity (sleep deprivation, increased stress, alcohol and drug abuse) counseling women of childbearing age about epilepsy, medications, and pregnancy

Driving and Seizure Disorders

Although the laws vary somewhat from state to state, most states have rules regarding when seizure patients can legally resume driving. Typically, patients must have been seizure-free 6 months to a year. While physicians generally are not required to report patient seizures to their state motor vehicle departments, patients are expected to comply with the laws in their state.