What causes epilepsy?

is caused by abnormal electric impulses in groups of nerve cells (neurons) found in the brain. For diagnostic
Epilepsy

Electroencephalography (EEG) can show where in the brain the convulsions start.

purposes, epilepsy is divided into two main groups

Idiopathic epilepsy (From Greek idos = self.) n cases of this type, the cause is unknown. !owever, it is believed that attacks are caused by the lack of a particular group of chemical substances (the neurotransmitters) used to regulate the electric impulses in the brain.

"here may be an hereditary (genetic) background, since epilepsy of the same type is often seen among relatives. #oreover, EEG irregularities similar to those of the patient are often seen among family members, even if they do not suffer from epilepsy $ a kind of genetic mark. %ew research has shown that certain cases of idiopathic epilepsy are clearly hereditary, caused by chromosomal abnormality. "he patient has no other signs of neurological illness or mental defects. &"

and

#' scans

are normal.

Symptomatic epilepsy Epilepsy of this type is caused by a known illness in the brain.

Epilepsy triggers
%umerous illnesses or types of brain damage can cause epilepsy. "he following are the most common. Developmental anomalies (amage occurring to the brain as it develops during the first three months of pregnancy. "his can be revealed by modern #' scans

and causes many of the difficult$to$control cases in children. )n the other hand, damage inflicted during delivery (cerebral palsy) is fairly uncommon.
Trauma to the skull

, trauma can be so serious that the patient is admitted to a neuro$surgical ward. "he possibility of epilepsy following trauma varies from + to +, per cent, with the highest risk following a depressed skull fracture where the brain tissue has been partly damaged, or a gunshot wound to the
*nlike ordinary concussion

head.
Blood clots (infarcts) and haemorrhages in the rain -bout ., per cent of all brain infarcts cause epilepsy. Brain tumours Especially slow$growing superficial tumours. /ince these can be surgically removed, it is important to check for these if a patient develops epilepsy, especially if the attacks start in a limited part of the brain (focal attacks $ consult the article on the types of attacks

techni0ues are

&" scans

). "he most important and #' scans.

Encephalitis 1rolonged sei2ures and fever convulsions could induce brain damage. !lcohol a use #ay cause epilepsy as a result of the cramps associated with delirium tremens. n certain cases, an #' scan reveals abnormalities in the brain, but no evidence of neurological illness. /uch cases are called cryptogenic (from Greek3 kryptos = hidden).
Based on a te"t y

(r 45rgen -lving, consultant

#ast updated

,6.,7.8,,+

http://www.netdoctor.co.uk/diseases/facts/epilepsycauses.htm

Get Web page suited for printing Email this to a friend or colleague Request free mailed brochure Versi n en Espa!ol Table of Contents (click to jump to sections) "ntroduction What is Epilepsy# What $auses Epilepsy# Genetic %actors &ther 'isorders (ead "n)ury *renatal "n)ury and 'e+elopmental *roblems *oisoning What ,re the 'ifferent -inds of .ei/ures# %ocal .ei/ures Generali/ed .ei/ures What ,re the 'ifferent -inds of Epilepsy# When ,re .ei/ures 0ot Epilepsy# %irst .ei/ures %ebrile .ei/ures 0onepileptic E+ents Eclampsia (ow is Epilepsy 'iagnosed# EEG 1onitoring 2rain .cans 1edical (istory 2lood 3ests

'e+elopmental4 0eurological4 and 2eha+ioral 3ests $an Epilepsy be *re+ented# (ow can Epilepsy be 3reated# 1edications 3ailoring the dosage of antiepileptic drugs 'iscontinuing medication .urgery .urgery to treat underlying conditions .urgery to remo+e a sei/ure focus 1ultiple subpial transection $orpus callosotomy (emispherectomy and hemispherotomy 'e+ices 'iet &ther 3reatment .trategies (ow 'oes Epilepsy ,ffect 'aily 5ife# 2eha+ior and Emotions 'ri+ing and Recreation Education and Employment *regnancy and 1otherhood ,re 3here .pecial Risks ,ssociated With Epilepsy# .tatus Epilepticus .udden 6ne7plained 'eath What Research "s 2eing 'one on Epilepsy# (ow $an " (elp Research on Epilepsy# What 3o 'o "f 8ou .ee .omeone (a+ing a .ei/ure $onclusion Where can " get more information# Glossary Introduction

%ew e7periences match the drama of a con+ulsi+e sei/ure. , person ha+ing a se+ere sei/ure may cry out4 fall to the floor unconscious4 twitch or mo+e uncontrollably4 drool4 or e+en lose bladder control. Within minutes4 the attack is o+er4 and the person regains consciousness but is e7hausted and da/ed. 3his is the image most people ha+e when they hear the word epilepsy. (owe+er4 this type of sei/ure 99 a generalized tonic-clonic seizure 99 is only one kind of epilepsy. 3here are many other kinds4 each with a different set of symptoms. Epilepsy was one of the first brain disorders to be described. "t was mentioned in ancient 2abylon more than :4;;; years ago. 3he strange beha+ior caused by some sei/ures has contributed through the ages to many superstitions and pre)udices. 3he word epilepsy is deri+ed from the Greek word for <attack.< *eople once thought that those with epilepsy were being +isited by demons or gods. (owe+er4 in =;; 2.$.4 the early physician (ippocrates suggested that epilepsy was a disorder of the brain 99 and we now know that he was right. top What is Epilepsy?

Epilepsy is a brain disorder in which clusters of ner+e cells4 or neurons4 in the brain sometimes signal abnormally. 0eurons normally generate electrochemical impulses that act on other neurons4 glands4 and muscles to produce human thoughts4 feelings4 and actions. "n epilepsy4 the normal pattern of neuronal acti+ity becomes disturbed4 causing strange sensations4 emotions4 and beha+ior4 or sometimes convulsions 4 muscle spasms4 and loss of consciousness. 'uring a sei/ure4 neurons may fire as many as >;; times a second4 much faster than normal. "n some people4 this happens only occasionally? for others4 it may happen up to hundreds of times a day.

1ore than @ million people in the 6nited .tates 99 about A in A;; 99 ha+e e7perienced an unpro+oked sei/ure or been diagnosed with epilepsy. %or about B; percent of those diagnosed with epilepsy4 sei/ures can be controlled with modern medicines and surgical techniques. (owe+er4 about @> to :; percent of people with epilepsy will continue to e7perience sei/ures e+en with the best a+ailable treatment. 'octors call this situation intractable epilepsy. (a+ing a sei/ure does not necessarily mean that a person has epilepsy. &nly when a person has had two or more sei/ures is he or she considered to ha+e epilepsy. Epilepsy is not contagious and is not caused by mental illness or mental retardation. .ome people with mental retardation may e7perience sei/ures4 but sei/ures do not necessarily mean the person has or will de+elop mental impairment. 1any people with epilepsy ha+e normal or abo+e9a+erage intelligence. %amous people who are known or rumored to ha+e had epilepsy include the Russian writer 'ostoye+sky4 the philosopher .ocrates4 the military general 0apoleon4 and the in+entor of dynamite4 ,lfred 0obel4 who established the 0obel *ri/e. .e+eral &lympic medalists and other athletes also ha+e had epilepsy. .ei/ures sometimes do cause brain damage4 particularly if they are se+ere. (owe+er4 most sei/ures do not seem to ha+e a detrimental effect on the brain. ,ny changes that do occur are usually subtle4 and it is often unclear whether these changes are caused by the sei/ures themsel+es or by the underlying problem that caused the sei/ures. While epilepsy cannot currently be cured4 for some people it does e+entually go away. &ne study found that children with idiopathic epilepsy4 or epilepsy with an unknown cause4 had a CB to D@ percent chance of becoming sei/ure9free by @; years after their diagnosis. 3he odds of becoming sei/ure9free are not as good for adults or for children with se+ere epilepsy syndromes4 but it is nonetheless possible that sei/ures may decrease or e+en stop o+er time. 3his is more likely if the epilepsy has been well9controlled by medication or if the person has had epilepsy surgery. top What Causes Epilepsy?

Epilepsy is a disorder with many possible causes. ,nything that disturbs the normal pattern of neuron acti+ity 99 from illness to brain damage to abnormal brain de+elopment 99 can lead to sei/ures. Epilepsy may de+elop because of an abnormality in brain wiring4 an imbalance of ner+e signaling chemicals called neurotransmitters4 or some combination of these factors. Researchers belie+e that some people with epilepsy ha+e an abnormally high le+el of excitatory neurotransmitters that increase neuronal acti+ity4 while others ha+e an abnormally low le+el of inhibitory neurotransmitters that decrease neuronal acti+ity in the brain. Either situation can result in too much neuronal acti+ity and cause epilepsy. &ne of the most9studied neurotransmitters that plays a role in epilepsy is GABA4 or gamma9aminobutyric acid4 which is an inhibitory neurotransmitter. Research on G,2, has led to drugs that alter the amount of this neurotransmitter in the brain or change how the brain responds to it. Researchers also are studying e7citatory neurotransmitters such as glutamate. "n some cases4 the brainEs attempts to repair itself after a head in)ury4 stroke4 or other problem may inad+ertently generate abnormal ner+e connections that lead to epilepsy. ,bnormalities in brain wiring that occur during brain de+elopment also may disturb neuronal acti+ity and lead to epilepsy. Research has shown that the cell membrane that surrounds each neuron plays an important role in epilepsy. $ell membranes are crucial for a neuron to generate electrical impulses. %or this reason4 researchers are studying details of the membrane structure4 how molecules mo+e in and out of membranes4 and how the cell nourishes and repairs the membrane. , disruption in any of these processes may lead to epilepsy. .tudies in animals ha+e shown that4 because the brain continually adapts to changes in stimuli4 a small change in neuronal acti+ity4 if repeated4 may e+entually lead to full9blown epilepsy. Researchers are in+estigating whether this phenomenon4 called kindling4 may also occur in humans. "n some cases4 epilepsy may result from changes in non9neuronal brain cells called glia. 3hese cells regulate concentrations of chemicals in the brain that can affect neuronal signaling.

,bout half of all sei/ures ha+e no known cause. (owe+er4 in other cases4 the sei/ures are clearly linked to infection4 trauma4 or other identifiable problems. top Genetic Factors

Research suggests that genetic abnormalities may be some of the most important factors contributing to epilepsy. .ome types of epilepsy ha+e been traced to an abnormality in a specific gene. 1any other types of epilepsy tend to run in families4 which suggests that genes influence epilepsy. .ome researchers estimate that more than >;; genes could play a role in this disorder. (owe+er4 it is increasingly clear that4 for many forms of epilepsy4 genetic abnormalities play only a partial role4 perhaps by increasing a personEs susceptibility to sei/ures that are triggered by an en+ironmental factor. .e+eral types of epilepsy ha+e now been linked to defecti+e genes for ion channels4 the <gates< that control the flow of ions in and out of cells and regulate neuron signaling. ,nother gene4 which is missing in people with progressive myoclonus epilepsy4 codes for a protein called cystatin 2. 3his protein regulates en/ymes that break down other proteins. ,nother gene4 which is altered in a se+ere form of epilepsy called LaFora's disease4 has been linked to a gene that helps to break down carbohydrates. While abnormal genes sometimes cause epilepsy4 they also may influence the disorder in subtler ways. %or e7ample4 one study showed that many people with epilepsy ha+e an abnormally acti+e +ersion of a gene that increases resistance to drugs. 3his may help e7plain why anticon+ulsant drugs do not work for some people. Genes also may control other aspects of the bodyEs response to medications and each personEs susceptibility to sei/ures4 or seizure threshold. ,bnormalities in the genes that control neuronal migration 99 a critical step in brain de+elopment 99 can lead to areas of misplaced or abnormally formed neurons4 or dysplasia4 in the brain that can cause epilepsy. "n some cases4 genes may contribute to de+elopment of epilepsy e+en in people with no family history of the disorder. 3hese people may ha+e a newly de+eloped abnormality4 or mutation4 in an epilepsy9 related gene. top ther !isorders

"n many cases4 epilepsy de+elops as a result of brain damage from other disorders. %or e7ample4 brain tumors4 alcoholism4 and ,l/heimerEs disease frequently lead to epilepsy because they alter the normal workings of the brain. .trokes4 heart attacks4 and other conditions that depri+e the brain of o7ygen also can cause epilepsy in some cases. ,bout :@ percent of all cases of newly de+eloped epilepsy in elderly people appears to be due to cerebro+ascular disease4 which reduces the supply of o7ygen to brain cells. 1eningitis4 ,"'.4 +iral encephalitis4 and other infectious diseases can lead to epilepsy4 as can hydrocephalus 99 a condition in which e7cess fluid builds up in the brain. Epilepsy also can result from intolerance to wheat gluten Falso known as celiac diseaseG4 or from a parasitic infection of the brain called neurocysticercosis. .ei/ures may stop once these disorders are treated successfully. (owe+er4 the odds of becoming sei/ure9free after the primary disorder is treated are uncertain and +ary depending on the type of disorder4 the brain region that is affected4 and how much brain damage occurred prior to treatment. Epilepsy is associated with a +ariety of de+elopmental and metabolic disorders4 including cerebral palsy4 neurofibromatosis4 pyru+ate dependency4 tuberous sclerosis4 5andau9-leffner syndrome4 and autism. Epilepsy is )ust one of a set of symptoms commonly found in people with these disorders. top

"ead Injury

"n some cases4 head in)ury can lead to sei/ures or epilepsy. .afety measures such as wearing seat belts in cars and using helmets when riding a motorcycle or playing competiti+e sports can protect people from epilepsy and other problems that result from head in)ury. top #renatal Injury and !e$elopmental #roblems

3he de+eloping brain is susceptible to many kinds of in)ury. 1aternal infections4 poor nutrition4 and o7ygen deficiencies are )ust some of the conditions that may take a toll on the brain of a de+eloping baby. 3hese conditions may lead to cerebral palsy4 which often is associated with epilepsy4 or they may cause epilepsy that is unrelated to any other disorders. ,bout @; percent of sei/ures in children are due to cerebral palsy or other neurological abnormalities. ,bnormalities in genes that control de+elopment also may contribute to epilepsy. ,d+anced brain imaging has re+ealed that some cases of epilepsy that occur with no ob+ious cause may be associated with areas of dysplasia in the brain that probably de+elop before birth. top #oisonin%

.ei/ures can result from e7posure to lead4 carbon mono7ide4 and many other poisons. 3hey also can result from e7posure to street drugs and from o+erdoses of antidepressants and other medications. .ei/ures are often triggered by factors such as lack of sleep4 alcohol consumption4 stress4 or hormonal changes associated with the menstrual cycle. 3hese seizure triggers do not cause epilepsy but can pro+oke first sei/ures or cause breakthrough sei/ures in people who otherwise e7perience good sei/ure control with their medication. .leep depri+ation in particular is a uni+ersal and powerful trigger of sei/ures. %or this reason4 people with epilepsy should make sure to get enough sleep and should try to stay on a regular sleep schedule as much as possible. %or some people4 light flashing at a certain speed or the flicker of a computer monitor can trigger a sei/ure? this problem is called photosensitive epilepsy. .moking cigarettes also can trigger sei/ures. 3he nicotine in cigarettes acts on receptors for the e7citatory neurotransmitter acetylcholine in the brain4 which increases neuronal firing. .ei/ures are not triggered by se7ual acti+ity e7cept in +ery rare instances. top What &re the !ifferent 'inds of (ei)ures?

'octors ha+e described more than :; different types of sei/ures. .ei/ures are di+ided into two ma)or categories 99 ocal seizures and generalized seizures. (owe+er4 there are many different types of sei/ures in each of these categories. top Focal (ei)ures

%ocal sei/ures4 also called partial sei/ures4 occur in )ust one part of the brain. ,bout C; percent of people with epilepsy ha+e focal sei/ures. 3hese sei/ures are frequently described by the area of the brain in which they originate. %or e7ample4 someone might be diagnosed with focal frontal lobe sei/ures. "n a simple ocal seizure4 the person will remain conscious but e7perience unusual feelings or sensations that can take many forms. 3he person may e7perience sudden and une7plainable feelings of )oy4 anger4 sadness4 or nausea. (e or she also may hear4 smell4 taste4 see4 or feel things that are not real. "n a complex ocal seizure4 the person has a change in or loss of consciousness. (is or her consciousness may be altered4 producing a dreamlike e7perience. *eople ha+ing a comple7 focal sei/ure may display strange4 repetitious beha+iors such as blinks4 twitches4 mouth mo+ements4 or e+en walking in a circle. 3hese repetitious mo+ements are called automatisms. 1ore complicated actions4 which may seem purposeful4 can also occur in+oluntarily. *atients may also continue acti+ities they started before the sei/ure began4 such as washing dishes in a repetiti+e4 unproducti+e fashion. 3hese sei/ures usually last )ust a few seconds. .ome people with focal sei/ures4 especially comple7 focal sei/ures4 may e7perience auras 99 unusual sensations that warn of an impending sei/ure. 3hese auras are actually simple focal sei/ures in which the person maintains consciousness. 3he symptoms an indi+idual person has4 and the progression of those symptoms4 tend to be stereotyped! or similar e+ery time. 3he symptoms of focal sei/ures can easily be confused with other disorders. %or instance4 the dreamlike perceptions associated with a comple7 focal sei/ure may be misdiagnosed as migraine headaches4 which also may cause a dreamlike state. 3he strange beha+ior and sensations caused by focal sei/ures also can be istaken for symptoms of narcolepsy4 fainting4 or e+en mental illness. "t may take many tests and careful monitoring by an e7perienced physician to tell the difference between epilepsy and other disorders. top Generali)ed (ei)ures

Generali/ed sei/ures are a result of abnormal neuronal acti+ity on both sides of the brain. 3hese sei/ures may cause loss of consciousness4 falls4 or massi+e muscle spasms. 3here are many kinds of generali/ed sei/ures. "n absence seizures4 the person may appear to be staring into space and/or ha+e )erking or twitching muscles. 3hese sei/ures are sometimes referred to as petit mal seizures4 which is an older term. "onic seizures cause stiffening of muscles of the body4 generally those in the back4 legs4 and arms. #lonic seizures cause repeated )erking mo+ements of muscles on both sides of the body. $yoclonic seizures cause )erks or twitches of the upper body4 arms4 or legs. Atonic seizures cause a loss of normal muscle tone. 3he affected person will fall down or may drop his or her head in+oluntarily. "onic-clonic seizures cause a mi7ture of symptoms4 including stiffening of the body and repeated )erks of the arms and/or legs as well as loss of consciousness. 3onic9clonic sei/ures are sometimes referred to by an older term: grand mal seizures. 0ot all sei/ures can be easily defined as either focal or generali/ed. .ome people ha+e sei/ures that begin as focal sei/ures but then spread to the entire brain. &ther people may ha+e both types of sei/ures but with no clear pattern. .ocietyEs lack of understanding about the many different types of sei/ures is one of the biggest problems for people with epilepsy. *eople who witness a non9con+ulsi+e sei/ure often find it difficult to understand that beha+ior which looks deliberate is not under the personEs control. "n some cases4 this has led to the affected person being arrested oradmitted to a psychiatric hospital. 3o combat these problems4 people e+erywhere need to understand the many different types of sei/ures and how they may appear. top

What &re the !ifferent 'inds of Epilepsy?

Hust as there are many different kinds of sei/ures4 there are many different kinds of epilepsy. 'octors ha+e identified hundreds of different epilepsy syndromes 99 disorders characteri/ed by a specific set of symptoms that include epilepsy. .ome of these syndromes appear to be hereditary. %or other syndromes4 the cause is unknown. Epilepsy syndromes are frequently described by their symptoms or by where in the brain they originate. *eople should discuss the implications of their type of epilepsy with their doctors to understand the full range of symptoms4 the possible treatments4 and the prognosis. *eople with absence epilepsy ha+e repeated absence sei/ures that cause momentary lapses of consciousness. 3hese sei/ures almost always begin in childhood or adolescence4 and they tend to run in families4 suggesting that they may be at least partially due to a defecti+e gene or genes. .ome people with absence sei/ures ha+e purposeless mo+ements during their sei/ures4 such as a )erking arm or rapidly blinking eyes. &thers ha+e no noticeable symptoms e7cept for brief times when they are <out of it.< "mmediately after a sei/ure4 the person can resume whate+er he or she was doing. (owe+er4 these sei/ures may occur so frequently that the person cannot concentrate in school or other situations. $hildhood absence epilepsy usually stops when the child reaches puberty. ,bsence sei/ures usually ha+e no lasting effect on intelligence or other brain functions. "emporal lobe epilepsy4 or 35E4 is the most common epilepsy syndrome with focal sei/ures. 3hese sei/ures are often associated with auras. 35E often begins in childhood. Research has shown that repeated temporal lobe sei/ures can cause a brain structure called the hippocampus to shrink o+er time. 3he hippocampus is important for memory and learning. While it may take years of temporal lobe sei/ures for measurable hippocampal damage to occur4 this finding underlines the need to treat 35E early and as effecti+ely as possible. %eocortical epilepsy is characteri/ed by sei/ures that originate from the brainEs corte74 or outer layer. 3he sei/ures can be either focal or generali/ed. 3hey may include strange sensations4 +isual hallucinations4 emotional changes4 muscle spasms4 con+ulsions4 and a +ariety of other symptoms4 depending on where in the brain the sei/ures originate. 3here are many other types of epilepsy4 each with its own characteristic set of symptoms. 1any of these4 including Lennox-Gastaut syndrome and &asmussen's encephalitis4 begin in childhood. $hildren with 5enno79 Gastaut syndrome ha+e se+ere epilepsy with se+eral different types of sei/ures4 including atonic sei/ures4 which cause sudden falls and are also called drop attacks. 3his se+ere form of epilepsy can be +ery difficult to treat effecti+ely. RasmussenEs encephalitis is a progressi+e type of epilepsy in which half of the brain shows continual inflammation. "t sometimes is treated with a radical surgical procedure called hemispherectomy Fsee the section on 'urgeryG. .ome childhood epilepsy syndromes4 such as childhood absence epilepsy4 tend to go into remission or stop entirely during adolescence4 whereas other syndromes such as (uvenile myoclonic epilepsy and LennoxGastaut syndrome are usually present for life once they de+elop. .ei/ure syndromes do not always appear in childhood4 howe+er. Epilepsy syndromes that are easily treated4 do not seem to impair cogniti+e functions or de+elopment4 and usually stop spontaneously are often described as benign. 2enign epilepsy syndromes include benign in antile encephalopathy and benign neonatal convulsions. &ther syndromes4 such as early myoclonic encephalopathy4 include neurological and de+elopmental problems. (owe+er4 these problems may be caused by underlying neurodegenerati+e processes rather than by the sei/ures. Epilepsy syndromes in which the sei/ures and/or the personEs cogniti+e abilities get worse o+er time are called progressive epilepsy. .e+eral types of epilepsy begin in infancy. 3he most common type of infantile epilepsy is in antile spasms4 clusters of sei/ures that usually begin before the age of C months. 'uring these sei/ures the infant may bend and cry out. ,nticon+ulsant drugs often do not work for infantile spasms4 but the sei/ures can be treated with A#") Fadrenocorticotropic hormoneG or prednisone. top

When &re (ei)ures *ot Epilepsy?

While any sei/ure is cause for concern4 ha+ing a sei/ure does not by itself mean a person has epilepsy. %irst sei/ures4 febrile sei/ures4 nonepileptic e+ents4 and eclampsia are e7amples of sei/ures that may not be associated with epilepsy. top First (ei)ures

1any people ha+e a single sei/ure at some point in their li+es. &ften these sei/ures occur in reaction to anesthesia or a strong drug4 but they also may be unpro+oked4 meaning that they occur without any ob+ious triggering factor. 6nless the person has suffered brain damage or there is a family history of epilepsy or other neurological abnormalities4 these single sei/ures usually are not followed by additional sei/ures. &ne recent study that followed patients for an a+erage of B years found that only :: percent of people ha+e a second sei/ure within = years after an initial sei/ure. *eople who did not ha+e a second sei/ure within that time remained sei/ure9free for the rest of the study. %or people who did ha+e a second sei/ure4 the risk of a third sei/ure was about I: percent on a+erage by the end of = years. When someone has e7perienced a first sei/ure4 the doctor will usually order an electroencephalogram! or **G! to determine what type of sei/ure the person may ha+e had and if there are any detectable abnormalities in the personEs brain wa+es. 3hedoctor also may order brain scans to identify abnormalities that may be +isible in the brain. 3hese tests may help the doctor decide whether or not to treat the person with antiepileptic drugs. "n some cases4 drug treatment after the first sei/ure may help pre+ent future sei/ures and epilepsy. (owe+er4 the drugs also can cause detrimental side effects4 so doctors prescribe them only when they feel the benefits outweigh the risks. E+idence suggests that it may be beneficial to begin anticon+ulsant medication once a person has had a second sei/ure4 as the chance of future sei/ures increases significantly after this occurs. top Febrile (ei)ures

.ometimes a child will ha+e a sei/ure during the course of an illness with a high fe+er. 3hese sei/ures are called ebrile seizures F ebrile is deri+ed from the 5atin word for <fe+er<G and can be +ery alarming to the parents and other caregi+ers. "n the past4 doctors usually prescribed a course of anticon+ulsant drugs following a febrile sei/ure in the hope of pre+enting epilepsy. (owe+er4 most children who ha+e a febrile sei/ure do not de+elop epilepsy4 and long9term use of anticon+ulsant drugs in children may damage the de+eloping brain or cause other detrimental side effects. E7perts at a ADB; consensus conference coordinated by the 0ational "nstitutes of (ealth concluded that pre+enti+e treatment after a febrile sei/ure is generally not warranted unless certain other conditions are present: a family history of epilepsy4 signs of ner+ous system impairment prior to the sei/ure4 or a relati+ely prolonged or complicated sei/ure. 3he risk of subsequent non9febrile sei/ures is only @ to : percent unless one of these factors is present. Researchers ha+e now identified se+eral different genes that influence the risk of febrile sei/ures in certain families. .tudying these genes may lead to new understanding of how febrile sei/ures occur and perhaps point to ways of pre+enting them. top

*onepileptic E$ents

.ometimes people appear to ha+e sei/ures4 e+en though their brains show no sei/ure acti+ity. 3his type of phenomenon has +arious names4 including nonepileptic e+ents and pseudosei/ures. 2oth of these terms essentially mean something that looks like a sei/ure but isnEt one. 0onepileptic e+ents that are psychological in origin may be referred to as psychogenic sei/ures. *sychogenic sei/ures may indicate dependence4 a need for attention4 a+oidance of stressful situations4 or specific psychiatric conditions. .ome people with epilepsy ha+e psychogenic sei/ures in addition to their epileptic sei/ures. &ther people who ha+e psychogenic sei/ures do not ha+e epilepsy at all. *sychogenic sei/ures cannot be treated in the same way as epileptic sei/ures. "nstead4 they are often treated by mental health specialists. &ther nonepileptic e+ents may be caused by narcolepsy4 3ourette syndrome4 cardiac arrythmia4 and other medical conditions with symptoms that resemble sei/ures. 2ecause symptoms of these disorders can look +ery much like epileptic sei/ures4 they are often mistaken for epilepsy. 'istinguishing between true epileptic sei/ures and nonepileptic e+ents can be +ery difficult and requires a thorough medical assessment4 careful monitoring4 and knowledgeable health professionals. "mpro+ements in brain scanning and monitoring technology may impro+e diagnosis of nonepileptic e+ents in the future. top Eclampsia

Eclampsia is a life9threatening condition that can de+elop in pregnant women. "ts symptoms include sudden ele+ations of blood pressure and sei/ures. *regnant women who de+elop une7pected sei/ures should be rushed to a hospital immediately. Eclampsia can be treated in a hospital setting and usually does not result in additional sei/ures or epilepsy once the pregnancy is o+er. top "o+ is Epilepsy !ia%nosed?

'octors ha+e de+eloped a number of different tests to determine whether a person has epilepsy and4 if so4 what kind of sei/ures the person has. "n some cases4 people may ha+e symptoms that look +ery much like a sei/ure but in fact are nonepileptic e+ents caused by other disorders. E+en doctors may not be able to tell the difference between these disorders and epilepsy without close obser+ation and intensi+e testing. top EEG ,onitorin%

,n EEG records brain wa+es detected by electrodes placed on the scalp. 3his is the most common diagnostic test for epilepsy and can detect abnormalities in the brainEs electrical acti+ity. *eople with epilepsy frequently ha+e changes in their normal pattern of brain wa+es4 e+en when they are not e7periencing a sei/ure. While this type of test can be +ery useful in diagnosing epilepsy4 it is not foolproof. .ome people continue to show normal brain wa+e patterns e+en after they ha+e e7perienced a sei/ure. "n other cases4 the unusual brain wa+es are generated deep in the brain where the EEG is unable to detect them. 1any people who do not ha+e epilepsy also show some unusual brain acti+ity on an EEG. Whene+er possible4 an EEG should be performed within @= hours of a patientEs first sei/ure. "deally4 EEGs should be performed while the patient is sleeping as well as when he or she is awake4 because brain acti+ity during sleep is often quite different than at other times.

Video monitoring is often used in con)unction with EEG to determine the nature of a personEs sei/ures. "t also can be used in some cases to rule out other disorders such as cardiac arrythmia or narcolepsy that may look like epilepsy. top -rain (cans

&ne of the most important ways of diagnosing epilepsy is through the use of brain scans. 3he most commonly used brain scans include #" Fcomputed tomographyG4 +*" Fpositron emission tomographyG and $&, Fmagnetic resonance imagingG. $3 and 1R" scans re+eal the structure of the brain4 which can be useful for identifying brain tumors4 cysts4 and other structural abnormalities. *E3 and an adapted kind of 1R" called unctional $&, Ff1R"G can be used to monitor the brainEs acti+ity and detect abnormalities in how it works. '+*#" Fsingle photon emission computed tomographyG is a relati+ely new kind of brain scan that is sometimes used to locate sei/ure foci in the brain. "n some cases4 doctors may use an e7perimental type of brain scan called a magnetoencephalogram4 or $*G. 1EG detects the magnetic signals generated by neurons to allow doctors to monitor brain acti+ity at different points in the brain o+er time4 re+ealing different brain functions. While 1EG is similar in concept to EEG4 it does not require electrodes and it can detect signals from deeper in the brain than an EEG. 'octors also are e7perimenting with brain scans called magnetic resonance spectroscopy F$&'G that can detect abnormalities in the brainEs biochemical processes4 and with near-in rared spectroscopy4 a technique that can detect o7ygen le+els in brain tissue. top ,edical "istory

3aking a detailed medical history4 including symptoms and duration of the sei/ures4 is still one of the best methods a+ailable to determine if a person has epilepsy and what kind of sei/ures he or she has. 3he doctor will ask questions about the sei/ures and any past illnesses or other symptoms a person may ha+e had. .ince people who ha+e suffered a sei/ure often do not remember what happened4 caregi+ersE accounts of the sei/ure are +ital to this e+aluation. top -lood Tests

'octors often take blood samples for testing4 particularly when they are e7amining a child. 3hese blood samples are often screened for metabolic or genetic disorders that may be associated with the sei/ures. 3hey also may be used to check for underlying problems such as infections4 lead poisoning4 anemia4 and diabetes that may be causing or triggering the sei/ures. top !e$elopmental. *eurolo%ical. and -eha$ioral Tests

'octors often use tests de+ised to measure motor abilities4 beha+ior4 and intellectual capacity as a way to determine how the epilepsy is affecting that person. 3hese tests also can pro+ide clues about what kind of epilepsy the person has. top Can Epilepsy be #re$ented?

1any cases of epilepsy can be pre+ented by wearing seatbelts and bicycle helmets4 putting children in car seats4 and other measures that pre+ent head in)ury and other trauma. *rescribing medication after first or second sei/ures or febrile sei/ures also may help pre+ent epilepsy in some cases. Good prenatal care4 including treatment of high blood pressure and infections during pregnancy4 can pre+ent brain damage in the de+eloping baby that may lead to epilepsy and other neurological problems later. 3reating cardio+ascular disease4 high blood pressure4 infections4 and other disorders that can affect the brain during adulthood and aging also may pre+ent many cases of epilepsy. %inally4 identifying the genes for many neurological disorders can pro+ide opportunities for genetic screening and prenatal diagnosis that may ultimately pre+ent many cases of epilepsy. top "o+ can Epilepsy be Treated?

,ccurate diagnosis of the type of epilepsy a person has is crucial for finding an effecti+e treatment. 3here are many different ways to treat epilepsy. $urrently a+ailable treatments can control sei/ures at least some of the time in about B; percent of people with epilepsy. (owe+er4 another @; percent 99 about C;;4;;; people with epilepsy in the 6nited .tates 99 ha+e intractable sei/ures4 and another =;;4;;; feel they get inadequate relief from a+ailable treatments. 3hese statistics make it clear that impro+ed treatments are desperately needed. 'octors who treat epilepsy come from many different fields of medicine. 3hey include neurologists4 pediatricians4 pediatric neurologists4 internists4 and family physicians4 as well as neurosurgeons and doctors called epileptologists who speciali/e in treating epilepsy. *eople who need speciali/ed or intensi+e care for epilepsy may be treated at large medical centers and neurology clinics at hospitals or by neurologists in pri+ate practice. 1any epilepsy treatment centers are associated with uni+ersity hospitals that perform research in addition to pro+iding medical care. &nce epilepsy is diagnosed4 it isimportant to begin treatment as soon as possible. Research suggests thatmedication and other treatments may be less successful in treating epilepsy once sei/ures and their consequences become established. top ,edications

,ccurate diagnosis of the type of epilepsy a person has is crucial for finding an effecti+e treatment. 3here are many different ways to treat epilepsy. $urrently a+ailable treatments can control sei/ures at least some of the time in about B; percent of people with epilepsy. (owe+er4 another @> to :; percent 99 about C;;4;;; people with epilepsy in the 6nited .tates 99 ha+e intractable sei/ures4 and another =;;4;;; feel they get inadequate relief from a+ailable treatments. 3hese statistics make it clear that impro+ed treatments are desperately needed. 'octors who treat epilepsy come from many different fields of medicine. 3hey include neurologists4 pediatricians4 pediatric neurologists4 internists4 and family physicians4 as well as neurosurgeons and doctors called epileptologists who speciali/e in treating epilepsy. *eople who need speciali/ed or intensi+e care for

epilepsy may be treated at large medical centers and neurology clinics at hospitals or by neurologists in pri+ate practice. 1any epilepsy treatment centers are associated with uni+ersity hospitals that perform research in addition to pro+iding medical care. &nce epilepsy is diagnosed4 it is important to begin treatment as soon as possible. Research suggests that medication and other treatments may be less successful in treating epilepsy once sei/ures and their consequences become established. top Tailorin% the dosa%e of antiepileptic dru%s

When a person starts a new epilepsy drug4 it is important to tailor the dosage to achie+e the best results. *eopleEs bodies react to medications in +ery different and sometimes unpredictable ways4 so it may take some time to find the right drug at the right dose to pro+ide optimal control of sei/ures while minimi/ing side effects. , drug that has no effect or +ery bad side effects at one dose may work +ery well at another dose. 'octors will usually prescribe a low dose of the new drug initially and monitor blood le+els of the drug to determine when the best possible dose has been reached. Generic +ersions are a+ailable for many antiepileptic drugs. 3he chemicals in generic drugs are e7actly the same as in the brand9name drugs4 but they may be absorbed or processed differently in the body because of the way they are prepared. 3herefore4 patients should always check with their doctors before switching to a generic +ersion of their medication. top !iscontinuin% medication

.ome doctors will ad+ise people with epilepsy to discontinue their antiepileptic drugs after @ years ha+e passed without a sei/ure. &thers feel it is better to wait for = to > years. 'iscontinuing medication should al+ays be done with a doctorEs ad+ice and super+ision. "t is +ery important to continue taking epilepsy medication for as long as the doctor prescribes it. *eople also should ask the doctor or pharmacist ahead of time what they should do if they miss a dose. 'iscontinuing medication without a doctorEs ad+ice is one of the ma)or reasons people who ha+e been sei/ure9free begin ha+ing new sei/ures. .ei/ures that result from suddenly stopping medication can be +ery serious and can lead to status epilepticus. %urthermore4 there is some e+idence that uncontrolled sei/ures trigger changes in neurons that can make it more difficult to treat the sei/ures in the future. 3he chance that a person will e+entually be able to discontinue medication +aries depending on the personEs age and his or her type of epilepsy. 1ore than half of children who go into remission with medication can e+entually stop their medication without ha+ing new sei/ures. &ne study showed that CB percent of adults who had been sei/ure9free for @ years before stopping medication were able to do so without ha+ing more sei/ures and I> percent could successfully discontinue medication if they had been sei/ure9free for : years. (owe+er4 the odds of successfully stopping medication are not as good for people with a family history of epilepsy4 those who need multiple medications4 those with focal sei/ures4 and those who continue to ha+e abnormal EEG results while on medication. top (ur%ery

When sei/ures cannot be adequately controlled by medications4 doctors may recommend that the person be e+aluated for surgery. .urgery for epilepsy is performed by teams of doctors at medical centers. 3o decide if a person may benefit from surgery4 doctors consider the type or types of sei/ures he or she has. 3hey also take into account the brain region in+ol+ed and how important that region is for e+eryday beha+ior. .urgeons usually a+oid operating in areas of the brain that are necessary for speech4 language4 hearing4 or other important abilities. 'octors may perform tests such as a Wada test Fadministration of the drug amobarbitol into the carotid arteryG to find areas of the brain that control speech and memory. 3hey often monitor the patient intensi+ely prior to surgery in order to pinpoint the e7act location in the brain where sei/ures begin. 3hey also may use implanted electrodes to record brain acti+ity from the surface of the brain. 3his yields better information than an e7ternal EEG. , ADD; 0ational "nstitutes of (ealth consensus conference on surgery for epilepsy concluded that there are three broad categories of epilepsy that can be treated successfully with surgery. 3hese include focal sei/ures4 sei/ures that begin as focal sei/ures before spreading to the rest of the brain4 and unilateral multifocal epilepsy with infantile hemiplegia Fsuch as RasmussenEs encephalitisG. 'octors generally recommend surgery only after patients ha+e tried two or three different medications without success4 or if there is an identifiable brain lesion--a damaged or dysfunctional area99belie+ed to cause the sei/ures. , study published in @;;; compared surgery to an additional year of treatment with antiepileptic drugs in people with longstanding temporal lobe epilepsy. 3he results showed that C= percent of patients recei+ing surgery became sei/ure9free4 compared to B percent of those who continued with medication only. 2ecause of this study and other e+idence4 the ,merican ,cademy of 0eurology F,,0G now recommends surgery for 35E when antiepileptic drugs are not effecti+e. (owe+er4 the study and the ,,0 guidelines do not pro+ide guidance on how long sei/ures should occur4 how se+ere they should be4 or how many drugs should be tried before surgery is considered. , nationwide study is now underway to determine how soon surgery for 35E should be performed. "f a person is considered a good candidate for surgery and has sei/ures that cannot be controlled with a+ailable medication4 e7perts generally agree that surgery should be performed as early as possible. "t can be difficult for a person who has had years of sei/ures to fully re9adapt to a sei/ure9free life if the surgery is successful. 3he person may ne+er ha+e had an opportunity to de+elop independence4 and he or she may ha+e had difficulties with school and work that could ha+e been a+oided with earlier treatment. .urgery should always be performed with support from rehabilitation specialists and counselors who can help the person deal with the many psychological4 social4 and employment issues he or she may face. While surgery can significantly reduce or e+en halt sei/ures for some people4 it is important to remember that any kind of surgery carries some amount of risk Fusually smallG. .urgery for epilepsy does not always successfully reduce sei/ures and it can result in cogniti+e or personality changes4 e+en in people who are e7cellent candidates for surgery. *atients should ask their surgeon about his or her e7perience4 success rates4 and complication rates with the procedure they are considering. E+en when surgery completely ends a personEs sei/ures4 it is important to continue taking sei/ure medication for some time to gi+e the brain time to re9adapt. 'octors generally recommend medication for @ years after a successful operation to a+oid new sei/ures. top (ur%ery to treat underlyin% conditions

"n cases where sei/ures are caused by a brain tumor4 hydrocephalus4 or other conditions that can be treated with surgery4 doctors may operate to treat these underlying conditions. "n many cases4 once the underlying condition is successfully treated4 a personEs sei/ures will disappear as well. top

(ur%ery to remo$e a sei)ure focus

3he most common type of surgery for epilepsy is remo+al of a seizure ocus4 or small area of the brain where sei/ures originate. 3his type of surgery4 which doctors may refer to as a lobectomy or lesionectomy4 is appropriate only for focal sei/ures that originate in )ust one area of the brain. "n general4 people ha+e a better chance of becoming sei/ure9free after surgery if they ha+e a small4 well9defined sei/ure focus. 5obectomies ha+e a >>9I; percent success rate when the type of epilepsy and the sei/ure focus is well9defined. 3he most common type of lobectomy is a temporal lobe resection! which is performed for people with temporal lobe epilepsy. 3emporal lobe resection leads to a significant reduction or complete cessation of sei/ures about I; 9 D; percent of the time. top ,ultiple subpial transection

When sei/ures originate in part of the brain that cannot be remo+ed4 surgeons may perform a procedure called a multiple subpial transection. "n this type of operation4 which has been commonly performed since ADBD4 surgeons make a series of cuts that are designed to pre+ent sei/ures from spreading into other parts of the brain while lea+ing the personEs normal abilities intact. ,bout I; percent of patients who undergo a multiple subpial transection ha+e satisfactory impro+ement in sei/ure control. top Corpus callosotomy

#orpus callosotomy4 or se+ering the network of neural connections between the right and left hal+es4 or hemispheres4 of the brain4 is done primarily in children with se+ere sei/ures that start in one half of the brain and spread to the other side. $orpus callosotomy can end drop attacks and other generali/ed sei/ures. (owe+er4 the procedure does not stop sei/ures in the side of the brain where they originate4 and these focal sei/ures may e+en increase after surgery. top "emispherectomy and hemispherotomy

3hese procedures remo+e half of the brainEs corte74 or outer layer. 3hey are used predominantly in children who ha+e sei/ures that do not respond to medication because of damage that in+ol+es only half the brain4 as occurs with conditions such as RasmussenEs encephalitis4 .turge9Weber syndrome4 and hemimegencephaly. While this type of surgery is +ery radical and is performed only as a last resort4 children often reco+er +ery well from the procedure4 and their sei/ures usually cease altogether. With intense rehabilitation4 they often reco+er nearly normal abilities. .ince the chance of a full reco+ery is best in young children4 hemispherectomy should be performed as early in a childEs life as possible. "t is rarely performed in children older than A:. top !e$ices

3he +agus ner+e stimulator was appro+ed by the 6... %ood and 'rug ,dministration F%',G in ADDI for use in people with sei/ures that are not well9controlled by medication. 3he +agus ner+e stimulator is a battery9powered de+ice that is surgically implanted under the skin of the chest4 much like a pacemaker4 and is attached to the +agus ner+e in the lower neck. 3his de+ice deli+ers short bursts of electrical energy to the brain +ia the +agus ner+e. &n a+erage4 this stimulation reduces sei/ures by about @; 9 =; percent. *atients usually cannot stop taking epilepsy medication because of the stimulator4 but they often e7perience fewer sei/ures and they may be able to reduce the dose of their medication. .ide effects of the +agus ner+e stimulator are generally mild but may include hoarseness4 ear pain4 a sore throat4 or nausea. ,d)usting the amount of stimulation can usually eliminate most side effects4 although the hoarseness typically persists. 3he batteries in the +agus ner+e stimulator need to be replaced about once e+ery > years? this requires a minor operation that can usually be performed as an outpatient procedure. .e+eral new de+ices may become a+ailable for epilepsy in the future. Researchers are studying whether transcranial magnetic stimulation -"$'.4 a procedure which uses a strong magnet held outside the head to influence brain acti+ity4 may reduce sei/ures. 3hey also hope to de+elop implantable de+ices that can deli+er drugs to specific parts of the brain. top !iet

.tudies ha+e shown that4 in some cases4 children may e7perience fewer sei/ures if they maintain a strict diet rich in fats and low in carbohydrates. 3his unusual diet4 called the ketogenic diet4 causes the body to break down fats instead of carbohydrates to sur+i+e. 3his condition is called ketosis. &ne study of A>; children whose sei/ures were poorly controlled by medication found that about one9fourth of the children had a D; percent or better decrease in sei/ures with the ketogenic diet4 and another half of the group had a >; percent or better decrease in their sei/ures. 1oreo+er4 some children can discontinue the ketogenic diet after se+eral years and remain sei/ure9 free. 3he ketogenic diet is not easy to maintain4 as it requires strict adherence to an unusual and limited range of foods. *ossible side effects include retarded growth due to nutritional deficiency and a buildup of uric acid in the blood4 which can lead to kidney stones. *eople who try the ketogenic diet should seek the guidance of a dietician to ensure that it does not lead to serious nutritional deficiency. Researchers are not sure how ketosis inhibits sei/ures. &ne study showed that a byproduct of ketosis called beta9 hydro7ybutyrate F2(2G inhibits sei/ures in animals. "f 2(2 also works in humans4 researchers may e+entually be able to de+elop drugs that mimic the sei/ure9inhibiting effects of the ketogenic diet. top ther Treatment (trate%ies

Researchers are studying whether biofeedback 99 a strategy in which indi+iduals learn to control their own brain wa+es 99 may be useful in controlling sei/ures. (owe+er4 this type of therapy is contro+ersial and most studies ha+e shown discouraging results. 3aking large doses of +itamins generally does not help a personEs sei/ures and may e+en be harmful in some cases. 2ut a good diet and some +itamin supplements4 particularly folic acid4 may help reduce some birth defects and medication9related nutritional deficiencies. 6se of non9+itamin supplements such as melatonin is contro+ersial and can be risky. &ne study showed that melatonin may reduce sei/ures in some children4 while another found that the risk of sei/ures increased measurably with melatonin. 1ost non9 +itamin supplements such as those found in health food stores are not regulated by the %',4 so their true effects and their interactions with other drugs are largely unknown. top

"o+ !oes Epilepsy &ffect !aily /ife?

1ost people with epilepsy lead outwardly normal li+es. ,ppro7imately B; percent can be significantly helped by modern therapies4 and some may go months or years between sei/ures. (owe+er4 the condition can and does affect daily life for people with epilepsy4 their family4 and their friends. *eople with se+ere sei/ures that resist treatment ha+e4 on a+erage4 a shorter life e7pectancy and an increased risk of cogniti+e impairment4 particularly if the sei/ures de+eloped in early childhood. 3hese impairments may be related to the underlying conditions tha cause epilepsy or to epilepsy treatment rather than the epilepsy itself. top -eha$ior and Emotions

"t is not uncommon for people with epilepsy4 especially children4 to de+elop beha+ioral and emotional problems. .ometimes these problems are caused by embarrassment or frustration associated with epilepsy. &ther problems may result from bullying4 teasing4 or a+oidance in school and other social settings. "n children4 these problems can be minimi/ed if parents encourage a positi+e outlook and independence4 do not reward negati+e beha+ior with unusual amounts of attention4 and try to stay attuned to their childEs needs and feelings. %amilies must learn to accept and li+e with the sei/ures without blaming or resenting the affected person. $ounseling ser+ices can help families cope with epilepsy in a positi+e manner. Epilepsy support groups also can help by pro+iding a way for people with epilepsy and their family members to share their e7periences4 frustrations4 and tips for coping with the disorder. *eople with epilepsy ha+e an increased risk of poor self9esteem4 depression4 and suicide. 3hese problems may be a reaction to a lack of understanding or discomfort about epilepsy that may result in cruelty or a+oidance by other people. 1any people with epilepsy also li+e with an e+er9present fear that they will ha+e another sei/ure. top !ri$in% and 0ecreation

%or many people with epilepsy4 the risk of sei/ures restricts their independence4 in particular the ability to dri+e. 1ost states and the 'istrict of $olumbia will not issue a dri+erEs license to someone with epilepsy unless the person can document that they ha+e gone a specific amount of time without a sei/ure Fthe waiting period +aries from a few months to se+eral yearsG. .ome states make e7ceptions for this policy when sei/ures donEt impair consciousness4 occur only during sleep4 or ha+e long auras or other warning signs that allow the person to a+oid dri+ing when a sei/ure is likely to occur. .tudies show that the risk of ha+ing a sei/ure9related accident decreases as the length of time since the last sei/ure increases. &ne study found that the risk of ha+ing a sei/ure9related motor +ehicle accident is D: percent less in people who wait at least A year after their last sei/ure before dri+ing4 compared to people who wait for shorter inter+als. 3he risk of sei/ures also restricts peopleEs recreational choices. %or instance4 people with epilepsy should not participate in sports such as skydi+ing or motor racing where a momentEs inattention could lead to in)ury. &ther acti+ities4 such as swimming and sailing4 should be done only with precautions and/or super+ision. (owe+er4 )ogging4 football4 and many other sports are reasonably safe for a person with epilepsy. .tudies to date ha+e not shown any increase in sei/ures due to sports4 although these studies ha+e not focused on any acti+ity in particular. 3here is some e+idence that regular e7ercise may e+en impro+e sei/ure control in some people. .ports are often such a positi+e factor in life that it is best for the person to participate4 although the person with epilepsy and the coach or other leader should take appropriate safety precautions. "t is important to take steps to a+oid potential sports9related problems such as dehydration4 o+ere7ertion4 and hypoglycemia4 as these problems can increase the risk of sei/ures.

top Education and Employment

2y law4 people with epilepsy or other handicaps in the 6nited .tates cannot be denied employment or access to any educational4 recreational4 or other acti+ity because of their sei/ures. (owe+er4 one sur+ey showed that only about >C percent of people with epilepsy finish high school and about A> percent finish college 99 rates much lower than those for the general population. 3he same sur+ey found that about @> percent of working9age people with epilepsy are unemployed. 3hese numbers indicate that significant barriers still e7ist for people with epilepsy in school and work. Restrictions on dri+ing limit the employment opportunities for many people with epilepsy4 and many find it difficult to face the misunderstandings and social pressures they encounter in public situations. ,ntiepileptic drugs also may cause side effects that interfere with concentration and memory. $hildren with epilepsy may need e7tra time to complete schoolwork4 and they sometimes may need to ha+e instructions or other information repeated for them. 3eachers should be told what to do if a child in their classroom has a sei/ure4 and parents should work with the school system to find reasonable ways to accommodate any special needs their child may ha+e. top #re%nancy and ,otherhood

Women with epilepsy are often concerned about whether they can become pregnant and ha+e a healthy child. 3his is usually possible. While some sei/ure medications and some types of epilepsy may reduce a personEs interest in se7ual acti+ity4 most people with epilepsy can become pregnant. 1oreo+er4 women with epilepsy ha+e a D; percent or better chance of ha+ing a normal4 healthy baby4 and the risk of birth defects is only about = to C percent. 3he risk that children of parents with epilepsy will de+elop epilepsy themsel+es is only about > percent unless the parent has a clearly hereditary form of the disorder. *arents who are worried that their epilepsy may be hereditary may wish to consult a genetic counselor to determine what the risk might be. ,mniocentesis and high9 le+el ultrasound can be performed during pregnancy to ensure that the baby is de+eloping normally4 and a procedure called a maternal serum alpha9fetoprotein test can be used for prenatal diagnosis of many conditions if a problem is suspected. 3here are se+eral precautions women can take before and during pregnancy to reduce the risks associated with pregnancy and deli+ery. Women who are thinking about becoming pregnant should talk with their doctors to learn any special risks associated with their epilepsy and the medications they may be taking. .ome sei/ure medications4 particularly +alproate4 trimethidone4 and phenytoin4 are known to increase the risk of ha+ing a child with birth defects such as cleft palate4 heart problems4 or finger and toe defects. %or this reason4 a womanEs doctor may ad+ise switching to other medications during pregnancy. Whene+er possible4 a woman should allow her doctor enough time to properly change medications4 including phasing in the new medications and checking to determine when blood le+els are stabili/ed4 before she tries to become pregnant. Women should also begin prenatal +itamin supplements 99 especially with folic acid4 which may reduce the risk of some birth defects 99 well before pregnancy. Women who disco+er that they are pregnant but ha+e not already spoken with their doctor about ways to reduce the risks should do so as soon as possible. (owe+er4 they should continue taking sei/ure medication as prescribed until that time to a+oid pre+entable sei/ures. .ei/ures during pregnancy can harm the de+eloping baby or lead to miscarriage4 particularly if the sei/ures are se+ere. 0e+ertheless4 many women who ha+e sei/ures during pregnancy ha+e normal4 healthy babies. Women with epilepsy sometimes e7perience a change in their sei/ure frequency during pregnancy4 e+en if they do not change medications. ,bout @> to =; percent of women ha+e an increase in their sei/ure frequency while they are pregnant4 while other women may ha+e fewer sei/ures during pregnancy. 3he frequency of sei/ures during pregnancy may be influenced by a +ariety of factors4 including the womanEs increased blood +olume during pregnancy4 which can dilute the effect of medication. Women should ha+e their blood le+els of sei/ure

medications monitored closely during and after pregnancy4 and the medication dosage should be ad)usted accordingly. *regnant women with epilepsy should take prenatal +itamins and get plenty of sleep to a+oid sei/ures caused by sleep depri+ation. 3hey also should take +itamin - supplements after := weeks of pregnancy to reduce the risk of a blood9clotting disorder in infants called neonatal coagulopathy that can result from fetal e7posure to epilepsy medications. %inally4 they should get good prenatal care4 a+oid tobacco4 caffeine4 alcohol4 and illegal drugs4 and try to a+oid stress. 5abor and deli+ery usually proceed normally for women with epilepsy4 although there is a slightly increased risk of hemorrhage4 eclampsia4 premature labor4 and cesarean section. 'octors can administer antiepileptic drugs intra+enously and monitor blood le+els of anticon+ulsant medication during labor to reduce the risk that the labor will trigger a sei/ure. 2abies sometimes ha+e symptoms of withdrawal from the motherEs sei/ure medication after they are born4 but these problems wear off in a few weeks or months and usually do not cause serious or long9term effects. , motherEs blood le+els of anticon+ulsant medication should be checked frequently after deli+ery as medication often needs to be decreased. Epilepsy medications need not influence a womanEs decision about breast9feeding her baby. &nly minor amounts of epilepsy medications are secreted in breast milk4 usually not enough to harm the baby and much less than the baby was e7posed to in the womb. &n rare occasions4 the baby may become e7cessi+ely drowsy or feed poorly4 and these problems should be closely monitored. (owe+er4 e7perts belie+e the benefits of breast9feeding outweigh the risks e7cept in rare circumstances. 3o increase doctorsE understanding of how different epilepsy medications affect pregnancy and the chances of ha+ing a healthy baby4 1assachusetts General (ospital has begun a nationwide registry for women who take antiepileptic drugs while pregnant. Women who enroll in this program are gi+en educational materials on pre9 conception planning and perinatal care and are asked to pro+ide information about the health of their children Fthis information is kept confidentialG. Women and physicians can contact this registry by calling A9BBB9@::9 @::= or CAI9I@C9AI=@ Ffa7: CAI9I@=9B:;IG. Women with epilepsy should be aware that some epilepsy medications can interfere with the effecti+eness of oral contracepti+es. Women who wish to use oral contracepti+es to pre+ent pregnancy should discuss this with their doctors4 who may be able to prescribe a different kind of antiepileptic medication or suggest other ways of a+oiding an unplanned pregnancy. top &re There (pecial 0isks &ssociated With Epilepsy?

,lthough most people with epilepsy lead full4 acti+e li+es4 they are at special risk for two life9threatening conditions: status epilepticus and sudden une7plained death. top (tatus Epilepticus

.tatus epilepticus is a potentially life9threatening condition in which a person either has an abnormally prolonged sei/ure or does not fully regain consciousness between sei/ures. ,lthough there is no strict definition for the time at which a sei/ure turns into status epilepticus4 most people agree that any sei/ure lasting longer than > minutes should4 for practical purposes4 be treated as though it was status epilepticus. .tatus epilepticus affects about AD>4;;; people each year in the 6nited .tates and results in about =@4;;; deaths. While people with epilepsy are at an increased risk for status epilepticus4 about C; percent of people who de+elop

this condition ha+e no pre+ious sei/ure history. 3hese cases often result from tumors4 trauma4 or other problems that affect the brain and may themsel+es be life9threatening. While most sei/ures do not require emergency medical treatment4 someone with a prolonged sei/ure lasting more than > minutes may be in status epilepticus and should be taken to an emergency room immediately. "t is important to treat a person with status epilepticus as soon as possible. &ne study showed that B; percent of people in status epilepticus who recei+ed medication within :; minutes of sei/ure onset e+entually stopped ha+ing sei/ures4 whereas only =; percent reco+ered if @ hours had passed before they recei+ed medication. 'octors in a hospital setting can treat status epilepticus with se+eral different drugs and can undertake emergency life9sa+ing measures4 such as administering o7ygen4 if necessary. *eople in status epilepticus do not always ha+e se+ere con+ulsi+e sei/ures. "nstead4 they may ha+e repeated or prolonged noncon+ulsi+e sei/ures. 3his type of status epilepticus may appear as a sustained episode of confusion or agitation in someone who does not ordinarily ha+e that kind of mental impairment. While this type of episode may not seem as se+ere as con+ulsi+e status epilepticus4 it should still be treated as an emergency. top (udden 1ne2plained !eath

%or reasons that are poorly understood4 people with epilepsy ha+e an increased risk of dying suddenly for no discernible reason. 3his condition4 called sudden unexplained death4 can occur in people without epilepsy4 but epilepsy increases the risk about two9fold. Researchers are still unsure why sudden une7plained death occurs. &ne study suggested that use of more than two anticon+ulsant drugs may be a risk factor. (owe+er4 it is not clear whether the use of multiple drugs causes the sudden death4 or whether people who use multiple anticon+ulsants ha+e a greater risk of death because they ha+e more se+ere types of epilepsy. top What 0esearch Is -ein% !one on Epilepsy?

While research has led to many ad+ances in understanding and treating epilepsy4 there are many unanswered questions about how and why sei/ures de+elop4 how they can best be treated or pre+ented4 and how they influence other brain acti+ity and brain de+elopment. Researchers4 many of whom are supported by the 0ational "nstitute of 0eurological 'isorders and .troke F0"0'.G4 are studying all of these questions. 3hey also are working to identify and test new drugs and other treatments for epilepsy and to learn how those treatments affect brain acti+ity and de+elopment. 3he 0"0'.Es ,nticon+ulsant .creening *rogram F,.*G studies potential new therapies with the goal of enhancing treatment for patients with epilepsy. .ince it began in ADI>4 more than :D; public9pri+ate partnerships ha+e been created. 3hese partnerships ha+e resulted in state9of9the9art e+aluations of more than @>4;;; compounds for their potential as antiepileptic drugs. 3his go+ernment9sponsored effort has contributed to the de+elopment of fi+e drugs that are now appro+ed for use in the 6nited .tates. "t has also aided in the disco+ery and profiling of si7 new compounds currently in +arious stages of clinical de+elopment. 2esides testing for safer4 more efficacious therapies4 the *rogram is de+eloping and +alidating new models that may one day find therapies that inter+ene in the disease process itself as well as models of resistant or refractory epilepsy. .cientists continue to study how e7citatory and inhibitory neurotransmitters interact with brain cells to control ner+e firing. 3hey can apply different chemicals to cultures of neurons in laboratory dishes to study how those chemicals influence neuronal acti+ity. 3hey also are studying how glia and other non9neuronal cells in the brain contribute to sei/ures. 3his research may lead to new drugs and other new ways of treating sei/ures.

Researchers also are working to identify genes that may influence epilepsy in some way. "dentifying these genes can re+eal the underlying chemical processes that influence epilepsy and point to new ways of pre+enting or treating this disorder. Researchers also can study rats and mice that ha+e missing or abnormal copies of certain genes to determine how these genes affect normal brain de+elopment and resistance to damage from disease and other en+ironmental factors. "n the future4 researchers may be able to use panels of gene fragments4 called <gene chips4< to determine each personEs genetic makeup. 3his information may allow doctors to pre+ent epilepsy or to predict which treatments will be most beneficial. 'octors are now e7perimenting with se+eral new types of therapies for epilepsy. "n one preliminary clinical trial4 doctors ha+e begun transplanting fetal pig neurons that produce G,2, into the brains of patients to learn whether the cell transplants can help control sei/ures. *reliminary research suggests that stem cell transplants also may pro+e beneficial for treating epilepsy. Research showing that the brain undergoes subtle changes prior to a sei/ure has led to a prototype de+ice that may be able to predict sei/ures up to : minutes before they begin. "f this de+ice works4 it could greatly reduce the risk of in)ury from sei/ures by allowing people to mo+e to a safe area before their sei/ures start. 3his type of de+ice also may be hooked up to a treatment pump or other de+ice that will automatically deli+er an antiepileptic drug or an electric impulse to forestall the sei/ures. Researchers are continually impro+ing 1R" and other brain scans. *re9surgical brain imaging can guide doctors to abnormal brain tissue and away from essential parts of the brain. Researchers also are using brain scans such as magnetoencephalograms F1EGG and magnetic resonance spectroscopy F1R.G to identify and study subtle problems in the brain that cannot otherwise be detected. 3heir findings may lead to a better understanding of epilepsy and how it can be treated. top "o+ Can I "elp 0esearch on Epilepsy?

3here are many ways that people with epilepsy and their families can help with research on this disorder. *regnant women with epilepsy who are taking antiepileptic drugs can help researchers learn how these drugs affect unborn children by participating in the ,ntiepileptic 'rug *regnancy Registry4 which is maintained by the Genetics and 3eratology 6nit of 1assachusetts General (ospital Fsee section on +regnancy and $otherhoodG. *eople with epilepsy that may be hereditary can aid research by participating in the Epilepsy Gene 'isco+ery *ro)ect4 which is supported by the Epilepsy %oundation. 3his pro)ect helps to educate people with epilepsy about new genetic research on the disorder and enlists families with hereditary epilepsy for participation in gene research. *eople who enroll in this pro)ect are asked to create a family tree showing which people in their family ha+e or ha+e had epilepsy. Researchers then e7amine this information to determine if the epilepsy is in fact hereditary4 and they may in+ite participants to enroll in genetic research studies. "n many cases4 identifying the gene defect responsible for epilepsy in an indi+idual family leads researchers to new clues about how epilepsy de+elops. "t also can pro+ide opportunities for early diagnosis and genetic screening of indi+iduals in the family. *eople with epilepsy can help researchers test new medications4 surgical techniques4 and other treatments by enrolling in clinical trials. "nformation on clinical trials can be obtained from the 0"0'. as well as many pri+ate pharmaceutical and biotech companies4 uni+ersities4 and other organi/ations. , person who wishes to participate in a clinical trial must ask his or her regular physician to refer him or her to the doctor in charge of that trial and to forward all necessary medical records. While e7perimental therapies may benefit those who participate in clinical trials4 patients and their families should remember that all clinical trials also in+ol+e some risks. 3herapies being tested in clinical trials may not work4 and in some cases doctors may not yet be sure that the therapies are safe. *atients should be certain they understand the risks before agreeing to participate in a clinical trial. *atients and their families also can help epilepsy research by donating their brain to a brain bank after death. 2rain banks supply researchers with tissue they can use to study epilepsy and other disorders. 2elow are some brain banks that accept tissue from patients with epilepsy: -rain and Tissue -ank for !e$elopmental !isorders 6ni+ersity of 1aryland

C>> West 2altimore .treet4 Room A;9;:> 2R2 2altimore4 1' @A@;A9A>>D B;;9B=I9A>:D E9mail: btbumabJumaryland.edu http://medschool.umaryland.edu/232ank/ -tissue rom children only. -rain and Tissue -ank for !e$elopmental !isorders 6ni+ersity of 1iami 'epartment of *athology4 R9> *apanicolaou 2uilding4 Room =A; 1iami4 %5 ::A:C B;;9>D2R,"0 F>D@9I@=CG E9mail: btbJmed.miami.edu www.miami.edu/braintissue9bank -tissue rom adults only. -rain Endo+ment -ank 6ni+ersity of 1iami A>;A 0W 0inth ,+enue4 .uite K=;A: 1iami4 %5 ::A:C :;>9@=:9C@AD B;;96192R,"0 FBC@9I@=CG *ational !isease 0esearch Interchan%e B *enn $enter4 Bth %loor *hiladelphia4 *, ADA;: @A>9>>I9I:CA B;;9@@@90'R" FC:I=G E9mail: htorJndri.com www.ndri.com "uman -rain and (pinal Fluid 0esource Center 0eurology Research FA@I,G W. 5os ,ngeles (ealthcare $enter AA:;A Wilshire 2oule+ard 5os ,ngeles4 $, D;;I: :A;9@CB9:>:C *age: :A;9C:C9>ADD E9mail: R10bbankJucla.edu www.loni.ucla.edu/Lnnrsb/00R.2 top http://www.ninds.nih.gov/disorders/epilepsy/detail_epilepsy.htm

http://www.strokesafe.org/resources/strokeMandMsei/ures.html

(troke and (ei)ures

&ne of the many sequellae of stroke is the de+elopment of an epileptic9type sei/ure4 or of recurrent sei/ures. ,mong elderly people in whom sei/ures occur as a new9onset disorder4 stroke is most often the underlying cause. "n order to understand the relationship between these two neurological disorders4 it is necessary to define them. " will assume that the reader is already familiar with the definition and physiological mechanisms of strokes. " will merely remind that there are two ma)or stroke types: ischemic4 resulting

from blockage of a blood +essel and death of brain tissue in that blood +esselEs domain? and hemorrhagic4 resulting from rupture or leak of a blood +essel and e7tra+asation of blood into brain tissue or the fluid surrounding it. 3he word <sei/ure< is applied loosely and often erroneously to a +ariety of physiological phenomena ranging from strokes to heart attacks to muscle cramps. 3rue medical sei/ures are phenomena that occur in the brain. 2rain cells4 or neurons4 normally send out electrical signal pulses through long wire9like e7tensions called a7ons. %or neurons in the motor areas of the brain4 these signal pulses are relayed to muscles. When a muscle recei+es appropriate signals4 it contracts4 producing mo+ement of the corresponding body part. &ther neurons4 in areas of the brain responsible for recogni/ing sensory information4 recei+e relayed information such as touch sensation or pain from the body through their a7ons. 1ost neurons are constantly sending out and/or recei+ing low le+els of electrical signal pulses through their a7ons. When a group of neurons becomes pro+oked or irritated by a pathologic process or agent4 it may become hyperacti+e and begin discharging a high le+el of electrical signals. "f the timing of such strong signal pulses becomes synchroni/ed among all neurons in the group4 a motor or sensory sei/ure can occur. %or e7ample4 if the electrical hyperacti+ity were occurring on the left side of the brain4 focally in the motor area for the arm4 it would produce tight contraction or +iolent con+ulsion of the right arm. "f the sei/ure occurs in a sensory area of the brain4 then the patient may notice a sudden tingling4 numbness4 or other ambiguous sensation in the corresponding body part. 3he synchronous electrical hyperacti+ity from a group of neurons can spread to ad)acent or distant areas of the brain4 producing a more generalized sei/ure. &ther limbs and body parts can become in+ol+ed4 and +arious degrees of impairment of consciousness can occur. "n a generali/ed sei/ure in+ol+ing many areas on both sides of the brain4 complete loss of consciousness accompanied by +iolent con+ulsion of all the limbs occurs. 3his is called a generali/ed tonic9clonic sei/ure4 also known as a <grand mal< sei/ure. Focal motor or sensory seizures and generalized tonic clonic seizures are the most common types encountered as a result o stroke. .ei/ures can be precipitated by strokes by a number of mechanisms. We will first discuss sei/ures that occur immediately during or shortly after a stroke. .uch sei/ures most often result from hemorrhagic strokes in which a stream of blood squirts out of an artery under pressure into brain tissue. 3he blood produces a ripping and tearing effect in the tissue as it forces a space for itself. ,dditionally4 it pushes aside ad)acent brain tissue causing a compression effect. 3he compressed tissue also becomes depri+ed of o7ygen Fa state known as anoxiaG. 3he tearing4 compression4 and ano7ia all act as pro+ocati+e factors that can precipitate epileptic electrical discharges from neurons4 resulting in a sei/ure. 5ess commonly4 immediate sei/ures can occur in an ischemic stroke. "n this case4 blockage of a blood +essel depri+es a portion of the brain of blood flow4 and hence o7ygen4 producing ano7ia. 5arge ischemic strokes can produce local swelling of brain tissue in their +icinity4 producing a compressi+e effect. Either or both of these

mechanisms may precipitate a sei/ure during or shortly after an ischemic stroke. ,s the bolus of blood in a hemorrhagic stroke is reabsorbed4 or as the dead swollen tissue of an ischemic stroke subsides4 the pro+ocation for sei/ures usually resol+es. 3he most common sei/ures resulting from strokes are those that occur weeks or months after the initial e+ent. When a region of brain tissue dies during a stroke4 it begins to degenerate into scar tissue after a few weeks. 3he dead area contracts into a fibrous nodule of scar tissue. 3he presence of this scar tissue acts a pro+ocati+e irritant to the normal neurons ad)acent to it4 precipitating a sei/ure months or e+en years later. 3he likelihood of any stroke producing such delayed sei/ures is dependent on its si/e and location. .mall strokes deeper in the brain4 such as lacunar strokes4 are unlikely to cause sei/ures. 5arger strokes and those in+ol+ing the outer surface of the brain known as the grey matter4 or cortex4 are more likely to cause delayed sei/ures. 1ost neurons are located in the corte7. 2ecause scar tissue is permanent4 delayed9onset sei/ures ha+e greater chance for recurrence. ,s a general rule4 sei/ures that first occur immediately during or shortly after a stroke ha+e a low chance of heralding the de+elopment of a permanent recurrent sei/ure disorder. &n the other hand4 sei/ures which first occur weeks or months after a stroke ha+e a much greater likelihood of heralding the onset of a permanent disorder characteri/ed by episodically recurring sei/ures and requiring long9term or lifelong medication therapy. .ome physicians will prescribe a temporary anti9sei/ure medication as a pre+entati+e measure immediately after a stroke e+en if no sei/ure has occurred. 3his is most often done in the case of hemorrhagic stroke. 3he use of sei/ure medication in other cases is a comple7 medical decision based on the occurrence of sei/ure4 type and location of the stroke4 information from other diagnostic tests such as the electroencephalogram FEEGG4 and the desires of the patient. N 1ayank *athak4 1.'. .,%E F.troke ,wareness for E+eryone4 "nc.G has been gi+en permission to reproduce this article by its author4 1ayank *athak4 1.'. 'r. *athak is .taff *hysician4 at 3he *arkinsonEs and 1o+ement 'isorders "nstitute4 %ountain Valley4 $alifornia.

-rain Tumor (ymptoms

2rain tumor symptoms +ary from patient to patient4 and most of these symptoms can also be found in people who do 0&3 ha+e brain tumors. 3herefore4 the only sure way to tell if you ha+e a brain tumor or not is to see your doctor and get a brain scan. " did a sur+ey of about :I> brain tumor patients to learn what symptoms they had that caused them to seek medical care. 8ou can see the full results by clicking here. 3he

sur+ey is ongoing4 and you can participate by going to symptomssur+ey.cfm. 3he results below are as of @/@>/@;;:. 3hey reported:

"eadaches3 3his was the most common symptom4 with =CO of the patients reporting ha+ing headaches. 3hey described the headaches in many different ways4 with no one pattern being a sure sign of brain tumor. 1any 9 perhaps most 9 people get headaches at some point in their life4 so this is not a definite sign of brain tumors. 8ou should mention it to your doctors if the headaches are: different from those you e+er had before4 are accompanied by nausea / +omiting4 are made worse by bending o+er or straining when going to the bathroom.FAG (ei)ures3 3his was the second most common symptom reported4 with ::O of the patients reporting a sei/ure before the diagnosis was made. .ei/ures can also be caused by other things4 like epilepsy4 high fe+ers4 stroke4 trauma4 and other disorders. F:G 3his is a symptom that should ne+er be ignored4 whate+er the cause. "n a person who ne+er had a sei/ure before4 it usually indicates something serious and you must get a brain scan. , sei/ure is a sudden4 in+oluntary change in beha+ior4 muscle control4 consciousness4 and/or sensation. .ymptoms of a sei/ure can range from sudden4 +iolent shaking and total loss of consciousness to muscle twitching or slight shaking of a limb. .taring into space4 altered +ision4 and difficulty in speaking are some of the other beha+iors that a person may e7hibit while ha+ing a sei/ure. ,ppro7imately A;O of the 6... population will e7perience a single sei/ure in their lifetime. *ausea and 4omitin%3 ,s with headaches4 these are non9specific 9 which means that most people who ha+e nausea and +omiting do 0&3 ha+e a brain tumor. 3wenty9two percent of the people in our sur+ey reported that they had nausea and /or +omiting as a symptom. 0ausea and / or +omiting is more likely to point towards a brain tumor if it is accompanied by the other symptoms mentioned here. 4ision or hearin% problems3 3wenty9fi+e percent reported +ision problems. 3his one is easy 9 if you notice any problem with your hearing or +ision4 it must be checked out. " commonly hear that the eye doctor is the first one to make the diagnosis 9 because when they look in your eyes4 they can sometimes see signs of increased intracranial pressure. 3his must be in+estigated. #roblems +ith +eakness of the arms. le%s or face muscles. and stran%e sensations in your head or hands5 3wenty9fi+e percent reported weakness of the arms and/or legs. .i7teen percent reported strange feelings in the head4 and DO reported strange feelings in the hands. 3his may result in an altered gait4 dropping ob)ects4 falling4 or an asymmetric facial e7pression. 3hese could also be symptoms of a stroke. .udden onset of these symptoms is an emergency 9 you should go to the emergency room. "f you notice a gradual change o+er time4 you

must report it to your doctor. -eha$ioral and co%niti$e problems3 1any reported beha+ioral and cogniti+e changes4 such as: problems with recent memory4 inability to concentrate or finding the right words4 acting out 9 no patience or tolerance4 and loss of inhibitions 9 saying or doing things that are not appropriate for the situation.

"% you think something is wrong4 go see your doctor. E7plain that you are worried it is a brain tumor. -eep in mind that brain tumors are relati+ely rare compared to most other disorders4 so the primary care doctor is not usually going to be thinking it is a brain tumor. 3hey first think of more common causes of the symptoms. .i7ty9four percent of the time4 the doctor thought it was 0&3 a brain tumor when respondents first went to the doctor. 1ore than half of the people reported that they had the symptoms for more than a month before the correct diagnosis of brain tumor was made. With the malignant brain tumors4 a delay of a month in starting treatment can make a ma)or impact on the outcome. 3here is a more detailed paper on brain tumor symptoms at: http://+irtualtrials.com/symptoms.pdf References: F$lick on the links to get more informationG A. 0"0'. 2rain and .pinal 3umors "nformation *age @. 3he $auses of .ei/ures and .ei/ure9like Episodes :. Epilepsy %oundation 5ast updated: :/@=/@;;C by ,l 1usella4 '*1

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http://www.+irtualtrials.com/symptoms.cfm