What You Should Know About Epilepsy and Seizures

Epilepsy and seizures affect more than three million Americans, with about 200,000 new cases diagnosed each year. Rebecca Spiegel, MD, a neurologist and Director, along with David A. Chesler, MD, PhD, a neurological surgeon, both at the Stony Brook Epilepsy Center, explain how when properly diagnosed and treated, most people with epilepsy can expect to get their seizures under control.

What is the difference between a seizure and epilepsy?
Dr. Chesler: Seizures happen when your nerve cells fire more rapidly and with less control than usual, affecting how a person feels or acts. These range from a brief lapse of conscious activity to a full loss of consciousness with the potential for falling, shaking and difficulty breathing. Epilepsy refers to a brain disorder resulting in multiple seizures.

Does having a seizure mean you have epilepsy?
Dr. Spiegel: No, seizures are not always related to epilepsy. They can be a symptom of a disruption of brain function, such as from a high fever, a head injury or lack of oxygen. Ten percent of Americans will experience a seizure at least once in their lifetime, with the highest incidence occurring under the age of two and over the age of 65.

What causes epilepsy?
Dr. Spiegel: Epilepsy may be related to genetic factors, structural abnormalities of the brain or brain metabolism, and can begin in infancy and childhood. It can also occur during the course of one’s life due to infection of the brain, trauma, tumors or stroke. Sometimes, no clear cause is found on initial testing, and the neurologist has to look further.

How is epilepsy treated?
Dr. Spiegel: For most patients, antiepilepsy drugs are helpful in controlling the seizures while minimizing medication side effects. There are three new antiepileptic drugs available: PotigaTM (ezogabine), EycompaTM (perampanel) and AptiomTM (eslicarbazepine). Diet can also be a treatment for some, specifically the ketogenic diet or a modified Atkins diet. The diets should be prescribed by a physician and carefully monitored by a dietitian.
Dr. Chesler: When anti-epilepsy medications and dietary modifications fail, surgery may be recommended for patients whose seizures are associated with structural brain abnormalities, such as brain tumors, malformations of blood vessels and damage related to strokes. There are basically three types of seizure surgery — the surgical removal (resection) of the lesion that is causing the seizure, ablation (using heat or ultrasound energy to burn out the lesion), and electronic modulation that delivers current to the brain before a seizure happens to control or reduce the seizure’s effect.

What is the success rate for controlling epilepsy?
Dr. Spiegel: Most people with epilepsy do very well when properly diagnosed and treated. Nationally, two out of three people with epilepsy can be expected to enter remission; that is, five or more years free of seizures while using medication.

What distinguishes Stony Brook’s approach?
Dr. Spiegel: Patients who have persistent, recurrent seizures or those with an unconfirmed seizure diagnosis can benefit from the advanced services and technology that our Epilepsy Center offers. This includes access to positron emission tomography/magnetic resonance imaging (PET/MRI), which is sometimes used to detect brain lesions that may not have been detected previously. Seizures and epilepsy can involve and affect multiple body systems, and having a team of specialists that is readily available helps achieve more effective treatment plans. Our team includes renowned epileptologists, pediatric neurologists, neuropsychologists, radiologists, and of course neurosurgeons like Dr. Chesler, who are experts in the latest surgical techniques for epilepsy. 
Dr. Chesler: All of the surgeries I mentioned earlier — resection, ablation and electronic modulation — can be performed at Stony Brook. We generally recommend these options only when other types of treatment have failed.
Dr. Spiegel: Our center also features a six-bed dedicated video-EEG epilepsy monitoring unit with 24/7 observation staff and a portable video-EEG epilepsy monitoring system. The portable system can be set up anywhere in the hospital for patients who may be experiencing possible seizures. As part of an academic medical center, we also have access to research, including clinical trials of new treatments. And our patients and their families benefit from our support and education services, which include a nurse practitioner and a support group that is co-run by one of our physicians and a social worker from the Epilepsy Foundation.

For more information about Stony Brook’s Epilepsy Center, call (631) 444-4000 or visit neuro.stonybrookmedicine.edu.