Diagnosis
A doctor will review an individual’s medical history and the symptoms they have experienced, including a description and timeline of past seizures, to diagnose epilepsy.
They may also request tests to determine the type of epilepsy and the type of seizures the person has. Based on these results, the doctor will be able to recommend treatment options, such as antiseizure medications.
Testing for epilepsy
Several types of imaging test can help a doctor diagnose epilepsy. These tests include:
- an EEG, to look for abnormal brain waves
- CT and MRI scans, to detect tumors or other structural irregularities
- functional MRI scans, which can identify normal and abnormal brain function in specific areas
- single-photon emission CT scans, which may be able to find the original site of a seizure in the brain
- a magnetoencephalogram, which can identify irregularities in brain function using magnetic signals
The doctor may also use blood tests to identify any underlying conditions that could be causing the epilepsy. Neurological tests may also help a doctor determine the type of epilepsy the person has.
Is epilepsy genetic?
According to one 2015 research review, around 70–80% of epilepsy cases occur as a result of genetics.
A 2017 review of research linked over 900 genes to epilepsy. This number continues to grow as more studies take place.
Genes may link to epilepsy directly, to brain anomalies that can lead to epilepsy, or to other genetic conditions that can cause seizures.
Some people inherit genetic factors. However, certain genetic mutations may also cause epilepsy in people without a family history of the condition.
A doctor may sometimes request genetic testing to determine the cause of epilepsy.
Triggers
A variety of factors can lead to seizures. One 2014 study identified stress, sleep deprivation, and fatigue as the most frequent triggers among 104 participants. Flickering lights and high levels of alcohol consumption can also cause seizures.
Stress is a common cause of seizures, but the reason is unclear. Research from 2016 in the journal Science Signaling focused on this trigger. The team found that the brain’s stress response worked differently in rats with epilepsy than in those without.
The study also found that the molecule that typically suppresses brain activity in response to stress enhanced activity instead. This may contribute to seizures.
Epilepsy vs. seizures
Seizures are the main symptom of epilepsy. In fact, Johns Hopkins Medicine define epilepsy as having “two or more unprovoked seizures.”
Some people may have a single seizure, or they may experience seizures that are not due to epilepsy.
It is even possible for doctors to misdiagnose nonepileptic seizures as epilepsy. However, nonepileptic seizures do not stem from abnormal electrical activity in the brain. The causes of these can be physical, emotional, or psychological.
There are also different types of seizure, which may vary among people with epilepsy. In two people with epilepsy, for example, the condition may look different.
For this reason, the CDC describe epilepsy as a spectrum disorder.
Is it a disability?
The Americans with Disabilities Act (ADA) prohibits discrimination against people with disabilities, including epilepsy. This applies whether or not the person is able to manage their seizures with medication or surgery.
People with epilepsy have certain employment-related protections under the ADA, including the following:
- Employers may not ask about job applicants’ medical conditions, including epilepsy.
- Job applicants do not need to inform an employer that they have epilepsy unless they need reasonable accommodation during the application period.
- Employers may not cancel a job offer if the person can complete the primary functions of the job.
According to the Social Security Administration, people with epilepsy may be eligible for disability benefits. This requires that people document their seizure type and frequency while taking all the prescribed medications.
Warning devices
Some devices can monitor seizures and alert caregivers, potentially benefiting treatment and helping prevent sudden unexpected death in epilepsy (SUDEP).
A small 2018 study involving 28 participants, the results of which appeared in the journal Neurology, compared one such multimodality device, the Nightwatch, to an Emfit bed sensor. The Nightwatch detected 85% of all severe seizures, compared with 21% for the bed sensor. It also only missed one serious attack every 25 nights.
Nearly 70% of SUDEP cases occur during sleep, according to one 2017 study. This indicates that there may be potential benefits of using accurate nighttime warning systems.
Is it contagious?
Anyone can develop epilepsy, but it is not contagious. A 2016 review of research highlighted some misconceptions and stigma about epilepsy, including the false belief that epilepsy can transmit between people.
The study authors note that people with lower education levels and socioeconomic status had a high rate of misconceptions, as did those who did not know any people with epilepsy.
As a result, interventions and other educational efforts may be useful to reduce stigma around epilepsy and increase understanding of the condition.
Prognosis
Epilepsy can impair a person’s life in multiple ways, and the outlook will depend on various factors.
Seizures can sometimes be fatal, depending on the circumstances. However, many people with epilepsy can manage their seizures using antiseizure medications.
More research is necessary to confirm the alleged relationship between seizures and brain damage.
Is epilepsy fatal?
Seizures can lead to drowning, falling, vehicle accidents, or other injuries that could be fatal. Although it is rare, SUDEP can also occur.
Cases of SUDEP typically occur during a seizure or immediately after it. For example, the seizure may cause the person to go too long without breathing, or it could result in heart failure.
The exact cause of SUDEP is unclear, but a 2018 animal study suggested that acid reflux could explain it.
After blocking acid from reaching the esophagus, SUDEP did not occur in the rats the researchers tested. It is not clear whether this has any relevance to humans, however.
Read more about the study and its implications here.
According to the CDC, people are at more risk of SUDEP if they have had epilepsy for many years, or if they have regular seizures. Following these steps can help reduce the risk of SUDEP:
- taking all doses of antiseizure medication
- limiting alcohol intake
- getting sufficient sleep
Regularly taking prescribed medication may also help prevent status epilepticus, a condition wherein seizures last for longer than 5 minutes.
A 2016 study found that treating status epilepticus within 30 minutes reduced the risk of death.
Will seizures continue?
A 2013 review of research in the journal Brain indicated that 65–85% of people may experience long-term remission of seizures.
Seizures with an identifiable cause, however, are more likely to continue.
Other factors affecting the chances of remission include:
- access to treatment
- response to treatment
- other health conditions a person may have
With the correct use of antiseizure medications, the majority of people with epilepsy may be able to control their seizures.
Can epilepsy lead to brain damage?
Research into whether or not seizures can cause brain damage has shown mixed outcomes.
A 2018 study examined postsurgical brain tissue from people with recurrent seizures. The researchers found no brain damage markers in people with certain types of epilepsy.
However, several other studies have suggested that severe, long lasting seizures could lead to brain injury. For example, one 2013 study found that seizures could result in brain abnormalities, with status epilepticus causing irreversible brain lesions.
Other studies have looked at cognitive changes in children as they get older, either with or without epilepsy. Results suggest that epilepsy is associated with worse cognitive outcomes.
However, it is unclear whether:
- epilepsy causes the impairment
- a similar structural change causes both epilepsy and the impairment
- antiepileptic drugs have an effect
This is an area that needs further research.
Other effects
Epilepsy can affect various aspects of a person’s life, including their:
- emotions and behavior
- social development and interaction
- ability to study and work
The scale of impact on these areas of life will depend largely on the frequency and severity of their seizures.
Life expectancy of people with epilepsy
In 2013, researchers from the University of Oxford and University College London, both in the United Kingdom, reported that people with epilepsy are 11 times more likely to experience premature death than people without it..
The risk appears to be greater if the person also has a mental health condition. Suicide, accidents, and assaults accounted for 15.8% of early deaths. Most people affected by these had also received a diagnosis of a mental health condition.
Lead researcher Seena Fazel says, “Our results have significant public health implications, as around 70 million people worldwide have epilepsy, and they emphasize that carefully assessing and treating psychiatric disorders as part of standard checks in [people] with epilepsy could help reduce the risk of premature death in these patients.”
“Our study,” he adds, “also highlights the importance of suicide and nonvehicle accidents as major preventable causes of death in people with epilepsy.”
