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Epilepsy

Brief Overview: According to UpToDate, “Epilepsy is a neurologic condition with an intrinsic predisposition to experience seizures. It is practically defined by the occurrence of two or more unprovoked seizures separated by more than 24 hours or by the occurrence of a single unprovoked seizure with risk factors indicating an equivalent probability of recurrence.”

Prevalence: According to the CDC, “During 2021 and 2022, about 2.9 million U.S. adults 18 and older reported having active epilepsy. That is about 1% of all U.S. adults.”

Etiology: According to the CDC, “Epilepsy can be caused by different conditions that affect the brain. Some of these causes are preventable. Many times, doctors don't know the cause. Less than half of newly diagnosed cases of epilepsy have a known cause. Some known causes of epilepsy include:

  • Cysticercosisinfection, the leading cause of epilepsy worldwide.
  • Stroke.
  • Brain tumor.
  • Traumatic brain injury.
  • Loss of oxygen to the brain.
  • Genetic conditions (such as Down syndrome).
  • Other neurological diseases (such as Alzheimer's disease.)”

Risk Factors:

  • Family history of epilepsy
  • Prior brain injury or stroke
  • Central nervous system infections
  • Developmental or congenital brain abnormalities
  • Dementia or neurodegenerative disease
  • Prolonged febrile seizures in childhood

Commonly Associated Conditions:

  • Depression and anxiety
  • Psychiatric disorders
  • Cognitive impairment or learning difficulties
  • Sleep disorders
  • Migraine headaches
  • Injuries related to seizures (falls, head trauma)
  • Social and occupational limitations

Common Medications: Anti-seizure medications (ASMs) are the mainstay of treatment. Selection depends on seizure type, age, comorbidities, pregnancy considerations, and side-effect profile. According to UpToDate, “reasonable initial ASM choices include the following:

Key medication considerations:

  • Adherence is critical—missed doses can trigger seizures.
  • Some ASMs require serum level monitoring.
  • Certain medications have risks and require specialist guidance and ongoing caution/monitoring.

Common Labs, Imaging, and Tests:

  • Rapid POC glucose, CBC, CMP, serum lactate, renal and kidney function tests
  • Urinalysis
  • EEG
  • Neuroimaging – CT, MRI
  • Lumbar puncture

Common Symptoms: Symptoms vary by seizure type and may include:

  • Loss of consciousness or awareness
  • Convulsions or rhythmic jerking
  • Staring spells
  • Sudden confusion
  • Sensory symptoms (odd smells, visual changes)
  • Postictal fatigue, headache, or confusion after seizures

Common Treatments:

  • Long-term anti-seizure medication therapy (see above)
  • Lifestyle modification to reduce triggers
  • Surgical evaluation for medication-resistant epilepsy (selected patients)
  • Neuromodulation devices (vagus nerve stimulation, responsive neurostimulation)
  • Ongoing neurology follow-up

Physical Findings:

  • Often normal between seizures
  • Possible neurologic deficits depending on underlying cause
  • Injuries or tongue biting following generalized seizures
  • Postictal confusion or lethargy after seizure events

Potential Complications and Contraindications:

  • Potential complications:
    • Seizure-related injuries
    • Status epilepticus (medical emergency)
    • Sudden unexpected death in epilepsy (SUDEP – rare but important)
    • Medication side effects (sedation, dizziness, mood changes)
    • Per UpToDate, “Individuals with epilepsy are at increased risk for personal injury, accidental death, and drowning as well as psychiatric comorbidity, suicidal deaths, and sudden unexpected death in epilepsy.”
  • Contraindications / cautions:
    • Abrupt discontinuation of ASMs can provoke seizures
    • Alcohol and recreational drugs may lower seizure threshold
    • Some medications interact with ASMs (important during medication reconciliation)
    • Per UpToDate, “Patients should be advised to avoid unsupervised activities that might pose danger with sudden loss of consciousness, including bathing, swimming alone, working at heights, and operating heavy machinery. The bathtub is the most common site of seizure-induced drowning, and patients with epilepsy should be told to take showers instead of baths.”
    • Per UpToDate, “States and countries vary in driver licensing requirements for patients with an episode of loss of consciousness, including from seizures and epilepsy, and in the legal responsibilities of clinicians to notify state authorities [90]. Most if not all require at least some period of abstinence from driving after a seizure or other event associated with loss or alteration of consciousness.”

General Health and Lifestyle Guidance:

  • Take medications exactly as prescribed; do not skip doses
  • Maintain regular sleep patterns
  • Avoid known seizure triggers (sleep deprivation, alcohol excess, etc.)
  • Use safety precautions (showers instead of baths, caution with heights)
  • Follow driving restrictions per state law and provider guidance
  • Wear medical alert identification if recommended

Suggested Questions to Ask Patients:

  1. When was your last seizure? How often do they occur?
  2. What type of seizures do you experience?
  3. Are you taking your medication consistently? Any missed doses?
  4. Any side effects from medications (fatigue, mood changes, dizziness)?
  5. Have you identified triggers (poor sleep, stress, illness)?
  6. Any recent injuries or ER visits related to seizures?
  7. Are seizures affecting work, driving, or daily activities?

Suggested Talking Points:

  • Epilepsy is a chronic condition, but many people achieve good seizure control.
  • Taking medication consistently is the most important way to prevent seizures.
  • Let your healthcare provider know right away if seizures increase, medications are missed, or side effects become concerning.
    • Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.  
  • Good sleep and avoiding triggers play a big role in seizure control.
  • With the right plan, many people with epilepsy live very full, independent lives.

Common Seizure Triggers: Per Cleveland Clinic, “Commonly reported seizure triggers include:

  • Stress
  • Sleep issues such as not sleeping well, not getting enough sleep, being overtired, disrupted sleep and sleep disorders like sleep apnea.
  • Alcohol use, alcohol withdrawal, recreational drug use.
  • Hormonal changes or menstrual hormonal changes.
  • Illness, fever.
  • Flashing lights or patterns.
  • Not eating healthy, balanced meals or drinking enough fluids; vitamin and mineral deficiencies, skipping meals.
  • Physical overexertion.
  • Specific foods (caffeine is a common trigger).
  • Dehydration
  • Certain times of the day or night.
  • Use of certain medications. Diphenhydramine, an ingredient in cold, allergy and sleep over-the-counter products, is a reported trigger.
  • Missed anti-seizure medication doses.”

Sources:

This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.