Seizures and Epilepsy: Diagnosis, Treatment and Living Safely

Witnessing a seizure, or waking up after one, can be frightening. Afterwards, people are left with urgent questions: Why did it happen? Will it happen again? Is it epilepsy? Can I drive? A careful neurological evaluation answers these questions and, for most people with epilepsy, leads to treatment that controls seizures and allows a full, active life.

This guide explains the difference between a seizure and epilepsy, how the diagnosis is made, current treatment options and practical safety advice.

Seizure vs. Epilepsy

A seizure is a sudden, temporary burst of abnormal electrical activity in the brain. Depending on where it starts and how far it spreads, it can cause anything from a brief stare or strange feeling to convulsions and loss of consciousness.

Not every seizure means epilepsy. Some seizures are provoked by a clear, temporary cause such as very low blood sugar, alcohol withdrawal, certain medications, a high fever in young children or an acute head injury. Epilepsy is diagnosed when a person has a lasting tendency to have seizures, generally defined as:

• Two or more unprovoked seizures occurring more than 24 hours apart, or
• One unprovoked seizure when tests show a high risk of more, or
• A diagnosis of a specific epilepsy syndrome.

Types of Seizures

Seizures are grouped by where they begin in the brain.

Focal seizures

These start in one area of the brain. In a focal aware seizure, the person stays alert and may notice a rising feeling in the stomach, déjà vu, an odd smell or taste, or twitching of one limb. In a focal impaired awareness seizure, the person seems "absent," may stare, chew, fumble with objects or wander, and does not remember the event. Focal seizures can spread to become a bilateral tonic-clonic seizure.

Generalized seizures

These involve both sides of the brain from the start. Examples include tonic-clonic seizures (stiffening followed by rhythmic jerking), absence seizures (brief staring spells of a few seconds, most common in children) and myoclonic seizures (sudden muscle jerks, often in the morning).

Identifying the seizure type matters because it guides the choice of medication. Some medications that work well for one type can worsen another.

Evaluating a First Seizure

Anyone with a first seizure should be evaluated by a physician, and many are first seen in an emergency department. The neurological evaluation usually includes:

• A detailed history. What happened before, during and after the event? An eyewitness description is extremely valuable, and a phone video can be even better.
• A neurological examination.
• Blood tests for blood sugar, electrolytes and other contributing factors.
• An EEG to look for electrical patterns that indicate a seizure tendency. If the routine test is normal, a longer ambulatory or video EEG may follow. Learn about the options in our guide to routine, ambulatory and video EEG.
• Brain imaging, ideally MRI, to look for a structural cause such as scar tissue, a prior stroke or a developmental abnormality.

Part of the evaluation is also ruling out conditions that can look like seizures, including fainting, heart rhythm disturbances, migraine, sleep disorders and stress-related non-epileptic events.

Treatment Options

Antiseizure medications

Medication is the main treatment for epilepsy. There are many antiseizure medications, and the choice depends on seizure type, age, other medical conditions, potential side effects, interactions with other drugs and, for women, plans for pregnancy. Most people with epilepsy become seizure-free with the first or second appropriate medication. The aim is complete seizure control with as few side effects as possible.

Taking medication every day, exactly as prescribed is critical. Missed doses are one of the most common reasons for breakthrough seizures. Never stop a seizure medication suddenly without medical guidance.

When medications are not enough

If seizures continue after two well-chosen medications have been tried at adequate doses, the epilepsy is called drug-resistant. These patients should be referred to a comprehensive epilepsy center, where options may include:

• Epilepsy surgery to remove or disconnect the area where seizures begin, when it can be safely identified.
• Neurostimulation devices, such as vagus nerve stimulation or responsive neurostimulation.
• Dietary therapies, such as the ketogenic diet or modified Atkins diet, under medical supervision.

Seizure First Aid

Family, friends and coworkers can help by knowing what to do during a convulsive seizure:

• Stay calm and time the seizure.
• Move hard or sharp objects away and cushion the head.
• Turn the person onto their side to keep the airway clear.
• Do not put anything in the mouth and do not hold the person down.
• Stay with them until they are fully awake and oriented.
• Call 911 if the seizure lasts longer than 5 minutes, if another seizure follows, if the person is injured, pregnant or has trouble breathing, if it happens in water, or if it is a first seizure.

Living Safely With Epilepsy

• Protect your sleep. Sleep deprivation is a common seizure trigger.
• Limit alcohol and avoid recreational drugs.
• Keep a seizure diary to track events, triggers and medication changes.
• Swim with a companion and take showers rather than baths if seizures are not controlled.
• Ask about driving. New Jersey, like other states, has specific rules about driving after a seizure. Your neurologist can explain how they apply to you.
• Plan pregnancy with your doctor, since some medications need adjustment and folic acid is recommended.
• Talk about mood and memory. Depression, anxiety and concentration problems are common with epilepsy and are treatable.

Uncontrolled seizures carry real risks, including injury and, rarely, sudden unexpected death in epilepsy (SUDEP). The best protection is good seizure control, which is why regular follow-up and honest discussion of missed doses or side effects are so important.

Epilepsy Care in Westwood, NJ

Dr. David D. Van Slooten is board certified in Clinical Neurophysiology, with specialized interests in video EEG and epilepsy monitoring. Our office offers routine, 24–48 hour ambulatory and video EEG, so testing and follow-up can be managed in one practice close to home.

If you or a family member has had a seizure, review our neurology services or find directions on our contact page.

This article is for general education and does not replace advice from your own physician. If you think you are having a medical emergency, call 911.