Who Gets Epilepsy Surgery?

Surgical therapy to treat seizures was developed in the 1800s! Yet, while epilepsy surgery has come a long way since then, it is still not for everyone. Several types of surgeries can help to eliminate or reduce seizures in people with epilepsy. Brain surgery is an important decision, and is usually undertaken when multiple medication trials have failed to control seizures. The vast majority of people who are treated with epilepsy surgery have partial seizures. Surgery can be performed on children as well as infants under one year of age. Several factors are important in considering someone for possible epilepsy surgery. They include whether the patient has: seizures that are not controlled by systematic medication trials; localized seizure onset in the brain; a level of health that makes brain surgery relatively safe; and an understanding and acceptance of the risks. Generally, epilepsy surgery is considered for people who have seizures that cannot be controlled by anti-epilepsy drugs, because of ongoing seizures, unacceptable side effects, or both. This unfortunate situation - poorly controlled seizures - occurs in 1 out of every 3 people with epilepsy. For epilepsy surgery to be considered, seizures also need to be severe, or frequent enough, to impair quality of life, a standard that varies tremendously for different people. For some people, seizures that prevent them from being able to drive, or high doses of medications that cause continual side-effects, is reason enough to pursue possible surgery. Other people have daily seizures and side effects but still do not want to consider brain surgery. Most doctors will not perform surgery until a patient has had uncontrollable seizures for at least two years. Although when seizures are frequent or severe, it may be considered sooner. Typically, surgery is considered only if the patients seizures are unable to be controlled by at least two single drugs and one two-drug combination. It is critical that these medication trials are done systematically. Just one week on a drug is long enough to determine a bad side effect, like a rash, but is not an adequate trial of how well the medication works. A doctor gradually increases medication dosages to the maximum tolerable level, to see if greater doses will effectively control seizures. Once a patient is considered for surgery, tests are performed to identify what area of the brain is giving rise to seizures. This is because some areas of the brain can be removed without changing intellect or personality. But removal of other brain areas can cause problems with language, memory, sensation, strength and other functions. In some cases, the risks of surgery outweigh the benefits, while in others, the chances for seizure control are good, with limited risk to vital brain functions. The decision to have surgery involves careful, individualized consideration by both patient and doctor. Remember, epilepsy surgery is elective, and should ultimately, be the patients decision. If you think you may be a candidate for surgical therapy for epilepsy, talk to your physician about a referral to an epilepsy center.

Most people with epilepsy can work productively at full-time jobs. Yet, people with epilepsy have about twice the unemployment rate of the general population. Why is that? Often, people with epilepsy want to work but may encounter employers who are afraid of the potential effects of a seizure on the job. These employers may worry about liability, missed work, or a customer seeing someone having a seizure. While these things can happen, they are not valid reasons to avoid hiring people with epilepsy. The only time when a potential employee's epilepsy is relevant to the hiring decision, is in a case where seizures on the job would endanger a person's, or the public's, well-being. Such exceptions might apply, for example, to pilots, bus drivers, firemen, roofers, and tree cutters. In addition, people with seizures should avoid work that involves driving, working underwater, or in other dangerous locations, or spending prolonged periods around fire, dangerous machinery, or chemicals. Despite these limitations, over 90 percent of jobs can be done-and done well-by people with epilepsy! Just as importantly, it is illegal to discriminate against people with epilepsy. This became law when President Bush Senior signed the Americans with Disabilities Act, or ADA, in 1990, which listed epilepsy as a protected disability. The Bill was championed by Tony Coelho, who was then the Democratic Whip in Congress. Coelho, who is publicly a person with epilepsy, is currently the Honorary Lifetime Chair of the Epilepsy Foundation of America, the main organization in the Advocating for people with epilepsy. The ADA applies to government employers or contractors, educational institutions, and private businesses with over 15 employees. Knowing this, should you disclose your epilepsy on a job application? Generally, the answer is still no. It is not legal for an employer to ask about disabilities, medical conditions, or what medications you are taking. Employers are, however, allowed to ask whether you have any conditions that would prevent you from fulfilling the duties of the job, and if you do, you should answer honestly. Once you have a job, you will have to decide whether to let your coworkers, supervisor, or human resources department know about your seizures. So what if you do have seizures on the job and they cause a problem? Once again, the ADA comes to your aid, stating that the company must attempt to make reasonable accommodations for you. For example, there might be another position in the company that would be less problematic, or you might be excused from overtime if missing sleep provokes seizures. If you have been unfairly treated on the job because of epilepsy, you have at least three levels of recourse. First, you can attempt to work the problem out within the company. Second, you can contact your regional Equal Employment Opportunity Commission, which you can find by visiting their website at www.eeoc.gov. The EEOC will hear your story and decide whether to pursue it on your behalf, at no charge. If they take your case, they may communicate with your employer or pursue legal action. The third option is to hire an employment discrimination attorney. While this may be successful, it can also be expensive. No matter the job, however, people with epilepsy must want to work and be able to perform the job to gain employment, just like people who do not have seizures. Simply put, though, if you have epilepsy and want to work, you have options, opportunities and legal rights. Look into them!

Epilepsy can be caused by genetic factors or acquired, although in most cases it arises in part from both. In this video, we will look at the genetic causes of epilepsy. First, some basics. What is a gene? Our genes are the instruction set for building the human body. Our genes reside on chromosomes. Every person has 46 chromosomes, carrying a total of about 30,000 genes. We get half our chromosomes from our mother and half from our father. While genes determine the structure of our bodies, they also control the excitability of our brain cells. Defective genes can make hyper-excitable brain cells, which are prone to seizures. In recent years, several epilepsy conditions have been linked to mutations in genes. But the matter is complicated by the fact that different genes may be involved in different circumstances. In general, the most common epilepsy conditions, including partial seizures, seem to be more acquired than genetic. But even partial epilepsy has a genetic component. For example, if two people suffer a similar blow to the head, only one may develop epilepsy. This is because some people have genetically-determined risk factors for developing seizures after head trauma. Recently, doctors have discovered a technique called the gene chip, which can quickly screen thousands of genes in an individual. Each bright spot in the gene chip represents a strong presence of a particular gene in the person being tested. But how can knowledge of genes help us become more aware of epilepsy, and better able to treat it? For one thing, genetic testing can help us to diagnose certain epilepsy conditions. a. Gene testing will soon be able to identify predispositions to epilepsy, b. allowing doctors to help a patient get treatment c. and to assist with family counseling. One day, doctors may be able to simply swab a patient's cheek, test his genes, and predict his response to various epilepsy medicines, eliminating much trial and error! Eventually, we may even be able to repair or replace defective genes predisposed to epilepsy, a process called gene therapy. Our growing understanding of genetics and its relationship with epilepsy even makes it possible, to some extent, to determine the likelihood of epilepsy being passed from parent to child. The general population has about a 1 percent risk of developing seizures. Meanwhile, children of mothers with epilepsy have a 3 to 9 percent risk, while children of fathers with epilepsy have a 1.5 to 3 percent risk. Still, the actual risk depends upon the specific type of epilepsy. For example, partial seizures are less likely to run in families than are generalized seizures. In any event, with the usual forms of epilepsy, even if a parent does have the condition, there is more than a 90 percent chance that their child will not. Clearly, genes determine a great deal of who we are, including our risk for epilepsy. But what happens to us in life and what we do is still the larger part of our risk for epilepsy. Talk to your medical team and genetic counselors for more information about genetic predisposition to epilepsy.

Having epilepsy does impose some restrictions on certain recreational activities. All too often, families or medical advisors of people with epilepsy place a heavy blanket of restrictions over all activities that may even remotely lead to an injury. While reasonable precautions, like not allowing someone with uncontrolled seizures to fly a plane, are sensible...excessive restrictions can take the fun out of life and further stigmatize a person with epilepsy. So how do we decide which activities are reasonable, and which are not worth the risk? There is no general answer to this question, however four points should be considered. The first point to look at is the nature of a person's seizures. Some seizures are minor and do not pose much risk. They may be the simple partial type, which occur with only an internal feeling or a fleeting sensation. Complex partial seizures and absence seizures are more of a risk during recreation, because of the associated confusion and memory loss. Tonic-clonic seizures, meanwhile, present an even higher level of risk for injury. Second, it is important to look at how well a person's seizures are controlled. While there is no precise definition of seizure control, patients who have not had seizures for a year or in several years are considered to be in good control. Meanwhile, those having several seizures per month have poor seizure control. But boundaries are imprecise, because even after years of being seizure-free, another seizure is always possible. Third, the risk level of the activity should be considered, since different recreational activities pose different risks. People with seizures usually can participate in low-risk activities, even if their seizures are not in good control - but a medical care professional should first be consulted. Some popular low risk activities are: running, bowling, golf, baseball, basketball, soccer, and volleyball. Medium risk activities, meanwhile, may be engaged in if seizures are mild or infrequent, but, of course, review your individual circumstances with your medical team. Some medium risk activities include football, hockey and ice skating, bike racing, gymnastics, horseback riding, swimming in shallow water with a buddy, and boating. As a general rule, if having a seizure during a recreational activity would likely cause you significant harm, then use common sense and avoid activity. High-risk recreational activities include: hang gliding, motor sports. Some doctors recommend not engaging in high-risk recreational activities at all if you have a history of epilepsy. But, at the very least, a patient should not participate in high risk recreation unless he or she has been seizure-free for years. A final consideration when determining what recreational activities are safe for a person with seizures, is the risk level that the person is willing to assume. Doctors and family can and should give advice, but ultimately, assuming that the person with epilepsy is mentally competent, he or she should make final the decision.

Febrile seizures occur in 3 to 5 percent of children ages 6 months to 6 years, making them the most common known cause of seizures. A febrile seizure is a seizure that is provoked by fever above 100 degrees Fahrenheit. A febrile seizure, or even several febrile seizures, does not usually point to epilepsy. This is because these seizures are not spontaneous, and most children outgrow them by age 6. A febrile seizure is a very frightening experience for parents, partly because the fever may not be recognized until after the seizure occurs. In addition, the seizure often takes the form of a convulsion. Still, febrile seizures are usually harmless, unless the child is injured during the seizure. In fact, two studies of children with febrile seizures showed that the intellectual development of the children was the same as their siblings who did not have seizures. Following a first febrile seizure, a child should be evaluated right away to rule out infectious meningitis and other serious causes of seizures and fever. Meningitis can be ruled out by a spinal tap, or even with clinical observation. Febrile seizures do have a tendency to run in a family. For example, the younger sibling of a child with febrile seizures is three times more likely than normal to experience the condition. Even so, most febrile seizures occur with no family history of seizures. After one febrile seizure, about half of children will have another one sometime in their life, but this doesn't necessarily lead to epilepsy. Several studies have examined the risk for later epilepsy among children with febrile seizures, and found it to be in the range of 2 to 4 percent. This means that about 10 to 20 percent of people with epilepsy have previously had a febrile seizure. Certain complicating factors, though, can increase the risk for later epilepsy after a febrile seizure. Among them are: febrile seizures longer than 15 minutes, febrile seizures in one focal part of the body, multiple febrile seizures within 24 hours; or a family history of non-febrile seizures. It is difficult to notice or treat a rising fever before a febrile seizure occurs. Daily antiepileptic medications might prevent febrile seizures...but there is no good evidence that trying to prevent this condition with antiepileptic medicines reduces the risk that a person will develop epilepsy. This is an important issue, since seizure medications can impair a child's learning and personality. For example, phenobarbital, which is the usual medication used to prevent febrile seizures, can produce hyperactivity and behavioral and learning problems in a significant percentage of children. For these reasons, most pediatric neurologists believe that treatment of febrile seizures is worse than the risk of having one, and advise no therapy. Remember, while 3 to 5 percent of children will experience febrile seizures, they are only a very slight risk marker for later epilepsy, as over 95 percent of the children with febrile seizures will not develop epilepsy!

Driving is not just a convenience! It also may represent freedom, independence, and economic self-sufficiency. Are these benefits off-limits for people with epilepsy? Many people with epilepsy are able to drive, but before you take the wheel, let's look at a few statistics. Between 5 and 10 percent of Americans crash a car each year. For people with epilepsy, the rate is about 30 to 50 percent higher. While that sounds alarming, a 50 percent risk increase is far below the higher crash risk for drinking drivers, young male drivers, or elderly drivers. Not every car crash involving a person with epilepsy is from a seizure. Sometimes, the crash results from normal causes. Other times, sleepiness and delayed reactions-which can stem from anti-seizure medications-might lead to a crash as well. Of course, if someone is having frequent seizures with loss of awareness, it's not wise for them to be driving. So how long should a person be seizure-free-known as the seizure-free interval- before seizures are sufficiently controlled for safe driving? Different states in the US have different answers to this question, varying from 3 months to 2 years. Others leave it to the discretion of your physician Most states do make exceptions for people with certain types of seizures, including seizures too minor to affect driving ability, seizures with a prolonged and consistent aura-or warning sign-and seizures that occur only in an established pattern during sleep. So how does the state find out if a person has seizures? Most patients, and epilepsy doctors, believe that reporting of seizures should be the responsibility of the individual who has them. However, six states in the US-California, Nevada, Oregon, Pennsylvania, New Jersey and Delaware- currently mandate that physicians report loss of consciousness and seizure disorders. Unfortunately, required reporting can be harmful to the patient-physician relationship and it may encourage concealment of seizures. For this reason, attempts are underway to change these mandatory physician reporting requirements. Commercial driving uses a stricter standard. In the US, these rules require federally certified drivers to be seizure-free for at least ten years and off of seizure medications. Interestingly, some people, such as cab drivers or highway patrol, do not require a commercial driver's license, but spend much of the day driving anyway. Some doctors believe that these people should be seizure-free for longer periods than the average driver. In closing, if you experience seizures, here are some things to consider before you get behind the wheel. Do not drive until you and your medical team have determined that it is safe to do so, and notify your physician if your seizure condition has deteriorated. Be aware of your state or national laws about seizures and driving. And, should you feel a seizure coming on while driving, it's best to stop in the road and remain in the car. Pull over only if you are sure you can make it to safety. If you or someone you know has seizures, remember to put safety first...both the public's and your own!

Strokes and seizures...both can be very disturbing, but do they have anything else in common? People sometimes confuse strokes and seizures, but they are two very different conditions. First, here are some basics about each. A stroke results from reduced blood flow to all or part of the brain, in turn leading to the death of some brain cells. Meanwhile, a seizure is the result of excessive synchronous electrical activity in brain circuits. Eventually, a brain affected by a seizure will recover. A seizure may appear more dramatic and upsetting, but a stroke is medically much more serious. So how are strokes and seizures linked? First of all, both stroke and seizure are common, and some people can actually have both. Anything that injures the brain, including stroke, can lead later to seizures. In addition, both strokes and transient ischemic attacks, or TIAs, which are sometimes called warning strokes, can be mistaken for seizures. A seizure can also imitate a stroke. It's important to know, however, that seizures almost never cause actual strokes. However, a body part that is involved in a seizure may be temporarily weak or paralyzed, and this can look like a stroke. Temporary paralysis post-seizure is called "Todd's paresis." On rare occasions-about 2 to 5 percent of the time-a stroke will lead to one or more seizures. If a seizure occurs within a week of a stroke, then it is called an acute symptomatic seizure, and is not diagnosed as being epilepsy. A seizure that occurs more than a week after a stroke, however, does raise the question of possible epilepsy. Two or more seizures post-stroke is definitively epilepsy. Some types of strokes are more likely to produce seizures, such as those that result from bleeding in the brain or from a traveling blood clot that blocks a brain artery. Epilepsy that follows a stroke can sometimes be delayed, starting months or even years after the stroke. This may be because, as circuits in the brain heal and reconnect over timethey become hyper-excitable, making the brain more prone to seizures. Importantly, a seizure does NOT mean that the person is having another stroke. When epilepsy occurs later in life, it may stem from prior strokes, even very small ones of which the person is not aware. While scars from these small strokes may be visible on an MRI, but there is no easy way to know which, if any, of these scars is causing the seizures. Treatment of seizures caused by strokes is similar to the treatment of any focal seizure, and usually involves antiepileptic medications. Of course, preventing a future stroke is also very important. More information can be obtained from your doctor or by searching the web for "stroke prevention." If you or someone you care for may be having seizure or stroke symptoms, please contact a physician!

Epilepsy surgery is not for everyone! So how is a patient considered and assessed for a surgical procedure? Before a person can even be considered for surgery, his or her seizures must persist despite medications and must also interfere with the patient's quality of life. In addition, the surgical candidate must be healthy enough for a brain operation, and be willing to accept the risks of surgery. If these criteria are met, a pre-surgical evaluation is conducted to try and find the area where seizures start, called the seizure focus. The best candidates are those in whom a single, relatively small seizure focus is found in a part of the brain that can be safely removed. The first part of pre-surgical assessment is a careful description of seizures by the patient. This can give clues about the location in the brain where seizures arise. Next, an EEG, or electroencephalogram, is conducted to measure brain waves, in turn helping to localize abnormal electrical activity in the brain. While EEGs taken between seizures can help, recordings during a seizure are most informative. This procedure is usually completed in a video EEG monitoring unit, where patients stay for several days or longer to record EEG and video during seizures. If three or more seizures show a consistent place of origin, surgery will likely be successful! Neuro-imaging with an MRI is another important test for localizing a seizure focus, because it may show a scar or brain injury that is causing the seizures. When both the EEG seizure focus and an MRI abnormality are in the same region, confidence regarding the very best surgical target is increased. Another vital assessment is neuropsychological testing. Pencil and paper tests are given to measure the person's skill in memory, language and other thinking tasks. A. In most right-handed people, the left side of the brain controls language and calculations, B. while the right side controls picture memory and spatial perception. Specific thinking problems shown during neuropsychological testing can help identify abnormal function in different brain areas. Video EEGs, MRIs, and neuropsychological tests are completed in all candidates being seriously considered for epilepsy surgery. Several other tests are done on an individualized basis. One such test, a PET scan, is an imaging test that uses a radioactive tracer to measure consumption of glucose in the brain. This is useful because the seizure focus may consume less glucose between seizures than normal areas of the brain. PET scans are often used when a patient's MRI does not show a clearly abnormal region giving rise to seizures. Another test that measures brain activity, and may be used, is called magnet-oencephalography, or MEG. This can provide a 3-dimensional map of where epilepsy waves come from. If these tests suggest that surgery can help control seizures, the doctor may recommend additional tests that are more invasive. These additional tests allow direct stimulation of different parts of the brain, which can help pinpoint seizure focus and localize normal functions further. To learn more about these tests and how they are administered, please see the next video in this series.

Several conditions can result in loss of consciousness, yet not be associated with the abnormal electrical discharge in the brain characteristic of a seizure. When a person suddenly loses consciousness, it can be a tense and frightening moment! If an observer reports that a person is stiffening, shaking or jerking during the period of unconsciousness-or if an experienced medical history taker notes symptoms of epilepsy-then the event can be categorized as a seizure. Often, however, this period of unconsciousness goes unobserved, or the symptoms during the event are unclear. It is important to understand that there are other conditions that can cause sudden loss of consciousness! The most common medical cause of loss of consciousness is fainting, for which the medical term is syncope. Fainting happens when the brain does not get enough blood flow. You can blame the "fight-or-flight" response for this occurrence! When the brain experiences a sudden stress, blood rushes to the muscles in anticipation of fleeing or counterattacking a danger. The contraction of the muscles during the fight or flight that follows returns blood to the heart and brain. But in modern society, we may not react to certain kinds of perceived danger or pain, like the drawing of blood for laboratory tests. In cases like this, blood pools in the muscles, and the lack of muscle contraction may prevent the heart from having enough blood to pump to the brain. This can cause the brain to temporarily shut down, resulting in vasovagal syncope, the medical term for a common faint. Fainting can also can happen when people have lost blood, are dehydrated, or have certain cardiac problems. Fainting from heart problems can be serious, and requires immediate medical investigation. Usually when people faint, they lie limp. However, some faints provoke a true seizure, which is one way the brain may react to reduced blood supply. A seizure with fainting, which is called convulsive syncope, does not imply epilepsy...but it does require that medical professionals look into what is causing the fainting. In other cases, loss of consciousness can stem from a loss of one of the brain's two vital "fuels": sugar and oxygen. Excessively low sugar is called hypoglycemia, and can definitely cause loss of consciousness. Low sugar can result from prolonged fasting, excess insulin hormone, medication side effects, or a reaction to a high carbohydrate load. People with hypoglycemia usually feel a buildup of hunger, lightheadedness, and a general ill feeling before losing consciousness. While hypoglycemia can cause symptoms, like loss of consciousness, that imitate seizures, it can also provoke real seizures. Low oxygen, which can result from lung disease, choking, or high altitude, can also cause symptoms that imitate a seizure, or provoke a real one. Another common reason for loss of consciousness is a condition called transient ischemic attack, or TIA. In a TIA, blood flow to a piece of the brain is interrupted briefly, causing brain tissue to temporarily stop working Some parts of the brain-like the brainstem-are critical for the maintenance of consciousness. When a TIA affects this area, consciousness may suddenly be lost. Because loss of consciousness can be caused by several different conditions, many people who are having seizures mistakenly think they are experiencing something else. On the other side of the coin are people who think they have seizures, but actually have one of the imitators. In the end, if seizures do not respond to the usual treatments, then the diagnosis should be reconsidered.+

In a resective surgery, a portion of the brain is removed. When this is not possible, doctors may consider other forms of brain surgery to treat epilepsy. While resective surgery is the most common type of epilepsy surgery, there are several others which can be useful. One such procedure is called a "lesionectomy." A lesion is an abnormal structure in the brain, like an old scar. The scar may be present due to past trauma, bleeding, infection, stroke, abnormal blood vessels, a birth defect, or a tumor. A. Seizures often originate around a lesion,B. so a lesionectomy removes it, C. as well as a rim of surrounding brain tissue believed to be involved in seizures. Another type of procedure, called disconnection surgery, involves severing specific nerve pathways in the brain along which seizures spread. One disconnection surgery - which reduces atonic, tonic-clonic, and tonic seizures - is corpus callosotomy. During this procedure, the corpus callosum-which is the large fiber bundle in the brain that connects the two hemispheres-is cut. Often, the operation involves severing just the front two-thirds of this area. Following this partial procedure, seizure reduction hovers around 75 percent. Later, a second operation may be performed to disconnect the remaining third of the corpus callosum, reducing rates of some seizures by up to 85 percent. The most dramatic surgery performed to treat epilepsy is hemispherectomy. This operation involves removing and or disconnecting one cerebral hemisphere from the rest of the brain. Hemispherectomy is usually only considered in patients with severe seizures who also have some weakness and sensory loss on the side of the body opposite from surgery. This is because the surgery will cause severe weakness and sensory loss, even if it is not there already. Another rare form of epilepsy surgery is a multiple subpial transection procedure. This operation is used to control seizures that stem from areas of the brain which cannot safely be removed. For example, if seizures originate in an area that is critical for language, removing this area might devastate the understanding of language or speech. A subpial transection involves making multiple superficial cuts into the more shallow layers of the brain. A. These cuts, or transections, B. interrupt fibers that connect neighboring parts of the brain, C. in turn disrupting the spread of seizure activity. This procedure is not as effective as removal or disconnection surgery and only a minority of patients become entirely seizure free after this procedure. Still, major complications of a subpial transection are rare, and the benefits can outweigh potential complications. No matter the form of epilepsy surgery considered, however, surgery is not for everyone and is always a patient's choice. If your seizures are not being controlled, discuss the possibility of epilepsy surgery with your medical team.

Conditions that imitate seizures can be grouped according to which aspect of seizure they mimic. One category of seizure imitators causes abnormal movements. Many epileptic seizures involve abnormal movements such as twisting or twitching. But other movement disorders-including conditions such as tremors, Parkinson's disease, dystonia, chorea, and tics-also involve odd postures and movements. People who have these movement disorders do not show the concurrent EEG changes characteristic of an epileptic seizure, which can help to distinguish these conditions from a real seizure. Let's look at how each movement disorder typically manifests itself. A tremor is rhythmical shaking of one body part. If a tremor comes and goes, it may be misdiagnosed as a partial seizure with motor manifestations. Dystonia is the continued maintenance of an abnormal posture. Dystonia can be confusing to a diagnostician, because some seizures include dystonia as a symptom. Then again, dystonia can also be a movement disorder symptom on its own, completely unrelated to epilepsy. Another movement disorder, chorea, comes from the Greek word for dance. It manifests itself as if the hands were actually doing a little dance. A person with chorea looks extra-fidgety, and may try to cover up a chorea movement with a seemingly normal activity, like brushing their hair. Athetosis is a movement disorder that also comes from the Greek, meaning "swimming," and indeed...a person with athetosis makes arm or leg movements like he or she is swimming. Chorea and athetosis often combine into a condition called choreoathetosis. Another seizure movement imitator, hemiballismus, is a rare condition that shows up as violent flinging movements, usually restricted to one side of the body. Finally, tics, which are habitual, quick, abnormal movements, can mimic seizures. Tics seem to relieve tension and are semi-voluntary, meaning that people can inhibit them-at least for a while- with effort. These movement disorders can all present in a manner that imitates the symptoms of a seizure. But remember that not everything that shakes is a seizure! If you or someone close to you has seizures or a look-alike, please seek medical attention to get the correct diagnosis and treatment.

Sudden confusion is a common symptom of certain types of seizure, but it is also a symptom that can be caused by one of many seizure imitators! One common condition that can produce sudden confusion that may look like a seizure is a transient ischemic attack, or TIA. TIAs occur when blood flow to the brain is interrupted briefly, causing the brain to temporarily stop working. This can cause a variety of different responses, depending on what part of the brain is deprived of blood. A TIA affecting the speech memory or senory-motot centers of the brain can produce confusion, tingling, weakness, or other symptoms that imitate a seizure.Another common confusion imitator-as most of us know from our own experience-is uncontrollable sleepiness. Some people who are "asleep on their feet" at inappropriate times may be thought to be experiencing a partial seizure. These people may be excessively sleepy because of missed or interrupted sleep, medication side effects, or a sleep disorder. Two common sleep disorders are sleep apnea, in which breathing stops and starts during sleep, and narcolepsy, a neurological disorder involving sleep/wake cycles. A. People with narcolepsy can experience cataplexy, B. which is a sudden loss of muscle tone and falling at a point of high emotion. This is commonly called getting "weak in the knees." But whether it stems from narcolepsy or other causes, sleep confusion usually results in an irresistible sleepiness before the attack, as well as the ability to be woken up during the attack. These factors allow doctors to distinguish a sleep problem from a seizure.During the night, some people sleepwalk, act out their dreams, or have screaming attacks called night terrors. These episodes can raise a question of seizures once again.Since some seizures do occur primarily during sleep, a medical evaluation may be needed. In the early stages of a migraine headache, some patients may experience an aura, which involves seeing shapes, colors or lights, and may include lightheadedness or dizziness. People who are experiencing an aura may find it hard to think straight. A migraine aura is confusing, and-particularly in cases where the other symptoms of headache are not prominent-can be misdiagnosed as seizures. Another seizure imitator which is fairly common is called transient global amnesia, or TGA. During a TGA attack, a person suddenly loses the ability to form new memories and often asks the same questions over and over. A TGA usually lasts just a few hours. While TGAs are frightening, they are probably harmless and do not require treatment, just the correct diagnosis. One final condition that causes seizure-like confusion is delirium, or encephalopathy. Delirium is prolonged confusion that waxes and wanes. Hundreds of medical conditions, including common ones like infection or fever, can produce delirium. When delirium comes and goes, a legitimate question arises as to whether the person experiencing it is having repeated small seizures. A careful neurological evaluation including an EEG of brainwaves may settle the question. If you or someone close to you may have undiagnosed seizures, or if you think your seizures may actually be symptoms caused by an imitating condition, please seek medical attention.