Epilepsy & Seizures | Treatments & Diagnosis

Symptoms and causes of seizures

Severe seizures typically last only a minute or two and may involve loss of consciousness and uncontrolled muscle movements. Some patients have "silent seizures," with symptoms so subtle that others may not notice. These symptoms can include:

Clouded awareness
Difficulty communicating
Unusual sounds or smells
Emotional changes
Tingling or twitching in arms, hands, or feet

Less intense symptoms might be warning signs that a more severe seizure will soon occur. As patients recover, they may have a period of fatigue or lingering confusion.

How is epilepsy diagnosed?

If you've had more than one unprovoked seizure, you'll need a thorough exam for a diagnosis. Your doctor may send you to our Epilepsy Monitoring Unit (EMU) at MedStar Georgetown University Hospital.

The EMU is an advanced diagnostic center staffed by specially trained neurologists, nurses, and technicians who will help pinpoint where in the brain your seizure started and what type of epilepsy you have. The information we gather from tests and exams in the EMU will help guide your treatment plan.

Electroencephalogram

The first step in diagnosis is a safe and painless test called an electroencephalogram (EEG). Technicians monitor and record your brain activity for an extended period. EEG results provide a complete picture of brain activity before, during, and after seizures. This helps your neurologist define the type of seizure and pinpoint where it originates.

Advanced testing

If medications aren’t working, your doctor may order more thorough monitoring with imaging:

Phase I evaluation
Our specialists will analyze your seizures and where they begin in the brain. We may recommend imaging and tests that include:

Functional magnetic resonance imaging (fMRI): Measures small changes in blood flow that occur with brain activity and brain abnormalities that can't be seen with other imaging techniques.

Magnetic resonance imaging (MRI): Magnets produce pictures of your brain to reveal physical abnormalities that may be causing seizures.

Positron emission tomography (PET): Identifies areas of hypometabolism, or decreased sugar consumption. These are likely the focal point of epileptic episodes.

Single photo emission computed tomography (SPECT): Injected radioactive isotopes show the blood flow in your brain and help pinpoint where the seizure starts.

Wada tests: A neurologist will use medication to isolate each hemisphere of your brain and establish where your language and memory skills originate.

Robotic stereotactic assistance (ROSA): Image guidance that helps to map areas of the brain where it would be safe to position electrodes, devices, and surgical instruments for brain procedures.
Phase II study

You may need a Phase II study if the origin of your seizures cannot be located with Phase I testing. This involves implanting electrodes in areas of the brain that your doctors suspect may be responsible for the epileptic episodes.

Types of epileptic seizures

Neurology specialists no longer use "grand mal" or "petit mal" to describe a seizure. Instead, seizures are categorized as "generalized" or "focal." Each category covers several specific types of seizure activity.

Generalized seizures

Generalized seizures involve the entire brain. Because of the extensive area affected, symptoms always include loss of consciousness.

Absence seizures

Absence seizures were formerly referred to as petit mal seizures. They cause a 10- to 20-second loss of consciousness and staring. Symptoms are so fleeting that they may go unnoticed for some time. This type of generalized seizure is more likely to affect children.
Myoclonic seizures

Myoclonic seizures cause you to lose consciousness and experience rapid, brief muscle contractions. The affected muscles will usually contract on both sides of the body at the same time. To a bystander, it may look like sudden jerks or clumsiness.
Atonic seizures

Atonic seizures can be particularly dangerous. Along with loss of consciousness, abrupt, sudden muscle weakness occurs without any warning. This can cause you to fall suddenly, sometimes resulting in head or face injuries.
Tonic-clonic seizures
Grand mal seizures are now called tonic-clonic seizures. These are characterized by:

Loss of consciousness for 1- 2 minutes

Stiffening of the limbs (the tonic phase), followed by jerking of the limbs and face (the clonic phase)

Crying out or falling as the seizure begins

Exhaustion, confusion, or amnesia during recovery

Focal seizures

Focal seizures, once called partial seizures, originate in a single area of the brain. This means they affect different physical, emotional, or sensory functions. While the symptoms of focal seizures vary, they all tend to be brief, lasting at most a minute or two.

Focal seizures with intact awareness

These seizures do not involve loss of consciousness but can cause sudden jerking or unusual sensations or movements.
Focal seizures with impaired awareness

This type involves impaired or total loss of awareness. You may experience an aura, have a 30-60 second period of staring, and be unaware of your environment. Afterwards, you’ll likely be confused and sleepy.
Focal to bilateral seizures

This is when a focal seizure spreads to both hemispheres and causes a tonic-clonic seizure.

Treatment options for epilepsy and seizures

Depending on what our epilepsy treatment specialists find during monitoring, they may recommend the following treatment options.

Medications

For most patients, a single medication or personalized combination can reduce or even eliminate seizures. However, about 30% of patients with epilepsy do not respond to medications.
Surgery
Surgery might be the best treatment for patients whose seizures are not controlled with medication. MedStar Health offers the most sophisticated surgical techniques, including:

Temporal lobe resection: Removes all or part of the brain area where many focal seizures originate.

Extratemporal cortical resection: Removes all or part of other lobes associated with seizure activity.

Lesion resection: Removes brain tumors or abnormal tissues that are causing seizure activity.

Corpus callosal section: Severs the nerve pathways connecting the two halves of the brain to contain seizures to one side.
Anti-seizure devices
Neurostimulator devices are implanted in a nerve in the neck or directly in your brain.

Vagal nerve stimulation (VNS): Prevents seizures by sending small electrical signals directly to your brain through the vagus nerve in your neck. The device resembles a cardiac pacemaker but stimulates your brain instead of your heart.

Deep brain stimulation: Prevents seizures by sending small electrical signals from a device implanted in your brain.

Responsive neurostimulation (RNS): Detects abnormal activity in the brain and delivers electrical pulses to disrupt the seizure. The device is implanted inside the brain.
Dietary changes

For reasons not fully understood, ketosis and the ketogenic diet can contribute to seizure control. The diet is most often prescribed for children whose seizures have not responded well to medication.
Our bodies function on energy derived from glucose. When our glucose stores run out, our bodies begin to go into starvation mode and burn fat instead. This process is known as ketosis. The ketogenic diet maintains a low calorie count by making fat the primary dietary component. The diet forces the body to remain in ketosis for long periods.