'Wait, Was That a Seizure?' Understanding Epilepsy's Symptoms

Many people who experience their first seizure dismiss it as simply “spacing out” or having a momentary lapse in attention. But if you’ve had two unexplained episodes in which you lost awareness, felt confused or experienced unusual sensations or movements, it’s time to take these symptoms seriously. What might seem like innocent daydreaming or stress-related moments could actually be seizures — and getting a proper medical evaluation is crucial for your health and safety.

While not everyone who has a seizure has epilepsy, recognizing the warning signs early can lead to proper diagnosis, treatment and peace of mind about what’s really happening in those moments when your brain seems to “check out.”

Many people think epilepsy is primarily characterized by uncontrollable seizures, with jerking movements and possible fainting. While such seizures do occur and should be evaluated by medical professionals, symptoms can also be far more subtle, even undetectable to the patient.

“A lot of times they might comment and say, ‘I’m not sure what this episode was’ or ‘I was told it’s a seizure; I’m not sure,’” says neurologist Pooja Patel, M.D., director of the Epilepsy Program and Epilepsy Monitoring Unit at Marcus Neuroscience Institute, part of Baptist Health, at Boca Raton Regional Hospital.

Dr. Patel recently led a “Lunch and Learn” program at Boca Regional to help increase awareness and understanding of epilepsy and seizure disorders. About 3.4 million people in the U.S. currently live with some form of epilepsy, a disorder in which clusters of nerve cells in the brain misfire, causing seizures. Each year, another 150,000 people are diagnosed with epilepsy.

Understanding Epilepsy

Everything we think, feel and do is controlled by brain cells communicating with one another. They send messages through neurotransmitters like dopamine or via electrical pulses that travel through long nerve fibers in the brain.

Normally, these electrical signals move in a steady, consistent pattern. When a person has a seizure, however, the pattern is disrupted so that large groups of neurons send messages at the same time. This produces a flood of electrical activity that temporarily inhibits the function of some areas of the brain.

Seizures or epilepsy can be caused by almost anything that disturbs the normal pattern of brain circuit activity — from excessive alcohol use to metabolic abnormalities, dehydration, illness, a traumatic brain injury or a structural issue in the brain. Epilepsy is defined as two unprovoked seizures that happen 24 hours or more apart.

Fortunately, advancements in technology are helping neurologists pinpoint the origins of seizures with a great deal of accuracy, says neurologist Luis Tornes, M.D., director of epilepsy at Baptist Health Miami Neuroscience Institute.

“The most profound progress has been in understanding the nuances of an individual’s specific type of epilepsy,” Dr. Tornes says. “By accurately identifying both the origin of their seizures and the underlying cause, we are better equipped to develop highly personalized treatment plans for patients.”

Unraveling the Mystery

Although the episode may have passed, it’s wise to seek expert care. A neurologist can learn a lot just by asking questions.

“When we’re trying to take the history from patients, we’re asking them, ‘What did you feel before? We look at what happened before, what happened during and what happened after,” Dr Patel explains. Observations from friends and family, and especially video recordings of the episode, can be very helpful.

Patients may not be able to say what happened during the experience. But details about the aftermath can be revealing, Dr. Patel says. “When you came to, what did you feel? Did you feel okay within five minutes? Did it take you a couple of hours? Did you have any other symptoms lingering afterwards?”

Diagnostic tests may include an MRI to check for structural abnormalities in the brain, functional neuroimaging, neuropsychological testing and an electroencephalogram (EEG), a test that measures the electrical activity of the brain.

“We’re trying to find out if you have any electrical abnormalities,” Dr. Patel says of the EEG, which involves placing small electrodes on the scalp to detect brainwaves. “Even if you’re not currently having a seizure, we can pick up certain things on the EEG that tell us whether you are at high risk for seizure or not.”

Finding the Right Treatment

The landscape of epilepsy treatment has greatly evolved over the past two decades. More than a dozen new anti-seizure medications have been approved by the U.S. Food & Drug Administration (FDA) since 2000, bringing the total to more than 30.

“The first line, mainstay epilepsy treatment is always medications,” Dr. Patel says, adding that about 60 percent of patients can experience good control of their seizures by consistently taking a medication, or a combination of medications.

The many options offer a wider opportunity than ever for patients to find effective treatments with reduced side effects, Dr. Patel says.

“They have different mechanisms of action. One benefit of having more medications available is that we can choose the mechanisms that work best for each person,” she says. “They have a synergistic effect when they work together, and the side effects are not bothersome because the medications are not from the same class.”

For the approximately 40 percent of patients who don’t achieve good control with medications, additional treatments are available, including brain surgery and neurostimulation. Less invasive than surgery, therapies such as vagus nerve stimulation, responsive neurostimulation and deep brain stimulation use heat or electrical pulses to destroy seizure-causing brain tissue.

Some patients with epilepsy who adopt a strict ketogenic, or “keto,” diet have seen improvement. That’s because the burning of fats instead of carbohydrates for the body’s fuel leads to changes in the metabolism of the brain.

“Advances in medication and other treatment options have made it possible for many people with epilepsy to control their seizures effectively,” Dr. Tornes says. “This can lead to a marked improvement in quality of life, allowing individuals to participate in most of the activities that those without epilepsy can.”

What’s an Epilepsy Monitoring Unit?

Both Marcus Neuroscience Institute and Miami Neuroscience Institute have an advanced epilepsy monitoring unit (EMU) to help neurologists gain insight into the needs of patients.

Based at Boca Regional and Baptist Hospital, the EMUs allows 24-hour monitoring over a hospitalization of several days with continuous monitoring by video and EEG. It provides a safe environment for anti-seizure medication to be withheld, allowing seizures to occur. The EEG records brain activity, helping physicians to categorize the type of seizure and locate its source.

“This is one of the few times we actually want the patient to have seizures so we can identify where the seizures are being generated while they are connected to an EEG,” Dr. Tornes explains. “We want to pinpoint exactly where these seizures are coming from, what part of the brain. Today’s treatments involve highly personalized strategies that target the specific cause of seizures in an effort to lessen or eliminate them.”

Miami Neuroscience Institute and Marcus Neuroscience Institute, both part of Baptist Health Brain & Spine Care, offer a one-stop solution for epilepsy care. Both programs are accredited by the National Association of Epilepsy Centers.

“Treating epilepsy effectively requires a team approach involving various specialties. Our institutes bring together experts in neurology, neurosurgery, neuroradiology and neuropsychology to provide well-rounded care,” Dr. Tornes says. “This multidisciplinary collaboration ensures that we can conduct all the necessary tests and studies under one roof, helping us identify the best possible treatment for each individual.”

Pooja Patel, M.D., director of the Epilepsy Program and Epilepsy Monitoring Unit at Marcus Neuroscience Institute, part of Baptist Health, at Boca Raton Regional Hospital

Luis Tornes, M.D., neurologist and director of epilepsy at Baptist Health Miami Neuroscience Institute