301-530-9744
Bethesda, Maryland

Epilepsy



“I came in truly frustrated about my sons unknown condition; Dr. Klein and his nurse were very professional and asked so many questions that made me believe that they are truly concerned about finding my son’s right diagnosis”


Mid-Atlantic Epilepsy and Sleep Center (MAES) offers evaluation and management of patients with epilepsy. Our services include:

  • Consultation services at the request of patients, primary care physicians, neurologists, neurosurgeons and other specialists
  • Specialized evaluation and care of women with epilepsy, including pregnancy
  • Epilepsy Monitoring Unit for advanced diagnostic and pre-surgical patient evaluation
  • Epilepsy Surgery for patients whose seizures are not controlled by medications or for patients with structural lesions
  • Dietary Treatment (Ketogenic Diet Program) for treatment of epilepsy that is not controlled by medications or surgery
  • Participation in clinical research of new treatments of epilepsy

 

 

Epilepsy Overview

Epilepsy is a common neurological disorder that affects 2.5-3 million people in the United States. There are many types of seizures and different forms of epilepsy. A seizure is generated by abnormal electrical discharges of brain cells that disrupts normal function. It can produce a wide variety of symptoms including a change in a person’s consciousness or behavior and uncontrolled movements or sensations. Epilepsy is a condition of recurring seizures.

There are many different types of seizures, and people with epilepsy may experience one or more types. The kind of seizure a person has depends on which part of the brain is affected by the electrical disturbance that produces seizures.

There are many possible causes of epilepsy. Head trauma, brain tumors, stroke, brain infection or genetic causes can all cause epilepsy. In some cases, however, the cause is not known.

Different Types of Seizures

Seizures are generally divided into two different groups: “generalized” seizures and “partial” seizures. The following explains the terminology and describes more specifically the different kinds of seizures.

Generalized Seizures

A generalized seizure occurs when a burst of electrical energy involves the whole brain at once, both sides of the brain. There is usually loss of consciousness. Generalized seizures include the following types:

  • Generalized Tonic-Clonic Seizures (also called “grand mal” seizures)
    This seizure is characterized by several phases. The body, arms, and legs or the whole body stiffen, (“tonic”) followed by a convulsion (shaking or “clonic” activity) and the postictal period. During the postictal period, the person may be sleepy, tired, and have a headache or body aches.
  • Tonic Seizures
    Stiffening or contraction in a fixed posture, often with bent elbows and stiff, straightened legs.
  • Absence Seizures (also called “petit mal” seizures)
    These seizures are characterized by a brief altered state of consciousness and staring episodes. Typically, the person’s posture is maintained during the seizure. The mouth or face may move or the eyes may blink. The seizure usually last 5-20 seconds. When the seizure is over, the person may not recall what happened and may go on with his/her activities as if nothing had happened. These seizures may occur several times a day. This type of seizure is sometimes mistaken for a learning problem or behavioral problem. Absence seizures usually start in childhood or early adolescence.
  • Myoclonic Seizures
    This type of seizure refers to quick movements or sudden jerking of a group of muscles. Patients are often fully conscious during them. These seizures tend to occur in clusters, meaning that they may occur several times a day, or for several days in a row.
  • Atonic Seizures (also called “drop attacks”)
    With atonic seizures, there is a sudden loss of muscle tone and the person may fall from a standing position or suddenly drop his/her head. During the seizure, the person is limp and unresponsive.

Partial Seizures

Focal seizures occur when abnormal electrical brain function occurs in only one part of the brain (which is also why they are usually called “partial” seizures). With partial seizures a person may experience an aura before the seizure occurs. An aura is a strange feeling, either consisting of visual changes, hearing abnormalities or changes in the sense of smell. Partial seizures are divided into two types:

  • Simple Partial Seizures
    Simple partial seizure is a focal seizure without loss or alteration of consciousness. The person may show different symptoms depending upon which area of the brain is involved. If the abnormal brain function is in the frontal lobe (the front part of the brain that is involved with control of movements), the person may have abnormal movements. If it is in the occipital lobe (the back part of the brain that is involved with vision), visual perception may be altered. The seizures typically last less than one minute.
  • Complex Partial Seizures
    This is a focal seizure with impairment of consciousness. Consciousness is lost during these seizures and a variety of behaviors can occur which again depend on the part of the brain affected by the seizure. This type of seizure commonly occurs in the temporal lobe of the brain, the area of the brain that controls emotion and memory. These behaviors may include gagging, lip smacking, running, screaming, crying and/or laughing. When the person regains consciousness, he/she may be confused and may complain of being tired or sleepy after the seizure. This is called the postictal period. This seizure usually lasts between one to two minutes.
  • Secondarily Generalized Seizures
    This type of seizure begins in one part of the brain, either as a simple partial seizure or complex partial, and then spreads to both sides of the brain where consciousness is lost. Clinically, it looks like the generalized tonic clonic seizure listed below.

Non-Epileptic Seizures

(NES, also called “pseudoseizures”) are events involving unusual behavior, movement or sensation that resemble an epileptic seizure but that are not associated with abnormal electrical discharges of the brain. NES is frequently associated with a history of abuse (physical and sexual). Negative emotions, stress, anger and trauma often play a role in the development of the disorder. The symptoms of seizures and non-epileptic seizures are similar, including similar abnormal movements such as falling or shaking. Due to the similar symptoms, patients are sometimes treated with anti-seizure medications, but this is usually ineffective. The diagnosis is made with continuous video-EEG monitoring (VEEG) when typical events are recorded and it is determined whether there is any associated abnormal brain activity.