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“Generally speaking, people whose epilepsy is well controlled on medication can lead healthy and active lives,” said Dr. Ellen Kotwas-Song, a neurologist at Highland Medical, P.C., Rockland Neurological Associates and a consulting neurologist at Nyack Hospital. “The key is to find a neurologist you feel comfortable with, go regularly to your medical appointments and take your medication as directed.”
Epilepsy Basics
Epilepsy can start at any age, but most commonly appears in childhood or in older adults, said Kotwas-Song. “In older adults, epilepsy often starts after a person has had a stroke. In many cases, we don’t have a clear answer about what has caused a person’s epilepsy.” Some patients are able to tell if a seizure is coming on, either through an unusual smell or a feeling that something is about to happen.
There are two broad types of epilepsy: generalized onset and focal onset. Generalized onset seizures are more common in younger people, tend to impair consciousness and may cause a stiffening or jerking of their arms and legs. A person with focal onset epilepsy may be aware of what is happening, or they may have impaired consciousness. Symptoms may include twitching or jerking of the arm or leg on one side of the body, or unusual repetitive behavior, such as lip-smacking or picking.
Diagnosis and Treatment
To diagnose epilepsy, the doctor will order an electroencephalogram (EEG) to evaluate the electrical activity in the brain, usually along with an MRI or CT of the brain. In order to determine the best treatment, they look to see whether the seizure was caused by an underlying medical issue, like very low blood sugar in a diabetic. If no underlying cause can be found, the doctor will start the patient on an anti-seizure medication. “We try to find the most effective medication for the type of seizure the person has,” said Kotwas-Song. “Medications overall are much better tolerated than in the past, with fewer side effects.”
Living With Epilepsy
Once a person has started epilepsy medication, their doctor will determine when it is safe for them to start driving again. “There are state laws about driving with epilepsy, but generally most people are able to drive again once their epilepsy is under control,” said Kotwas-Song.
For everyone with epilepsy, taking your medication as prescribed is the most significant thing you can do, Kotwas-Song emphasized. “One of the most common reasons for breakthrough seizures is a person stopping medication on their own,” she said. “That is why compliance with medication is so important.”
