Dear Dr. Garner,
This has been a rough summer. In June, I experienced a seizure, which I have had in the past as well. This one put me in the hospital for several days, and then in rehab. My doctor also put me on medication.
Will you please explain what a seizure is and how to treat it? I just feel you could explain more than my own doctor has.
Thank you for your help.
Recurrent Seizures in Ridgewood

Dear Recurrent Seizures,
Thank you for your kind words. One of the purposes of the column, and the television show on The NET, is to address questions that you may not have asked of your own physician. Unfortunately, with managed care, our doctors do not always spend the same amount of time they did in the past in discussing a problem with their patients.

There are many different types of seizures in children. They may be related to high fevers. In adults, it may be related to epilepsy, or tumors of the brain. Sometimes, we never find the cause of a seizure. Strokes may sometimes present with seizures.
From your comment that you have had recurrent seizures and the medication you are taking, it sounds like you have epilepsy.
A seizure can be very scary. Epilepsy was one of the first brain disorders to be described. The word is derived from the Greek word for “attack.” People once thought that those with epilepsy were being visited by demons or gods.

In epilepsy, nerve cells in the brain sometimes send signals at the wrong time. Strange sensations, emotions and behavior, or convulsions, and loss of consciousness occurs. During a seizure, the nerve cells send out signals at 10 times the normal rate. In some people, this happens only occasionally, but for others it may happen several times a day.

More than two million people in the United States, about one in 100, have experienced seizures or have been diagnosed with epilepsy. For most, the seizures can be controlled with medication. About 20% will continue to experience seizures, even with the best available treatment.

Epilepsy is not contagious and is not caused by mental illness or retardation.

There are many possible causes. It may be related to illness, brain damage, or abnormal brain development. About half of all seizures have no known cause. There seems to be a genetic factor in developing epilepsy, and scientists have found a specific gene that may be a major cause.

There are different kinds of seizures that may occur. Seizures are divided into two major categories – focal seizures and generalized seizures.

In focal seizures, also called partial seizures, only one part of the brain is affected. The patient may remain conscious but experience unusual feelings or sensations. The person may experience sudden feelings of joy, anger, sadness, or nausea. He or she may hear, smell, taste, see, or feel things that are not real.

In other focal seizures, there may be strange behaviors, such as blinking, twitching, or even walking in a circle. The symptoms of focal seizures can be confused with other disorders. For instance, it may sometimes mimic migraine headaches. Sometimes the person is thought to have mental illness.

In generalized seizures, there may be loss of consciousness, falls, or massive muscle spasms. These are usually dramatic with stiffening of the muscles, and twitching and thrashing about.

Society’s lack of understanding about different types of seizures is one of the biggest problems for people with epilepsy. People watching a patient have a seizure may not realize that this is beyond the person’s control. In some cases, a person has been arrested or admitted to a psychiatric hospital.

Your doctor will be able to diagnose epilepsy with the following tests:
•  EEG Monitoring — An EEG records brain waves using metal devices placed on the scalp. Brain waves of people with epilepsy will have an abnormal configuration.
•  Brain Scans — Having a CT scan, PET scan and MRI will show if there is a tumor or damage to  the brain, which could cause the seizures.
•  Medical History — This is probably the most important part of the diagnosis. The doctor will find out what the seizure was like, when it comes, and if anything is associated with it, either before or after the seizures. Sometimes a partner or caregiver can give the best information.
•  Blood Tests — Blood samples are screened for any genetic or chemical imbalance that might be present.
Treatment depends on making an accurate diagnosis of the type present. A neurologist can help diagnose the condition and then work with your doctor to ensure that you are well controlled. As I said before, at least 80% of people with epilepsy can have their seizures controlled. It is important to get treatment as soon as possible. Sometimes a physician may recommend surgery for people who are not adequately controlled by medications. Focal seizures are the type that respond best to surgery.
It is not an easy life for people with epilepsy, but with the proper precautions and treatment, a relatively normal existence can occur.

[hr] Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on The NET, Tuesdays at 8 p.m. on Channel 97 Time Warner and Channel 30 Cablevision.