Does having a seizure mean you have epilepsy?

Epilepsy and seizures affect more than three million Americans.

What’s the difference between a seizure and epilepsy? 
Dr. Mikell: Seizures happen when your nerve cells fire more rapidly and with less control than usual, affecting how you act or feel. These range from a brief sensory or motor abnormality to a full loss of consciousness with the potential for falling, shaking and difficulty breathing. Epilepsy refers to a brain disorder resulting in multiple seizures.

Does having a seizure mean you have epilepsy?
Dr. Spiegel: No, seizures are not always related to epilepsy. They can be a symptom of a disruption of brain function, such as from a high fever (in children), exposure to certain medications or substances as well as an electrolyte imbalance. Ten percent of Americans will experience a seizure at least once in their lifetime; the highest incidence occurring under the age of two and over the age of 65.

What causes epilepsy?
Dr. Spiegel: Epilepsy may be related to genetic factors that lead brain cells to misfire and can begin in infancy and childhood. However, in most cases, there is no clear genetic cause, and the seizures may be due to structural abnormalities in the brain due to infections, trauma, tumors or stroke, to name just a few examples. Sometimes, no clear cause is found on initial testing, and the neurologist has to look further.

How is epilepsy treated?
Dr. Spiegel: For most, anti-seizure drugs help control the seizures while minimizing medication side effects. Diet can also be a treatment for some, such as the ketogenic diet or a modified Atkins diet, when prescribed by a physician and carefully monitored by a dietitian.
Dr. Mikell: When anti-seizure medications and dietary modifications fail, surgery may be recommended for those whose seizures are associated with structural brain abnormalities, such as brain tumors, malformations of blood vessels and damage related to strokes. There are basically three types of seizure surgery — the surgical removal (resection) of the lesion that is causing the seizure, ablation (using heat to treat the lesion) and electronic modulation that delivers current to the brain before a seizure happens to control or reduce the seizure’s effect. All of these surgeries can be performed at Stony Brook.

How controllable is epilepsy?
Dr. Mikell: Most people with epilepsy do very well when properly diagnosed and treated. Nationally, two out of three people with epilepsy can be expected to enter remission; that is, five or more years free of seizures while using medication.

What distinguishes Stony Brook’s approach?
Dr. Spiegel: Stony Brook is a National Association of Epilepsy Centers-designated Level 4 Epilepsy Center. This is the highest level an epilepsy center can attain. It means that an epilepsy center must have the professional expertise and facilities to provide the most advanced level of medical and surgical evaluation and treatment for patients with complex epilepsy. Patients who have persistent, recurrent seizures or those with an unconfirmed seizure diagnosis can benefit from the advanced services and technology we offer. This includes access to positron emission tomography/magnetic resonance imaging of various types (PET/FMRI/MRI/SPECT), used to detect brain lesions that may not have been detected previously. Seizures and epilepsy can involve and affect multiple body systems, and having a team of specialists readily available helps achieve more effective treatment plans. Our team includes adult and pediatric epileptologists; neuropsychologists; radiologists; and neurosurgeons like Dr. Chuck Mikell and Dr. David Chesler, who are experts in the latest surgical techniques for epilepsy.

Our center also features 11-bed dedicated video-EEG epilepsy monitoring units with 24/7 observation staff and a portable video-EEG epilepsy monitoring system that can be set up anywhere in the hospital for patients who may be experiencing seizures. We also have a state-of-the-art neuro ICU with 10 EEG beds and one dedicated pediatric ICU bed. And our patients and their families benefit from clinical trials and our support and education services, including a nurse practitioner and a support group co-run by one of our physicians and a social worker. 

For more information about Stony Brook Comprehensive Epilepsy Center, visit neuro.stonybrookmedicine.edu.