About epilepsy and seizures
Seizures take many forms. Some involve loss of consciousness and convulsions; others are brief absences, episodes of confusion, unusual sensations or movements of one part of the body. Not every blackout is a seizure: faints, heart rhythm problems and functional (dissociative) seizures can look similar and need different treatment, which is why an accurate diagnosis at the start is so important.
Our epilepsy clinic is led by Prof Peter Widdess-Walsh, who is US board certified in neurology, epilepsy and clinical neurophysiology and also works at the National Neuroscience Centre at Beaumont Hospital, and by Dr Arif Shukralla, whose training covers epilepsy and headache disorders.
Symptoms we assess
Reasons for referral include:
- A first seizure or blackout, once emergency assessment is complete
- Recurrent blackouts of uncertain cause
- Brief episodes of staring, unresponsiveness or confusion
- Jerks, unusual movements or sensations, particularly on waking
- Known epilepsy with continuing seizures despite treatment
- Planning a pregnancy, or wanting to review or stop medication
- Questions about driving, work or safety with seizures
How we diagnose it
The diagnosis rests on an accurate description of the events, so the consultant will want to hear from anyone who witnessed one. A video recorded on a phone is often the single most useful piece of evidence. The consultant then arranges an EEG, which records the brain's electrical activity, and usually an MRI of the brain to look for a structural cause. A normal EEG does not exclude epilepsy, and a prolonged or sleep-deprived recording is sometimes needed.
Where events might be cardiac, an ECG and sometimes heart monitoring are arranged. Blood tests are done at the first assessment. The aim is to answer three questions: was this a seizure, what type of epilepsy is it, and what caused it, because the answers decide the treatment.
Treatment and follow-up
Most people with epilepsy are treated with a single daily anti-seizure medication, chosen for the type of epilepsy, age, other health conditions, pregnancy plans and side-effect profile. The dose is built up gradually and reviewed. If the first medicine does not control seizures, the consultant will reassess the diagnosis and adjust or change treatment; around two thirds of patients become seizure-free with the first or second drug.
For epilepsy that does not respond to medication, options include referral for surgical assessment, dietary therapies and stimulation devices, arranged through the national epilepsy service. The clinic also covers the practical side: driving regulations, safety at home and work, contraception and pregnancy planning, and what family members should do during a seizure.
Review continues until control is stable, after which many patients are seen once a year with GP care in between.
When to see a GP, and when to see a consultant
Anyone who has had a first seizure should be assessed in an emergency department the same day and then referred to a neurologist. Ask your GP for a referral if you have unexplained blackouts, if seizures continue despite treatment, if you are planning a pregnancy or want to come off medication, or if you have never had a specialist review of your epilepsy.
