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Seizures vs. Epilepsy

Seizure Disorders

The proper use of medical terminology is very important when it comes to informing patients about the neurological problems at hand for which they are seeing me for.

I often see patients who are confused about definitions. Some patients are emphatic when they tell me that they have a “seizure disorder” but do not have “epilepsy.” The word, “epilepsy,” is fraught with negative connotations that stem from the incorrect yet still believed historical view that it may be a sign of demon possession.

The word brings fear to people in that they associate patients who suffer from epilepsy as being unable to think properly, control their impulses and emotions and who have convulsive types of seizures. So the term “seizure disorder” came to be – to use more diplomatic and politically correct phrasing to describe the same thing.

A seizure disorder is the same thing as epilepsy. Having a seizure, however, does not automatically equate to having epilepsy.

A seizure is a transient event where there is a sudden burst of rhythmic electrical activity that starts within a portion of the cerebral cortex (partial seizure or focal seizure) or starts in both sides of the brain at the same time (generalized seizure).

1 in 10 people will have a seizure in his or her lifetime.

These seizures are provoked, for the most part. The seizure may occur for the following reasons:

  • drug/alcohol withdrawal (alcoholic patients who suddenly abstain
  • patients using chronic benzodiazepines like Xanax who suddenly stop, etc)
  • toxic or metabolic abnormalities (patient in the hospital with sepsis, fever and electrolyte imbalances)
  • extreme stress, hunger, sleep deprivation, etc.

In these settings, the seizures are provoked due to some inciting event.

Provoked seizures do not equate to being epileptic in etiology and the history of presentation is key.

Contact Seizure

One common seizure that is provoked and does not warrant a serious evaluation for epilepsy is a “contact seizure.” A contact seizure occurs just after a bout of head trauma – for example if someone falls and hits his/her head and then has a convulsive seizure – this seizure is related to the head trauma and not related to an unprovoked event. If the patient continues to have seizures in the days/weeks/months prior -

In my practice, if the history is clear that the reason for the new onset seizure is related to a provoking event – I may not proceed to do expensive workups at all. I may do a basic workup including a routine EEG study to start and, if abnormal, I may advance the workup accordingly.

What is Epilepsy?

Epilepsy is a disorder of the brain where patients tend to have recurrent, unprovoked seizures. Approximately 1% of the population in the US has an epileptic disorder – which means it is VERY common (in 3-4 million Americans). Most patients with epilepsy may have seizures that are nonconvulsive in nature however much of the time, it is the convulsive seizures that trigger patients to get the proper workup done with an epileptologist.

Epilepsy is a syndrome and does not just involve seizures.

Syndromes are defined essentially as a group of symptoms and objective signs that present together in a very coincidental fashion when normally, these signs and symptoms should not occur in conjunction with each other coincidentally.

The syndrome of epilepsy, for example, involves the following:

  • epileptic seizures
  • cognitive changes
  • sleep changes
  • changes in emotional control/regulation
  • changes in coordination, etc.

In addition, with all that is involved in epilepsy beyond seizures, many psychosocial stressors also contribute to the overall sense of good, average of poor quality of life for each patient and family of the epileptic patient.

A seizure does not automatically equate to an epileptic diagnosis.

Many seizures are provoked and provoked seizures are not considered to be epileptic in nature. Many unprovoked seizures go unrecognized as being related to an epileptic phenomenon unless there is convulsive activity involved. Convulsive seizures, however, are the minority of seizures. Most seizures are nonconvulsive in nature yet it is because of the extreme and traumatic presentation of convulsive seizures that has lead to the belief that all seizures are “convulsive” in nature – a dangerously ignorant and incorrect belief.