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Epilepsy

Clinical Trials  |  Add a link  |  Regulations  |  Discussion Board  |  Ask the Nurse | Last Update January 1st. 2009  |  About FDA.COM  | Media Kit


Epilepsy is a brain disorder that causes people to have recurring seizures. The seizures happen when clusters of nerve cells, or neurons, in the brain send out the wrong signals. People may have strange sensations and emotions or behave strangely. They may have violent muscle spasms or lose consciousness.

Epilepsy has many possible causes, including illness, brain injury and abnormal brain development. In many cases, the cause is unknown.

Doctors use brain scans and other tests to diagnose epilepsy. It is important to start treatment right away. There is no cure for epilepsy, but medicines can control seizures for most people. When medicines are not working well, surgery or implanted devices such as vagus nerve stimulators may help. Special diets can help some children with epilepsy.

Introduction

Few experiences match the drama of a convulsive seizure. A person having a severe seizure may cry out, fall to the floor unconscious, twitch or move uncontrollably, drool, or even lose bladder control. Within minutes, the attack is over, and the person regains consciousness but is exhausted and dazed. This is the image most people have when they hear the word epilepsy. However, this type of seizure -- a generalized tonic-clonic seizure -- is only one kind of epilepsy. There are many other kinds, each with a different set of symptoms.

Epilepsy was one of the first brain disorders to be described. It was mentioned in ancient Babylon more than 3,000 years ago. The strange behavior caused by some seizures has contributed through the ages to many superstitions and prejudices. The word epilepsy is derived from the Greek word for "attack." People once thought that those with epilepsy were being visited by demons or gods. However, in 400 B.C., the early physician Hippocrates suggested that epilepsy was a disorder of the brain -- and we now know that he was right.

What is Epilepsy?

Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally. Neurons normally generate electrochemical impulses that act on other neurons, glands, and muscles to produce human thoughts, feelings, and actions. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior, or sometimes convulsions , muscle spasms, and loss of consciousness. During a seizure, neurons may fire as many as 500 times a second, much faster than normal. In some people, this happens only occasionally; for others, it may happen up to hundreds of times a day.

More than 2 million people in the United States -- about 1 in 100 -- have experienced an unprovoked seizure or been diagnosed with epilepsy. For about 80 percent of those diagnosed with epilepsy, seizures can be controlled with modern medicines and surgical techniques. However, about 25 to 30 percent of people with epilepsy will continue to experience seizures even with the best available treatment. Doctors call this situation intractable epilepsy. Having a seizure does not necessarily mean that a person has epilepsy. Only when a person has had two or more seizures is he or she considered to have epilepsy.

Epilepsy is not contagious and is not caused by mental illness or mental retardation. Some people with mental retardation may experience seizures, but seizures do not necessarily mean the person has or will develop mental impairment. Many people with epilepsy have normal or above-average intelligence. Famous people who are known or rumored to have had epilepsy include the Russian writer Dostoyevsky, the philosopher Socrates, the military general Napoleon, and the inventor of dynamite, Alfred Nobel, who established the Nobel Prize. Several Olympic medalists and other athletes also have had epilepsy. Seizures sometimes do cause brain damage, particularly if they are severe. However, most seizures do not seem to have a detrimental effect on the brain. Any changes that do occur are usually subtle, and it is often unclear whether these changes are caused by the seizures themselves or by the underlying problem that caused the seizures.

While epilepsy cannot currently be cured, for some people it does eventually go away. One study found that children with idiopathic epilepsy, or epilepsy with an unknown cause, had a 68 to 92 percent chance of becoming seizure-free by 20 years after their diagnosis. The odds of becoming seizure-free are not as good for adults or for children with severe epilepsy syndromes, but it is nonetheless possible that seizures may decrease or even stop over time. This is more likely if the epilepsy has been well-controlled by medication or if the person has had epilepsy surgery.

What Causes Epilepsy?

Epilepsy is a disorder with many possible causes. Anything that disturbs the normal pattern of neuron activity -- from illness to brain damage to abnormal brain development -- can lead to seizures.

Epilepsy may develop because of an abnormality in brain wiring, an imbalance of nerve signaling chemicals called neurotransmitters, or some combination of these factors. Researchers believe that some people with epilepsy have an abnormally high level of excitatory neurotransmitters that increase neuronal activity, while others have an abnormally low level of inhibitory neurotransmitters that decrease neuronal activity in the brain. Either situation can result in too much neuronal activity and cause epilepsy. One of the most-studied neurotransmitters that plays a role in epilepsy is GABA, or gamma-aminobutyric acid, which is an inhibitory neurotransmitter. Research on GABA has led to drugs that alter the amount of this neurotransmitter in the brain or change how the brain responds to it. Researchers also are studying excitatory neurotransmitters such as glutamate.

In some cases, the brain's attempts to repair itself after a head injury, stroke, or other problem may inadvertently generate abnormal nerve connections that lead to epilepsy. Abnormalities in brain wiring that occur during brain development also may disturb neuronal activity and lead to epilepsy.

Research has shown that the cell membrane that surrounds each neuron plays an important role in epilepsy. Cell membranes are crucial for a neuron to generate electrical impulses. For this reason, researchers are studying details of the membrane structure, how molecules move in and out of membranes, and how the cell nourishes and repairs the membrane. A disruption in any of these processes may lead to epilepsy. Studies in animals have shown that, because the brain continually adapts to changes in stimuli, a small change in neuronal activity, if repeated, may eventually lead to full-blown epilepsy. Researchers are investigating whether this phenomenon, called kindling, may also occur in humans.

In some cases, epilepsy may result from changes in non-neuronal brain cells called glia. These cells regulate concentrations of chemicals in the brain that can affect neuronal signaling.

About half of all seizures have no known cause. However, in other cases, the seizures are clearly linked to infection, trauma, or other identifiable problems.

Genetic Factors

Research suggests that genetic abnormalities may be some of the most important factors contributing to epilepsy. Some types of epilepsy have been traced to an abnormality in a specific gene. Many other types of epilepsy tend to run in families, which suggests that genes influence epilepsy. Some researchers estimate that more than 500 genes could play a role in this disorder. However, it is increasingly clear that, for many forms of epilepsy, genetic abnormalities play only a partial role, perhaps by increasing a person's susceptibility to seizures that are triggered by an environmental factor.

Several types of epilepsy have now been linked to defective genes for ion channels, the "gates" that control the flow of ions in and out of cells and regulate neuron signaling. Another gene, which is missing in people with progressive myoclonus epilepsy, codes for a protein called cystatin B. This protein regulates enzymes that break down other proteins. Another gene, which is altered in a severe form of epilepsy called LaFora's disease, has been linked to a gene that helps to break down carbohydrates.

While abnormal genes sometimes cause epilepsy, they also may influence the disorder in subtler ways. For example, one study showed that many people with epilepsy have an abnormally active version of a gene that increases resistance to drugs. This may help explain why anticonvulsant drugs do not work for some people. Genes also may control other aspects of the body's response to medications and each person's susceptibility to seizures, or seizure threshold. Abnormalities in the genes that control neuronal migration -- a critical step in brain development -- can lead to areas of misplaced or abnormally formed neurons, or dysplasia, in the brain that can cause epilepsy. In some cases, genes may contribute to development of epilepsy even in people with no family history of the disorder. These people may have a newly developed abnormality, or mutation, in an epilepsy-related gene.

Other Disorders

In many cases, epilepsy develops as a result of brain damage from other disorders. For example, brain tumors, alcoholism, and Alzheimer's disease frequently lead to epilepsy because they alter the normal workings of the brain. Strokes, heart attacks, and other conditions that deprive the brain of oxygen also can cause epilepsy in some cases. About 32 percent of all cases of newly developed epilepsy in elderly people appears to be due to cerebrovascular disease, which reduces the supply of oxygen to brain cells. Meningitis, AIDS, viral encephalitis, and other infectious diseases can lead to epilepsy, as can hydrocephalus -- a condition in which excess fluid builds up in the brain. Epilepsy also can result from intolerance to wheat gluten (also known as celiac disease), or from a parasitic infection of the brain called neurocysticercosis. Seizures may stop once these disorders are treated successfully. However, the odds of becoming seizure-free after the primary disorder is treated are uncertain and vary depending on the type of disorder, the brain region that is affected, and how much brain damage occurred prior to treatment.

Epilepsy is associated with a variety of developmental and metabolic disorders, including cerebral palsy, neurofibromatosis, pyruvate dependency, tuberous sclerosis, Landau-Kleffner syndrome, and autism. Epilepsy is just one of a set of symptoms commonly found in people with these disorders.

Head Injury

In some cases, head injury can lead to seizures or epilepsy. Safety measures such as wearing seat belts in cars and using helmets when riding a motorcycle or playing competitive sports can protect people from epilepsy and other problems that result from head injury.

Prenatal Injury and Developmental Problems

The developing brain is susceptible to many kinds of injury. Maternal infections, poor nutrition, and oxygen deficiencies are just some of the conditions that may take a toll on the brain of a developing baby. These conditions may lead to cerebral palsy, which often is associated with epilepsy, or they may cause epilepsy that is unrelated to any other disorders. About 20 percent of seizures in children are due to cerebral palsy or other neurological abnormalities. Abnormalities in genes that control development also may contribute to epilepsy. Advanced brain imaging has revealed that some cases of epilepsy that occur with no obvious cause may be associated with areas of dysplasia in the brain that probably develop before birth.

Poisoning
 

Seizures can result from exposure to lead, carbon monoxide, and many other poisons. They also can result from exposure to street drugs and from overdoses of antidepressants and other medications.

Seizures are often triggered by factors such as lack of sleep, alcohol consumption, stress, or hormonal changes associated with the menstrual cycle. These seizure triggers do not cause epilepsy but can provoke first seizures or cause breakthrough seizures in people who otherwise experience good seizure control with their medication. Sleep deprivation in particular is a universal and powerful trigger of seizures. For this reason, people with epilepsy should make sure to get enough sleep and should try to stay on a regular sleep schedule as much as possible. For some people, light flashing at a certain speed or the flicker of a computer monitor can trigger a seizure; this problem is called photosensitive epilepsy. Smoking cigarettes also can trigger seizures. The nicotine in cigarettes acts on receptors for the excitatory neurotransmitter acetylcholine in the brain, which increases neuronal firing. Seizures are not triggered by sexual activity except in very rare instances.

What Are the Different Kinds of Seizures?

Doctors have described more than 30 different types of seizures. Seizures are divided into two major categories -- focal seizures and generalized seizures. However, there are many different types of seizures in each of these categories.

Focal Seizures
 

Focal seizures, also called partial seizures, occur in just one part of the brain. About 60 percent of people with epilepsy have focal seizures. These seizures are frequently described by the area of the brain in which they originate. For example, someone might be diagnosed with focal frontal lobe seizures.

In a simple focal seizure, the person will remain conscious but experience unusual feelings or sensations that can take many forms. The person may experience sudden and unexplainable feelings of joy, anger, sadness, or nausea. He or she also may hear, smell, taste, see, or feel things that are not real.

In a complex focal seizure, the person has a change in or loss of consciousness. His or her consciousness may be altered, producing a dreamlike experience. People having a complex focal seizure may display strange, repetitious behaviors such as blinks, twitches, mouth movements, or even walking in a circle. These repetitious movements are called automatisms. More complicated actions, which may seem purposeful, can also occur involuntarily. Patients may also continue activities they started before the seizure began, such as washing dishes in a repetitive, unproductive fashion. These seizures usually last just a few seconds.

Some people with focal seizures, especially complex focal seizures, may experience auras -- unusual sensations that warn of an impending seizure. These auras are actually simple focal seizures in which the person maintains consciousness. The symptoms an individual person has, and the progression of those symptoms, tend to be stereotyped, or similar every time.

The symptoms of focal seizures can easily be confused with other disorders. For instance, the dreamlike perceptions associated with a complex focal seizure may be misdiagnosed as migraine headaches, which also may cause a dreamlike state. The strange behavior and sensations caused by focal seizures also can be istaken for symptoms of narcolepsy, fainting, or even mental illness. It may take many tests and careful monitoring by an experienced physician to tell the difference between epilepsy and other disorders.

Generalized Seizures
 

Generalized seizures are a result of abnormal neuronal activity on both sides of the brain. These seizures may cause loss of consciousness, falls, or massive muscle spasms.

There are many kinds of generalized seizures. In absence seizures, the person may appear to be staring into space and/or have jerking or twitching muscles. These seizures are sometimes referred to as petit mal seizures, which is an older term. Tonic seizures cause stiffening of muscles of the body, generally those in the back, legs, and arms. Clonic seizures cause repeated jerking movements of muscles on both sides of the body. Myoclonic seizures cause jerks or twitches of the upper body, arms, or legs. Atonic seizures cause a loss of normal muscle tone. The affected person will fall down or may drop his or her head involuntarily. Tonic-clonic seizures cause a mixture of symptoms, including stiffening of the body and repeated jerks of the arms and/or legs as well as loss of consciousness. Tonic-clonic seizures are sometimes referred to by an older term: grand mal seizures.

Not all seizures can be easily defined as either focal or generalized. Some people have seizures that begin as focal seizures but then spread to the entire brain. Other people may have both types of seizures but with no clear pattern.

Society's lack of understanding about the many different types of seizures is one of the biggest problems for people with epilepsy. People who witness a non-convulsive seizure often find it difficult to understand that behavior which looks deliberate is not under the person's control. In some cases, this has led to the affected person being arrested or admitted to a psychiatric hospital. To combat these problems, people everywhere need to understand the many different types of seizures and how they may appear.

What Are the Different Kinds of Epilepsy?
 

Just as there are many different kinds of seizures, there are many different kinds of epilepsy. Doctors have identified hundreds of different epilepsy syndromes -- disorders characterized by a specific set of symptoms that include epilepsy. Some of these syndromes appear to be hereditary. For other syndromes, the cause is unknown. Epilepsy syndromes are frequently described by their symptoms or by where in the brain they originate. People should discuss the implications of their type of epilepsy with their doctors to understand the full range of symptoms, the possible treatments, and the prognosis.

People with absence epilepsy have repeated absence seizures that cause momentary lapses of consciousness. These seizures almost always begin in childhood or adolescence, and they tend to run in families, suggesting that they may be at least partially due to a defective gene or genes. Some people with absence seizures have purposeless movements during their seizures, such as a jerking arm or rapidly blinking eyes. Others have no noticeable symptoms except for brief times when they are "out of it." Immediately after a seizure, the person can resume whatever he or she was doing. However, these seizures may occur so frequently that the person cannot concentrate in school or other situations. Childhood absence epilepsy usually stops when the child reaches puberty. Absence seizures usually have no lasting effect on intelligence or other brain functions.

Temporal lobe epilepsy, or TLE, is the most common epilepsy syndrome with focal seizures. These seizures are often associated with auras. TLE often begins in childhood. Research has shown that repeated temporal lobe seizures can cause a brain structure called the hippocampus to shrink over time. The hippocampus is important for memory and learning. While it may take years of temporal lobe seizures for measurable hippocampal damage to occur, this finding underlines the need to treat TLE early and as effectively as possible.

Neocortical epilepsy is characterized by seizures that originate from the brain's cortex, or outer layer. The seizures can be either focal or generalized. They may include strange sensations, visual hallucinations, emotional changes, muscle spasms, convulsions, and a variety of other symptoms, depending on where in the brain the seizures originate.

There are many other types of epilepsy, each with its own characteristic set of symptoms. Many of these, including Lennox-Gastaut syndrome and Rasmussen's encephalitis, begin in childhood. Children with Lennox-Gastaut syndrome have severe epilepsy with several different types of seizures, including atonic seizures, which cause sudden falls and are also called drop attacks. This severe form of epilepsy can be very difficult to treat effectively. Rasmussen's encephalitis is a progressive type of epilepsy in which half of the brain shows continual inflammation. It sometimes is treated with a radical surgical procedure called hemispherectomy (see the section on Surgery). Some childhood epilepsy syndromes, such as childhood absence epilepsy, tend to go into remission or stop entirely during adolescence, whereas other syndromes such as juvenile myoclonic epilepsy and Lennox-Gastaut syndrome are usually present for life once they develop. Seizure syndromes do not always appear in childhood, however.

Epilepsy syndromes that are easily treated, do not seem to impair cognitive functions or development, and usually stop spontaneously are often described as benign. Benign epilepsy syndromes include benign infantile encephalopathy and benign neonatal convulsions. Other syndromes, such as early myoclonic encephalopathy, include neurological and developmental problems. However, these problems may be caused by underlying neurodegenerative processes rather than by the seizures. Epilepsy syndromes in which the seizures and/or the person's cognitive abilities get worse over time are called progressive epilepsy.

Several types of epilepsy begin in infancy. The most common type of infantile epilepsy is infantile spasms, clusters of seizures that usually begin before the age of 6 months. During these seizures the infant may bend and cry out. Anticonvulsant drugs often do not work for infantile spasms, but the seizures can be treated with ACTH (adrenocorticotropic hormone) or prednisone.

When Are Seizures Not Epilepsy?

While any seizure is cause for concern, having a seizure does not by itself mean a person has epilepsy. First seizures, febrile seizures, nonepileptic events, and eclampsia are examples of seizures that may not be associated with epilepsy.

First Seizures
 

Many people have a single seizure at some point in their lives. Often these seizures occur in reaction to anesthesia or a strong drug, but they also may be unprovoked, meaning that they occur without any obvious triggering factor. Unless the person has suffered brain damage or there is a family history of epilepsy or other neurological abnormalities, these single seizures usually are not followed by additional seizures. One recent study that followed patients for an average of 8 years found that only 33 percent of people have a second seizure within 4 years after an initial seizure. People who did not have a second seizure within that time remained seizure-free for the rest of the study. For people who did have a second seizure, the risk of a third seizure was about 73 percent on average by the end of 4 years.

When someone has experienced a first seizure, the doctor will usually order an electroencephalogram, or EEG, to determine what type of seizure the person may have had and if there are any detectable abnormalities in the person's brain waves. Thedoctor also may order brain scans to identify abnormalities that may be visible in the brain. These tests may help the doctor decide whether or not to treat the person with antiepileptic drugs. In some cases, drug treatment after the first seizure may help prevent future seizures and epilepsy. However, the drugs also can cause detrimental side effects, so doctors prescribe them only when they feel the benefits outweigh the risks. Evidence suggests that it may be beneficial to begin anticonvulsant medication once a person has had a second seizure, as the chance of future seizures increases significantly after this occurs.

Febrile Seizures
 

Sometimes a child will have a seizure during the course of an illness with a high fever. These seizures are called febrile seizures (febrile is derived from the Latin word for "fever") and can be very alarming to the parents and other caregivers. In the past, doctors usually prescribed a course of anticonvulsant drugs following a febrile seizure in the hope of preventing epilepsy. However, most children who have a febrile seizure do not develop epilepsy, and long-term use of anticonvulsant drugs in children may damage the developing brain or cause other detrimental side effects. Experts at a 1980 consensus conference coordinated by the National Institutes of Health concluded that preventive treatment after a febrile seizure is generally not warranted unless certain other conditions are present: a family history of epilepsy, signs of nervous system impairment prior to the seizure, or a relatively prolonged or complicated seizure. The risk of subsequent non-febrile seizures is only 2 to 3 percent unless one of these factors is present.

Researchers have now identified several different genes that influence the risk of febrile seizures in certain families. Studying these genes may lead to new understanding of how febrile seizures occur and perhaps point to ways of preventing them.

Nonepileptic Events

Sometimes people appear to have seizures, even though their brains show no seizure activity. This type of phenomenon has various names, including nonepileptic events and pseudoseizures. Both of these terms essentially mean something that looks like a seizure but isn't one. Nonepileptic events that are psychological in origin may be referred to as psychogenic seizures. Psychogenic seizures may indicate dependence, a need for attention, avoidance of stressful situations, or specific psychiatric conditions. Some people with epilepsy have psychogenic seizures in addition to their epileptic seizures. Other people who have psychogenic seizures do not have epilepsy at all. Psychogenic seizures cannot be treated in the same way as epileptic seizures. Instead, they are often treated by mental health specialists.

Other nonepileptic events may be caused by narcolepsy, Tourette syndrome, cardiac arrythmia, and other medical conditions with symptoms that resemble seizures. Because symptoms of these disorders can look very much like epileptic seizures, they are often mistaken for epilepsy. Distinguishing between true epileptic seizures and nonepileptic events can be very difficult and requires a thorough medical assessment, careful monitoring, and knowledgeable health professionals. Improvements in brain scanning and monitoring technology may improve diagnosis of nonepileptic events in the future.

Eclampsia

Eclampsia is a life-threatening condition that can develop in pregnant women. Its symptoms include sudden elevations of blood pressure and seizures. Pregnant women who develop unexpected seizures should be rushed to a hospital immediately. Eclampsia can be treated in a hospital setting and usually does not result in additional seizures or epilepsy once the pregnancy is over.

How is Epilepsy Diagnosed?

Doctors have developed a number of different tests to determine whether a person has epilepsy and, if so, what kind of seizures the person has. In some cases, people may have symptoms that look very much like a seizure but in fact are nonepileptic events caused by other disorders. Even doctors may not be able to tell the difference between these disorders and epilepsy without close observation and intensive testing.

EEG Monitoring

An EEG records brain waves detected by electrodes placed on the scalp. This is the most common diagnostic test for epilepsy and can detect abnormalities in the brain's electrical activity. People with epilepsy frequently have changes in their normal pattern of brain waves, even when they are not experiencing a seizure. While this type of test can be very useful in diagnosing epilepsy, it is not foolproof. Some people continue to show normal brain wave patterns even after they have experienced a seizure. In other cases, the unusual brain waves are generated deep in the brain where the EEG is unable to detect them. Many people who do not have epilepsy also show some unusual brain activity on an EEG. Whenever possible, an EEG should be performed within 24 hours of a patient's first seizure. Ideally, EEGs should be performed while the patient is sleeping as well as when he or she is awake, because brain activity during sleep is often quite different than at other times.

Video monitoring is often used in conjunction with EEG to determine the nature of a person's seizures. It also can be used in some cases to rule out other disorders such as cardiac arrythmia or narcolepsy that may look like epilepsy.

Brain Scans

One of the most important ways of diagnosing epilepsy is through the use of brain scans. The most commonly used brain scans include CT (computed tomography), PET (positron emission tomography) and MRI (magnetic resonance imaging). CT and MRI scans reveal the structure of the brain, which can be useful for identifying brain tumors, cysts, and other structural abnormalities. PET and an adapted kind of MRI called functional MRI (fMRI) can be used to monitor the brain's activity and detect abnormalities in how it works. SPECT (single photon emission computed tomography) is a relatively new kind of brain scan that is sometimes used to locate seizure foci in the brain.

In some cases, doctors may use an experimental type of brain scan called a magnetoencephalogram, or MEG. MEG detects the magnetic signals generated by neurons to allow doctors to monitor brain activity at different points in the brain over time, revealing different brain functions. While MEG is similar in concept to EEG, it does not require electrodes and it can detect signals from deeper in the brain than an EEG. Doctors also are experimenting with brain scans called magnetic resonance spectroscopy (MRS) that can detect abnormalities in the brain's biochemical processes, and with near-infrared spectroscopy, a technique that can detect oxygen levels in brain tissue.

Medical History
 

Taking a detailed medical history, including symptoms and duration of the seizures, is still one of the best methods available to determine if a person has epilepsy and what kind of seizures he or she has. The doctor will ask questions about the seizures and any past illnesses or other symptoms a person may have had. Since people who have suffered a seizure often do not remember what happened, caregivers' accounts of the seizure are vital to this evaluation.

Blood Tests
 

Doctors often take blood samples for testing, particularly when they are examining a child. These blood samples are often screened for metabolic or genetic disorders that may be associated with the seizures. They also may be used to check for underlying problems such as infections, lead poisoning, anemia, and diabetes that may be causing or triggering the seizures.

Developmental, Neurological, and Behavioral Tests

Doctors often use tests devised to measure motor abilities, behavior, and intellectual capacity as a way to determine how the epilepsy is affecting that person. These tests also can provide clues about what kind of epilepsy the person has.

Can Epilepsy be Prevented?

Many cases of epilepsy can be prevented by wearing seatbelts and bicycle helmets, putting children in car seats, and other measures that prevent head injury and other trauma. Prescribing medication after first or second seizures or febrile seizures also may help prevent epilepsy in some cases. Good prenatal care, including treatment of high blood pressure and infections during pregnancy, can prevent brain damage in the developing baby that may lead to epilepsy and other neurological problems later. Treating cardiovascular disease, high blood pressure, infections, and other disorders that can affect the brain during adulthood and aging also may prevent many cases of epilepsy. Finally, identifying the genes for many neurological disorders can provide opportunities for genetic screening and prenatal diagnosis that may ultimately prevent many cases of epilepsy.

How can Epilepsy be Treated?

Accurate diagnosis of the type of epilepsy a person has is crucial for finding an effective treatment. There are many different ways to treat epilepsy. Currently available treatments can control seizures at least some of the time in about 80 percent of people with epilepsy. However, another 20 percent -- about 600,000 people with epilepsy in the United States -- have intractable seizures, and another 400,000 feel they get inadequate relief from available treatments. These statistics make it clear that improved treatments are desperately needed.

Doctors who treat epilepsy come from many different fields of medicine. They include neurologists, pediatricians, pediatric neurologists, internists, and family physicians, as well as neurosurgeons and doctors called epileptologists who specialize in treating epilepsy. People who need specialized or intensive care for epilepsy may be treated at large medical centers and neurology clinics at hospitals or by neurologists in private practice. Many epilepsy treatment centers are associated with university hospitals that perform research in addition to providing medical care.

Once epilepsy is diagnosed, it is important to begin treatment as soon as possible. Research suggests that medication and other treatments may be less successful in treating epilepsy once seizures and their consequences become established.

Medications

By far the most common approach to treating epilepsy is to prescribe antiepileptic drugs.  The first effective antiepileptic drugs were bromides, introduced by an English physician named Sir Charles Locock in 1857.  He noticed that bromides had a sedative effect and seemed to reduce seizures in some patients.  More than 20 different antiepileptic drugs are now on the market, all with different benefits and side effects.  The choice of which drug to prescribe, and at what dosage, depends on many different factors, including the type of seizures a person has, the person’s lifestyle and age, how frequently the seizures occur, and, for a woman, the likelihood that she will become pregnant.  People with epilepsy should follow their doctor’s advice and share any concerns they may have regarding their medication.

Doctors seeing a patient with newly developed epilepsy often prescribe carbamazepine, valproate, lamotrigine, oxcarbazepine, or phenytoin first, unless the epilepsy is a type that is known to require a different kind of treatment.  For absence seizures, ethosuximide is often the primary treatment.  Other commonly prescribed drugs include clonazepam, phenobarbital, and primidone.   Some relatively new epilepsy drugs include tiagabine, gabapentin, topiramate, levetiracetam, and felbamate.   Other drugs are used in combination with one of the standard drugs or for intractable seizures that do not respond to other medications.  A few drugs, such as fosphenytoin, are approved for use only in hospital settings to treat specific problems such as status epilepticus (see section, “Are There Special Risks Associated With Epilepsy?” ).  For people with stereotyped recurrent severe seizures that can be easily recognized by the person’s family, the drug diazepam is now available as a gel that can be administered rectally by a family member.  This method of drug delivery may be able to stop prolonged or repeated seizures before they develop into status epilepticus. 

For most people with epilepsy, seizures can be controlled with just one drug at the optimal dosage.  Combining medications usually amplifies side effects such as fatigue and decreased appetite, so doctors usually prescribe monotherapy, or the use of just one drug, whenever possible.  Combinations of drugs are sometimes prescribed if monotherapy fails to effectively control a patient’s seizures.

The number of times a person needs to take medication each day is usually determined by the drug’s half-life, or the time it takes for half the drug dose to be metabolized or broken down into other substances in the body.  Some drugs, such as phenytoin and phenobarbital, only need to be taken once a day, while others such as valproate must be taken two or three times a day.

Most side effects of antiepileptic drugs are relatively minor, such as fatigue, dizziness, or weight gain.  However, severe and life-threatening side effects such as allergic reactions can occur.  Epilepsy medication also may predispose people to developing depression or psychoses.  People with epilepsy should consult a doctor immediately if they develop any kind of rash while on medication, or if they find themselves depressed or otherwise unable to think in a rational manner.  Other danger signs that should be discussed with a doctor immediately are extreme fatigue, staggering or other movement problems, and slurring of words.  People with epilepsy should be aware that their epilepsy medication can interact with many other drugs in potentially harmful ways.  For this reason, people with epilepsy should always tell doctors who treat them which medications they are taking.  Women also should know that some antiepileptic drugs can interfere with the effectiveness of oral contraceptives, and they should discuss this possibility with their doctors.

Since people can become more sensitive to medications as they age, they may need to have their blood levels of medication checked occasionally to see if the dose needs to be adjusted.  The effects of a particular medication also sometimes wear off over time, leading to an increase in seizures if the dose is not adjusted.  People should know that some citrus fruit, in particular grapefruit juice, may interfere with breakdown of many drugs.  This can cause too much of the drug to build up in their bodies, often worsening the side effects.

People taking epilepsy medication should be sure to check with their doctor and/or seek a second medical opinion if their medication does not appear to be working or if it causes unexpected side effects.

Tailoring the dosage of antiepileptic drugs

When a person starts a new epilepsy drug, it is important to tailor the dosage to achieve the best results. People's bodies react to medications in very different and sometimes unpredictable ways, so it may take some time to find the right drug at the right dose to provide optimal control of seizures while minimizing side effects. A drug that has no effect or very bad side effects at one dose may work very well at another dose. Doctors will usually prescribe a low dose of the new drug initially and monitor blood levels of the drug to determine when the best possible dose has been reached.

Generic versions are available for many antiepileptic drugs. The chemicals in generic drugs are exactly the same as in the brand-name drugs, but they may be absorbed or processed differently in the body because of the way they are prepared. Therefore, patients should always check with their doctors before switching to a generic version of their medication.

Discontinuing medication

Some doctors will advise people with epilepsy to discontinue their antiepileptic drugs after 2 years have passed without a seizure. Others feel it is better to wait for 4 to 5 years. Discontinuing medication should always be done with a doctor's advice and supervision. It is very important to continue taking epilepsy medication for as long as the doctor prescribes it. People also should ask the doctor or pharmacist ahead of time what they should do if they miss a dose. Discontinuing medication without a doctor's advice is one of the major reasons people who have been seizure-free begin having new seizures. Seizures that result from suddenly stopping medication can be very serious and can lead to status epilepticus. Furthermore, there is some evidence that uncontrolled seizures trigger changes in neurons that can make it more difficult to treat the seizures in the future.

The chance that a person will eventually be able to discontinue medication varies depending on the person's age and his or her type of epilepsy. More than half of children who go into remission with medication can eventually stop their medication without having new seizures. One study showed that 68 percent of adults who had been seizure-free for 2 years before stopping medication were able to do so without having more seizures and 75 percent could successfully discontinue medication if they had been seizure-free for 3 years. However, the odds of successfully stopping medication are not as good for people with a family history of epilepsy, those who need multiple medications, those with focal seizures, and those who continue to have abnormal EEG results while on medication.

Surgery

When seizures cannot be adequately controlled by medications, doctors may recommend that the person be evaluated for surgery. Surgery for epilepsy is performed by teams of doctors at medical centers. To decide if a person may benefit from surgery, doctors consider the type or types of seizures he or she has. They also take into account the brain region involved and how important that region is for everyday behavior. Surgeons usually avoid operating in areas of the brain that are necessary for speech, language, hearing, or other important abilities. Doctors may perform tests such as a Wada test (administration of the drug amobarbitol into the carotid artery) to find areas of the brain that control speech and memory. They often monitor the patient intensively prior to surgery in order to pinpoint the exact location in the brain where seizures begin. They also may use implanted electrodes to record brain activity from the surface of the brain. This yields better information than an external EEG.

A 1990 National Institutes of Health consensus conference on surgery for epilepsy concluded that there are three broad categories of epilepsy that can be treated successfully with surgery. These include focal seizures, seizures that begin as focal seizures before spreading to the rest of the brain, and unilateral multifocal epilepsy with infantile hemiplegia (such as Rasmussen's encephalitis). Doctors generally recommend surgery only after patients have tried two or three different medications without success, or if there is an identifiable brain lesion--a damaged or dysfunctional area--believed to cause the seizures.

A study published in 2000 compared surgery to an additional year of treatment with antiepileptic drugs in people with longstanding temporal lobe epilepsy. The results showed that 64 percent of patients receiving surgery became seizure-free, compared to 8 percent of those who continued with medication only. Because of this study and other evidence, the American Academy of Neurology (AAN) now recommends surgery for TLE when antiepileptic drugs are not effective. However, the study and the AAN guidelines do not provide guidance on how long seizures should occur, how severe they should be, or how many drugs should be tried before surgery is considered. A nationwide study is now underway to determine how soon surgery for TLE should be performed.

If a person is considered a good candidate for surgery and has seizures that cannot be controlled with available medication, experts generally agree that surgery should be performed as early as possible. It can be difficult for a person who has had years of seizures to fully re-adapt to a seizure-free life if the surgery is successful. The person may never have had an opportunity to develop independence, and he or she may have had difficulties with school and work that could have been avoided with earlier treatment. Surgery should always be performed with support from rehabilitation specialists and counselors who can help the person deal with the many psychological, social, and employment issues he or she may face.

While surgery can significantly reduce or even halt seizures for some people, it is important to remember that any kind of surgery carries some amount of risk (usually small). Surgery for epilepsy does not always successfully reduce seizures and it can result in cognitive or personality changes, even in people who are excellent candidates for surgery. Patients should ask their surgeon about his or her experience, success rates, and complication rates with the procedure they are considering.

Even when surgery completely ends a person's seizures, it is important to continue taking seizure medication for some time to give the brain time to re-adapt. Doctors generally recommend medication for 2 years after a successful operation to avoid new seizures.

Surgery to treat underlying conditions

In cases where seizures are caused by a brain tumor, hydrocephalus, or other conditions that can be treated with surgery, doctors may operate to treat these underlying conditions. In many cases, once the underlying condition is successfully treated, a person's seizures will disappear as well.

Surgery to remove a seizure focus
 

The most common type of surgery for epilepsy is removal of a seizure focus, or small area of the brain where seizures originate. This type of surgery, which doctors may refer to as a lobectomy or lesionectomy, is appropriate only for focal seizures that originate in just one area of the brain. In general, people have a better chance of becoming seizure-free after surgery if they have a small, well-defined seizure focus. Lobectomies have a 55-70 percent success rate when the type of epilepsy and the seizure focus is well-defined. The most common type of lobectomy is a temporal lobe resection, which is performed for people with temporal lobe epilepsy. Temporal lobe resection leads to a significant reduction or complete cessation of seizures about 70 - 90 percent of the time.

Multiple subpial transection

When seizures originate in part of the brain that cannot be removed, surgeons may perform a procedure called a multiple subpial transection. In this type of operation, which has been commonly performed since 1989, surgeons make a series of cuts that are designed to prevent seizures from spreading into other parts of the brain while leaving the person's normal abilities intact. About 70 percent of patients who undergo a multiple subpial transection have satisfactory improvement in seizure control.

Corpus callosotomy

Corpus callosotomy, or severing the network of neural connections between the right and left halves, or hemispheres, of the brain, is done primarily in children with severe seizures that start in one half of the brain and spread to the other side. Corpus callosotomy can end drop attacks and other generalized seizures. However, the procedure does not stop seizures in the side of the brain where they originate, and these focal seizures may even increase after surgery.

Hemispherectomy and hemispherotomy

These procedures remove half of the brain's cortex, or outer layer. They are used predominantly in children who have seizures that do not respond to medication because of damage that involves only half the brain, as occurs with conditions such as Rasmussen's encephalitis, Sturge-Weber syndrome, and hemimegencephaly. While this type of surgery is very radical and is performed only as a last resort, children often recover very well from the procedure, and their seizures usually cease altogether. With intense rehabilitation, they often recover nearly normal abilities. Since the chance of a full recovery is best in young children, hemispherectomy should be performed as early in a child's life as possible. It is rarely performed in children older than 13.

Devices

The vagus nerve stimulator was approved by the U.S. Food and Drug Administration (FDA) in 1997 for use in people with seizures that are not well-controlled by medication. The vagus nerve stimulator is a battery-powered device that is surgically implanted under the skin of the chest, much like a pacemaker, and is attached to the vagus nerve in the lower neck. This device delivers short bursts of electrical energy to the brain via the vagus nerve. On average, this stimulation reduces seizures by about 20 - 40 percent. Patients usually cannot stop taking epilepsy medication because of the stimulator, but they often experience fewer seizures and they may be able to reduce the dose of their medication. Side effects of the vagus nerve stimulator are generally mild but may include hoarseness, ear pain, a sore throat, or nausea. Adjusting the amount of stimulation can usually eliminate most side effects, although the hoarseness typically persists. The batteries in the vagus nerve stimulator need to be replaced about once every 5 years; this requires a minor operation that can usually be performed as an outpatient procedure.

Several new devices may become available for epilepsy in the future. Researchers are studying whether transcranial magnetic stimulation (TMS), a procedure which uses a strong magnet held outside the head to influence brain activity, may reduce seizures. They also hope to develop implantable devices that can deliver drugs to specific parts of the brain.

Diet

Studies have shown that, in some cases, children may experience fewer seizures if they maintain a strict diet rich in fats and low in carbohydrates. This unusual diet, called the ketogenic diet, causes the body to break down fats instead of carbohydrates to survive. This condition is called ketosis. One study of 150 children whose seizures were poorly controlled by medication found that about one-fourth of the children had a 90 percent or better decrease in seizures with the ketogenic diet, and another half of the group had a 50 percent or better decrease in their seizures. Moreover, some children can discontinue the ketogenic diet after several years and remain seizure-free. The ketogenic diet is not easy to maintain, as it requires strict adherence to an unusual and limited range of foods. Possible side effects include retarded growth due to nutritional deficiency and a buildup of uric acid in the blood, which can lead to kidney stones. People who try the ketogenic diet should seek the guidance of a dietician to ensure that it does not lead to serious nutritional deficiency.

Researchers are not sure how ketosis inhibits seizures. One study showed that a byproduct of ketosis called beta-hydroxybutyrate (BHB) inhibits seizures in animals. If BHB also works in humans, researchers may eventually be able to develop drugs that mimic the seizure-inhibiting effects of the ketogenic diet.

Other Treatment Strategies

Researchers are studying whether biofeedback -- a strategy in which individuals learn to control their own brain waves -- may be useful in controlling seizures. However, this type of therapy is controversial and most studies have shown discouraging results. Taking large doses of vitamins generally does not help a person's seizures and may even be harmful in some cases. But a good diet and some vitamin supplements, particularly folic acid, may help reduce some birth defects and medication-related nutritional deficiencies. Use of non-vitamin supplements such as melatonin is controversial and can be risky. One study showed that melatonin may reduce seizures in some children, while another found that the risk of seizures increased measurably with melatonin. Most non-vitamin supplements such as those found in health food stores are not regulated by the FDA, so their true effects and their interactions with other drugs are largely unknown.

How Does Epilepsy Affect Daily Life?
 

Most people with epilepsy lead outwardly normal lives. Approximately 80 percent can be significantly helped by modern therapies, and some may go months or years between seizures. However, the condition can and does affect daily life for people with epilepsy, their family, and their friends. People with severe seizures that resist treatment have, on average, a shorter life expectancy and an increased risk of cognitive impairment, particularly if the seizures developed in early childhood. These impairments may be related to the underlying conditions tha cause epilepsy or to epilepsy treatment rather than the epilepsy itself.

Behavior and Emotions
 

It is not uncommon for people with epilepsy, especially children, to develop behavioral and emotional problems. Sometimes these problems are caused by embarrassment or frustration associated with epilepsy. Other problems may result from bullying, teasing, or avoidance in school and other social settings. In children, these problems can be minimized if parents encourage a positive outlook and independence, do not reward negative behavior with unusual amounts of attention, and try to stay attuned to their child's needs and feelings. Families must learn to accept and live with the seizures without blaming or resenting the affected person. Counseling services can help families cope with epilepsy in a positive manner. Epilepsy support groups also can help by providing a way for people with epilepsy and their family members to share their experiences, frustrations, and tips for coping with the disorder.

People with epilepsy have an increased risk of poor self-esteem, depression, and suicide. These problems may be a reaction to a lack of understanding or discomfort about epilepsy that may result in cruelty or avoidance by other people. Many people with epilepsy also live with an ever-present fear that they will have another seizure.

Driving and Recreation

For many people with epilepsy, the risk of seizures restricts their independence, in particular the ability to drive. Most states and the District of Columbia will not issue a driver's license to someone with epilepsy unless the person can document that they have gone a specific amount of time without a seizure (the waiting period varies from a few months to several years). Some states make exceptions for this policy when seizures don't impair consciousness, occur only during sleep, or have long auras or other warning signs that allow the person to avoid driving when a seizure is likely to occur. Studies show that the risk of having a seizure-related accident decreases as the length of time since the last seizure increases. One study found that the risk of having a seizure-related motor vehicle accident is 93 percent less in people who wait at least 1 year after their last seizure before driving, compared to people who wait for shorter intervals.

The risk of seizures also restricts people's recreational choices. For instance, people with epilepsy should not participate in sports such as skydiving or motor racing where a moment's inattention could lead to injury. Other activities, such as swimming and sailing, should be done only with precautions and/or supervision. However, jogging, football, and many other sports are reasonably safe for a person with epilepsy. Studies to date have not shown any increase in seizures due to sports, although these studies have not focused on any activity in particular. There is some evidence that regular exercise may even improve seizure control in some people. Sports are often such a positive factor in life that it is best for the person to participate, although the person with epilepsy and the coach or other leader should take appropriate safety precautions. It is important to take steps to avoid potential sports-related problems such as dehydration, overexertion, and hypoglycemia, as these problems can increase the risk of seizures.

Education and Employment

By law, people with epilepsy or other handicaps in the United States cannot be denied employment or access to any educational, recreational, or other activity because of their seizures. However, one survey showed that only about 56 percent of people with epilepsy finish high school and about 15 percent finish college -- rates much lower than those for the general population. The same survey found that about 25 percent of working-age people with epilepsy are unemployed. These numbers indicate that significant barriers still exist for people with epilepsy in school and work. Restrictions on driving limit the employment opportunities for many people with epilepsy, and many find it difficult to face the misunderstandings and social pressures they encounter in public situations. Antiepileptic drugs also may cause side effects that interfere with concentration and memory. Children with epilepsy may need extra time to complete schoolwork, and they sometimes may need to have instructions or other information repeated for them. Teachers should be told what to do if a child in their classroom has a seizure, and parents should work with the school system to find reasonable ways to accommodate any special needs their child may have.

Pregnancy and Motherhood

Women with epilepsy are often concerned about whether they can become pregnant and have a healthy child. This is usually possible. While some seizure medications and some types of epilepsy may reduce a person's interest in sexual activity, most people with epilepsy can become pregnant. Moreover, women with epilepsy have a 90 percent or better chance of having a normal, healthy baby, and the risk of birth defects is only about 4 to 6 percent. The risk that children of parents with epilepsy will develop epilepsy themselves is only about 5 percent unless the parent has a clearly hereditary form of the disorder. Parents who are worried that their epilepsy may be hereditary may wish to consult a genetic counselor to determine what the risk might be. Amniocentesis and high-level ultrasound can be performed during pregnancy to ensure that the baby is developing normally, and a procedure called a maternal serum alpha-fetoprotein test can be used for prenatal diagnosis of many conditions if a problem is suspected.

There are several precautions women can take before and during pregnancy to reduce the risks associated with pregnancy and delivery. Women who are thinking about becoming pregnant should talk with their doctors to learn any special risks associated with their epilepsy and the medications they may be taking. Some seizure medications, particularly valproate, trimethidone, and phenytoin, are known to increase the risk of having a child with birth defects such as cleft palate, heart problems, or finger and toe defects. For this reason, a woman's doctor may advise switching to other medications during pregnancy. Whenever possible, a woman should allow her doctor enough time to properly change medications, including phasing in the new medications and checking to determine when blood levels are stabilized, before she tries to become pregnant. Women should also begin prenatal vitamin supplements -- especially with folic acid, which may reduce the risk of some birth defects -- well before pregnancy. Women who discover that they are pregnant but have not already spoken with their doctor about ways to reduce the risks should do so as soon as possible. However, they should continue taking seizure medication as prescribed until that time to avoid preventable seizures. Seizures during pregnancy can harm the developing baby or lead to miscarriage, particularly if the seizures are severe. Nevertheless, many women who have seizures during pregnancy have normal, healthy babies.

Women with epilepsy sometimes experience a change in their seizure frequency during pregnancy, even if they do not change medications. About 25 to 40 percent of women have an increase in their seizure frequency while they are pregnant, while other women may have fewer seizures during pregnancy. The frequency of seizures during pregnancy may be influenced by a variety of factors, including the woman's increased blood volume during pregnancy, which can dilute the effect of medication. Women should have their blood levels of seizure medications monitored closely during and after pregnancy, and the medication dosage should be adjusted accordingly.

Pregnant women with epilepsy should take prenatal vitamins and get plenty of sleep to avoid seizures caused by sleep deprivation. They also should take vitamin K supplements after 34 weeks of pregnancy to reduce the risk of a blood-clotting disorder in infants called neonatal coagulopathy that can result from fetal exposure to epilepsy medications. Finally, they should get good prenatal care, avoid tobacco, caffeine, alcohol, and illegal drugs, and try to avoid stress.

Labor and delivery usually proceed normally for women with epilepsy, although there is a slightly increased risk of hemorrhage, eclampsia, premature labor, and cesarean section. Doctors can administer antiepileptic drugs intravenously and monitor blood levels of anticonvulsant medication during labor to reduce the risk that the labor will trigger a seizure. Babies sometimes have symptoms of withdrawal from the mother's seizure medication after they are born, but these problems wear off in a few weeks or months and usually do not cause serious or long-term effects. A mother's blood levels of anticonvulsant medication should be checked frequently after delivery as medication often needs to be decreased.

Epilepsy medications need not influence a woman's decision about breast-feeding her baby. Only minor amounts of epilepsy medications are secreted in breast milk, usually not enough to harm the baby and much less than the baby was exposed to in the womb. On rare occasions, the baby may become excessively drowsy or feed poorly, and these problems should be closely monitored. However, experts believe the benefits of breast-feeding outweigh the risks except in rare circumstances.

To increase doctors' understanding of how different epilepsy medications affect pregnancy and the chances of having a healthy baby, Massachusetts General Hospital has begun a nationwide registry for women who take antiepileptic drugs while pregnant. Women who enroll in this program are given educational materials on pre-conception planning and perinatal care and are asked to provide information about the health of their children (this information is kept confidential). Women and physicians can contact this registry by calling 1-888-233-2334 or 617-726-1742 (fax: 617-724-8307).

Women with epilepsy should be aware that some epilepsy medications can interfere with the effectiveness of oral contraceptives. Women who wish to use oral contraceptives to prevent pregnancy should discuss this with their doctors, who may be able to prescribe a different kind of antiepileptic medication or suggest other ways of avoiding an unplanned pregnancy.

Are There Special Risks Associated With Epilepsy?
 

Although most people with epilepsy lead full, active lives, they are at special risk for two life-threatening conditions: status epilepticus and sudden unexplained death.

Status Epilepticus

Status epilepticus is a potentially life-threatening condition in which a person either has an abnormally prolonged seizure or does not fully regain consciousness between seizures. Although there is no strict definition for the time at which a seizure turns into status epilepticus, most people agree that any seizure lasting longer than 5 minutes should, for practical purposes, be treated as though it was status epilepticus.

Status epilepticus affects about 195,000 people each year in the United States and results in about 42,000 deaths. While people with epilepsy are at an increased risk for status epilepticus, about 60 percent of people who develop this condition have no previous seizure history. These cases often result from tumors, trauma, or other problems that affect the brain and may themselves be life-threatening.

While most seizures do not require emergency medical treatment, someone with a prolonged seizure lasting more than 5 minutes may be in status epilepticus and should be taken to an emergency room immediately. It is important to treat a person with status epilepticus as soon as possible. One study showed that 80 percent of people in status epilepticus who received medication within 30 minutes of seizure onset eventually stopped having seizures, whereas only 40 percent recovered if 2 hours had passed before they received medication. Doctors in a hospital setting can treat status epilepticus with several different drugs and can undertake emergency life-saving measures, such as administering oxygen, if necessary.

People in status epilepticus do not always have severe convulsive seizures. Instead, they may have repeated or prolonged nonconvulsive seizures. This type of status epilepticus may appear as a sustained episode of confusion or agitation in someone who does not ordinarily have that kind of mental impairment. While this type of episode may not seem as severe as convulsive status epilepticus, it should still be treated as an emergency.

Sudden Unexplained Death

For reasons that are poorly understood, people with epilepsy have an increased risk of dying suddenly for no discernible reason. This condition, called sudden unexplained death, can occur in people without epilepsy, but epilepsy increases the risk about two-fold. Researchers are still unsure why sudden unexplained death occurs. One study suggested that use of more than two anticonvulsant drugs may be a risk factor. However, it is not clear whether the use of multiple drugs causes the sudden death, or whether people who use multiple anticonvulsants have a greater risk of death because they have more severe types of epilepsy.

What Research Is Being Done on Epilepsy?

While research has led to many advances in understanding and treating epilepsy, there are many unanswered questions about how and why seizures develop, how they can best be treated or prevented, and how they influence other brain activity and brain development. Researchers, many of whom are supported by the National Institute of Neurological Disorders and Stroke (NINDS), are studying all of these questions. They also are working to identify and test new drugs and other treatments for epilepsy and to learn how those treatments affect brain activity and development.

The NINDS's Anticonvulsant Screening Program (ASP) studies potential new therapies with the goal of enhancing treatment for patients with epilepsy. Since it began in 1975, more than 390 public-private partnerships have been created. These partnerships have resulted in state-of-the-art evaluations of more than 25,000 compounds for their potential as antiepileptic drugs. This government-sponsored effort has contributed to the development of five drugs that are now approved for use in the United States. It has also aided in the discovery and profiling of six new compounds currently in various stages of clinical development. Besides testing for safer, more efficacious therapies, the Program is developing and validating new models that may one day find therapies that intervene in the disease process itself as well as models of resistant or refractory epilepsy.

Scientists continue to study how excitatory and inhibitory neurotransmitters interact with brain cells to control nerve firing. They can apply different chemicals to cultures of neurons in laboratory dishes to study how those chemicals influence neuronal activity. They also are studying how glia and other non-neuronal cells in the brain contribute to seizures. This research may lead to new drugs and other new ways of treating seizures.

Researchers also are working to identify genes that may influence epilepsy in some way. Identifying these genes can reveal the underlying chemical processes that influence epilepsy and point to new ways of preventing or treating this disorder. Researchers also can study rats and mice that have missing or abnormal copies of certain genes to determine how these genes affect normal brain development and resistance to damage from disease and other environmental factors. In the future, researchers may be able to use panels of gene fragments, called "gene chips," to determine each person's genetic makeup. This information may allow doctors to prevent epilepsy or to predict which treatments will be most beneficial.

Doctors are now experimenting with several new types of therapies for epilepsy. In one preliminary clinical trial, doctors have begun transplanting fetal pig neurons that produce GABA into the brains of patients to learn whether the cell transplants can help control seizures. Preliminary research suggests that stem cell transplants also may prove beneficial for treating epilepsy. Research showing that the brain undergoes subtle changes prior to a seizure has led to a prototype device that may be able to predict seizures up to 3 minutes before they begin. If this device works, it could greatly reduce the risk of injury from seizures by allowing people to move to a safe area before their seizures start. This type of device also may be hooked up to a treatment pump or other device that will automatically deliver an antiepileptic drug or an electric impulse to forestall the seizures.

Researchers are continually improving MRI and other brain scans. Pre-surgical brain imaging can guide doctors to abnormal brain tissue and away from essential parts of the brain. Researchers also are using brain scans such as magnetoencephalograms (MEG) and magnetic resonance spectroscopy (MRS) to identify and study subtle problems in the brain that cannot otherwise be detected. Their findings may lead to a better understanding of epilepsy and how it can be treated.

How Can I Help Research on Epilepsy?
 

There are many ways that people with epilepsy and their families can help with research on this disorder. Pregnant women with epilepsy who are taking antiepileptic drugs can help researchers learn how these drugs affect unborn children by participating in the Antiepileptic Drug Pregnancy Registry, which is maintained by the Genetics and Teratology Unit of Massachusetts General Hospital (see section on Pregnancy and Motherhood). People with epilepsy that may be hereditary can aid research by participating in the Epilepsy Gene Discovery Project, which is supported by the Epilepsy Foundation. This project helps to educate people with epilepsy about new genetic research on the disorder and enlists families with hereditary epilepsy for participation in gene research. People who enroll in this project are asked to create a family tree showing which people in their family have or have had epilepsy. Researchers then examine this information to determine if the epilepsy is in fact hereditary, and they may invite participants to enroll in genetic research studies. In many cases, identifying the gene defect responsible for epilepsy in an individual family leads researchers to new clues about how epilepsy develops. It also can provide opportunities for early diagnosis and genetic screening of individuals in the family.

People with epilepsy can help researchers test new medications, surgical techniques, and other treatments by enrolling in clinical trials. Information on clinical trials can be obtained from the NINDS as well as many private pharmaceutical and biotech companies, universities, and other organizations. A person who wishes to participate in a clinical trial must ask his or her regular physician to refer him or her to the doctor in charge of that trial and to forward all necessary medical records. While experimental therapies may benefit those who participate in clinical trials, patients and their families should remember that all clinical trials also involve some risks. Therapies being tested in clinical trials may not work, and in some cases doctors may not yet be sure that the therapies are safe. Patients should be certain they understand the risks before agreeing to participate in a clinical trial.

Patients and their families also can help epilepsy research by donating their brain to a brain bank after death. Brain banks supply researchers with tissue they can use to study epilepsy and other disorders. Below are some brain banks that accept tissue from patients with epilepsy:

Brain and Tissue Bank for Developmental Disorders
University of Maryland
655 West Baltimore Street, Room 10-035 BRB
Baltimore, MD 21201-1559
800-847-1539
E-mail: btbumab@umaryland.edu
http://medschool.umaryland.edu/BTBank/

(tissue from children only)
Brain and Tissue Bank for Developmental Disorders
University of Miami
Department of Pathology, R-5
Papanicolaou Building, Room 410
Miami, FL 33136
800-59BRAIN (592-7246)
E-mail: btb@med.miami.edu
www.miami.edu/braintissue-bank

(tissue from adults only)
Brain Endowment Bank
University of Miami
1501 NW Ninth Avenue, Suite #4013
Miami, FL 33136
305-243-6219
800-UM-BRAIN (862-7246)

National Disease Research Interchange
8 Penn Center, 8th Floor
Philadelphia, PA 19103
215-557-7361
800-222-NDRI (6374)
E-mail: htor@ndri.com
www.ndri.com

Human Brain and Spinal Fluid Resource Center
Neurology Research (127A)
W. Los Angeles Healthcare Center
11301 Wilshire Boulevard
Los Angeles, CA 90073
310-268-3536
Page: 310-636-5199
E-mail: RMNbbank@ucla.edu
www.loni.ucla.edu/~nnrsb/NNRSB

What To Do If You See Someone Having a Seizure

If you see someone having a seizure with convulsions and/or loss of consciousness, here's how you can help:
  1. Roll the person on his or her side to prevent choking on any fluids or vomit.
  2. Cushion the person's head.
  3. Loosen any tight clothing around the neck.
  4. Keep the person's airway open. If necessary, grip the person's jaw gently and tilt his or her head back.
  5. Do NOT restrict the person from moving unless he or she is in danger.
  6. Do NOT put anything into the person's mouth, not even medicine or liquid. These can cause choking or damage to the person's jaw, tongue, or teeth. Contrary to widespread belief, people cannot swallow their tongues during a seizure or any other time.
  7. Remove any sharp or solid objects that the person might hit during the seizure.
  8. Note how long the seizure lasts and what symptoms occurred so you can tell a doctor or emergency personnel if necessary.
  9. Stay with the person until the seizure ends.

Call 911 if:

The person is pregnant or has diabetes.

The seizure happened in water.

The seizure lasts longer than 5 minutes.

The person does not begin breathing again or does not return to consciousness after the seizure stops.

Another seizure starts before the person regains consciousness.

The person injures himself or herself during the seizure.

This is a first seizure or you think it might be. If in doubt, check to see if the person has a medical identification card or jewelry stating that they have epilepsy or a seizure disorder.

After the seizure ends, the person will probably be groggy and tired. He or she also may have a headache and be confused or embarrassed. Be patient with the person and try to help him or her find a place to rest if he or she is tired or doesn't feel well. If necessary, offer to call a taxi, a friend, or a relative to help the person get home safely.

If you see someone having a non-convulsive seizure, remember that the person's behavior is not intentional. The person may wander aimlessly or make alarming or unusual gestures. You can help by following these guidelines:

Remove any dangerous objects from the area around the person or in his or her path.

Don't try to stop the person from wandering unless he or she is in danger.

Don't shake the person or shout.

Stay with the person until he or she is completely alert.

Conclusion

Many people with epilepsy lead productive and outwardly normal lives. Medical and research advances in the past two decades have led to a better understanding of epilepsy and seizures than ever before. Advanced brain scans and other techniques allow greater accuracy in diagnosing epilepsy and determining when a patient may be helped by surgery. More than 20 different medications and a variety of surgical techniques are now available and provide good control of seizures for most people with epilepsy. Other treatment options include the ketogenic diet and the first implantable device, the vagus nerve stimulator. Research on the underlying causes of epilepsy, including identification of genes for some forms of epilepsy and febrile seizures, has led to a greatly improved understanding of epilepsy that may lead to more effective treatments or even new ways of preventing epilepsy in the future.
Information Resources: March 2004


 Where can I get more information?

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's Brain Resources and Information Network (BRAIN) at:

BRAIN
P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424
http://www.ninds.nih.gov
 

Information also is available from the following organizations:

Citizens United for Research in Epilepsy (CURE)
730 N. Franklin Street
Suite 404
Chicago, IL   60654
info@CUREepilepsy.org
http://www.CUREepilepsy.org
Tel: 312-255-1801
Fax: 312-255-1809
Non-profit grassroots organization formed by parents and families to raise funds for epilepsy research.

 
Epilepsy Foundation
8301 Professional Place
Landover, MD   20785-7223
postmaster@efa.org
http://www.epilepsyfoundation.org
Tel: 301-459-3700 800-EFA-1000 (332-1000)
Fax: 301-577-2684
National charitable organization dedicated to the welfare of people with epilepsy. Works for children and adults affected by seizures through education, advocacy, services, and research towards a cure. Offers a Legal Defense Program through a fund.

 
Epilepsy Institute
257 Park Avenue South
New York, NY   10010
website@epilepsyinstitute.org
http://www.epilepsyinstitute.org
Tel: 212-677-8550
Fax: 212-677-5825
Non-profit organization that provides comprehensive social services and resources for people with epilepsy and their families.

 
People Against Childhood Epilepsy (PACE)
7 East 85th Street
Suite A3
New York, NY   10028
pacenyemail@aol.com
http://www.paceusa.org
Tel: 212-665-PACE (7223)
Fax: 212-327-3075
Non-profit research resource that provides information and support to families of children with epilepsy.

 
Family Caregiver Alliance/ National Center on Caregiving
180 Montgomery Street
Suite 1100
San Francisco, CA   94104
info@caregiver.org
http://www.caregiver.org
Tel: 415-434-3388 800-445-8106
Fax: 415-434-3508
Supports and assists families and caregivers of adults with debilitating health conditions. Offers programs and consultation on caregiving issues at local, state, and national levels. Offers free publications and support online, including a national directory of publicly funded caregiver support programs.

 
National Council on Patient Information and Education
4915 St. Elmo Avenue
Suite 505
Bethesda, MD   20814-6082
ncpie@ncpie.info
http://www.talkaboutrx.org
Tel: 301-656-8565
Fax: 301-656-4464
Coalition of nearly 150 organizations committed to safer, more effective medicine use through better communication. Additional website is www.bemedwise.org.

 
National Family Caregivers Association
10400 Connecticut Avenue
Suite 500
Kensington, MD   20895-3944
info@thefamilycaregiver.org
http://www.thefamilycaregiver.org
Tel: 301-942-6430 800-896-3650
Fax: 301-942-2302
Grassroots organization dedicated to supporting and improving the lives of America's family caregivers. Created to educate, support, empower, and advocate for the millions of Americans who care for their ill, aged, or disabled loved ones.

 
National Organization for Rare Disorders (NORD)
P.O. Box 1968
(55 Kenosia Avenue)
Danbury, CT   06813-1968
orphan@rarediseases.org
http://www.rarediseases.org
Tel: 203-744-0100 Voice Mail 800-999-NORD (6673)
Fax: 203-798-2291
Federation of voluntary health organizations dedicated to helping people with rare "orphan" diseases and assisting the organizations that serve them. Committed to the identification, treatment, and cure of rare disorders through programs of education, advocacy, research, and service.

 
International RadioSurgery Association
3002 N. Second Street
Harrisburg, PA   17110
office1@irsa.org
http://www.irsa.org
Tel: 717-260-9808
Fax: 717-260-9809
Proactive patient organization providing information and referrals on Gamma Knife, Linac, and particle beam radiosurgery for brain tumors, arteriovenous malformations (AVMs), and neurological pain and movement disorders.

 
Charlie Foundation to Help Cure Pediatric Epilepsy
1223 Wilshire Blvd.
Suite #815
Santa Monica, CA   90403
ketoman@aol.com
http://www.charliefoundation.org
Tel: 310-393-2347
Fax: 310-453-4585
Non-profit organization that raises money for scientific research focusing on the ketogenic diet. Offers education programs and materials for families and dieticians.

 
Epilepsy Therapy Development Project
11921 Freedom Drive
Suite 730
Reston, VA   20190
EpilepsyCure@aol.com
http://www.epilepsytdp.org
Tel: 703-437-4250
Fax: 703-437-4288
Nonprofit corporation that works to advance new treatments for people living with epilepsy. Supports innovative research in academia and industry. Provides information through the www.epilepsy.com website.

 
Antiepileptic Drug Pregnancy Registry
MGH East, CNY-149, 10th Floor
149 13th Street
Charlestown, MA   02129-2000
ebaldwin@partners.org
http://www.aedpregnancyregistry.org
Tel: 888-AED-AED4 (233-2334)
Fax: 617-724-8307
Registry designed to determine what therapies are associated with increased risk of harmful fetal effects. Participation is confidential.

 
Glossary

 
Note: Due to the large number of epilepsy syndromes and treatments, only a few are discussed in this booklet. Additional information may be available from your doctor, other health professionals, medical libraries, or by calling the NINDS Office of Communications and Public Liaison at the number provided on the Information Resources card in the back pocket of this brochure.
absence epilepsy
epilepsy in which the person has repeated absence seizures.
absence seizures
the type of seizure seen in absence epilepsy, in which the person experiences a momentary loss in consciousness. The person may stare into space for several seconds and may have some twitching or jerking of muscles.
ACTH (adrenocorticotropic hormone)
a substance that can be used to treat infantile spasms.
atonic seizures
seizures which cause a sudden loss of muscle tone, also called drop attacks.
auras
unusual sensations or movements that warn of an impending, more severe seizure. These auras are actually simple focal seizures in which the person maintains consciousness.
automatisms
strange, repetitious behaviors that occur during a seizure. Automatisms may include blinks, twitches, mouth movements, or even walking in a circle.
benign infantile encephalopathy
a type of epilepsy syndrome that occurs in infants. It is considered benign because it does not seem to impair cognitive functions or development.
benign neonatal convulsions
a type of epilepsy syndrome in newborns that does not seem to impair cognitive functions or development.
biofeedback
a strategy in which individuals learn to control their own brain waves or other normally involuntary functions. This is an experimental treatment for epilepsy.
celiac disease
an intolerance to wheat gluten in foods that can lead to seizures and other symptoms.
clonic seizures
seizures that cause repeated jerking movements of muscles on both sides of the body.
complex focal seizures
seizures in which only one part of the brain is affected, but the person has a change in or loss of consciousness.
convulsions
sudden contractions of the muscles that may be caused by seizures.
corpus callosotomy
surgery that severs the corpus callosum, or network of neural connections between the right and left hemispheres of the brain.
CT (computed tomography)
a type of brain scan that reveals the structure of the brain.
drop attacks
seizures that cause sudden falls; another term for atonic seizures.
dysplasia
areas of misplaced or abnormally formed neurons in the brain.
early myoclonic encephalopathy
a type of epilepsy syndrome that usually includes neurological and developmental problems.
eclampsia
a life-threatening condition that can develop in pregnant women. Its symptoms include sudden elevations of blood pressure and seizures.
electroencephalogram (EEG)
a test which uses electrodes to record brain waves.
epilepsy syndromes
disorders with a specific set of symptoms that include epilepsy.
excitatory neurotransmitters
nerve signaling chemicals that increase activity in neurons.
febrile seizures
seizures in infants and children that are associated with a high fever.
focal seizures
seizures that occur in just one part of the brain.
frontal lobe epilepsy
a type of epilepsy that originates in the frontal lobe of the brain. It usually involves a cluster of short seizures with a sudden onset and termination.
functional MRI (functional magnetic resonance imaging)
a type of brain scan that can be used to monitor the brain's activity and detect abnormalities in how it works.
GABA (gamma-aminobutyric acid)
an inhibitory neurotransmitter that plays a role in some types of epilepsy.
generalized seizures
seizures that result from abnormal neuronal activity in many parts of the brain. These seizures may cause loss of consciousness, falls, or massive muscle spasms.
glia
cells that regulate concentrations of chemicals that affect neuron signaling and perform other important functions in the brain.
glutamate
an excitatory neurotransmitter that may play a role in some types of epilepsy.
grand mal seizures
an older term for tonic-clonic seizures.
hemispheres
the right and left halves of the brain.
hippocampus
a brain structure important for memory and learning.
idiopathic epilepsy
epilepsy with an unknown cause.
infantile spasms
clusters of seizures that usually begin before the age of 6 months. During these seizures the infant may bend and cry out.
inhibitory neurotransmitters
nerve signaling chemicals that decrease activity in neurons.
intractable
about 20 percent of people with epilepsy will continue to experience seizures even with the best available treatment.
ion channels
molecular "gates" that control the flow of ions in and out of cells and regulate neuron signaling.
juvenile myoclonic epilepsy
a type of epilepsy characterized by sudden myoclonic jerks that usually begins in childhood or adolescence.
ketogenic diet
a strict diet rich in fats and low in carbohydrates that causes the body to break down fats instead of carbohydrates to survive.
kindling
a phenomenon in which a small change in neuronal activity, if it is repeated, can eventually lead to full-blown epilepsy.
LaFora's disease
a severe, progressive form of epilepsy that begins in childhood and has been linked to a gene that helps to break down carbohydrates.
Lennox-Gastaut syndrome
a type of epilepsy that begins in childhood and usually causes several different kinds of seizures, including absence seizures.
lesion
damaged or dysfunctional part of the brain or other parts of the body.
lesionectomy
removal of a specific brain lesion.
lobectomy
removal of a lobe of the brain.
magnetic resonance spectroscopy (MRS)
a type of brain scan that can detect abnormalities in the brain's biochemical processes.
magnetoencephalogram (MEG)
a type of brain scan that detects the magnetic signals generated by neurons to allow doctors to monitor brain activity at different points in the brain over time, revealing different brain functions.
metabolized
broken down or otherwise transformed by the body.
monotherapy
treatment with only one antiepileptic drug.
MRI (magnetic resonance imaging)
a type of brain scan that reveals the structure of the brain.
multiple sub-pial transection
a type of operation in which surgeons make a series of cuts in the brain that are designed to prevent seizures from spreading into other parts of the brain while leaving the person's normal abilities intact.
mutation
an abnormality in a gene.
myoclonic seizures
seizures that cause sudden jerks or twitches, especially in the upper body, arms, or legs.
near-infrared spectroscopy
a technique that can detect oxygen levels in brain tissue.
neocortical epilepsy
epilepsy that originates in the brain's cortex, or outer layer. Seizures can be either focal or generalized, and may cause strange sensations, hallucinations, or emotional changes.
neurocysticercosis
a parasitic infection of the brain that can cause seizures.
neurotransmitters
nerve signaling chemicals.
nonconvulsive
any type of seizure that does not include violent muscle contractions.
nonepileptic events
any phenomena that look like seizures but do not result from abnormal brain activity. Nonepileptic events may include psychogenic seizures or symptoms of medical conditions such as sleep disorders, Tourette syndrome, or cardiac arrythmia.
partial seizures
another term used to describe focal seizures, those that occur in just one part of the brain.
PET (photon emission tomography)
a type of brain scan that can be used to monitor the brain's activity and detect abnormalities in how it works.
petit mal seizures
an older term for absence seizures.
photosensitive epilepsy
epilepsy with seizures triggered by flickering or flashing lights. It also may be called photic epilepsy or photogenic epilepsy.
prednisone
a drug that can be used to treat infantile spasms.
progressive epilepsy
epilepsy in which seizures and/or the person's cognitive abilities get worse over time.
progressive myoclonus epilepsy
a type of epilepsy that has been linked to an abnormality in the gene that codes for a protein called cystatin B. This protein regulates enzymes that break down other proteins.
psychogenic seizure
a type of non-epileptic event that is caused by psychological factors.
Rasmussen's encephalitis
a progressive type of epilepsy in which half of the brain shows continual inflammation.
seizure focus
an area of the brain where seizures originate.
seizure threshold
a term that refers to a person's susceptibility to seizures.
seizure triggers
phenomena that trigger seizures in some people. Seizure triggers do not cause epilepsy but can lead to first seizures or cause breakthrough seizures in people who otherwise experience good seizure control with their medication.
simple focal seizures
seizures that affect only one part of the brain. People experiencing simple focal seizures remain conscious but may experience unusual feelings or sensations.
SPECT (single photon emission computed tomography)
a type of brain scan sometimes used to locate seizure foci in the brain.
status epilepticus
a potentially life-threatening condition in which a seizure is abnormally prolonged. Although there is no strict definition for the time at which a seizure turns into status epilepticus, most people agree that any seizure lasting longer than 5 minutes should, for practical purposes, be treated as though it was status epilepticus.
stereotyped
similar every time. In epilepsy this refers to the symptoms an individual person has, and the progression of those symptoms.
sudden unexplained death
death that occurs suddenly for no discernible reason. Epilepsy increases the risk of sudden explained death about two-fold.
temporal lobe epilepsy
the most common epilepsy syndrome with focal seizures.
temporal lobe resection
a type of surgery for temporal lobe epilepsy in which all or part of the affected temporal lobe of the brain is removed.
tonic seizures
seizures that cause stiffening of muscles of the body, generally those in the back, legs, and arms.
tonic-clonic seizures
seizures that cause a mixture of symptoms, including loss of consciousness, stiffening of the body, and repeated jerks of the arms and legs. In the past these seizures were sometimes referred to as grand mal seizures.
transcranial magnetic stimulation (TMS)
a procedure which uses a strong magnet held outside the head to influence brain activity. This is an experimental treatment for seizures.

Reference Links - Add a link

Clinical Trials - Add a clinical trial

Top  
1
Recruiting
Epilepsy Phenome/Genome Project
Conditions:
Epilepsy;   Localization-Related Epilepsy;   Infantile Spasms;   Lennox-Gastaut Syndrome 
Intervention:
 
 
 

 
2
Not yet recruiting
The Impact of Reducing Overtreatment on Quality of Life in Children With Refractory Epilepsy
Condition:
Intractable Epilepsy 
Interventions:
Other: Reduction of anti-epileptic medications;   Procedure: No drug change 
 
 

 
3
Recruiting
Language Mapping in Patients With Epilepsy
Conditions:
Epilepsy;   Epilepsy, Temporal Lobe;   Partial Epilepsy 
Intervention:
 
 
 

 
4
Recruiting
Study Comparing Best Medical Practice With or Without VNS Therapy in Pharmacoresistant Partial Epilepsy Patients
Conditions:
Epilepsy;   Partial Epilepsy;   Quality of Life 
Intervention:
Device: VNS Therapy system 
 
 

 
5
Recruiting
Ketogenic Diet vs.Antiepileptic Drug Treatment in Drug Resistant Epilepsy
Conditions:
Epilepsy;   Mental Retardation 
Interventions:
Dietary Supplement: Ketogenic diet;   Drug: Antiepileptic drug (AED) 
 
 

 
 
7
Recruiting
Search for Genes Influencing Childhood Absence Epilepsy Study
Conditions:
Childhood Absence Epilepsy;   Epilepsy;   Seizures 
Intervention:
 
 
 

 
8
Recruiting
Managing Epilepsy Well- WebEase Project
Condition:
Epilepsy 
Interventions:
Behavioral: WebEase;   Behavioral: WebEase 
 
 

 
9
Recruiting
Language and Emotional Function in Patients With Temporal Lobe Epilepsy
Conditions:
Epilepsy;   Temporal Lobe 
Intervention:
 
 
 

 
10
Recruiting
A Study of the Effects of JNJ-26489112 on the Photic Induced Paroxysmal Electroencepholgram (EEG) Response in Patients With Photosensitive Epilepsy
Conditions:
Reflex Epilepsy, Photosensitive;   Epilepsy 
Intervention:
Drug: JNJ-26489112 
 
 

 
11
Recruiting
Electrical Brain Stimulation to Reduce Epileptic Seizures
Condition:
Temporal Lobe Epilepsy 
Intervention:
 
 
 

 
12
Recruiting
Prevention of Post-Traumatic Seizures With Levetiracetam
Condition:
Epilepsy, Post-Traumatic 
Interventions:
Drug: Levetiracetam;   Drug: Placebo 
 
 

 
13
Recruiting
Brain Infusion of Muscimol to Treat Epilepsy
Condition:
Epilepsy 
Intervention:
Drug: Muscimol 
 
 

 
14
Recruiting
Evaluation and Treatment of Patients With Epilepsy
Condition:
Epilepsy 
Intervention:
 
 
 

 
15
Recruiting
Study of Specimens Obtained During Epilepsy Surgery
Condition:
Epilepsy 
Intervention:
 
 
 

 
16
Recruiting
P-Glycoprotein Inhibition as Adjunct Treatment for Medically Refractory Epilepsy.
Condition:
Epilepsy 
Intervention:
Drug: Carvedilol-CR 
 
 

 
17
Recruiting
Genetics of Rolandic Epilepsy
Condition:
Epilepsy 
Intervention:
 
 
 

 
18
Recruiting
Phase 3 Study to Evaluate Efficacy and Safety of Oxcarbazepine Extended-Release in Subjects With Refractory Partial Seizures Due to Epilepsy When Used With up to 2 Other Antiepileptic Drugs.
Condition:
Epilepsy 
Interventions:
Drug: Placebo;   Drug: Oxcarbazepine Extended Release;   Drug: Oxcarbazepine Extended Release 
 
 

 
19
Recruiting
Efficacy of YKP3089 in Patients With Photosensitive Epilepsy
Condition:
Epilepsy 
Intervention:
Drug: YKP3089 
 
 

 
20
Recruiting
fMRI Investigation of Depression in Patients With Epilepsy
Conditions:
Epilepsy;   Depression 
Intervention:
 
 
 

 
21
Not yet recruiting
Verapamil and Catamenial Epilepsy
Condition:
Catamenial Epilepsy 
Intervention:
Drug: verapamil hyrochloride 
 
 

 
22
Not yet recruiting
 

 
23
Recruiting
Bipolar Disorder in Epilepsy
Conditions:
Epilepsy;   Bipolar Disorder 
Intervention:
 
 
 

 
24
Recruiting
Cardiac Rhythm Abnormalities in Patients With Refractory Epilepsy at High Risk for Sudden Death
Conditions:
Refractory Epilepsy;   Arrhythmia;   Sudden Death 
Intervention:
Device: Medtronic REVEAL 
 
 

 
25
Recruiting
 

 
26
Recruiting
Randomized Controlled Trial of Hippocampal Stimulation for Temporal Lobe Epilepsy
Condition:
Temporal Lobe Epilepsy 
Intervention:
Procedure: Hippocampal Electrical Stimulation 
 
 

 
27
Recruiting
Emotional Processing and Memory Evaluation in Epilepsy Patients
Condition:
Epilepsy 
Intervention:
Behavioral: neuropsychological evaluation 
 
 

 
28
Recruiting
STIMEP : Assessment of Subthalamic Nucleus Stimulation in Drug Resistant Epilepsy
Conditions:
Epilepsy;   Drug Resistant 
Intervention:
Device: High frequency neurostimulation of subthalamic nucleus : quadrupolar electrode, type 3389, n° : I7 02 08 39709 158, Medtronic, Minneapolis, USA 
 
 

 
29
Recruiting
Pilot Trial of a Behavioral Treatment for Epilepsy
Condition:
Epilepsies, Partial 
Intervention:
Behavioral: Andrews/Reiter behavioral treatment for epilepsy 
 
 

 
30
Recruiting
A Study on the Effectiveness and Safety of Diazepam Injection (Vanquix™) for Patients With Epilepsy That Receive Antiepileptic Drugs, But Still Experience Acute Repetitive Seizures (Bouts or Clusters of Seizures) That Require Treatment
Conditions:
Epilepsy;   Epilepsy, Generalized;   Epilepsy, Complex Partial;   Epilepsies, Partial;   Seizures 
Interventions:
Drug: Diazepam;   Drug: Placebo 
 
 

 
31
Recruiting
Spanish Validation Of Quality of Life Questionnaire (QOLIE-10) For Epilepsy
Condition:
Epilepsy 
Interventions:
Drug: lamotrigine;   Drug: valproic acid 
 
 

 
32
Recruiting
Lamotrigine Extended-Release In Elderly Patients With Epilepsy
Condition:
Epilepsy 
Intervention:
Drug: Lamotrigine 
 
 

 
33
Recruiting
COPE Intervention for Parents of Children With Epilepsy
Condition:
Epilepsy 
Interventions:
Behavioral: COPE (Creating Opportunities for Parent Empowerment);   Behavioral: Standard education 
 
 

 
34
Recruiting
EXTENT: EXtended Tolerability and Efficacy of a Novel Formulation of Oxcarbazepine in a Trial in Partial Epilepsy
Condition:
Partial Epilepsy 
Intervention:
Drug: modified release formulation of oxcarbazepine (OXC MR) 
 
 

 
35
Recruiting
Yoga for Patients With Epilepsy
Condition:
Epilepsy 
Intervention:
Behavioral: Yoga 
 
 

 
36
Recruiting
Internet Administration of the Modified Atkins Diet for Adults With Intractable Epilepsy
Condition:
Epilepsy 
Intervention:
Behavioral: Dietary management of seizures 
 
 

 
37
Recruiting
Efficacy of Modified Ketogenic Diet (Atkins) in Management of Epilepsy
Condition:
Epilepsy 
Interventions:
Behavioral: atkins diet;   Behavioral: ability to follow low carbohydrate diet 
 
 

 
38
Recruiting
Atkins Plus KetoCal for Childhood Epilepsy
Condition:
Epilepsy 
Intervention:
Dietary Supplement: Modified Atkins diet and KetoCal 
 
 

 
39
Recruiting
Transcranial Magnetic Stimulation and Anti-Epileptic Effect: Optimization and Evaluation With Electrophysiology.
Condition:
Refractory Frontal Lobe Epilepsy 
Intervention:
Device: cortical magnetic stimulation provided by an eight-shaped coïl placed upon the skull. 
 
 

 
40
Recruiting
Human Epilepsy Genetics--Neuronal Migration Disorders Study
Conditions:
Epilepsy;   Seizures;   Cognition Disorders;   Neuronal Migration Disorders 
Intervention:
 
 
 

 
41
Recruiting
Hormone Profiles in Adults With Newly Diagnosed Epilepsy
Condition:
Epilepsy 
Interventions:
Drug: Sodium valproate;   Drug: Lamotrigine 
 
 

 
42
Recruiting
Combined Role of Position Emission Tomography (PET) and Magnetoencephalography (MEG) in Nonlesional Epilepsy
Condition:
Epilepsy 
Interventions:
Device: magnetoencephalography;   Device: Positron emission tomography (PET);   Device: Magnetic resonance imaging 
 
 

 
43
Recruiting
Lamotrigine Versus Levetiracetam in the Initial Monotherapy of Epilepsy
Condition:
Epilepsy 
Interventions:
Drug: Lamotrigine;   Drug: Levetiracetam 
 
 

 
44
Recruiting
Study of Phenobarbital Inhibition of Catamenial Epilepsy
Condition:
Epilepsy 
Intervention:
Drug: Phenobarbital 
 
 

 
45
Recruiting
Preventing Epilepsy After Traumatic Brain Injury With Topiramate
Conditions:
Traumatic Brain Injury;   Epilepsy 
Interventions:
Drug: topiramate;   Drug: topiramate;   Drug: phenytoin 
 
 

 
46
Recruiting
 

 
 
48
Recruiting
Progesterone vs Placebo Therapy for Women With Epilepsy
Condition:
Epilepsy 
Intervention:
Biological: Natural Progesterone 
 
 

 
49
Recruiting
 

 
50
Recruiting
Mapping of the Epileptic Brain
Condition:
Epilepsy 
Intervention:
 
 
 

 
52
Not yet recruiting
Study on Migraine and Headache in Epileptic Patients
Condition:
Epilepsy 
Intervention:
 
 
 

 
53
Recruiting
Evaluating the Transporter Protein Inhibitor Probenecid In Patients With Epilepsy
Condition:
Epilepsy 
Interventions:
Drug: phenytoin;   Drug: phenytoin and probenecid 
 
 

 
54
Recruiting
MRI in Autosomal Dominant Partial Epilepsy With Auditory Features
Condition:
Epilepsies, Partial 
Intervention:
 
 
 

 
 
56
Recruiting
Escitalopram Treatment of Major Depression in Patients With Temporal Lobe Epilepsy
Conditions:
Major Depression;   Temporal Lobe Epilepsy 
Interventions:
Drug: escitalopram;   Drug: placebo 
 
 

 
57
Recruiting
The Role of Serotonin in Seizures
Condition:
Epilepsy 
Intervention:
 
 
 

 
58
Recruiting
 

 
59
Not yet recruiting
Evaluation of Functional MRI and DTI (Imaging Techniques) in Children With Epilepsy and Focal Brain Lesions
Conditions:
Epilepsy;   Focal Brain Lesion 
Intervention:
Procedure: Functional MRI, Diffusion Tensor Imaging 
 
 

 
60
Recruiting
Efficacy and Safety of Adjunctive Zonisamide in Myoclonic Seizures Associated With Idiopathic Generalized Epilepsy
Condition:
Epilepsy 
Interventions:
Drug: Zonisamide;   Drug: Placebo 
 
 

 
61
Recruiting
Methylphenidate for Treating Attention Deficit Hyperactivity Disorder in Children With Both ADHD and Epilepsy
Conditions:
Attention Deficit Disorder With Hyperactivity;   Epilepsy 
Intervention:
Drug: Extended Release Methylphenidate (OROS-Methylphenidate) 
 
 

 
62
Recruiting
Trial Comparing Different Stimulation Paradigms in Patients Treated With Vagus Nerve Stimulation for Refractory Epilepsy
Condition:
Epilepsy 
Interventions:
Device: Vagus nerve stimulation paradigm #1;   Device: Vagus nerve stimulation paradigm #2;   Device: Vagus nerve stimulation paradigm #3 
 
 

 
63
Recruiting
Premenstrual Dysphoric Disorder and Antiepileptic Drugs
Condition:
Epilepsy 
Intervention:
 
 
 

 
64
Recruiting
Study on the Treatment of Elderly Patients With Older and Newer Antiepileptic Drugs
Condition:
Focal Epilepsy 
Interventions:
Drug: levetiracetam;   Drug: carbamazepine slow release;   Drug: lamotrigine 
 
 

 
65
Recruiting
Study of Intranasal Clonazepam in Adult Subjects With Epileptic Seizures
Condition:
Epilepsy 
Intervention:
Drug: Clonazepam 
 
 

 
66
Recruiting
Functional Magnetic Resonance Imaging (fMRI) Study of Memory in Children
Condition:
Childhood Epilepsy 
Intervention:
Behavioral: Study of memory using MRI 
 
 

 
67
Recruiting
Relationship of HHV-6B Virus to Seizures and Brain Injury
Conditions:
Epilepsy;   HHV6B Infection 
Intervention:
 
 
 

 
68
Recruiting
Study Of The Safety And Efficacy Of Lyrica In The Treatment Of Newly Diagnosed Partial Epilepsy
Condition:
Epilepsy, Partial 
Interventions:
Drug: Pregabalin;   Drug: Lamotrigine 
 
 

 
69
Recruiting
HEAD-Study Optimizing the Treatment of Children With BECTS
Condition:
Epilepsy, Rolandic 
Intervention:
Drug: Treatment with levetiracetam or sulthiame over a six-month period. 
 
 

 
70
Recruiting
Why Are Patients With Absence Seizures Absent? A Brain Imaging Study
Condition:
Childhood Absence Epilepsy 
Intervention:
 
 
 

 
 
72
Recruiting
"Electroencephalography (EEG) and Deep Brain Stimulation (DBS) in Epilepsy"
Condition:
Epilepsy 
Intervention:
Procedure: computer-assisted analysis of the digitally-recorded EEG signals 
 
 

 
73
Recruiting
RNS™ System Pivotal Clinical Investigation
Condition:
Epilepsy 
Intervention:
Device: Responsive Neurostimulator System 
 
 

 
74
Recruiting
A Study of the Effectiveness, Safety, and Tolerability of Carisbamate as Add-On Therapy in Patients With Partial Onset Seizures.
Conditions:
Epilepsy, Simple Partial;   Focal Motor Epilepsy;   Epilepsy, Complex Partial;   Epilepsy, Partial, Motor 
Interventions:
Drug: placebo;   Drug: Carisbamate;   Drug: Carisbamate 
 
 

 
75
Recruiting
An Open-Label Extension Study of the Safety and Tolerability of Carisbamate as Add-On Therapy in Patients With Partial Onset Seizures
Conditions:
Epilepsy, Complex Partial;   Focal Motor Epilepsy;   Epilepsy, Simple Partial;   Epilepsy, Partial, Motor 
Interventions:
Drug: placebo;   Drug: carisbamate 
 
 

 
76
Recruiting
Trial of Levetiracetam in Patients With Primary Brain Tumors and Symptomatic Seizures Who Undergo Surgery
Conditions:
Primary Brain Tumor;   Epilepsy 
Intervention:
Drug: levetiracetam 
 
 

 
77
Recruiting
Effects of Keppra on Thinking, Emotions, and Balance in Elderly Healthy Volunteers
Condition:
Epilepsy 
Intervention:
Drug: Levetiracetam (Keppra) 
 
 

 
78
Recruiting
Effect of Valproic Acid Concentration on Photic Response
Condition:
Photosensitive Epilepsy 
Intervention:
Drug: sodium valproate 
 
 

 
79
Recruiting
Coping Skills Training (CST) for Children With Chronic Health Conditions
Conditions:
Rheumatologic Conditions;   Epilepsy;   Spina Bifida 
Intervention:
Behavioral: Coping Skills Training 
 
 

 
 
81
Recruiting
Tolerability and Efficacy of Depakote-ER in the Elderly
Conditions:
Elderly;   Epilepsy;   Seizures 
Intervention:
Drug: Divalproex Sodium Extended-Release Tablets 
 
 

 
82
Recruiting
Efficacy And Safety Study Of Pregabalin (Lyrica) As Monotherapy In Patients With Partial Seizures
Condition:
Epilepsies, Partial 
Interventions:
Drug: pregabalin 600 mg/day;   Drug: pregabalin 150 mg/day 
 
 

 
83
Recruiting
Developing Criteria for Cortical Resections
Conditions:
Epilepsy;   Tumor 
Intervention:
Procedure: Tissue sample (procedure/screening) 
 
 

 
84
Recruiting
Clobazam in Patients With Lennox-Gastaut Syndrome
Conditions:
Epilepsy;   Epilepsy, Generalized;   Seizures 
Interventions:
Drug: Clobazam;   Other: placebo 
 
 

 
 
 
87
Recruiting
Use of the Atkins Diet for Children With Sturge Weber Syndrome
Conditions:
Epilepsy;   Sturge Weber Syndrome 
Intervention:
Dietary Supplement: modified Atkins diet 
 
 

 
88
Recruiting
Pregabalin Versus Levetiracetam In Partial Seizures
Conditions:
Partial Seizures;   Epilepsies, Partial;   Partial Seizure Disorder;   Complex Partial Seizure Disorder;   Epilepsy 
Interventions:
Drug: pregabalin;   Drug: levetiracetam 
 
 

 
89
Recruiting
Comparative Study of Pregabalin and Gabapentin as Adjunctive Therapy in Subjects With Partial Seizures
Conditions:
Epilepsy;   Partial Seizure Disorder;   Epilepsies, Partial;   Complex Partial Seizure Disorder 
Interventions:
Drug: Pregabalin;   Drug: Gabapentin 
 
 

 
 
91
Not yet recruiting
Efficacy and Safety of Adjunctive Zonisamide in Paediatric Partial Onset Seizures (CATZ Study)
Condition:
Epilepsy; Paediatric Partial Onset Seizures 
Intervention:
Drug: Zonisamide 
 
 

 
92
Not yet recruiting
Study of Algorhithm for Epilepsy Alert Device
Condition:
Motor Seizures 
Intervention:
 
 
 

 
93
Recruiting
Visual Field Assessment With Subjects Who Receive Either Lyrica Or Sugar Pills
Condition:
Epilepsies, Partial 
Interventions:
Drug: Lyrica (pregabalin);   Drug: placebo 
 
 

 
94
Recruiting
Compare Tolerability of an Overnight Switch to Gradual Switch Between Two Different Forms of Depakote
Conditions:
Epilepsy;   Behavioral Disturbance 
Intervention:
Procedure: Rapid versus slow conversion 
 
 

 
95
Recruiting
Controlled Randomized Stimulation Versus Resection (CoRaStiR)
Condition:
Epilepsy 
Intervention:
Device: Implantation of an intracranial electrode 
 
 

 
96
Recruiting
 

 
97
Recruiting
Adjunctive Zonisamide in Primary Generalized Tonic Clonic Seizures
Condition:
Epilepsy 
Interventions:
Drug: Zonisamide;   Drug: Placebo 
 
 

 
98
Recruiting
Trial to Assess the Safety of a Single Dose of iv Lacosamide Followed by Twice Daily Oral Lacosamide in Patients With Partial-Onset Seizures
Condition:
Partial Epilepsies 
Interventions:
Drug: lacosamide;   Drug: lacosamide;   Drug: lacosamide;   Drug: lacosamide 
 
 

 
99
Recruiting
The Efficacy and Safety of Low Dose Combination of LTG and VPA Compared to CBZ Monotherapy
Condition:
Epilepsy 
Interventions:
Drug: lamotrigine+valproate;   Drug: carbamazepine 
 
 

 
100
Not yet recruiting
Ph. I Dasatinib/Protracted Temozolomide in Recurrent Malignant Glioma
Conditions:
Glioblastoma Multiforme;   Gliosarcoma;   Anaplastic Astrocytoma;   Anaplastic Oligodendroglioma;   Glioma 
Interventions:
Other: enzyme-inducing anti-epileptic drugs;   Other: enzyme-inducing anti-epileptic drugs 
 
 

 
102
Recruiting
Determination of Absorption and Elimination of Lamotrigine-XR
Conditions:
Epilepsy;   Seizures;   Bipolar Disorder;   Bipolar Depression 
Intervention:
 
 
 

 
103
Recruiting
UCB Antiepileptic Drugs (AED) Pregnancy Registry (Formerly the Keppra® Pregnancy Registry)
Conditions:
Birth Defects;   Pregnancy Complications;   Epilepsy;   Seizures 
Intervention:
 
 
 

 
104
Recruiting
Trial to Demonstrate the Efficacy and Safety of Conversion to Lacosamide Monotherapy for Partial-Onset Seizures
Condition:
Epilepsy 
Interventions:
Drug: lacosamide;   Drug: lacosamide 
 
 

 
105
Recruiting
Transcranial Direct Current Stimulation (tDCS) As A Tool For Prospective Responder Identification Before VNS Implantation
Conditions:
Epilepsy;   Electroencephalography;   Seizure Frequency;   Seizure Severity 
Intervention:
Procedure: transcranial direct current stimulation 
 
 

 
 
107
Recruiting
Comparing The Effect On Cognition Of Adjunctive Therapy With Zonisamide Versus Sodium Valproate
Condition:
Epilepsy 
Interventions:
Drug: Zonisamide;   Drug: Sodium valproate 
 
 

 
108
Recruiting
Rufinamide Given as Adjunctive Therapy in Patients With Refractory Partial Seizures
Condition:
Epilepsy 
Interventions:
Drug: Placebo;   Drug: Rufinamide 
 
 

 
109
Recruiting
A Quality of Life Study in Patients With Migraines
Conditions:
Migraine;   Headache;   Depression 
Intervention:
 
 
 

 
110
Recruiting
Safety, Tolerability, and Pharmacokinetic Study of Pregabalin in Pediatric Patients With Partial Onset Seizures
Condition:
Epilepsies, Partial 
Interventions:
Drug: Placebo;   Drug: Pregabalin 
 
 

 
111
Recruiting
 

 
112
Not yet recruiting
A Post-Marketing Clinical Pharmakokinetics Study Of Gabapentin In Japanese Epileptic Subjects With Renal Impairment
Condition:
Renal Impairment 
Interventions:
Drug: Gabapentin;   Drug: Gabapentin;   Drug: Gabapentin 
 
 

 
113
Recruiting
Pregabalin In Partial Seizures (PREPS): An Open-Label, Multicenter Add On Therapy Trial
Conditions:
Epilepsies, Partial;   Partial Seizure 
Intervention:
Drug: Pregabalin 
 
 

 
 
115
Recruiting
Phenytoin and Driving Safety
Conditions:
Cognitive Measures;   Driving Simulator Performance 
Intervention:
Drug: Phenytoin 
 
 

 
116
Recruiting
Brain Development Research Program
Conditions:
Brain Disorders;   Aicardi Syndrome 
Intervention:
 
 
 

 
117
Recruiting
Efficacy of Tacrolimus and i.v.-Immunoglobulins in Rasmussen Encephalitis
Condition:
Rasmussen Encephalitis 
Interventions:
Drug: Tacrolimus;   Drug: i.v. immunoglobulins 
 
 

 
118
Recruiting
Safety Study Of Intravenous Levetiracetam
Condition:
Seizures 
Interventions:
Drug: levetiracetam;   Drug: levetiracetam;   Drug: levetiracetam 
 
 

 
119
Recruiting
Levetiracetam Versus Carbamazepine in Post-Stroke Late Onset Crisis
Conditions:
Epileptic Seizures;   Stroke 
Interventions:
Drug: Levetiracetam;   Drug: Carbamazepine 
 
 

 
120
Not yet recruiting
Neonatal Brain Waves After Electrocoagulation
Condition:
Epilepsy 
Intervention:
 
 
 

 
121
Recruiting
Pharmacokinetics and Safety of Intravenous Topiramate in Adult Patients
Conditions:
Epilepsy;   Migraines 
Intervention:
Drug: intravenous topiramate 
 
 

 
122
Recruiting
Conversion to Monotherapy Study With Keppra XR for Partial Seizures
Condition:
Epilepsy 
Interventions:
Drug: Levetiracetam XR;   Drug: Levetiracetam XR 
 
 

 
123
Recruiting
Evaluation of the Efficacy and Safety of E2007 (Perampanel) Given as Adjunctive Therapy in Subjects With Refractory Partial Seizures
Condition:
Epilepsy 
Interventions:
Drug: Perampanel;   Drug: Perampanel;   Drug: Perampanel;   Drug: Perampanel;   Drug: Perampanel;   Drug: Perampanel 
 
 

 
124
Recruiting
Human Tissue Distribution of Orally Supplemented Natural Vitamin E Tocotrienol
Conditions:
End-Stage Heart Failure;   End-Stage Pulmonary Failure;   End Stage Liver Failure;   Morbid Obesity;   Recalcitrant Epilepsy Requiring Surgery;   Healthy Subjects 
Interventions:
Dietary Supplement: Vitamin E, Tocotrienol or Tocopherol;   Dietary Supplement: Tocotrienol or Tocopherol 
 
 

 
125
Recruiting
 

 
126
Recruiting
 

 
127
Recruiting
Levetiracetam Treatment of Children With Subclinical Sleep-Activated Epileptiform Activity (SSEA)
Conditions:
Subclinical Sleep-Activated Epileptiform Activity;   CSWS 
Intervention:
Drug: levetiracetam 
 
 

 
128
Recruiting
Characteristics of Blood- Brain Barrier Permeability in Neurological Patients
Conditions:
Traumatic Brain Injury;   Cerebral Infarction;   Cerebral Hemorrhage 
Intervention:
 
 
 

 
129
Recruiting
Psychiatric Correlates of Psychogenic Movement Disorder and Non-Epileptic Seizure
Conditions:
Psychogenic Movement Disorders;   Non-Epileptic Seizures 
Intervention:
 
 
 

 
130
Recruiting
Evaluating the Efficacy and Safety of E2007 (Perampanel) Given as Adjunctive Therapy in Subjects With Refractory Partial Seizures
Condition:
Refractory Partial Seizures 
Interventions:
Drug: E2007 (Perampanel);   Drug: E2007 (Perampanel);   Drug: Placebo 
 
 

 
131
Recruiting
Open-Label Extension Study of Rufinamide Given as Adjunctive Therapy in Patients With Refractory Partial Seizures
Condition:
Refractory Partial Onset Seizures 
Intervention:
Drug: Rufinamide 
 
 

 
132
Recruiting
Cognitive Behavioural Therapy in Dissociative Seizures
Condition:
Dissociative Seizures 
Interventions:
Behavioral: CBT;   Behavioral: Standard Care 
 
 

 
133
Recruiting
To Evaluate The Efficacy and Safety of E2007 (Perampanel) Given as Adjunctive Therapy in Subjects With Refractory Partial Seizures
Condition:
Refractory Partial Seizures 
Interventions:
Drug: E2007 (Perampanel);   Drug: E2007 (Perampanel);   Drug: Placebo 
 
 

 
134
Recruiting
Ph II Avastin + Bortezomib for Pts w Recurrent Malignant Glioma
Conditions:
Glioblastoma;   Gliosarcoma 
Intervention:
Drug: Avastin and Bortezomib 
 
 

 
135
Recruiting
High Dose CPT-11 in Recurrent Unresectable Malignant Glioma
Conditions:
Malignant Glioma;   Unresectable 
Interventions:
Drug: Irinotecan;   Drug: CPT-11;   Drug: Camptosar 
 
 

 
136
Recruiting
PTK787/ZK 222584 in Combination With Temozolomide and Radiation in Patients With Glioblastoma Taking Enzyme-Inducing Anti-Epileptic Drugs
Condition:
Glioblastoma 
Interventions:
Drug: PTK787/ZK 222584;   Drug: Temozolomide;   Procedure: Radiation Therapy 
 
 

 
137
Recruiting
PET Imaging of Peripheral Benzodiazepine Receptors in Patients With Neurocysticercosis Using [C-11]PBR28
Conditions:
Neurocysticercosis;   Healthy 
Intervention:
Drug: [C-11]PBR28 
 
 

 
138
Recruiting
Evaluation and Treatment of Neurosurgical Disorders
Condition:
Neurologic Disorders 
Intervention:
 
 
 

 
139
Recruiting
PET Imaging of Peripheral Benzodiazepine Receptors in Patients With Neurocysticercosis Using [F-18]FB
Conditions:
Neurocysticercosis;   Healthy 
Intervention:
Drug: [F-18]FBR 
 
 

 
140
Recruiting
Erlotinib and Sirolimus in Treating Patients With Recurrent Malignant Glioma
Condition:
Brain and Central Nervous System Tumors 
Interventions:
Drug: erlotinib hydrochloride;   Drug: sirolimus;   Procedure: biopsy;   Procedure: gene expression analysis;   Procedure: high performance liquid chromatography;   Procedure: immunohistochemistry staining method;   Procedure: mutation analysis;   Procedure: pharmacological study;   Procedure: polymerase chain reaction;   Procedure: polymorphism analysis 
 
 

 
141
Recruiting
Cediranib, Temozolomide, and Radiation Therapy in Treating Patients With Newly Diagnosed Glioblastoma
Condition:
Brain and Central Nervous System Tumors 
Interventions:
Drug: cediranib maleate;   Drug: temozolomide;   Procedure: adjuvant therapy;   Procedure: diffusion tensor imaging;   Procedure: diffusion-weighted magnetic resonance imaging;   Procedure: dynamic contrast-enhanced magnetic resonance imaging;   Procedure: immunoenzyme technique;   Procedure: immunohistochemistry staining method;   Procedure: intensity-modulated radiation therapy;   Procedure: laboratory biomarker analysis;   Procedure: proteomic profiling 
 
 

 
142
Not yet recruiting
Antiepileptic Drugs and Vascular Risk Markers
Condition:
Subarachnoid Hemorrhage 
Interventions:
Drug: phenytoin;   Drug: valporate;   Drug: levetiracetam 
 
 

 
143
Not yet recruiting
 

 
144
Not yet recruiting
Observational Study of Cortical Spreading Depression in Human Brain Trauma
Condition:
Traumatic Brain Injury 
Intervention:
 
 
 

 
145
Not yet recruiting
Lithium and Acetate for Canavan Disease
Conditions:
Canavan Disease;   Infantile;   Deficiency Disease;   Aspartoacylase;   Leukodystrophy, Spongiform 
Intervention:
Drug: Lithium Gluconate (drug) Glyceryl Triacetate GTA (drug) 
 
 

 
146
Recruiting
Physiologic Studies of Spasticity
Conditions:
Muscle Spasticity;   Healthy 
Intervention:
 
 
 

 
147
Recruiting
PET Imaging of P-Glycoprotein Function Using [11C]dLop
Condition:
Healthy 
Intervention:
 
 
 

 
148
Recruiting
Constitution of a Standardized Neural Imaging Database in Healthy Subjects
Condition:
Healthy 
Intervention:
Procedure: SPET, PET and MRI 
 
 

 
149
Not yet recruiting
Valproic Acid-Associated Hypoalbuminemia in Medically Fragile Patients
Condition:
Hypoalbuminemia 
Intervention:
Procedure: Specimen collection 
 
 

 
150
Not yet recruiting
 
151
Recruiting
Folic Acid Supplementation in Phenytoin Induced Gingival Overgrowth
Condition:
Gingival Overgrowth 
Interventions:
Drug: folic acid;   Drug: placebo 
 
 

 
152
Recruiting
Ph I Dasatinib + Erlotinib in Recurrent MG
Conditions:
Glioblastoma;   Gliosarcoma 
Intervention:
Drug: Erlotinib and Dasatinib 
 
 

 
153
Recruiting
Ph I Dose Escalation Trial of Vandetanib in Combo w Etoposide for Malignant Gliomas
Conditions:
Gliosarcoma;   Glioblastoma 
Intervention:
Drug: Vandetanib and Etoposide 
 
 

 
154
Recruiting
Ph I Zactima + Imatinib Mesylate & Hydroxyurea for Pts w Recurrent MG
Conditions:
Glioblastoma;   Gliosarcoma 
Intervention:
Drug: Zactima, Gleevec, Hydroxyurea 
 
 

 
155
Recruiting
Ketogenic Diet for Recurrent Glioblastoma
Condition:
Recurrent Glioblastoma 
Intervention:
Dietary Supplement: TAVARLIN 
 
 

 
156
Recruiting
Gabapentin for Smoking Cessation
Conditions:
Cigarette Smoking;   Tobacco Use 
Intervention:
Drug: gabapentin 
 
 

 
157
Not yet recruiting
Amitriptyline or Pregabalin to Treat Neuropathic Pain in Incurable Cancer
Conditions:
Cancer;   Neuralgia 
Interventions:
Drug: amitriptyline;   Drug: pregabalin 
 
 

 
158
Recruiting
 

 
 
160
Recruiting
Study of Selected X-Linked Disorders: Aicardi Syndrome
Conditions:
Aicardi Syndrome;   Brain Disorders 
Intervention:
 
 
 

 
161
Recruiting
Investigation of Simvastatin in Secondary Progressive Multiple Sclerosis
Condition:
Secondary Progressive Multiple Sclerosis 
Interventions:
Drug: Simvastatin;   Drug: Placebo 
 
 

 
162
Recruiting
Phase (Ph) II Bevacizumab + Erlotinib for Patients (Pts) With Recurrent Malignant Glioma (MG)
Conditions:
Glioblastoma;   Gliosarcoma 
Intervention:
Drug: Bevacizumab and Erlotinib 
 
 

 
163
Recruiting
IV Levetiracetam for the Treatment of Neonatal Seizures: a Pharmacokinetic and Preliminary Efficacy and Safety Study
Conditions:
Seizures;   Term Neonates 
Intervention:
Drug: Intravenous levetiracetam 
 
 

 
164
Not yet recruiting
Evaluating Efficacy and Safety of E2007 (Perampanel) Given as Adjunctive Therapy in Subjects With Refractory Partial Seizures
Condition:
Refractory Partial Seizures 
Interventions:
Drug: perampanel;   Drug: perampanel;   Drug: perampanel;   Drug: Placebo 
 
 

 
165
Recruiting
Treatment of Refractory Status Epilepticus
Condition:
Status Epilepticus 
Interventions:
Drug: propofol;   Drug: thiopental/pentobarbital 
 
 

 
166
Not yet recruiting
 

 
167
Recruiting
Nasal Versus Venous Lorazepam for Control of Acute Seizures in Children
Conditions:
Status Epilepticus;   Seizures 
Interventions:
Drug: Lorazepam;   Drug: Lorazepam 
 
 

 
168
Not yet recruiting
Efficacy of Keppra in Acute Alcohol Related Seizure Control--A Pilot Study
Condition:
Seizure, Alcohol Related 
Intervention:
Drug: levetiracetam 
 
 

 
169
Recruiting
Intravenous Levetiracetam as First-Line Anticonvulsive Treatment in Patients With Non-Convulsive Status Epilepticus
Condition:
Status Epilepticus, Non-Convulsive 
Intervention:
Drug: first-line i/v-levetiracetam 
 
 

 
170
Recruiting
Safety and Tolerability Study of Levetiracetam to Treat Patients With Status Epilepticus
Condition:
Status Epilepticus 
Intervention:
Drug: levetiracetam (add-on) 
 
 

 
171
Recruiting
Seizure Therapy With Intravenous Levetiracetam and Lorazepam
Condition:
Seizures 
Interventions:
Drug: Levetiracetam 1 g IV + Lorazepam 2 mg IV;   Drug: Placebo + Lorazepam 3 mg IV 
 
 

 
172
Not yet recruiting
Paramedic Treatment of Prolonged Seizures by Intramuscular Versus Intravenous Anticonvulsant Medications
Condition:
Status Epilepticus 
Intervention:
Other: Route of administration 
 
 

 
173
Recruiting
Blood Sugars in Children With Idiopathic Seizures.
Conditions:
Seizures;   Hypoglycemia;   Hyperammonemia 
Intervention:
 
 
 

 
174
Recruiting
Treatments for Psychogenic Nonepileptic Seizures (NES)
Conditions:
Convulsion, Non-Epileptic;   Conversion Disorder;   Depression;   Stress Disorders, Post-Traumatic 
Intervention:
Drug: sertraline 
 
 

 
175
Recruiting
Efficacy and Safety Study Comparing Lorazepam and Diazepam for Children in the Emergency Department With Seizures
Condition:
Status Epilepticus 
Intervention:
Drug: lorazepam or diazepam 
 
 

 
176
Recruiting
Neurobiology of Psychogenic Movement Disorder and Non-Epileptic Seizures
Conditions:
Psycogenic Movement Disorders;   Non-Epileptic Seizures 
Intervention:
 
 
 

 
177
Recruiting
Corticosteroids to Treat Neurocysticercosis
Conditions:
Seizures;   Neurocysticercosis;   Cysticercosis 
Intervention:
Drug: Dexamethasone