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Tuesday, December 10, 2013
Are all seizures epilepsy?
My sister had several grand mal seizures about 8 or 9 years ago. She saw a neurologist who put her on anti-seizure medication. She never had another one. She recently told me that she stopped taking the medication almost 4 yrs ago and she hasn't had any seizures since she went off it. So what does this mean? Does this mean she doesn't have epilepsy after all? Or never did have it? Or had it and got over it? Or that she might have a seizure again any moment? Is it safe for her to be driving without being on medication? If she doesn't have epilepsy, what else would cause her to have those grand mal seizures? I am worried about her.
The diagnosis of `epilepsy` is applied when a person has two or more seizures that are not provoked. Thus, your sister likely had epilepsy. The majority of people with epilepsy respond (become seizure-free) with the first or second anti-seizure medication used. Some patients with epilepsy are able to successfully be tapered off of their medications and continue to be free of seizures.
In addition there are some epilepsy syndromes that are considered `benign` - that is the seizures remit after a period of time. The diagnosis of these syndromes are based on the age of seizure onset, type of seizure and EEG and MRI data. Most people with epilepsy may drive after their seizures are controlled after 3 to 6 months. Studies suggest that someone will likely remain free of seizures after a 3 to 6 month seizure-free period. Although someone may be seizure-free for years, a patient may have a slightly higher risk of having another seizure than someone who has never had a seizure. A patient should avoid situations that may provoke a seizure such as sleep deprivation or excessive alcohol use.
David M Ficker, MD
College of Medicine
University of Cincinnati