Epilepsy Clinic

Conditions & Treatments

• Seizures & Driving

  In Connecticut, no specific period of seizure freedom is required by law before you are allowed to drive. The laws vary in neighboring states, as Massachusetts has a 6-month restriction, New York has one year, and Rhode Island requires you to be seizure-free for 18 months before resuming driving. Your physician may recommend that you should not drive for 3 to 6 months after a seizure for safety reasons. Get more information from the Epilepsy Foundation on driving information for other states.

• Causes of Seizures

  Seizures can be triggered by various factors, including:

  • Alcohol
  • Head trauma
  • Infections
  • Medication use or withdrawal
  • Strokes
  • Toxins
  • Tumors

  Sometimes, seizures can be inherited, and a number of genetic disorders or subtle brain malformations can cause seizures. Our team is skilled at investigating the root cause of your seizures, even when it may be elusive.

• Types of Seizures

  Epileptic seizures fall into two major categories:

  Focal seizures (formerly known as “partial seizures”) start in a part of the brain and can cause strange experiences, including:

  • Unusual smell
  • Numbness/tingling
  • Visual hallucinations
  • Butterflies in the stomach
  • A sense of déjà-vu called an aura
  • Loss of awareness
  • Unconscious chewing
  • Picking movements, known as automatisms

  These types of seizures will sometimes progress to a generalized tonic-clonic (GTC) seizure, also called grand mal seizure, with stiffening of the arms and legs, and rhythmic jerking, usually lasting about 1-2 minutes and often followed by sleepiness, confusion, and sometimes tongue biting or bladder incontinence. GTC seizures can also occur without an earlier focal seizure.

  Generalized seizures start all over the brain rather than in a single location. A GTC without focal onset is considered a type of generalized seizure. Other types of generalized seizures include absence seizures, which have bland staring without the automatisms seen in focal seizures, as well as:

  • Myoclonic seizures (brief jerks of the arms or head)
  • Tonic seizures (whole body stiffening with arms thrown upward)
  • Atonic seizures (whole body loss of tone causing a fall)

  Some of these seizure types occur with specific syndromes and have other symptoms as well.

  Since the seizure type frequently determines which medication is most helpful, your doctor will need a very good description of each type of spell you have, as well as any factors leading up to them. We will also want to know about any family history of seizures, whether you have had a severe head injury, convulsions with a high fever during early childhood, or a brain infection like meningitis or encephalitis.

• Routine Testing for Clarity

  We employ electroencephalograms (EEG), CT scans, and MRIs to diagnose and characterize seizures. Blood tests may also reveal underlying systemic factors. These essential tests aid in tailoring your treatment plan.

• Seizure Medications

  With nearly 30 seizure medications available, we'll work closely with you to select the most suitable option based on your seizure type and medical history. Sometimes, we have to try several medications before your seizures are fully controlled, and you may need more than one medication. If your seizures do not respond to different medications, we may explore alternatives like vagus nerve stimulation and epilepsy surgery.

• Electroencephalography

  Electroencephalography (EEG) is a simple test that records your brain's electrical activity. We can perform EEGs in either our outpatient Neurophysiology Suite (on the 3rd floor of the Connecticut Tower) or the hospital. EEGs are painless and non-invasive.

  Preparing for Your EEG

  To prepare for your EEG, ensure your hair is clean, and skip any hair products. During the test, we'll gently place electrodes on your scalp using a paste. You'll sit back in a comfy chair with your eyes closed while we record your brain's activity. It's like a snapshot of your brainwaves, helping us understand your condition better.

  What Happens During the EEG?

  The test typically takes 25 to 60 minutes, and all you need to do is lay back and relax. Sometimes, your doctor may request a longer study with video to capture specific events. You don’t need to have a seizure at the time of the recording to detect seizure-related discharges. However, you might be asked to count to 10 or perform a simple task to show your brain's alertness. You may also be asked to hyperventilate (breathe fast and deep) for several minutes, which also changes the brain waves, and a flickering strobe light may be used to stimulate the visual parts of your brain at different frequencies.

  After the test, the paste will come out when washing your hair. EEGs can be done to manage uncontrolled seizures in the hospital, and on critically ill patients to help predict recovery after a severe brain illness or to diagnose brain death.

• Ambulatory EEG Monitoring

  If you have spells or seizures, we may recommend ambulatory EEG monitoring. It's like an extended EEG, but we use a special glue to secure the electrodes for several days. You'll take a small recording device home, capturing your brainwaves around the clock for 1 to 3 days. Sometimes there is a video camera to set up and record your behavior during the ambulatory monitoring to help us diagnose events you are having.

  Keeping Track of Your Spells

  During the monitoring, keep a diary to record typical spells and when they occur. This diary helps us match your symptoms with the brain waves recorded. Once the recording period ends, return the device and diary to us. We'll remove the electrodes gently, ensuring your comfort. Our EEG epilepsy specialists will review the report and share the results within a few days or at your next neurology clinic appointment. We will let you know if we need to make any medication changes.

• Long-Term Video-EEG Monitoring

  Long-term video-EEG monitoring (LTM) is valuable for diagnosing seizures and preparing for epilepsy surgery. We'll admit you to a comfortable hospital room specially set up for continuous recording of your brain waves and activity.

  What to Expect During LTM

  When you arrive on the scheduled day for hospital admission, we'll attach electrodes to your head, similar to ambulatory monitoring. We’ll record your brain waves and video of your behavior continuously during the day and night. A long cable will allow you to move around the room. Cameras will capture all your activities except in the bathroom. If you take anti-seizure medications, we may adjust or withhold them during the test. Expect to stay up to 4 to 5 days or as needed to capture your seizures.

  Your Safety Is Our Priority

  While no one wants to have seizures, the hospital is the safest place to be. We have people watching you at all times and we can intervene quickly to ensure your safety. If no seizures happen, we'll resume your home medications and send you home. We may need to try again later if spells continue.

• Vagus Nerve Stimulation

  Vagus Nerve Stimulation (VNS) is a well established option for improving seizure control. It involves a small device, about the size of a silver dollar, implanted under the skin near your collarbone, with wires that connect to the vagus nerve in your neck.. A neurosurgeon will perform this outpatient surgical procedure and you should be able to go home the same day. You will then return a week or two later to your neurologist’s office for programming the device.

  How VNS Works

  VNS operates with a pattern of 30-second pulses followed by 5 minutes of rest, 24/7. Most people hardly notice it after a brief adjustment period. A provided magnet can sometimes stop a seizure in progress. You may experience a slightly hoarse voice when the stimulator activates, but if you sing in a choir or other group, you can tape a magnet over the stimulator while singing to prevent the stimulation during that time.

  What to Expect with VNS

  About half of people who get VNS will have a 50% or greater reduction in seizures, and most have some improvement. Few people become completely seizure-free with VNS. It has also been used to treat other conditions, including severe depression.

• Epilepsy Surgery Program

  When medication alone doesn't control seizures, surgery may offer hope. Our epilepsy surgery program begins with video-EEG monitoring to pinpoint seizure origins. Advanced tests, including MRI and PET scans, confirm surgical suitability. Surgical removal offers a 70 to 80 percent cure rate for those with seizures originating from one temporal lobe. If medications haven't worked, consider discussing epilepsy surgery with your provider.