Seizures are a sudden, uncontrolled electrical disturbance in the brain, which can cause changes in behavior, movements, sensations, or awareness. These events happen when brain cells fire signals abnormally, overloading affected areas of the brain. While some seizures might involve a temporary loss of consciousness and uncontrollable movements, others can be as subtle as a brief stare or a muscle twitch.
Initial Medical Contact
When a seizure occurs, especially for the first time, immediate medical attention is often necessary. If a seizure lasts longer than five minutes, if breathing does not resume, or if there is an injury, calling emergency medical services like 911 is advised. For a first-time seizure, an emergency room visit is crucial to rule out any immediate or life-threatening causes.
For non-emergency situations or after an initial emergency assessment, a primary care physician (PCP) is typically the first point of contact. The PCP can gather initial medical history, perform basic assessments, and help determine if a referral to a specialist is needed.
The Primary Specialist: The Neurologist
A neurologist is a medical doctor who specializes in disorders affecting the brain, spinal cord, nerves, and muscles. They are the primary specialists for diagnosing and treating seizure disorders. Neurologists evaluate a patient’s medical history, conduct a neurological examination, and interpret various diagnostic tests to understand the nature of the seizures.
Common diagnostic tools include an electroencephalogram (EEG), which records the brain’s electrical activity and can detect abnormal patterns associated with seizures. Imaging tests like magnetic resonance imaging (MRI) and computed tomography (CT) scans are also used to visualize the brain’s structure and identify any underlying causes such as tumors, bleeding, or structural abnormalities. Based on these evaluations, a neurologist can differentiate between various seizure types and formulate an initial treatment plan, often involving anti-seizure medications.
Specialized Care: The Epileptologist
While a general neurologist manages many seizure cases, some complex or difficult-to-control situations may require the expertise of an epileptologist. An epileptologist is a neurologist who has completed additional specialized training, typically one to three years of fellowship, focusing specifically on epilepsy and seizure disorders. They possess extensive knowledge of various seizure types, their causes, and advanced treatment options.
A referral to an epileptologist is often considered if seizures are not adequately controlled by initial medications, if the diagnosis remains unclear, or for evaluation prior to surgical interventions. Epileptologists utilize advanced diagnostic techniques, such as long-term video-EEG monitoring, which records both brain activity and physical manifestations of seizures simultaneously. They are also skilled in guiding decisions about epilepsy surgery and managing complex medication regimens.
Beyond the Neurologist: Multidisciplinary Care
Managing seizures, particularly in complex cases, often involves a collaborative approach with a team of healthcare professionals. This multidisciplinary care ensures that all aspects of a person’s health and well-being are addressed.
- Neurosurgeons may be involved for individuals who are candidates for seizure surgery, which can include procedures to remove the seizure-causing brain tissue or implant neuromodulation devices like vagus nerve stimulators.
- Neuropsychologists assess cognitive functions, memory, and attention, helping to understand how seizures or their treatments might affect a person’s mental abilities.
- Psychiatrists or therapists can provide support for co-occurring mental health conditions such as depression or anxiety, which are common among individuals with epilepsy.
- Dietitians may explore dietary therapies, like the ketogenic diet, as an additional management strategy.
- Geneticists can play a role if a genetic cause for the seizures is suspected, offering insights into diagnosis and potential future treatments.