Q&A With Dr. Fong-Isariyawongse

Joanna Fong-Isariyawongse, MD, of the UPMC Department of Neurology, specializes in the medical management of epilepsy and serves as the director of critical care continuous electroencephalogram (EEG) monitoring. Below, Dr. Fong discusses the distinctions between epilepsy and seizures and explains what to do if you are witnessing someone having a seizure.

What are the differences between epilepsy and a seizure?

Epilepsy is one of the most common neurological disorders in the world and affects about one in 26 people. It is important to note that a seizure is different than epilepsy and not everyone who has a seizure has epilepsy. A seizure is a clinical symptom related to an abnormal surge of activity in the brain. To be diagnosed with epilepsy, one needs to have recurrent seizures. In fact, someone needs to have at least two seizures in their lifetime to be diagnosed with epilepsy.

What are the warning signs of a seizure?

A clear warning sign of a seizure is when a person experiences violent convulsions, such as jerking and stiffening of the body. When this happens, the patient often is having a generalized seizure. Generalized seizures are typically caused by abnormal surge of activity in the whole brain, so the patient loses awareness quite quickly.

However, not all seizures are obvious. For example, focal seizures, which occur in one part of the brain, can be difficult to diagnose because symptoms can be internal. If someone is having a focal seizure, symptoms can vary. A person could experience changes in feeling or sensation, such as numbness, tingling, feeling hot or cold, or a sudden change in emotions. They may suddenly feel intense fear, confusion, or a feeling that their memory is altered. Symptoms could also include changes in heart rate or a lack of normal body movement.

What causes epilepsy?

Genetics is the most common cause of epilepsy. Other causes include concussions, strokes, brain tumors, infections, and congenital lesions. Sometimes when the brain is formed, the neurons don’t form properly in the brain. Usually, it’s these abnormal formations of the brain that can cause seizures. Metabolic factors such as low glucose, hypoglycemia, or low sodium can also cause epilepsy. Autoimmune diseases can also cause epilepsy when autoantibodies attack the brain.

How do doctors diagnose seizures?

To diagnose seizures, doctors need a good clinical history from a patient, much like diagnosing other medical conditions. But we also need to know what happened surrounding the seizure. Is there anything that could have caused the seizure? These are what we call provoking factors. Common triggers that can cause seizures are sleep deprivation, alcohol and drug withdrawal, low sodium, or low glucose. As a result, blood work is often needed especially in the emergency setting after a seizure. Then, if possible, we find out if there are any risk factors for seizures, such as family history of epilepsy, history of trauma or concussions, known brain lesions, brain tumors, or vascular lesions and stroke.

About 30% of patients who have a stroke can develop epilepsy. The onset of seizures can range widely from immediately after their stroke event to two or three years out from a stroke event.

What do I do if someone is having a seizure?

The first thing to do if someone is having a seizure is to stay calm and know that most seizures last only a couple of minutes. Look for a medical identifier, such as a bracelet, necklace tag, or a medical ID on his or her phone. If you have help, have someone time the seizure, and observe the movement or the symptoms of the person having the seizure, because all the subtle symptoms can help the doctor figure out where the seizure is coming from.

If you can find something to cushion the head, you should put it under the person’s head. Do not hold the person down because every single muscle in the body is contracting. If you were to hold the person down, you could cause dislocation, bone fractures, or other bodily injuries. It is also important to make sure there is nothing in the surrounding area that could be dangerous to the person having a seizure, such as any sharp objects, harsh chemicals, or flame.

There are six reasons for you to call 911 when someone is having a seizure. These are:

  1. If the seizure lasts longer than five minutes.
  2. If the person seems to not come out of the seizure or is having small seizures back to back.
  3. If the person having the seizure is having difficulty breathing.
  4. Is turning pale or blue in the face.
  5. Has no known medical conditions.
  6. Has an obvious burn, injury, or laceration.

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Neurology Care, Close to Home

Dr. Fong-Isariyawongse sees patients at UPMC Specialty Care in Murrysville, Pa., and the Kaufmann Medical Building in Pittsburgh’s Oakland neighborhood. For more information or to schedule an appointment, call 412-692-4920.

About UPMC

Headquartered in Pittsburgh, UPMC is a world-renowned health care provider and insurer. We operate 40 hospitals and 800 doctors’ offices and outpatient centers, with locations throughout Pennsylvania, Maryland, New York, West Virginia, and internationally. We employ 4,900 physicians, and we are leaders in clinical care, groundbreaking research, and treatment breakthroughs. U.S. News & World Report consistently ranks UPMC Presbyterian Shadyside as one of the nation’s best hospitals in many specialties and ranks UPMC Children’s Hospital of Pittsburgh on its Honor Roll of America’s Best Children’s Hospitals. We are dedicated to providing Life Changing Medicine to our communities.