There’s no question: Watching someone have a convulsive seizure is a truly frightening experience. But seizures aren’t always as alarming as people may think or fear. And they’re incredibly common: Up to 10 percent of people will have a seizure at some time in their life, while 1 in 26 people will develop epilepsy, according to the Epilepsy Foundation. Believe it or not, epilepsy is one of the most common neurological diseases on the planet, as more people have epilepsy than autism spectrum disorders, Parkinson’s disease, multiple sclerosis and cerebral palsy combined, according to the Epilepsy Foundation.
But many harbor misconceptions about what seizures are, what provokes them and what the risks are. “For most people, they’re not dangerous as long as they’re not in a place where they can injure themselves,” says Dr. Susan Arnold, a professor of pediatrics, neurology and neurotherapeutics at the UT Southwestern Medical School and director of the Comprehensive Epilepsy Center at Children’s Medical Center Dallas.
[See: Was That a Seizure?]
Here are five surprising facts about seizures that everyone should know:
Not all seizures involve convulsions. Some seizures simply cause brief spells of staring into space and losing awareness of what’s happening in the environment, strange sensations such as tingling or numbness in a part of the body, visual changes (including blurry vision, repeated blinking or seeing flashing lights), perceptions of smells that aren’t actually present or odd behaviors or sensations (like repeated lip smacking, stomach pain or a feeling of déja vu). With these symptoms, there’s no shaking involved. Most seizures last 30 seconds to three minutes.
If you have a seizure, it doesn’t mean you have epilepsy. “A seizure is a single event, whereas epilepsy is characterized by a tendency toward recurrent seizures,” explains Dr. Orrin Devinsky, director of the NYU Langone’s Comprehensive Epilepsy Center. Another key distinction: Seizures are considered provoked if “they’re caused by an underlying transient or correctable condition,” Arnold says. Provoked seizures — which can occur as a result of very low blood sugar in someone who has diabetes, alcohol withdrawal, cocaine use, infections or illnesses, fevers or head injuries such as concussions, as well as sleep deprivation, dehydration, stress or exposure to certain flashing lights and patterns (like the Pokémon cartoon incident in Japan that gave hundreds of children seizures in 1997) — are not considered epilepsy, even if the person has more than one. “Up to 70 percent of nonepileptic seizures are among women,” Devinsky notes.
By contrast, unprovoked seizures don’t have obvious causes. They can be triggered by genetic factors, metabolic or chemical imbalances or underlying neurological disorders. About half of people who have one seizure without an easily identifiable cause will have another one, usually within six months, according to the Epilepsy Foundation. Epilepsy, a seizure disorder, is characterized by an enduring predisposition to having recurrent, unprovoked seizures. “All seizures are generated from the brain, but with epilepsy the brain’s normal rhythmic activity goes away in the absence of a stressor or environmental trigger,” explains Dr. John Stern, professor of neurology and director of the epilepsy clinical program at the David Geffen School of Medicine at UCLA. “The seizure ends when the brain reclaims its normal [electrical] rhythm and function.”
[Read: Preventing Epilepsy Deaths.]
No single test can diagnose epilepsy. The diagnosis is made largely on a clinical history taken by a doctor, based on reports of seizures by the patient or from a witness, and a physical examination. Two tests are commonly used in the diagnostic process: an EEG (short for electroencephalogram) to look for abnormal bursts of electricity in the brain, and an MRI to check for a tumor or other abnormalities in the brain. “People with epilepsy are likely to have abnormal electrical activity in the brain even in times when they’re not having seizures,” Stern says. “But getting a normal EEG doesn’t exclude the possibility of epilepsy.”
You can develop a seizure disorder at any time in your life. While a seizure disorder can occur at any point, there are two prime windows of vulnerability: in early childhood (particularly under age 10) and in older adulthood (after age 65). Kids often have epilepsy because they were born with a brain abnormality or a metabolic disorder. What’s more, 30 percent of people with an autism spectrum disorder will develop epilepsy at some point. By contrast, head trauma, brain injuries, strokes, dementia and brain tumors are more likely to cause epilepsy in older adulthood.
[Read: When Your Child Has Out-of-Control Epilepsy.]
Having a seizure disorder isn’t necessarily a lifelong affliction. Some kids can outgrow a seizure disorder. “Up to 50 percent will have what we call spontaneous remission [of seizures] as they get older,” Arnold says. “As the brain changes as kids mature and get older, the tendency to have seizures may change as well.”
Even if epilepsy does persist past childhood, it often can be well-controlled with medications. If medications can’t sufficiently control seizures, often the ketogenic diet (a high-fat, low-carbohydrate diet) can be effective. In fact, a study published in the March 2017 issue of the journal Epilepsy Research found that when young children whose epilepsy didn’t respond to multiple medications were put on the ketogenic diet, 54 percent of them were seizure-free after six months and 86 percent of them experienced more than a 70 percent reduction in their seizures after two months on the diet. In a select population of those with a seizure disorder, sometimes surgery can make a difference if medications don’t, Arnold says.
As long as someone’s seizure disorder is controlled, the person can do everything — including driving, swimming and playing other sports — that someone without epilepsy can do. “Many people with epilepsy who have their seizures under good control are wildly successful in business, sports, medicine and other fields,” Devinsky says. “They’re able to lead full lives.”
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5 Surprising Facts About Seizures originally appeared on usnews.com
