2012 July | Epilepsy NYC - Epilepsy Foundation of Metropolitan New York

When Seizure Types Change: Part II


If in fact an evaluation has been made that confirms your seizure type has changed you may need to change medications. If you are now having seizures when they had previously been controlled it may mean that the medication you were taking does not work for the type of seizure you are now having.

A thorough evaluation is needed, as discussed in the previous blog, which will provide information about your new seizure type, why you are having a new seizure type, what this means in terms of controlling your epilepsy; and it will aid in choosing treatment.

Medications are usually the first line of treatment for seizures. They are chosen based upon seizure type. Your medication may need to be changed or a new medication may need to be added if your seizure type has changed.

Other things to think about when choosing a new medication are:

  • previous response to medications of the same class,
  • your age,
  • gender,
  • weight, allergies,
  •  and possible interactions with other medications that you are taking.


Q&A with Dr. Shahin Nouri

NEXT UP: Part II of “When Seizure Types Change”  by Ruth Shinnar, RN, MSN


The team at EFMNY would like to thank you for your questions! After each post, we’ll post answers from our experts to the most frequently asked questions we receive.  Please note that these Q&A post, like our provider articles, should not be taken as medical advice.  Each patient is unique.  For medical advice regarding your specific condition, please consult your doctor.


Q&A with Dr. Shahin Nouri:


 1. My son had absence seizures for the better part of five years. Our doctor recently diagnosed him as seizure-free at the age of 13.  He is eager to go off of his medication, but we’re afraid it will lead to a return of his seizures. How is it determined that one is “seizure-free.”  Is this the same as being “epilepsy-free?”

Absolutely! Absence epilepsy is a condition of childhood and adolescence. The Majority of people with absence so to say “grow out it”.  Only rarely will absence seizures accompany a person into adulthood. So , depending on your child’s age, he can become seizure-free.

However, it is possible that someone has epilepsy, and a longer EEG shows abnormal electrical activity. In the case of absence seizures, these electrical events need to be up to 10 seconds long before a clinical manifestation, in other words a seizure comes to light. Therefore, as long as your child hasn’t had any clinical seizures, and a longer EEG is unremarkable, it is safe to assume he has grown out it, and therefore is epilepsy-free.

As a general rule, after two years of seizure freedom and a normal EEG and imaging (MRI)  it is possible in most patients to attempt weaning off anti-seizure medications.

2. To the best of my knowledge, my husband has been without seizures for a little over two years. He used to have convulsions.  One of his co-workers recently told me that he’s been “spacing out” a lot at work.  Could this be what you refer to as an absence seizure?

Episodes of staring in adults are most probably Complex Partial Seizures and not absence seizures. Absence is an uncommon variety of Primary Generalized Epilepsy and only very rarely accompanies a person into adulthood. More frequently, people have Localization Related Epilepsy that can cause partial seizures. When partial seizures cause change in alertness, they are called Complex Partial Seizures. (more…)

When Seizure Types Change: Part I

Change in the Course and Pattern of Seizures

Many people with epilepsy can experience changes in the pattern, frequency and nature of their seizures. Such changes might mean worsening of the disorder, improvement of the condition, or have no consequences.

A change might have various causes and various consequences for each person. The epileptologist (epilepsy neurologist) can help make this distinction with the help of an accurate history and by using diagnostic methods, e.g. electroencephalogram (EEG) or imaging.

Epilepsy Types and Seizure Types

To develop a better understanding of a change, it is wise to review the different types of epilepsy and different types of seizures. Basically there are two main types of epilepsy. Eighty percent of people have Localization-Related Epilepsy (LRE) and 20 percent have Primary Generalized Epilepsy (PGE).

In LRE, seizures start in one focus in the brain. This focus can cause a brief and simple partial seizure (SPS), which manifests in different ways, depending on what part of the brain is involved. If a SPS affects alertness, it is called a Complex Partial Seizure (CPS). CPS’s are the most common manifestation of epilepsy. Both SPS’s and CPS’s can propagate to involve the whole brain and cause a generalized seizure, also known as a “Grand mal” seizure.

People with PGE experience generalized seizures, which involve the whole brain at the same time. These can be tonic-clonic (grand mal), tonic, myoclonic, atonic, or absence (petit mal) seizures. (more…)