Epilepsy & Seizure Care in Syracuse, NY — CNY Neurological Consulting

What Is Epilepsy?

Epilepsy is defined by two or more unprovoked seizures occurring more than 24 hours apart, or one unprovoked seizure with a high risk of recurrence. A seizure is a transient episode of abnormal electrical activity in the brain that can cause a wide range of symptoms depending on where in the brain the activity originates and how it spreads.

Seizures can be focal — originating in one part of the brain — or generalized, involving both hemispheres simultaneously. Focal seizures may remain localized or may evolve to involve the whole brain (focal to bilateral tonic-clonic seizures).

Not all seizures are epilepsy. Provoked seizures — caused by a reversible condition such as low blood sugar, fever, or medication withdrawal — do not by themselves constitute epilepsy.

Seizure Presentations

• Focal aware seizures — abnormal sensations, movements, or automatisms with preserved awareness
• Focal impaired awareness seizures — altered consciousness with automatisms or staring
• Tonic-clonic seizures — loss of consciousness with stiffening and rhythmic jerking
• Absence seizures — brief episodes of staring and unresponsiveness
• Myoclonic seizures — brief, sudden muscle jerks
• Atonic seizures — sudden loss of muscle tone

Neurological Evaluation

Evaluation of a first or recurrent seizure begins with a detailed history — including a description of the event from the patient and any witnesses, the circumstances surrounding the event, and any prior neurological history. A neurological examination is performed.

EEG (electroencephalogram) is a key diagnostic tool in epilepsy evaluation. It records the electrical activity of the brain and can identify abnormal patterns associated with epilepsy or specific epilepsy syndromes. Neuroimaging is typically obtained to evaluate for structural causes.

Medication Management

Anti-seizure medications are the primary treatment for epilepsy. The choice of medication depends on the seizure type, epilepsy syndrome, patient age, other medical conditions, and potential side effects. Many patients achieve good seizure control with medication.

For patients with drug-resistant epilepsy — defined as failure of two appropriately chosen and tolerated anti-seizure medications — additional evaluation and treatment options are considered, including epilepsy surgery evaluation and neuromodulation therapies.

Vagal Nerve Stimulator Management

Vagal nerve stimulation (VNS) is a neuromodulation therapy for patients with drug-resistant epilepsy who are not candidates for or have not benefited from epilepsy surgery. CNY Neurological Consulting provides VNS programming and management for patients with implanted devices.

When to Seek Urgent Evaluation

A first-time seizure, a seizure lasting more than five minutes, or a seizure in someone with no prior epilepsy diagnosis warrants prompt medical evaluation. Status epilepticus — a prolonged seizure or series of seizures without recovery — is a medical emergency requiring immediate care.

Frequently Asked Questions