Condition Epilepsy Care

Epilepsy

Epilepsy is a neurological condition that causes recurrent seizures and can affect children and adults of all ages. While many people achieve good seizure control with medication, specialized evaluation can identify surgical and neuromodulation options when seizures continue despite treatment.

Medically reviewed by Ronald P. Benitez, MD Last reviewed August 10, 2026 7 min read

Quick Answer

Epilepsy causes recurrent seizures due to abnormal electrical activity in the brain. When seizures continue despite appropriate medication, advanced testing can help determine where they begin and whether epilepsy surgery, laser therapy, RNS®, VNS, or another targeted treatment may help.

Key Takeaways

Epilepsy causes recurrent seizures that can look very different depending on where they begin in the brain.
Many people achieve good seizure control with anti-seizure medication.
Seizures that continue despite trials of two appropriate anti-seizure medications may be considered drug-resistant.
For drug-resistant epilepsy, advanced testing can identify where seizures begin and whether surgery, laser therapy, RNS®, VNS, or another targeted treatment may be appropriate.

EPILEPSY AT A GLANCE

Condition	A neurological disorder that causes recurrent, unprovoked seizures
Who it affects	Children and adults of all ages
Common symptoms	Staring, loss of awareness, unusual movements or sensations, muscle stiffening or jerking, and convulsive seizures
Diagnosis	Neurological evaluation, EEG, brain MRI, and other testing when needed
First-line treatment	Anti-seizure medication
Advanced treatment	Epilepsy surgery, laser ablation, RNS®, VNS, or other targeted therapies

Understanding Epilepsy

Epilepsy is a neurological disorder that causes recurrent seizures due to abnormal electrical activity in the brain. It can affect children and adults of all ages.

Having a single seizure does not necessarily mean someone has epilepsy. Epilepsy involves an ongoing tendency to have recurrent, unprovoked seizures. Seizures can look very different from one person to another depending on where they begin in the brain and which areas are affected.

Focal and Generalized Epilepsy

Epilepsy is commonly classified according to where seizures begin. Identifying the seizure type is important because it can help guide testing and treatment.

ONE AREA OF THE BRAIN

Focal Seizures

Focal seizures begin in one area or network on one side of the brain. A person may remain aware or experience impaired awareness. Symptoms can include unusual sensations, repetitive movements, staring, confusion, or involuntary movements.

BOTH SIDES OF THE BRAIN

Generalized Seizures

Generalized seizures involve networks on both sides of the brain from the beginning. They may cause absence episodes, muscle stiffening, rhythmic jerking, sudden loss of muscle tone, or other seizure types.

What Causes Epilepsy?

Epilepsy can have many causes, and in some people no specific cause is identified. Known causes may include:

Genetic factors
Brain tumors
Stroke
Traumatic brain injury
Congenital or developmental brain abnormalities
Previous brain infections
Scar tissue from a previous brain injury or surgery
Vascular abnormalities
Certain neurological disorders

What Is Drug-Resistant Epilepsy?

Most people with epilepsy are initially treated with anti-seizure medication. However, some continue to experience seizures despite appropriate medical treatment.

Epilepsy is generally considered drug-resistant when seizures continue despite adequate trials of two appropriately chosen and tolerated anti-seizure medications, whether used alone or in combination.

At that point, referral for a comprehensive epilepsy evaluation is important. Advanced testing may identify where seizures begin and whether epilepsy surgery, laser therapy, RNS®, VNS, or another targeted treatment could provide better seizure control.

Signs & Symptoms

Epilepsy does not always look like a convulsive seizure. Because seizures can affect different areas of the brain, symptoms vary depending on where abnormal electrical activity begins and can sometimes be subtle or difficult to recognize.

Common seizure symptoms may include:

Staring or becoming temporarily unresponsive
Loss of awareness
Sudden confusion
Repetitive movements, such as lip smacking or picking at clothing
Unusual smells, tastes, sensations, or feelings
Sudden fear or a sense of déjà vu
Tingling or numbness
Muscle stiffening
Rhythmic jerking of an arm, leg, or the entire body
Sudden loss of muscle tone or falling
Loss of consciousness
Temporary difficulty speaking or remembering what happened

Some people experience an aura before a more noticeable seizure. An aura is itself a type of focal seizure and may involve an unusual sensation, smell, visual change, feeling, or other symptom.

Epilepsy in Children

Seizures in children may sometimes be mistaken for daydreaming, behavioral changes, or other childhood behaviors. Depending on the type of seizure, a child may suddenly stare and become unresponsive, experience brief repetitive movements, fall unexpectedly, or have more recognizable convulsive seizures.

Frequent or uncontrolled seizures can affect learning, development, behavior, and daily activities, making accurate diagnosis and seizure control especially important.

When to Seek Epilepsy Evaluation

Seizures continue despite appropriate medications
Seizures are becoming more frequent or severe
Medication side effects significantly affect daily life
MRI shows a possible structural cause for seizures
Seizures interfere with development, school, work, or independence
The seizure type or diagnosis remains unclear

When to Seek Emergency Care

A seizure lasts 5 minutes or longer
Another seizure begins before the person recovers
Breathing or consciousness does not return after the seizure
A serious injury occurs during the seizure
A seizure occurs in water
A first-time seizure occurs

Diagnosis and Evaluation

Diagnosing epilepsy begins with a detailed medical history and neurological examination. Because the person experiencing a seizure may not remember exactly what happened, descriptions or videos from family members or other witnesses can provide valuable information.

Testing may include:

Electroencephalogram (EEG) to record electrical activity in the brain
Brain MRI to identify tumors, structural abnormalities, scar tissue, or other possible causes of seizures
Blood tests or other laboratory studies
Neuropsychological testing
Genetic testing in selected patients

The goal is to determine whether the episodes are seizures, identify the type of epilepsy, and, when possible, determine where seizures begin.

Evaluation for Drug-Resistant Epilepsy

When seizures continue despite appropriate medication trials, additional testing may help determine whether surgery, laser therapy, neuromodulation, or another targeted treatment may be appropriate.

Evaluation may include:

Prolonged video EEG monitoring
High-resolution epilepsy-protocol MRI
PET or other functional imaging
Neuropsychological testing
Functional brain mapping
Additional testing to evaluate language, memory, or other critical functions

Finding Where Seizures Begin

For some people, noninvasive testing does not provide enough information to identify the seizure source with confidence.

Stereo-electroencephalography (SEEG) uses thin electrodes placed in carefully selected areas of the brain to record seizure activity directly. This can help pinpoint the seizure network and determine whether it can be treated safely.

The results of epilepsy testing are considered together to determine the most appropriate treatment approach for each patient.

Treatment

When Should Epilepsy Surgery Be Considered?

Epilepsy surgery or neuromodulation may be considered when seizures continue despite appropriate medication. Evaluation does not mean surgery is inevitable—it is designed to determine where seizures begin, how they affect critical brain functions, and which treatment options may offer the best balance of seizure control and safety.

For some people, testing identifies a seizure source that can be safely removed or ablated. For others, responsive neurostimulation, vagus nerve stimulation, or another treatment may be more appropriate.

Treatment Options for Drug-Resistant Epilepsy

Treatment is individualized based on where seizures begin, the type of seizures, and whether the seizure network can be treated without affecting critical brain functions.

Depending on the results of your evaluation, treatment may involve removing or ablating the area where seizures begin, or using neuromodulation to reduce seizure activity.

Epilepsy Surgery

When seizures consistently arise from a defined area of the brain that can be safely treated, surgery may offer the best chance for long-term seizure control.

Surgical treatment may involve removing the seizure-producing tissue or using a minimally invasive approach such as laser interstitial thermal therapy (LITT) to precisely target it.

Minimally Invasive

Laser Therapy (LITT)

Uses precisely delivered laser energy to treat targeted brain tissue responsible for seizures. A thin laser catheter is guided through a small opening in the skull, with MRI monitoring in real time.

May be considered when: Seizures arise from a well-defined area that can be safely targeted.

Learn more about LITT →

Responsive Neuromodulation

Responsive Neurostimulation (RNS®) System

Continuously monitors electrical activity in the brain and delivers brief stimulation when it detects patterns associated with seizure activity.

Key difference: RNS® provides ongoing responsive treatment without removing or destroying brain tissue and collects information about brain activity over time.

Learn more about RNS® →

Neuromodulation

Vagus Nerve Stimulation (VNS)

Uses an implanted device to deliver electrical impulses to the vagus nerve in the neck. These signals travel to the brain and can help reduce seizure frequency and severity.

May be considered when: Seizures are not controlled with medication and removing or ablating the seizure source is not appropriate.

Learn more about VNS →

Other Surgical and Neuromodulation Options

Depending on where seizures begin and how they spread through the brain, other procedures may be considered.

Resective epilepsy surgery — Removes the area of brain tissue responsible for seizures when it can be safely identified and treated.
Corpus callosotomy — Interrupts connections between the two sides of the brain to limit the spread of certain severe seizures, particularly seizures that cause sudden falls.
Deep brain stimulation (DBS) — Delivers electrical stimulation to specific brain networks involved in seizure activity and may be considered when resection or ablation is not appropriate.

The best approach depends on the seizure type, where seizures begin, previous treatments, and the findings of a comprehensive epilepsy evaluation.

The Diagnosis-to-Treatment Pathway

1. Neurological evaluation

Seizure symptoms, medical history, and medications are reviewed.

2. EEG & brain imaging

Testing helps identify seizure activity and possible structural causes.

3. Advanced epilepsy evaluation

If seizures continue despite medication, specialized testing may help identify where they begin.

4. Treatment planning

Results guide recommendations for medication, surgery, laser ablation, RNS®, VNS, or other treatment.

5. Ongoing care

Seizure control and treatment response are monitored over time.

Frequently Asked Questions

A comprehensive epilepsy evaluation should be considered when seizures continue despite appropriate medication. Evaluation does not necessarily mean surgery will be recommended. Specialized testing helps determine where seizures begin and whether surgery, laser therapy, neuromodulation, or another treatment may be appropriate.

Testing may include prolonged video EEG monitoring, high-resolution epilepsy-protocol MRI, PET or other functional imaging, neuropsychological testing, and functional brain mapping. If noninvasive testing does not provide enough information, intracranial monitoring such as stereo-electroencephalography (SEEG) may be recommended.

Treatment depends on where seizures begin and whether that area can be safely treated. Options may include lesionectomy, cortical resection, disconnection procedures, corpus callosotomy, or minimally invasive laser therapy (LITT). Neuromodulation treatments such as RNS®, VNS, or deep brain stimulation (DBS) may also be considered.

Laser interstitial thermal therapy (LITT) is a minimally invasive treatment that uses precisely delivered laser energy to treat targeted brain tissue responsible for seizures. A thin laser catheter is guided through a small opening in the skull while MRI is used to monitor treatment in real time.

Responsive Neurostimulation (RNS®) continuously monitors electrical activity in the brain and delivers brief stimulation when it detects patterns associated with seizure activity. Unlike treatments that remove or destroy brain tissue, RNS® provides ongoing responsive therapy while also collecting information about brain activity over time.

Vagus nerve stimulation uses an implanted device to deliver electrical impulses to the vagus nerve in the neck. These signals travel to the brain and can help reduce seizure frequency and severity. VNS may be considered when seizures are not controlled with medication and removing or ablating the seizure source is not appropriate.

Yes. Atlantic Brain and Spine evaluates and treats both adults and children with epilepsy. Treatment for children is individualized based on the type of seizures, their cause, the child’s development, and findings from diagnostic testing.