Neurosciences

Epilepsy and Seizures

UTMB is certified as a Comprehensive Epilepsy Center by the National Association of Epilepsy Centers (NAEC), highlighting UTMB’s ability to provide comprehensive care to complex cases of epilepsy.

Patients living with epilepsy, a complex seizure disorder, face many challenges. Characterized by disabling seizures triggered by abnormal electrical activity in the brain cells, the disease can manifest itself through a range of symptoms from minor physical signs and thought disturbances to traumatic physical convulsions.

If you're struggling with epilepsy or seizures, you'll benefit from a comprehensive evaluation and a unique treatment plan that gives you the best chance to avoid further seizures.

Epilepsy Facts

Epilepsy is the 4th most common neurological problem

1 in 26 people in the U.S. will develop epilepsy in their lifetime

3.4 million people in the U.S. have active epilepsy

150,000 new cases of epilepsy each year

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What is Epilepsy?
Epilepsy is a disorder of the brain that causes seizures and can affect people in different ways. Seizures can be mild and barely noticeable, such as staring spells or twitches to the extremities, while others may be violent and harmful to the individual. Since epilepsy and seizures can occur in many different ways in many different people, diagnosing and treating the disorder is often challenging to patients and physicians.
The causes of epilepsy are just as challenging and can be caused by different conditions that affect a person’s brain. Often the cause is unknown, but some conditions that lead to epilepsy are stroke, brain tumor, traumatic brain injuries, head injury, and central nervous system infection. Seizures are the main sign of epilepsy and typically a person is diagnosed with epilepsy when they have had two or more seizures.
Did You Know?
1. Seizures seen in epilepsy are caused by disturbances in the brain’s electrical activity.
2. Epilepsy is usually diagnosed after a person has had two seizures that were not caused by some known medical condition. Epilepsy is not contagious, is not a mental illness and is not a developmental disability.
3. More than half the time, the cause of epilepsy is unknown. When a cause is found, it is often due to head injury, infection of the brain, stroke, brain tumor, Alzheimer’s disease, malformation of an area of the brain, and genetic factors.
4. Epilepsy is usually diagnosed with a medical history, neurological examination, blood work, electroencephalograph (EEG), CT, MRI or PET scans of brain.
5. Epilepsy is treated with anti-seizure medications. At times, depending on the type of seizure, surgery, Vagus Nerve Stimulation (VNS), responsive neurostimulation (RNS) and dietary therapies like ketogenic diets may be used.
Seizures are classified into two groups
Generalized seizures affect both sides of the brain.
Absence seizures, sometimes called petit mal seizures, can cause rapid blinking or a few seconds of staring into space.
Tonic-clonic seizures, also called grand mal seizures, can make a person:
Cry out
Lose consciousness
Fall to the ground
Have muscle jerks or spasms
Feel tired after a tonic-clonic seizure
Focal seizures are located in just one area of the brain. These seizures are also called partial seizures.
- Simple focal seizures affect a small part of the brain. These seizures can cause twitching or a change in sensation, such as a strange taste or smell.
- Complex focal seizures can make a person with epilepsy confused or dazed. The person will be unable to respond to questions or direction for up to a few minutes.
- Secondary generalized seizures begin in one part of the brain but then spread to both sides of the brain. In other words, the person first has a focal seizure, followed by a generalized seizure.
Seizures may last as long as a few minutes.
Seizure First Aid
Do I call 911?

Seizures do not usually require emergency medical attention. Only call 911 if one or more of these are true:
The person has never had a seizure before
The person has difficulty breathing or waking after the seizure
The seizure lasts longer than 5 minutes
The person has another seizure soon after the first one
The person is hurt during the seizure
The seizure happens in water
The person has a health condition like diabetes, heart disease, or is pregnant.
First aid for any type of seizure
There are many types of seizures. Most seizures end in a few minutes.
These are general steps to help someone who is having any type of seizure:
- Stay with the person until the seizure ends and he or she is fully awake. After it ends, help the person sit in a safe place. Once they are alert and able to communicate, tell them what happened in very simple terms.
- Comfort the person and speak calmly
- Check to see if the person is wearing a medical bracelet or other emergency information
- Keep yourself and other people calm
- Offer to arrange transportation to ensure the person gets home safely
Stop! Do NOT...
Knowing what NOT to do is important for keeping a person safe during or after a seizure. Never do any of the following:
- Do not hold the person down or try to stop his or her movements
- Do not put anything in the person’s mouth. This can injure teeth or the jaw. A person having a seizure cannot swallow his or her tongue
- Do not try to give mouth-to-mouth breaths (like CPR). People usually start breathing again on their own after a seizure
- Do not offer the person water or food until he or she is fully alert
Treatment and Prevention
A person who has a seizure for the first time should talk to a health care provider, such as a doctor or nurse practitioner. The provider will ask the person what happened, and look for the cause of the seizure. Many people who have seizures take tests such as brain scans for a closer look at what is going on. The most important step is to speak with your provider.
There are many things a provider and a person with epilepsy can do to stop or lessen seizures. The most common treatments for epilepsy are:
- Medicine. Anti-seizure drugs are medicines that limit the spread of seizures in the brain. A health care provider will change the amount of the medicine or prescribe a new drug if needed to find the best treatment plan. Medicines work for about 2 in 3 people with epilepsy.
- Surgery. When seizures come from a single area of the brain (focal seizures), surgery to remove that area may stop future seizures or make them easier to control with medicine. Epilepsy surgery is mostly used when the seizure focus is located in the temporal lobe of the brain.
- Other treatments. When medicines do not work and surgery is not possible, other treatments can help. These include vagus nerve stimulation, where an electrical device is placed, or implanted, under the skin on the upper chest to send signals to a large nerve in the neck.
Sometimes we can prevent epilepsy. These are some of the most common ways to reduce your risk of developing epilepsy:
- Have a healthy pregnancy. Some problems during pregnancy and childbirth may lead to epilepsy. Follow a prenatal care plan with your health care provider to keep you and your baby healthy.
- Prevent brain injuries.
- Lower the chances of stroke and heart disease.
- Be up-to-date on your vaccinations.
- Wash your hands and prepare food safely to prevent infections
Vagus Nerve Stimulation (VNS) Therapy

UTMB provides services such as noninvasive evaluations and the vagus nerve stimulation (VNS) implantation procedure. Surgeons who specialize in the treatment of cranial nerve disorders, spinal surgery, peripheral nerve surgery, minimally invasive surgery, neurotrauma and neurovascular surgery, perform VNS Therapy® as a day surgery procedure. The procedure is designed to prevent seizures by sending regular, mild pulses of energy to the brain via the vagus nerve.
Epilepsy Monitoring Unit and Common Questions about Epilepsy Monitoring
UTMB’s dedicated Epilepsy Monitoring Unit (EMU) was designed to evaluate, diagnose and treat patients who experience hard-to-treat epileptic seizures.
Under the leadership and expertise of EMU Director, Dr. Todd Masel, the highly specialized 4-bed unit offers continuous overnight video, microphone and electroencephalography (EEG) monitoring to identify the specific region of the brain in which each patient’s seizures originate.
The multidisciplinary care team (which consists of physicians, nurses, technicians, therapists and other health care workers) is then able to devise the appropriate care plan to reduce or eliminate the episodes, as well as provide long-term medical management treatments.
UTMB’s highly qualified EEG team also offers 24/7 EEG monitoring for UTMB’s inpatients. This is particularly useful in the Neurosciences Critical Care Unit, which cares for patients who are critically ill with neurological disorders.

Questions about Epilepsy Monitoring
As part of your evaluation at our EMU, we'll record your typical events for better diagnosis and/or to adjust your antiepileptic medication safely. To record your events, we use a video camera, microphones and continuous EEG recording. We do these so your doctor can learn more about your seizures and provide the best possible care for you.
Click each question below to expand/collapse for more details:
Neurosciences

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- Who is the EMU for?
  
  Patients with epilepsy who are interested in in finding out what type of epilepsy they have, in order to get the best medical and/or surgical treatment.
  
  Patients with epilepsy who are interested in finding out how well-controlled their epilepsy is.
  
  Patients who have seizure-like episodes and who are interested in finding out whether or not they have epilepsy.
- What will a patient get out of an EMU stay?
  
  An answer as to whether or not they have epilepsy, and if so, what type of epilepsy and what would be the best treatment for it. This treatment will usually be started during the EMU stay.
  
  If they are found to not have epilepsy, then during their EMU stay they will usually be started on treatment for whatever other underlying problem may be discovered.
  
  An in-depth explanation of whatever their diagnosis is found to be.
  
  All records from the EMU stay will be promptly available for the patient to have them sent to their primary care doctor.
- Epilepsy and Seizure Monitoring: What to Expect
  
  On the Day of Admission
  
  Please come to the UTMB John Sealy Hospital. We will tell you what time to arrive. You can park in the Public Parking Garage 1. The front of the hospital is a short walk; ask the information desk assistants for directions to Unit 9C/EMU. Please be aware you will need to bring your health insurance cards with you.
  
  Next you will go to your assigned room in the Epilepsy Monitoring Unit (EMU), on the 9th Floor of the John Sealy Hospital. You will have the EEG electrodes placed on your head in your room.
  
  In the EMU Room
  
  Once you are hooked up, you will not be able to leave the room.
  
  Your length of stay will depend on how long it takes us to record your seizures. We often just need to see 1 or 2 of your typical seizures. Plan to be admitted to the hospital on Monday morning and discharged on Friday morning. This may be shorter depending on you and your seizures. On the day of admission, continue taking your morning medicines as usual. Any medication adjustments will be made by the doctor once you are admitted and in the EMU.
  
  When you have a seizure, be sure you or the person staying with you will press the event push button. This is how the epileptologist reading your EEG knows that you have identified your event. Also, please record on the log sheet whether your seizure was typical or not. If you are not aware of your seizure, your family or significant other who stays with you during the EMU stay can do this for you. If you get a warning or aura, please push the button.
  
  If you are a smoker, please talk to a nurse once you get to your room about the options for nicotine replacement during your stay at the hospital. Smoking is NOT allowed anywhere in the hospital or on the hospital campus.
  
  Your electrodes will be checked daily. We may reattach or add conducting gel to make sure we get a good recording. These electrodes will stay on until you are discharged.
  
  You will not be able to wash or comb your hair during the recording. Please wash your hair with shampoo before you are admitted. Do not use any mousses, gels, oils, creams, hair spray or conditioner in your hair. If you have braids or dreadlocks, please try to have your hair unbraided for the EEG hookup. This will make the hookup more comfortable for you, and will allow the electrodes to work better.
  
  You will have a private room. In each room, you will notice that there is a video camera and microphone on the EEG recording device. There should be pads on the side rails of your bed. If you do not see these pads, please notify your nurse. Please keep the side rails up at all times for your safety.
  
  We suggest having a family member, spouse, or friend stay with you while you are admitted/being monitored. This is important for several reasons. Family members, spouses, or friends know you and may know what your seizures look like and can tell us if the seizures you have are typical or not. They will be able to help you if you are in a situation where you could hurt yourself during the seizures. If you cannot find someone to stay with you during the admission, please contact our epilepsy coordinator at (409) 772-1450.
  
  There is cable TV and a phone in your room. Your phone has a number on it which family and friends can use to call you directly. Please check your patient information pamphlet that you receive the day you are admitted for more details.
  
  The cable on your EEG unit is long enough for you to get up and use the bathroom to wash, brush your teeth and use the toilet. However, you must call your nurse for help when you need to get out of bed. While you are using the bathroom, you are required to keep the door open at least for a few inches for your safety. You may get up and sit in a chair with your nurse’s assistance. You will not be videotaped while you are in the bathroom, but try to make sure that you are on video any other time that you move around your room.
  
  During Testing
  
  Your nurse will check on you periodically through the day and night. They will obtain your blood pressure and other vital signs. A capped intravenous line will be placed in one of your veins. This is mandatory and for your safety. If you have a very severe seizure or a lot more seizures than normal we can give you medicine to stop them through this IV line. It will be checked every shift by your nurse to make sure it is working.
  
  We will probably decrease or stop your antiepileptic medicine while you are in the hospital to try to trigger your seizures. We might also deprive you of sleep to try to bring on a seizure. This means you would stay up very late and only get a couple of hours of sleep. The lack of sleep increases the chance of seizures; therefore we do not want you to sleep during the day. We also may make you breathe deeply and flash lights to provoke an event. These are similar to the procedures performed when you have a routine EEG and sometimes will bring on seizures. Also, if you are aware of anything that makes you more likely to have a seizure, please let us know.
  
  A physician will visit you daily and update you on your progress. We will discuss what information we have so far and what you can expect next. This is a good time for you to bring up any questions you or your family may have.
- EMU Checklist
  
  Download Checklist
- Why do I need this type of recording?
  
  A routine EEG lasts about half an hour. It gives us a “Snapshot” of the brain’s activity during that particular recording period. It may not give us enough information to help you with your seizure problem. Our recording has three parts:
  
  VIDEO: A camera will record all your physical activity while your brain waves are being recorded on the EEG. By videotaping your seizures we can see exactly what happens before, during, and after one of your events. This allows us a more accurate picture of your seizures.
  
  EEG RECORDING: You will also have a continuous EEG recording. This will allow us to detect any seizure activity that occurs, even if you are not aware it is happening. The EEG helps us decide in what portion of your brain your seizures begin, and gives us information about your brain wave activity between seizures. It also will help us decide if your seizures are due to epilepsy or some other cause.
  
  AUDIO: Please be aware that there are also microphones in the room to help us fully capture exactly what happens during your seizure.
- Why can't I have these tests at my local hospital?
  
  This Epilepsy Monitoring Unit evaluation with state of the art continuous video-EEG monitoring is highly specialized and is available only in hospitals employing epilepsy specialists. Our staff of EEG technologists and nurses is very experienced in caring for people with seizures. Our doctors have advanced training in EEG interpretation and epilepsy treatment. We feel our EMU offers you the best chance for receiving a comprehensive and expert evaluation of your seizure disorder.
- What could we find?
  
  This complex testing is to evaluate the cause of the events you are experiencing. Your doctor has asked for this testing to determine what would be the best treatment for you and this testing will provide valuable information to make those decisions. We may find that your events are caused by epileptic seizures and find clues as to where in the brain the seizures are coming from. However, sometimes patients are found to have something different from epileptic seizures. In spite of the vigorous tests, sometimes we cannot tell you definitively about the diagnosis if we were not able to capture the typical seizure or event, however; this is not a common occurrence. In fact, most patients that are admitted to the EMU do have at least one seizure or event occur, and sometimes we are able to obtain a diagnosis even if the patient does not have any events.
- When will I get the results of my tests?
  
  We will talk to you about your testing before you go home. In spite of the tests, sometimes we cannot tell definitively about what your spells are if we were not able to capture your typical seizure or event. Also, some epileptic seizures may not be visible on the scalp EEG.
  
  We also will tell you if we think you will need any more tests or need to see any other doctors. Your local doctor will receive a report of our testing shortly after you go home.
- What to bring for your monitoring admission:
  
  You will be able to wear your own shorts, pants, or sweat suit bottoms. It is important not to disturb the electrodes. You need to wear tops that button or zip down the front or back and can be removed without pulling them over your head.
  
  We can give you “tie in the back” hospital gowns. Please bring your slippers, bath robe, toothbrush, toothpaste, mouthwash, dental floss, shaver, and deodorant with you. You can also bring makeup.
  
  Video EEG telemetry can become very boring. Bring along some things that will help you pass the time. Books, magazines, puzzles, games, cards, cassette/CD players or DVD players are types of things you may bring. You may bring a portable laptop computer. However, it may cause some artifact on EEG. If this is the case, then we will ask you to turn off the electronics. Cell phone use is allowed in your room.
  
  We will provide the medicines you need during your admission. However, please bring all of your medicine bottles with you (both prescription and over-the-counter) so we can see what you are taking. If you take a special medicine that would be hard to get, please tell us. We will either arrange to get it here or ask you to bring it with you.
  
  We will provide meals for the patient, but the family member will need to provide their own food. You can feel free to bring non-perishable food from home (granola bars, crackers, etc). There is also a cafeteria in the hospital.
  
  You can bring your own pillow, comforter, stuffed animal, or family photos to help you feel more comfortable.
  
  DO NOT BRING:
  
  Do not bring electrical appliances such as hair dryers, electric razors, space heaters or coffee makers. Larger radios with plug in and TVs are also not allowed due to the electrical safety rules of the hospital. Please do not bring frozen food or any food requiring refrigerator or microwaves.
- A word about insurance:
  
  We have hospital staff that work on getting a pre-authorization for your admission, and we make every effort prior to your admission to get this completed. However, ultimately it is your responsibility to make sure the authorization is in place before you come into the hospital. We recommend that you contact your insurance company at least one day prior to the admission to check on any problems that may occur, and to get an idea of what out-of-pocket expenses you may be responsible for. Please note that some of the hospital charges may not be covered by your insurance plan. The hospital has financial advisors to help if you need it. Please contact the hospital’s financial advisors ahead of time if you feel it is necessary.
- Other services at John Sealy Hospital:
  
  Chaplain: Services of the hospital chaplain are available to all patients and their families. Your personal clergy person is also welcome to visit. The Chapel is on the 1st floor of the hospital. Family members can visit the chapel, but patients cannot leave the room.
  
  Accommodations: Only one family member/guest is allowed to stay in the patient’s room overnight. A reclining hospital chair/cot is available for your guest. We can provide you with a list of local motels if other family members or friends wish to stay near the hospital while you are here.

Some content sourced from the Epilepsy Foundation and Centers for Disease Control and Prevention.

In the Health Blog

An image that reads "National Association of Epilepsy Centers Level 4 Epilepsy Center"

UTMB Epilepsy Program given highest accreditation by national association

April 5, 2024 • 11:17 a.m.

Focused on providing the best possible care for persons with seizures, the University of Texas Medical Branch Epilepsy Program has received accreditation by the National Association of Epilepsy Centers (NAEC) as a Level 4 Epilepsy Center.

The designation is the highest level of accreditation offered by the NAEC.

“Level 4 epilepsy centers have the professional expertise and facilities to provide the highest level medical and surgical evaluation and treatment for patients with complex epilepsy,” according to the NAEC.

“Our recent Level 4 accreditation not only recognizes what we have accomplished in terms of diagnosing and treating seizure disorders, but it also certifies that we are an elite and top-tier institution in this realm,” said Dr. Todd Masel, associate professor of neurology, vice chair for clinical affairs and UTMB Epilepsy Program director.

“Level 4 accreditation recognizes that we provide high-quality access to the full spectrum of modern medical and surgical treatments for epilepsy,” said Dr. Patrick Karas, assistant professor of neurosurgery and an epilepsy neurosurgeon at UTMB.

Since the creation of UTMB’s Epilepsy Monitoring Unit in 2013, and with the subsequent and continued growth of the team through recruitment of highly talented experts, the UTMB Epilepsy Program has provided excellent service and care in terms of diagnosing seizure disorders and determining and implementing the best treatment for patients.

This is accomplished through a multistep process that often starts with a clinic visit with a UTMB epileptologist, typically followed by diagnostic testing such as electroencephalography in UTMB’s EEG lab or via admission to the Epilepsy Monitoring Unit and then medical and/or surgical treatment based on the results of the testing. Treatment is tailored to the needs and goals of the patient and has improved the outcomes and quality of life of numerous patients over the years.

The NAEC recommends when patients should be referred to a level 4 center like UTMB: “If you are seeing a general neurologist, and your seizures have not been brought under control after 12 months, you should request a referral to a specialized epilepsy center with an epileptologist.”

“We look forward to continuing to provide excellent care to patients with seizures disorders as we move into the future,” Masel said. “Our mission is to make sure that every person with seizures receives the best care possible.”