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What's the Difference between Seizures & Epilepsy?

Learn the difference between seizures and epilepsy from Steve Wolf, MD and Patty McGoldrick, NP in this Howcast video.


Patty McGoldrick: So seizure is a big burst of electricity in the brain all
at once. It can come from one area of the brain, one little spot, or it can
be the whole brain lighting up all at one time.

Dr. Steve Wolf: We like to think of it - imagine a man standing in the
forest with a box of matches. Every time he lights a match that's the short
circuit that we see on the EEG, on the brain wave test. Now, most of the
time he drops the match to the ground, it blows out, nothing happens. But
every once in a while that match, he lights off enough matches, it hits the ground,
starts a fire, the fire spreads, that's your seizure.

Patty McGoldrick: Right. So there's a difference between abnormalities on
the EEG and the clinical seizures. But then epilepsy starts when you've had
a bunch of unprovoked seizures. And the definitions vary. It can be more than two
unprovoked seizures. It can be more than three. You also have to take into
account the time between the seizures and what the abnormalities are on the
EEGs. So everybody has a little bit different definition. But typically,
epilepsy is unprovoked seizures, more than two or three with an abnormal

Dr. Steve Wolf: Now, the man with the box of matches can be caused by many
different things. So the short circuit in the brain can be from the brain
didn't develop properly, there's a scar from a stroke from either childhood
or at any point a stroke or damage, or just the brain for no reason the
EMRI can be perfectly normal and have some kind of deep unknown reason for
causing the short circuit with the guy with the box of matches, correct?

Patty McGoldrick: And those things are at such a microscopic level that we
may not even see it until - if a person ends up having epilepsy surgery until
pathology comes back and shows that there's an abnormality. So even when you
go in there and you're looking at the brain and the neurosurgeon has lifted off the skull, there may not be anything visible to the naked eye. But when you send pathology off to the lab you'll see some abnormality.

Dr. Steve Wolf: But there are people who have seizures who have perfectly
normal EEGs.

Patty McGoldrick: Right. And they can still have seizures because those
seizures may come from so deep in the brain that you're not seeing it on
the EEG. Because again, the EEG is showing electricity from deep in the
brain, but it has to shoot it out through the skull. So you're not seeing
abnormalities at the skull because they rise from so deep in the brain.

Dr. Steve Wolf: So basically, epilepsy are people who have had more than one
seizure. They might or might not have an abnormal EEG. We know it's a short
circuit in the brain, but we have to look for it.

Patty McGoldrick: And again, they're provoked or unprovoked. But you're not going to say a child who has febrile seizures who has a seizure every time they have
a temperature of 104 or 105, they have a seizure. That's not epilepsy. That's a different
problem. Nor is the child who stays up in all night in college and pulls an all-nighter
and then seizes, either because they've been drinking alcohol or they're
using drugs or they just stayed all night doing work. That's not epilepsy
either. That's a seizure.

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