He showed me his seizure diary and the type of medication he was taking. I read his thick medical record, asked questions about his condition and started writing the chart. As I was recording the frequency of his seizures and the dosage of his medication, a loud shout startled me. I looked up and saw his right arm and right leg slowly stretching out and his whole body starting to stiffen. Then the shouting ended, his eyes closed tightly, smacked his lips for about 14 seconds, and then his body relaxed and sat down in a chair. After the seizure, Xiao He appeared sleepy and hazy. I am quite sure that he did not fall or wander unconsciously out of the room during the seizure. He was unable to answer my questions for 10 minutes after the seizure. When Brian was more awake, I told him that he had just had a seizure. 1. What is epilepsy? Epilepsy is a type of abnormal brain function characterized by recurrent seizures, with an occurrence rate of about 0.5 to 1% of the world’s population. About 8 million people in China have epilepsy. Clinicians can diagnose about 300,000 new cases of epilepsy each year. A variety of injuries to the brain can cause epilepsy, such as birth defects, birth injuries, brain hemorrhage, infection, tumors, trauma, or stroke. Some cases of epilepsy have a genetic predisposition. Scientists have identified more than 200 abnormal genes associated with epilepsy. However, in about 50 percent of patients, no clear cause can be found, even after they have been seen for testing. When patients are seen for epilepsy, it is the doctor’s job to identify and address these causes and then minimize the extent and frequency of seizures through medication. The goal of treatment for epilepsy is to completely control seizures without significant side effects. 2. What is a seizure? A seizure is a synchronized abnormal discharge of neurons in the brain. Seizures can produce a wide variety of symptoms, depending on where the seizure originates and how the abnormal discharges spread through the brain. Some of these symptoms can be very strange and unique. Here are a few examples of patients I have met. My colleague’s mother, Auntie Sue, had a mild seizure after a mild cerebral infarction that manifested only as a tingling sensation in her right index finger. Pengpeng would have a “mild stomach upset” followed by loss of consciousness. Xiaoji would have a “blurred feeling, as if his sense of touch was gone. On another occasion, he seemed to see the refrigerator “singing”. The characteristic sensation of Alan’s seizure was “whatever he was experiencing seemed to have happened before”, and then he lost consciousness. Xiao Ma has the feeling that “something is wrong” and also feels “woody” in his head, which is manifested by staring at his eyes, clutching his arms and rolling in a ball. RongRong seizures are characterized by a “clanging in the head” followed by a loss of consciousness and a fall. Many patients have convulsions, in which the patient loses consciousness during a violent seizure, followed by stiffness and twitching of the limbs. Some patients have only two convulsive seizures a year, but when they occur, they last for several hours and are called “status epilepticus”, a serious life-threatening condition. It requires an ambulance to a hospital intensive care unit for treatment with intravenous antiepileptic drugs to stop the seizures. Experiencing or witnessing a seizure can be unsettling, and it takes a great deal of effort on the part of the patient and family to adapt to and accept this unique situation. 3. What should I do after my first seizure? Every patient needs to undergo a neurological examination quickly after the first seizure to determine the possible cause of the seizure. All subsequent treatment plans are based on the results of the first examination. Xiao He’s magnetic resonance imaging (MRI) scan showed that a portion of his left frontal lobe was not fully developed during fetal life. This was the cause of his seizures. Another patient had a seizure while out for a walk. His case was somewhat complicated by a CT scan of the head that showed no abnormalities, but his MRI of the head showed a tiny tumor in the left temporal lobe, and this patient was later treated with radiation therapy and surgery. Another young female patient had a seizure while working as a receptionist at a local inn, and her MRI showed the presence of multiple sclerosis in the brain, a relatively uncommon cause of seizures.