Epilepsy and Its Occurrence
Epilepsy is the fourth most common neurologic condition, after migraine, stroke and dementia.
It is a chronic disorder in which nerve cells in the brain fire electrical impulses at a higher than normal rate, causing seizures that can last seconds or minutes. This serious neurologic condition affects an estimated 2.5 million people in the United States.
Every year, 200,000 Americans develop seizures and epilepsy for the first time. Family history, head injuries, alcohol withdrawal, infections and brain abnormalities are all possible causes. Unfortunately, doctors can find no cause in about half the cases.
Definitions of Seizure and Epilepsy
When networks of brain cells fire abnormally, individuals may experience a change in behavior such as loss of consciousness, abnormal movements or abnormal sensations, or a combination of symptoms. These sudden unpredictable changes―physical, behavioral, or both―are called seizures and typically last from seconds to several minutes.
Epilepsy is a seizure disorder that is characterized by a tendency to have recurring unprovoked seizures. It is usually diagnosed after a person has had at least two seizures occurring >24 hours apart that were not caused by a known medical condition.
Symptoms of epilepsy, seizures and other potential related disorders may include the following:
• Repetitive abnormal movements
• Recurrent abnormal sensations
• Confusion or spells that last minutes to hours
• Staring spells
• Unexplained episodes of loss of consciousness
• Loss of consciousness
• Unusual movements in sleep
• Speech abnormalities
If you or someone you know exhibits any of these symptoms, you or the other person should be seen by a physician as soon as possible. In addition to epilepsy, conditions treated within the Comprehensive Epilepsy Center include migraines, strokes, transischemic attacks (TIAs), and nonepileptic seizures.
Doctors at Berman Brain & Spine Institute's Epilepsy Center rely on a comprehensive medical history, thorough neurologic examination and testing to diagnose epilepsy. Patient and family member or witness reports about what the seizures looked like and what happened just before and after the seizure are vital to an accurate diagnosis. The patient's prior medical history and family history can also provide important clues.
Several types of testing are used in the diagnosis of epilepsy. Usually, an electroencephalogram (EEG) is performed. Brain waves, recorded by small electrodes applied to the head, may show certain characteristic changes in people with epileptic seizures. Imaging methods like computerized tomography (CT) or magnetic resonance imaging (MRI) scans may be used to search for abnormalities like strokes, tumors, scars or other physical conditions in the brain that may be causing the seizures. Specialized techniques like PET and SPECT scans are sometimes used. Neuropsychological evaluations can also be utilized for diagnostic purposes.
Epilepsy Monitoring Unit
The Comprehensive Epilepsy Center features a 4-bed inpatient Epilepsy Monitoring Unit at Sinai Hospital that is part of a 36-bed dedicated neuroscience unit. In the Epilepsy Monitoring Unit, doctors can observe and record the brain waves of patients who are experiencing seizures or seizure-like behaviors in a comfortable, relaxed setting. Patients stay in private rooms that are equipped with minimally intrusive medical and video-monitoring equipment. By observing patients’ episodes and pinpointing the sources of their seizures, doctors can find better ways to treat those patients who may not be responding to medical therapies.
The goal of all epilepsy treatment is to prevent further seizures, minimize side effects from medications and make it possible for people to lead active lives.
When an epileptologist at the Comprehensive Epilepsy Center makes a diagnosis of seizures or epilepsy, the next step is to select the best form of treatment for each patient. Most often, the process starts with medical therapy. Many medications are available for the treatment of epilepsy, and with proper treatment, as many as 70 percent of patients may become free of seizures.
With current medication and treatment, most people can have their seizures relatively well controlled. In the last 15 years, researchers have developed promising new drugs for treating epilepsy, but finding the right drug for a patient can be challenging. Some drugs have potential medical, cognitive and behavioral side effects. A proper diagnosis is a critical first step to developing a successful treatment plan. The center's epileptologists work with other physicians within and outside of the Berman Brain & Spine Institute to provide a multidisciplinary and comprehensive approach to each patient’s care.
For reasons that remain to be explained, everyone's seizures are not controllable with medicine.
Studies suggest that between 50 percent and 70 percent of patients with epilepsy can be controlled (no seizures) with a single medication. However, it sometimes takes several trials of various medications and doses to find a dose that controls seizures with minimal or no side effects. Another 10 percent of patients may achieve control with multiple medications. Many patients choose to tolerate some medication side effects (commonly, drowsiness) in order to be seizure free. Other noninvasive treatments include a modified Atkins diet, a ketogenic diet and hormonal manipulation.
Unfortunately, approximately 20 percent of patients cannot be helped with medications, and they continue to have seizures. When medicine and other attempts to control seizures are not effective, surgery and implantable devices may be options.
Among the available procedures are laser ablation, placement of various neurostimulators and deep-brain stimulation.
Neurosurgeons at the Berman Brain & Spine Institute are able to offer several minimally invasive surgical treatments. Placement of a vagus nerve stimulator, for example, can effectively reduce the number of seizures and sometimes stop them altogether. Another technique is called laser ablation, with which neurosurgeons can directly target the brain region where seizures are originating and remove that region with a thin, imagery-guided laser probe. Removal of the malfunctioning area can often control seizures.
The information obtained during a patient’s stay in the Epilepsy Monitoring Unit is essential in determining if a patient is candidate for one of these procedures, and they all require extensive pre-surgical evaluations to ensure that surgery is safe for the patient and the very best treatment option for their epilepsy type.
The staff of the Comprehensive Epilepsy Center consists of highly skilled experts in neurologic health and provides comprehensive neurologic and neurophysiology services, including routine and video EEG for outpatients, ambulatory EEG, evoked potentials, intraoperative monitoring, a dedicated neuroscience care unit, and inpatient video EEG.
About the Unit
The inpatient Epilepsy Monitoring Unit at Sinai Hospital that allows doctors to observe and record the brain waves of patients experiencing seizures or seizure-like behaviors in a comfortable, relaxed setting. Patients stay in a private room equipped with minimally intrusive medical and video monitoring equipment. By observing the patient's episodes and pinpointing the source of the seizures, Sinai doctors can find better ways to treat patients who may not be responding to medical therapies. In the video below, Francis G.
Tirol, M.D., shares more about the unit:
Our faculty consists of highly skilled experts in neurological health
and provides comprehensive neurophysiology services, including routine
and video EEG for outpatients, evoked potentials, intraoperative
monitoring and inpatient video EEG. The Center’s epileptologists, neurophysiologists, neuropsychologists, and neurosurgeons, through a multidisciplinary team approach and multiple technologies, have developed sophisticated ways to evaluate seizures and treat patients whose epilepsy is resistant to other therapies.
Perry Jay Foreman, Ph.D., M.D., is the director of the Comprehensive Epilepsy Center. He earned his degree in medicine from the University of Texas Southwestern Medical School at Dallas and earned his doctorate in neuroscience from the University of Texas Medical Branch at Galveston. He completed a neurology residency and an NIH-sponsored, 2-year fellowship in developmental epilepsy and clinical neurophysiology at the Baylor College of Medicine. Dr. Foreman is board certified in neurology, with subspecialty certification in clinical neurophysiology.
Prior to joining the Brain & Spine Institute, Dr. Foreman remained on faculty at Baylor, where he was associate director of the Clinical Neurophysiology Fellowship Program and was the director of the Clinical Neurophysiology Laboratory at the Michael E. Debakey Veteran's Affairs Medical Center. Dr. Foreman's special interests include epilepsy in elderly patients, mortality issues associated with epilepsy, and medical considerations with driving.
In 2014, Dr. Foreman began serving a 2-year appointment as the Chairman of the Professional Advisory Board for the Epilepsy Foundation of the Chesapeake Region and is a member of the Medical Advisory Board for the State of Maryland Motor Vehicle Administration.
Francis G. Tirol, M.D., is an epileptologist and director of the Epilepsy Monitoring Unit at Sinai Hospital. After earning his medical degree from Georgetown University in Washington, D.C., Dr. Tirol completed a residency program in neurology at New York University Medical School and a fellowship in epilepsy and clinical neurophysiology at the University of California, Los Angeles/David Geffen School of Medicine. His special interests include epilepsy surgery, intraoperative monitoring, and advances in neuroimaging.
A recipient of research support from the National Epifellows Foundation, Dr. Tirol has co-authored studies that investigate outcome measures in the epilepsy monitoring unit and the utility of innovative imaging techniques in the presurgical evaluation of epilepsy patients. With board certification in neurology and clinical neurophysiology, Dr. Tirol is interested in the surgical treatment of epilepsy and the use of neuroimaging techniques in the presurgical evaluation of epilepsy.
Arash Foroughi, M.D., M.P.H., received his undergraduate degree from George Washington University in Washington, D.C. After completing graduate work in public health and physiology at the Medical College of Virginia, Virginia Commonwealth University, in Richmond, he received his medical degree from St. George's University School of Medicine in Grenada. Dr. Foroughi completed a neurology residency at SUNY Downstate in New York and a fellowship in clinical neurophysiology at Duke University Medical Center in Durham, North Carolina.
Board certified in neurology and clinical neurophysiology, he is a member of the American Academy of Neurology, the American Epilepsy Society, and the American Clinical Neurophysiology Society.
S. Marc Testa, Ph.D., A.B.P.P.-C.N., a state-licensed psychologist and board-certified clinical neuropsychologist, specializes in the areas of epilepsy, psychogenic seizures, cerebrovascular disease, dementia, and traumatic brain injury in the adult population.
Dr. Testa received his undergraduate degree from Syracuse University and earned a doctoral degree in clinical psychology with a focus on neuropsychology at the University of Cincinnati in Cincinnati, Ohio. He then completed a clinical psychology internship at the Veterans Administration Maryland Health Care System/University of Maryland and a clinical neuropsychology fellowship in the Department of Psychiatry and Behavioral Sciences at The Johns Hopkins University.
In addition to his clinical duties in the Division of Neuropsychology at the Berman Brain & Spine Institute, he serves as its clinical training director. An author of numerous journal articles, book chapters, and professional manuals, he has served as an ad hoc reviewer for several well-respected journals and is a member of the American Psychological Association, American Academy of Clinical Neuropsychology and the International Neuropsychological Society.
Omar Zalatimo, M.D., M.P.H., M.H.A., completed his undergraduate education at Bucknell University in Lewisburg, Pennsylvania. During his neurosurgical residency and a fellowship in functional neurosurgery at Penn State Hershey Medical Center in Hershey, Pennsylvania, he earned masters degrees in Public Health and Health Administration from Penn State University.
Dr. Zalatimo is board eligible in neurosurgery and is an active member of the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, the American College of Surgeons, and the American Medical Association. His active clinical and research interests are in the treatment of simple and complex spinal problems, brain and spinal tumors, brain hemorrhages, Chiari malformations, adult hydrocephalus, epilepsy, pain, trigeminal neuralgia, spinal stimulation, spasticity, peripheral nerve disorders, deep brain stimulation, and CyberKnife radiosurgery.
Watch a patient of The Sandra and Malcolm Berman Brain & Spine Institute give her insights on epilepsy.
For more information about epilepsy and the Epilepsy Center you can view our brochures online: Epilepsy Center, Perry Jay Foreman, Ph.D., M.D., and Francis Tirol, M.D.