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
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
-
Hallucinations
-
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.
Diagnosis
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.
Treatments
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.
Epilepsy Surgery
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.