Epilepsy affects more than 2 million people in the United States making it one of the most common neurobiological conditions. Seizures are the hallmark symptoms of epilepsy. In simple terms a seizure is an episodic event that involves hyperexcitability and hypersynchrony of the neuronal circuitry of the brain. When the excessive and disorderly discharge of neurons is large enough, it manifests itself as a seizure which can be detected clinically (by observers) or electrographically (by EEG recordings) or both. The attack may be localized or it can be spread to other areas of the brain. A seizure’s clinical presentation can be widely variable depending on the location of the brain that is affected. For a patient suffering from epilepsy, the disorder can have a profound social and psychological impact.
Because seizures manifest in so many different ways, the accurate classification of a person’s seizure type is essential. The epilepsy specialist is guided by a thorough history, including detailed questions about seizure characteristics from prodrome to post ictal symptoms. Important information is also gained by detailed questioning of the witness to the event. It is recommended that an observer of a seizure take note of the person’s activities before a seizure and pay close attention to their mood and behavior after the seizure. It is important to take note of the exact symptoms and duration.
Epilepsy may be a manifestation of an underlining medical illness or abnormality. The incidence of epilepsy is highest in those under 10 years of age and over the age of 65. Underlying causes of epilepsy include: stroke, head trauma, alcohol related, neurodegenerative, static encephalopathy, toxin related brain tumors, and infection. In about 62% of cases of epilepsy, the cause is unknown (idiopathic). There is also a category of seizures which is called “non-epileptiform seizure disorders.”
Medicinal therapy has been the mainstay of epilepsy treatment for decades. An epilepsy specialist will tell you the goal of pharmacotherapy with anti-epileptic drugs (AEDS) is to control seizures while minimizing adverse events. Treatments of epilepsy typically consist of daily, long-term antiepileptic drug regiment. Approximately 65% of patients respond to treatment with a single AED. Different AED medications treat different types of epilepsy syndromes. It has been found that once a patient has failed an adequate trial of two appropriate AEDS, the probability of attaining seizure freedom is less than 3%. Alternate medical and surgical therapies have been implemented in the “medically refractory” epilepsy patient. These include the modified Atkins diet, VNS Therapy and surgical interventions (invasive and non-invasive). VNS itself or a combination of VNS medications have been successful in controlling refractory epilepsy.
Managing the complexities of epilepsy requires good communication between physician and patient to achieve the best outcome for seizure control. This includes promoting compliance and treating comorbid conditions. Whether you are on medicine, require VNS therapy or are thinking about surgical options, our epilepsy treatment program at Northern Neurology Specialties will guide you and help you get the best diagnostics and medical management for your condition.