>> Our first topic is a serious one.
If you've ever experienced a seizure or witnessed someone who has had one, you know just how
scary the situation can be.
But they are only the symptoms.
Epilepsy is a disease which causes them.
Two doctors joining me here to today, Dr. Jayant Acharya, and also Dr. Michael Sather.
They are here to help us gain a better understanding of epilepsy and a patient's options.
Let's start with you, doctor.
What is the difference between epilepsy and then the seizures?
>> So seizures are neurological symptoms that occur when there is a sudden, excessive and
abnormal change in the electrical activity in the brain.
>> Okay.
>> The actual symptoms vary and depend on which part of the brain and how much of the
brain is actually affected.
But some of the common symptoms are change in the level of consciousness, stiffening
of the body or jerking movements of the body, sometimes just staring, all variety of sensations.
And sometimes patients can be fully conscious during the seizures.
>> That's really interesting, so maybe we won't, you think of a seizure you think of
somebody kind of convulsing.
>> Exactly.
>> But not necessarily.
>> Not necessarily, exactly.
And most seizures tend to be very brief.
They last maybe a couple of minutes or so.
On the other hand, epilepsy is the underlying brain disorder.
>> Okay.
>> That gives rise to seizures.
So most people with epilepsy have seizures over and over again.
Then oftentimes these are unprovoked.
Not all patients with seizures have epilepsy.
>> Okay.
>> And so that's another distinction.
>> Okay, it could be something else.
>> Well no, in a sense that if you have only one seizure, for instance, in your life, and
some people have that, or if you have seizures only in certain specific situations, such
as low blood sugar or lack sleep, severe sleep deprivation, alcohol withdraw, or high fever.
And this usually occurs in children.
Then such people are not considered to have epilepsy.
They just have seizures.
>> In terms of epilepsy though, how common is epilepsy.
>> Well epilepsy, as it turns out, is one of the most common neurological disorders.
And it affects about 1 in 26 people.
So 1 in 26 people will develop epilepsy sometime during their lives.
>> That's way more than I would have thought.
Treatment, though, is available.
How is it treatment used?
>> Absolutely, I think fortunately, epilepsy is one of the most treatable neurological
disorders.
And we usually begin treatment with medications.
There are more than 20 different medications available.
And so choosing the right medication for a patient depends on a number of different factors.
But once we get the right medication, it's usually effective in controlling seizures
in about 50% of patients.
>> What if it's not?
Is there where surgery would come in?
>> Yeah, there's about a third of patients that don't respond well to medical management.
The other two-thirds do very well with medical management.
About one-third do not.
And they are potential candidates for surgery.
The most effective surgery we have available is a surgical resection where a portion of
the brain that's actually causing the seizures is removed.
And of course, we need to do that safely, so we need to determine whether or not that
particular area of the brain has any function associated with it, whether that's speech,
vision, movement, sensation.
So there's various tests like the functional MRI that we'll use to assess for that.
>> Alright, we actually have a graphic of that.
This is how you'd look at the brain.
>> So there's a functional MRI, and the yellow-orange appearing blobs there you see are someone's
speech area.
So if the seizures were arriving in that location, that patient may not be a candidate for a
resection.
>> Oh sorry.
>> The most common example I can give of a resection is a temporal lobectomy where we
remove the temporal lobe, which sits right behind the eye, above the ear, in this location
here.
And that renders patients seizure-free about 70% of the time when we remove it.
So very effective and potentially cured of treatment.
>> The brain though, it's kind of scary.
It seems like it's so strong, it's so delicate, and there are places where maybe it's not
safe to do certain treatments.
Are there other options for that then?
>> Yeah, so that's the great news is we have options available to patients when they have
seizures that arise from either an area that we can't either, we can't safely remove.
Or sometimes patients have seizures that arise from more than one place in the brain, and
we can't potentially take both places out.
So we have neural stimulation.
And there's two different types of nerve stimulation out on the market.
And a neural stimulator is nothing more than a biomedical device that's delivering electrical
impulses to the nervous system to modulate the nervous system and decrease the seizures.
And one is a vagus nerve stimulator which involves placing of an electrode around the
vagus nerve in the neck, near the carotid artery, and the other is the one you'll see
here, which is the neuropace responsive neurostimulator, which actually involves implantation of brain
[inaudible].
>> That's this here, yeah.
>> In the surface of the brain in and around the area where the seizures start.
And then actually record the seizures.
And when there's a seizure starting, it will abort the seizure by sending an electrical
impulse which prevents its clinical manifestation.
So some very effective treatments when we do not have the surgical reception option
available.
>> So really the message I'm hearing is, you know, if somebody's experiencing these seizures,
there are treatments.
You don't have to live like that necessarily, and folks can learn more about epilepsy and
the different treatments and different symptoms at a webchat this afternoon.
Both doctors are participating in that Agency 27 webchat.
It starts at one this afternoon and will go for one hour.
You can find more at ABC27.com/chat.
Again, that webchat starts right after Good Day PA.
Thank you so much, doctors.