What is the difference between seizure and epilepsy?
Seizure and epilepsy are used interchangeably but to be
specific if you have one time seizure or single seizure it's called seizure but
when it becomes habitual and repetitive then it's called epilepsy.
What is a seizure and what do they look like?
Seizures happen when a group of neurons or brain cells start
sending repetitive or excessive electrical discharges which they normally do but not
as intense as they do during seizures and this electrical discharge may spread to
the other parts of the brain. And then depending on where this
electrical activity is located it can translate into different clinical presentations.
For example if the seizure focus is in the left hemisphere that controls the
right side in the area that controls the right hand then the patient may have his
or her right arm stiffen up or shake. Or if the seizure focus is in the
language cortex then the patient will have speech arrest.
What are the medical treatments for epilepsy?
Fortunately epilepsy is treatable and there are several
medications for that.
Up to early ‘90s we didn't have too many medications but fortunately now we have
about 12 medications that are used to treat epilepsy.
Of course medications will have some degree of side effects but we do our best
by adjusting the medical therapy to avoid side effects while we avoid seizures.
What are the surgical treatments for epilepsy?
There are surgical treatments for epilepsy too and by
surgical treatments mostly we are referring to finding or localizing the
seizure focus and surgically removing that seizure focus;
in other words the bad tissue or neurons that have gone bad can be removed - that's
called the resective surgery.
And there are other types of surgeries, in particular the one that's one of the
standard treatments is called Vagus Nerve Stimulator when a generator is placed
under the chest muscle and the probe or the wire goes around the vagus nerve
and sends impulses to the brain. In that case we don't remove any part of
the brain but of course the efficacy would be less than the receptive surgery.
Question: What can I expect as a patient coming to GUH for epilepsy?
Here at Georgetown we have an active epilepsy clinic and we
usually treat patients who have refractory epilepsy and they're usually referred to
us by our colleagues after they fail to respond to medical therapy.
In such cases we have to monitor patients in our Epilepsy Monitoring Unit in order
to record some of the seizures and find out if the seizures are coming from one
focus or they are multifocal or if they're coming from one hemisphere or from both hemispheres.
That also helps to categorize the seizures because some seizures come from
one focus and spread to the rest of the brain but there are seizures who come from
beginning from deep down in the brain and simultaneously spread to both hemispheres.
There are different treatments for these different types of seizures so after
classifying and categorizing the seizures then we'll have a plan for treatment.
If the patient happens to be a surgical candidate in that case our next step would
be to find out exactly the seizure focus, if necessary map the brain, and do the surgery.
But in the meantime of course we always optimize the medical therapy because
medical treatment remains the mainstay of treatments for epilepsy and even after
surgery for a while we continue medications.
How has epilepsy treatment improved in recent years?
Fortunately since early ‘90s because of extensive research
in epilepsy there have been several new medications which turned out to be much
better in terms of side effects and tolerability by the patients.
And nowadays we use these medications as first line treatment in epilepsy with
better side effect profile.