>> From Penn State Health this is Ask Us Anything About Epilepsy.
I'm Scott Gilbert.
Epilepsy is a group of disorders characterized by recurrent seizures.
In fact, it's the fourth most common neurological disorder and affects people of all ages.
We're going to learn more about epilepsy and how it's diagnosed and treated from Dr. Tiffany
Fisher.
She's a neurologist here at Penn State Health.
Dr. Fisher, thanks a lot for your time today.
Let's start with kind of a general definition of epilepsy.
What is it and how do you make that diagnosis?
>> Well, like you said it's recurrent unprovoked seizures.
And basically what you want to do is present to a neurologist.
They can take a thorough history.
They may require other labs to take as well.
And based off of that they may ask for additional testing.
And with that usually we ask for an electroencephalogram which is an EEG that looks at our brain activity.
And then we also may want imaging.
And typically that's with an MRI so we can see the fine detailed structure of the brain
to look for any abnormalities.
>> And when you say abnormalities what are you looking for in there in lay terms?
>> Okay.
So in lay terms sometimes there is a tumor that could cause it.
Sometimes it's some functional abnormality from development that was already there and
just manifests at a later age.
So all of those things that's the things we're looking for in an MRI.
>> Sure.
And how common is epilepsy in the general population?
>> All right.
So like you said it's the fourth most common neurological disorder.
There is about 65 million people worldwide who have epilepsy and 3.4 million people here
in the United States.
>> So it's not rare.
>> Not rare at all.
There's about 150,000 new cases diagnosed each year.
And 1 in 26 people will have epilepsy in their lifetime.
>> That sounds pretty high, but I imagine the severity of the condition probably varies
from person to person, right?
>> That's absolutely right.
So sometimes depending on how frequent those seizures are for each individual person will
vary.
And sometimes it depends on actually the types of seizures they have which are more severe
than others.
>> And we'll get into those in a moment.
But right now I want to remind you you're watching Ask Us Anything About Epilepsy from
Penn State Health.
We welcome your questions for Dr. Tiffany Fisher.
She's a neurologist here.
You can just put those in the comment field below this Facebook post and we'll get you
some answers.
That includes if you're watching this video on playback we can still get you answers that
we'll add to the comment section.
So, Dr. Fisher, what are the different types of seizures that you typically see in epilepsy?
>> So you can have what we think of as focal seizures that start in one place and they
may spread.
Or you can have generalized seizures that tend to start all over.
So when you think of generalized seizures, the classic case that people think about are
those grand mal seizures, the generalized tonic clonic seizures.
And so with those you have tonic stiffening of the body followed by clonic jerks that
can last usually from one to three minutes.
And then there's another generalized type of epilepsy that people know well and that
is absence epilepsy.
And that's usually with children, and the teacher may come and say the child is not
paying attention, they seem to be staring off.
They can have a lot of eye blinks or eye flutter and then some odd mouth movements associated
with that as well.
>> So it could be harder to notice those.
>> Absolutely, and those tend to only last seconds making them even harder to delineate.
And then as you move on you can have some atonic seizures which we call drop attacks
where the first person may fall out and fall to the floor.
So those last seconds.
You can have some myoclonic jerks which is fast jerking movements of any body part.
And then when we think about focal seizures we're tending to think about the things that
people used to know as complex partial or simple partial seizures.
So with focal seizures when the person is unaware they have this staring and unresponsiveness.
It looks like they're gazing off.
You might not notice it, but they're not responding to you, they're not answering questions.
And that can last minutes as well.
And then there is another type with focal where they're aware and they can have movements
of a single body part or a single side.
And then also they can have these odd what we call paresthesias, so it's like numbness,
tingling, burning, crawling sensation on one side.
So it all depends on where that seizure starts in the brain to depend on what symptoms, physical
symptoms that are manifested.
>> And so there's so many different types of seizures, durations, severity.
I imagine, though, it's still important to note any of them, right?
>> Yes, absolutely, absolutely.
So one of the things that we like to educate our patients on and their family is to take
note of when a seizure starts and what you're looking at, to know what side.
If the head turns to a certain side, if the eyes turn to a certain place that helps us
all to localize where the seizure may begin.
>> So given that there are so many types of seizures, I'm curious are you able to explain
in lay terms what's happening in the brain that's triggering these, or is it different
causes?
>> So usually what we think of when seizures occur is this excessive synchronous excitation.
So I like to explain to patients that if you think about a high school room and you walk
into the classroom, and many people are having their normal conversations, and there may
be subgroups in the classroom.
That's sort of like how our normal brain functions.
But think about when you go into a chorus and they're all singing a fast, upbeat song
all together that's what I think about as seizure activity, all that excessive synchronous
excitation occurring together.
>> You're watching Ask Us Anything About Epilepsy from Penn State Health.
I'm Scott Gilbert.
This is Dr. Tiffany Fisher.
She's a neurologist here, and we welcome your questions for her.
So put those in the comment field below this Facebook post.
And if you find this information useful as we hope you do why don't you share this on
your Facebook page so we can help the information to reach more people.
I'm curious what we know and perhaps what we don't know about the causes of epilepsy
including I guess hereditary links.
Does that kind of run in the family?
>> Well, it can, you can have genetic causes.
But for the majority of seizures about 50 to 60 percent of the causes are unknown, are
idiopathic.
For the remainder you can have a variety of reasons.
You can have those genetic or hereditary factors.
You can have brain tumors.
You can have head trauma, whether that be a penetrating injury or blunt force trauma.
You can have stroke, whether that be ischemia or hemorrhage or bleed into the brain.
Other factors can include infection.
As I talked about before you can have a malformation in a certain area of the brain.
And then late stages of Alzheimer's disease is associated with epilepsy as well.
>> How about things like certain foods or other triggers that people may be able to
control, are there some of those?
>> So, yes, so there are certain dietary factors that can come into play or bound nutrients
that can result in seizure activity.
There's also triggers such as photic stimulation or flashing lights can trigger epilepsy, sleep
deprivation, hyperventilation.
Things that lower your seizure threshold are going to be alcohol intake or alcohol withdrawal.
So all of those factors are important.
>> Are there any other factors we should know about that may increase somebody's risk of
epilepsy, anything that people should know about?
>> So in addition to what I said before about things that you can't control such as if you
have a head trauma, if you have a stroke, there are other factors that you need to think
about that can increase your risk.
And so those can include medications that can lower our seizure threshold whether they
be antibiotics, whether they be drug use such as cocaine.
A stimulate such of that nature can definitely cause seizures.
>> So we often associate epilepsy as being something that children have.
Is that always true?
I mean is it always true that I mean these are children, but I mean sometimes adults
they can carry this into adulthood as well, right?
>> Yes, so some children such as those with absence epilepsy or even with juvenile maraconis
epilepsy, JME, they may outgrow it.
But in some cases they don't.
And then as we get older our risk of having some type of brain injury increases especially
above the age of 60 where you have the increased risk factors of stroke, aneurism, bleed, things
of that nature.
So then you'll see that there's two populations.
You'll have a large increase as children who are born with it, genetic, hereditary factors,
and then again as we reach elderly age due to acquired injuries.
>> So onset can happen in childhood or adulthood.
Adult epilepsy doesn't have to be carried over from childhood?
>> Absolutely.
>> All right.
So if somebody believes they have a seizure, they believe their child has had a seizure,
is that automatic you've got to seek medical attention?
>> I think it is.
I think if you're worried enough you should seek medical attention.
You should try to talk to your primary physician, and then ultimately see a neurologist.
The story is very important to us of if the child or the adult had nocturnal seizures
or nighttime seizures that causes us to be on higher alert just based off the story.
And then those other things that I tell you about about the electroencephalogram and the
MRI looking for other causes of why they may have seizures.
>> You're watching Ask Us Anything About Epilepsy from Penn State Health.
We welcome your questions for Dr. Tiffany Fisher a neurologist here at Penn State Health.
Just add those to the comment field below this Facebook post.
Let's talk a bit about the treatment.
Because I know in some cases or maybe in all cases there's no cure per se but it can be
treated usually, right?
>> Absolutely.
So things that people think about most of all are medications, right?
So medications is at the forefront of all treatment of epilepsy.
And you'll try to use a variety of medications that can affect the channels that lead to
seizure propagation.
So usually that's a good discussion with your neurologist about what medications are appropriate
for the type of epilepsy you have, whether that be focal or generalized or absence seizures,
okay?
And then after that you can think about dietary restrictions such as a ketogenic diet where
you're mainly eating proteins and eliminating your carbohydrates.
That's another treatment for epilepsy and seizures.
And then classically we think about if that is not handled with dietary restrictions as
well as medications we can move onto surgery.
So surgery we think about resection, taking out the tissue that's actually seizing.
>> That's a very small amount of tissue we're talking.
>> That's absolutely right.
It's not the classic thought of lobectomies that people think that render them to institutions
like the old days.
It's very methodical and localized.
And then, again, with that you can think about laser ablation which is a new technique to
use an actual laser to zap that piece of tissues that's actually firing.
And then basically we can move into devices.
So devices people typically think about is the vagal nerve stimulator which is just like
a pacer, like a pacemaker.
It fits in the chest cavity wall.
And then it has a wire that wraps about the vagus nerve and the neck.
And so this delivers stimulation 24 hours a day throughout the day.
So it's on for a period of time, off for a period of time throughout your lifetime.
There is a new device called the DBS, the deep brain stimulator which was approved for
epilepsy in late 2018, last year, and people classically think of this as a device with
Parkinson's disease to help control the tremor, but it's actually used with epilepsy as well.
And then finally there's an RNS device, a responsive neurostimulator which is also another
type of device that delivers stimulation just at the onset of seizures when it detects it.
>> And that's amazing because it does, it does just that.
It actually detects when the seizure is about to happen and then negates it.
>> Right, absolutely.
>> That's really something else.
We have a question now from Jewel.
She's asking what makes Penn State Health a level 4 center and what does that mean to
a patient?
When we talk about that we're talking about a comprehensive epilepsy center here.
Can you talk a bit about that?
>> Yeah.
So Penn State Health and the department of neurology has a level 4 epilepsy center.
So that means that all of these things that I just discussed it's able to provide for
you.
So whether that's surgery, whether that's medication use or it's that dietary therapy
we are able to do that.
And that's a comprehensive, accreditation approved epilepsy center.
And so here you want to have neurologists that see all of these conditions and that
are able to provide you with the pathway which is best for you.
>> And this is all you do.
You focus on epilepsy.
>> Absolutely.
>> All right.
I be a question a lot of people have is what should they do if they come across somebody
or see somebody who is having what appears to be a seizure, especially a violent one
where there's some uncontrolled motions?
There's a lot of information out there.
But the thought of, well, do we try to hold the tongue down with something?
I mean there's a lot of bad information out there.
>> Absolutely.
>> Let's set it straight.
>> So the first thing which is easier said than done is don't panic.
And to help the person out try not to crowd them.
You want to support their head if possible with like a jacket and put it under their
head.
Remove any sharp objects surrounding them.
Turn them onto their side.
Remove their classes.
If they have any tight clothing around them such as a tie you want to remove that as well.
You don't want to hold the person down or restrict them.
And you do not want to put any objects in their mouth.
It's important that you look for any medical alert bracelets if they have a medical alert
about epilepsy or seizures.
You also want to time the seizure if you're aware enough of that to time the duration
of it.
Because when seizures reach that five minute mark that's when they're going into what we
call status epilepticus which is now a prolonged seizure and is more likely to pick up other
networks in the brain to propagate, prolong duration seizures, and that's harder to break.
So that's what you want to -- at that point call 9- 1-1 if it reaches the five minute
mark.
If you can't find an epilepsy bracelet on them you want to call.
If they've had any injury at that particular time to the body or anywhere else you want
to call.
If you see that they aren't breathing properly or maybe the seizure stopped and they're not
recovering and coming back to normal within a few minutes.
Or maybe they stop that seizure and then quickly go into a second seizure.
>> So it's really about trying to keep that person safe for the duration of their seizure.
Like you say not trying to do anything interventional, anything in the mouth, just trying to get
sharp objects and things away from them.
>> Absolutely.
>> All right.
I also understand that the folks with epilepsy sometimes are at higher risk of, for example,
drowning or falling.
Can you talk about some of those risks?
And I guess this all points back to the importance of getting diagnosed.
>> Absolutely.
So we tell our patients about seizure precautions.
And so those seizure precautions can include not driving a vehicle because they have either
loss of consciousness or loss of awareness in their surrounding.
It could be not operating heavy machinery because that could fall on you and injure
you.
Climbing heights, that's important.
Also not taking a bath or swimming unattended because you could drown.
Cooking over open flames that's really important.
I tell my epilepsy patients to cook on the back burner and not the front burners in case
they have seizures because then they can fall or knock over the pot and result in burn injuries.
So those are all important.
>> Wow.
And you're watching Ask Us Anything About Epilepsy from Penn State Health.
Your questions for Dr. Tiffany Fisher are welcomed here.
Just make sure you add those to the comment field below this Facebook post and we will
get those asked here.
How about pregnancy, is there a risk with women who have epilepsy getting pregnant?
>> So there's risk to the fetus with epilepsy drugs not per se with seizures unless it's
more of a risk if the person had uncontrolled epilepsy at the time that they're pregnant.
Because, as you can imagine, if you have the generalized tonic clonic seizures you can
either injure the fetus, or it can result in a lack of oxygen and blood flow to the
fetus during that time.
So the greatest thing we want to do is to help to control seizures before they go into
pregnancy.
Once pregnant and they have the child we talk about seizure precautions for that mother.
So you want to think about taking the baby up and down the steps in their carrier in
case you have a seizure so you won't drop them holding them.
Having someone around you when you bathe the child such that if you have a seizure you
won't drowned them.
Changing them on the floor, on a low surface, again, so you won't drop the baby.
So those are all precautions we talk about with women and pregnancy.
>> Does epilepsy come with an elevated risk of emotional health issues?
>> Absolutely.
So the two common most co-morbidities associated with epilepsy are depression and anxiety.
And so it's fairly common for our patients to talk about that.
And fortunately here at Penn State Health we have an epilepsy psychiatrist that strictly
sees our epilepsy patients because those co-morbidities are so high.
>> So as you mentioned before in up to half of all seizure cases we don't know what causes
them, and I'm sure there's room for improvement with treatment.
So what kind of research is under way to try to improve all this?
>> So research is always going on.
We have research trials here talking about new drugs and new mechanism of drug actions,
new devices just like the DBS that was approved last year.
So those are new ways to get drugs to their target.
So there's always ongoing research.
The best that you can do is to come to a level 3 or 4, hopefully Penn State Health Epilepsy
Center so we can engage you in those research projects.
>> Some of those dangers you mentioned like falling, drowning, even cooking in your own
stove, when you try to take certain precautions it seems like it could be perceived as trying
to take away someone's independence.
So part of what you do is work to give people their independence back.
>> Absolutely.
So the thing is is that all epileptologists want you to have zero seizures.
That's always our goal.
But we know that there has to be a quality of life balance.
So there are side effects from medication such as fatigue and sleepiness.
So we have to balance what's best for you and controlling your seizures.
So we always thing about that when we're treating you.
>> And, again, why it's so important to go somewhere where there are so many options
available, not just medication, not just one or two things but the whole gamut.
>> Yes, sir.
>> Okay.
And, by the way, if you like the information you're hearing tonight from Dr. Fisher we
encourage you to tune in tomorrow which is Wednesday, March 13th to ABC 27 at 7:30 p.m.
for Brainstorm.
This special half hour program from 7:30 until 8 will focus on a few different neurological
issues including epilepsy.
So that's from 7:30 until 8 on Wednesday the 13th.
We'll also put the information and the link to that program in the comment field below
this Facebook post.
And just a reminder also for that call in show you can call in and talk to experts from
Penn State Health from 7 to 8 p.m. tomorrow even with ABC 27.
Well, my thanks a lot to Dr. Tiffany Fisher.
She's a neurologist here at Penn State Health.
And our thanks to you for watching Ask Us Anything About Epilepsy.