Earlier this year, The Pioneer Press, in collaboration with the Epilepsy Foundation of Minnesota, published a special “Celebrating 60 Years” feature edition about Epilepsy in celebration of the 60th anniversary of the founding of the Epilepsy Foundation. The neurologists at Noran Clinic who specialize in epilepsy and seizure as part of their practice were asked to answer several questions about Epilepsy, medications, and SUDEP.
See our doctors’ questions and answers below. To read the full feature, including the Q&A with Noran Clinic doctors on pages 4 and 5, you can view it here:
Q: What is Epilepsy? (Gerald Dove, MD)
Epilepsy is used to describe a condition in which a person has a tendency for recurrent seizures. A seizure is what happens when the brain has abnormal uncontrolled electrical activity. Having a seizure does not necessarily imply epilepsy. This is due to the fact that some seizures can occur due to provoking factors, even in persons with no tendency to continue to have seizures. Such examples of situations where seizures occur, due to provoking factors, but are not epilepsy, are seizures that occur due to alcohol withdrawal and hypoglycemia. In these instances, when these situations or provoking situations are avoided, seizures never occur or recur. On the other hand, someone with epilepsy can have seizures, even when these situations are avoided.
There are many causes of Epilepsy, some inherited or genetic and others acquired, such as brain trauma, brain tumors, strokes, or brain infections.
Q: When should someone seek a specialist for epilepsy? (Tacjana Friday, MD)
An epileptologist is a neurologist who specializes in the treatment of seizures and epilepsy, and has acquired expertise in seizures and seizure disorders, anticonvulsants, and advanced treatment options such as epilepsy surgery. An epileptologist is mainly consulted when a patient has poorly controlled epilepsy requiring more complex medical management, requires further evaluation with an EEG (electroencephalogram) to help characterize their spells or seizures, and/or to discuss other treatment options.
Q: Will I be on anti-epileptic medication for the rest of my life? (Syed Shahkhan, MD)
Most people with well-controlled seizures would like to stop taking their seizure medicines. In some cases, this can be done with the supervision of your doctor. You have the best chance of remaining seizure-free without medication if:
- You had few seizures before you started taking seizure medicine
- Your seizures were easily controlled with one type of medicine
- You have normal results on a neurological examination
- You have a normal EEG
Children with symptomatic epilepsy (epilepsy due to a known cause like brain injury, infections, tumor, and brain mal formation), adolescent onset, and a longer time to achieve seizure control are associated with a worse prognosis. In adults, factors such as a longer duration of epilepsy, an abnormal neurologic examination, an abnormal EEG, and certain epilepsy syndromes are known to increase the risk of recurrence. Even in patients with a favorable prognosis, however, the risk of relapse can be as high as 20% to 25%. Most doctors will consider tapering the dosage and discontinuing your seizure medicines after a seizure-free period of 2 to 4 years.
A decision about whether to stop taking seizure medicines should only be made after a long conversation with your neurologist, weighing all the risks. Are the possible results of another seizure (like injury or loss of your driver’s license) more acceptable than the continued effects of your medication?
Q: A stat is out about how seniors will be the largest population with seizures in the next 5 years. Does a physician have any tips or special concerns a senior might need to know about having epilepsy? (Rupert Exconde, MD)
Epilepsy frequently affects the elderly. Relative to younger populations, the over-65 age group has a higher prevalence of epilepsy.
The clinical presentation of epilepsy in the elderly may be quite different from what is typically seen in younger people. In addition, common illnesses of older people can be easily mistaken for epileptic seizures, and vice versa. The elderly are more likely to present with nonspecific symptoms, such as altered mental status, memory lapses, episodes of confusion and loss of consciousness. Because of the atypical presentation, the diagnosis is usually delayed by several months even in the care of an experienced neurologist.
It is important to recognize that freedom from seizures can be achieved in the vast majority of elderly epileptic patients. However, the morbidity associated with epilepsy is substantial, so once a successful treatment regimen has been established, lifelong treatment may be important for selected individuals.
Q: What is SUDEP and what do I need to know about it? (Rupert Exconde, MD)
SUDEP (sudden unexpected death in epilepsy) is the leading cause of epilepsy-related deaths. It accounts for close to 20% of deaths in individuals who suffer from epilepsy. It is diagnosed if death occurred while the patient is in a reasonable state of health, death happened during normal and benign circumstances, death was not the direct result of a seizure or status epilepticus (prolonged seizure) and an obvious medical cause of death could not be determined at autopsy.
Known risk factors for SUDEP include: young age (25 to 35), male gender, developmental delay, use of alcohol and recreational drugs, uncontrolled generalized convulsive seizures, night time seizures, concurrent use of multiple anti-seizure medications, subtherapeutic anticonvulsant levels, and treatment other than medication (surgery, vagus nerve stimulator, ketogenic diet).
The goal for decreasing the risk for SUDEP is optimal seizure management. Adherence with medication intake is essential. Avoidance of alcohol, illicit drugs, seizure-provoking situations, and high-risk situations (e.g., driving, swimming) are of paramount importance.
Q: Thoughts on medical marijuana as an epilepsy therapy? (Beth Staab, MD)
Medical marijuana is a hot topic in the national media and the medical community. With it’s recent legalization in Colorado the medical community is now more aggressively looking into potential therapeutic options for marijuana-including its use in epilepsy.
Currently, there is only a small controlled clinical trial that was performed in 1980 showing its potential effectiveness in humans. There are case reports of medical marijuana being effective for medically intractable epilepsy in children. In animal studies, there is a suggestion that tetrahydrocannabinol (THC-the active ingredient in marijuana) can control seizures not responsive to other therapies.
Before marijuana becomes a mainstream therapy for medically intractable epilepsy, we need more clinical trials to determine dose and administration method but there is hope that this may be able to be added to the armamentarium that neurologists have to treat seizures.
If you have additional questions about epilepsy or seizure and would like to schedule an appointment with a neurologist experienced in the management of this condition, please contact Noran Neurological Clinic at 612-879-1500.