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Ask An Expert: Everything About Epilepsy

Ask An Expert: Everything About Epilepsy

With Neurologist Brian Wolf, MD

Epilepsy is one of the most common neurological disorders in the world, affecting as many as 50 million people globally. And it is estimated that nearly 70% of people living with epilepsy could live seizure-free, if properly diagnosed and treated. Still, epilepsy remains shrouded in medical mystery and societal stigma, as doctors search for answers and those affected seek understanding. Healthe-Matters spoke with Dr. Brian Wolf, a neurologist and expert in treating epilepsy, to learn more.

What is epilepsy, as opposed to a seizure?

A lot of people equate seizures with epilepsy, but they're very different. And not everyone who has a seizure has epilepsy. A seizure is, in colloquial terms, an electrical brainstorm. And what we see are physical manifestations of that. Epilepsy is when someone has recurrent unprovoked seizures. Some seizures are what we call “provoked,” meaning they happened under certain circumstances but never again. Those with epilepsy would have recurrent seizures for seemingly no reason at all.

What is happening during a seizure and how long do they last?An illustration of electrical activity between nerve cells.

On average, a seizure can last anywhere from 30 seconds to 2 minutes. And the brain is, for lack of a better term, misfiring. Classically, we think of a seizure as a grand mal seizure, where someone stiffens up, falls to the ground and is shaking. But seizures can present in many ways that are more subtle. Some people have staring episodes; some people have repetitive movements, what we call stereotypic movements. While this is happening, patients can be aware or may lack awareness.

What causes epilepsy?

There are different causes of epilepsy. But in adults, the most common reason people develop epilepsy is stroke. After a stroke, scar tissue can form and, over time, can disrupt normal circuitry of the brain and lead to seizure formation. This can also be caused by a brain tumor or a head injury. There can be genetic causes as well, and congenital defects. There's a lot of research going into it, because most of the time epilepsy is what we call idiopathic, meaning we just don't know.

How is epilepsy diagnosed?

Epilepsy can be tricky to diagnose, especially when someone has a first-time seizure. An MRI of the brain and an EEG give us a window into the person's brain to see if they’re at risk of having seizures in the future, but we may not have enough information to make a diagnosis. It's a dynamic process. Sometimes we're able to make the diagnosis off the bat; sometimes we may have to wait for a second unprovoked seizure.

How is epilepsy treated?

It's individualized for every patient. The mainstay of treatment is anti-seizure medication or antiepileptic medicines. Beyond medicine, we can offer patients surgical options, whether it be resective brain surgery or what we call neuromodulation, which is a device, similar to a pacemaker, that can help detect seizures and stop them as they come. And now there's talk about medical marijuana too.

Responding to a Seizure

When it comes to seizure first aid, a lot of people want to help but don't know what to do. Here are a couple tips:

  1. Do not attempt to restrain the person. Make an open space and minimize the chances that the person seizing could hurt themselves or others.
  2. Put them on their side, if possible.
  3. Don’t put anything in their mouth. The person can choke. You may get hurt.

When is surgery called for?

Typically, we prefer not to have to go into the brain and do surgery. But when two seizure medicines prove ineffective, the patient would fit what we call a refractory category, where they're unlikely to benefit from seizure medicines. And that's when we talk more about surgical options.

How do you define success in epilepsy treatment?

Our mantra is "No seizures and no side effects." That's our goal. We want to get you seizure-free, or as close to it as we can, but we're also looking to maintain quality of life and make sure that you tolerate your medicines well.

Is it possible to live a perfectly normal, happy, healthy life with epilepsy?

Absolutely. About 70% of patients can achieve seizure freedom on antiepileptic medication. It's a common misconception that epilepsy is a lifelong sentence, when there are good treatments now and patients can live perfectly healthy, normal lives.

How does someone seek treatment?

Start with your primary care. See a neurologist quickly.
There's a lot of taboo associated with seizures and people oftentimes are scared to seek treatment, but it's important to understand that patients with epilepsy are not alone. It's a very common diagnosis and there are good treatment options and a lot of resources out there.

Learn More

If you or a loved one is living with epilepsy and would like to learn more about treatment and management options available at Sarasota Memorial, click here or call (941) 917-7777 for more information.SMH Copywriter, Phil Lederer

To hear more from Dr. Wolf, click here for his latest appearance on the SMH podcast, SMH HealthCasts.

Written by Sarasota Memorial copywriter Philip Lederer, MA, who crafts a variety of external communications for the healthcare system. SMH’s in-house wordsmith, Lederer earned his Master’s degree in Public Administration and Political Philosophy from Morehead State University, KY, and has never broken a bone of his own.

Posted: Sep 26, 2023,
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