Epilepsy and Treatment Options

Possibly, your very first thought that comes to mind when thinking of epilepsy; is a person who is having a severe seizure, and collapsing to the grounding. While this is true, there is a lot more to it.

It all starts with the brain. Electrical activity running through nerve cells helps your brain tell your body what to do. However, if abnormal signals interrupt the brain’s normal functioning, a seizure will occur.

epilepsy infographicWhat is Epilepsy?

According to epilepsy.com, “Epilepsy is a chronic disorder, the hallmark of which is recurrent, unprovoked seizures. A person is diagnosed with epilepsy if they have two unprovoked seizures (or one unprovoked seizure with the likelihood of more) that were not caused by some known and reversible medical condition like alcohol withdrawal or extremely low blood sugar.” Epilepsy is very common with 65 million people around the world with it; it affects about 3.4 million Americans. One should do everything they can, in hopes to prevent it from ever occurring.

Andrew Lerman, MD, a neurologist with First Choice Neurology and Baptist Health Neuroscience Center, says the most definitive way to diagnose epilepsy is with a video electroencephalogram or EEG. An EEG measures the brain’s electrical activity and the video component captures the body’s reaction to the abnormal brain activity.

There are also numerous other tests that could be performed to discover or rule out different causes for the seizures such as:

A neurological exam will be used to find out useful information about the patient. Information such as your history; the doctor should ask you questions regarding your symptoms and conditions.

A blood test will help determine if a seizure was caused by epilepsy or another disorder. A blood test could also calculate the quantity of hormone prolactin in the blood.

Imaging test will determine if the brain has any lesions on the brain that may indicate a stroke or brain tumor.

Spinal tap if any will rule out infections.

Dr. Lerman states, “these tests help put everything together to provide an accurate diagnosis.”

Treating Epilepsy

Treatment will be a must in hopes to improve quality of life and prevent future repeated seizures.

Medication

Dr. Lerman says that “the first line of treatment for epilepsy is medications.” Thanks to research, they have improved dramatically, with medications that aim at specific areas and functions of the brain and control the different types of seizures the usually occur with epilepsy.

“We now have about 20 to 25 medication we can use to help manage epilepsy and other seizure disorders,” he continues. “We may need to combine medications through trial and error to find the formula that works best, but more patients have their epilepsy controlled with medication.”

“We are excited by great outcomes that we are observing in terms of seizure prevention and treatment of associated symptoms with use of medical cannabis. We’ve seen a reduction in seizure burden, improvement in the quality of life measures, sleep quality as well as comorbid mood complaints.”

Surgical Options

Depending on the severity of the patient’s epilepsy; some patients will fail to respond to medications, otherwise known as “medically refractory epilepsy.” In addition to those patients, Dr. Lerman states that “surgery often helps patients whose epilepsy affects one area of the brain.”

Usual procedures include:

Laser Interstitial Thermal Therapy (LITT) – a minimally invasive procedure in which the area of the brain where seizures originate is exposed to a laser, creating a type of scar that stops abnormal signals from occurring.

Implantation of a Responsive Neurostimulation (RNS) device – a pacemaker-like device implanted into the skull that senses abnormal brain activity and delivers electrical stimulation to the brain to stop a seizure from happening.

Lobectomy – surgeons remove a portion of the temporal lobe of the brain where seizures originate in temporal lobe epilepsy.

Corpus Callosotomy – surgeons disconnect the right and left sides of the brain to prevent seizures that occur on one side from moving to the other side.

Hemispherectomy – for severe cases of epilepsy, surgeons remove a portion of or an entire half of the brain involved with seizures.

Dr. Lerman states that “these technological advances, especially in the areas of minimally invasive procedures, such as RNS and LITT, are greatly improving the management of epilepsy and the quality of life for patients who undergo them.”

Complementary Treatments

Some patients have turned to alternative, complementary therapies that have shown promising results for epilepsy.

Patients with refractory epilepsy, who have adopted a strict ketogenic diet have seen effective management of their seizures. Dr. Lerman said it is because of the burning of fats, instead of carbohydrates, for the body’s fuel leads to changes in the metabolism of the brain. He also stated the keto diet can be effective if carefully followed.

Additionally, the FDA approved a drug, Epidiolex – a cannabidiol oral solution – for the treatment of two severe and rare forms of epilepsy, Lennox-Gastaut syndrome, and Dravet syndrome. Cannabidiol, or CBD, is derived from the plant used to make marijuana but doesn’t contain the high-producing chemical tetrahydrocannabinol, or THC, according to the FDA. Dr. Lerman said CBD acts like other chemicals that are naturally in our brains and help suppress seizures.

 

Living with Epilepsy

Dr. Lerman expresses the urgency of treating epilepsy to control seizures. “Our greatest fear is the risk of disability from seizures,” he said, “Seizures can even lead to death.”

Dr. Lerman wants the stigma associated with epilepsy must be addressed through education of patients, their families, and the public. Everyone should be educated about the disease and how it should be treated. Dr. Lerman wants people to understand the severity of the disorder and how to live with it. “By educating others about the disease and its treatment options, as well as proving social resources to help patients and their caregivers cope with the management of seizures, we can minimize the stigma and improve patients’ quality of life,” stated by Dr. Lerman.

The Epilepsy Program at Baptist Hospital is one of the few programs in the U.S. that combines advanced treatment approaches with education and social management of epilepsy. Patients have access to multiple solutions for treating epilepsy; Baptist offers psychosocial support to patients and their caregivers. Dr. Lerman states that “family involvement is crucial to epilepsy care. Baptist Health’s program recognizes that and offers caregivers the support they need. We’re living in exciting times to help patients with epilepsy have normal lives.”

 

About Dr. Andrew Lerman

Andrew Lerman, MDDr. Andrew Lerman - Epilepsy Specialist is a board-certified neurologist providing expert care for patients suffering from a seizure, neurophysiological, neuromuscular and neurological disorders in the Miami community.

Combining an academic, research-based philosophy with compassionate care, Dr. Lerman’s comprehensive approach addresses the needs of his patients and families.

Cutting-edge diagnostics and interventions play an important role in Dr. Lerman’s practice, reflecting the continued research, growing knowledge and innovative forms of treatment in the fields of epileptology, neurophysiology, and neurology. In addition to offering the latest diagnostics and treatments, ranging from EEG, electromyography, nerve conduction study, Botox, latest diagnostics and treatment options for concussion, most recent therapeutic option for treatment of cognitive impairment and dementia as well as expertise with use of medical cannabis for treatment of refractory epilepsy, Dr. Lerman continues to dedicate time to research, and seems to provide his patients with the most recent diagnostic portals as well as treatment options for helping to disease burden and optimize outcome and impact on his patients quality of life.