Epilepsy Diagnosis And Treatment
If I have one seizure, will I definitely have another?
With regards to the diagnosis and treatment of epilepsy, having one seizure and defiantly having others does depend on the underlying cause of the seizure. For some seizures, a febrile seizure or a seizure induced by a high fever in a young child may never occur again in the future. In terms of a bullet wound to the brain or a tumor, the first seizure is probably going to be one of many seizures that will be come again unless treated in some way.
What should I do if I think I have had a seizure?
With regards to the diagnosis and treatment of epilepsy, if u feel you have had an epileptic seizure you should immediately go to see your general practitioner, your family doctor and discuss the actual event. This could be whether you passed out or observed yourself having a muscle that moved in a very uncontrollable way. Have your family physician talk it over with you; take a case history which shows a background of yourself as the physician knows you better than anybody else. Usually, then what's going to happen is the family physician will refer you to a neurologist who will run a battery of tests to do a workup on the underlying cause of the seizure.
How is a seizure or epilepsy diagnosed?
With regards to the diagnosis and treatment of epilepsy, usually a parent will observe a seizure in their child or, for certain types of seizures in children, a school teacher may notice that a student starts to lose their concentration and then snap back to it. Usually people around you will also notice you're having the seizure. You yourself, oftentimes, may not even know you're having the seizure, you may not even be conscious of the seizure, unless there's something that occurs in the post dictal event or period when you notice something was kind of abnormal and not right.
What is an "Electroencephalography" or "EEG"?
With regards to the diagnosis and treatment of epilepsy, Electroencephalography or EEG involves connecting the head to various electrodes to a machine that would monitor activity between different points on the surface of the brain. This monitoring could be for an hour, it could be for 24 hours. There are now techniques where we can use telemetry for sending the information back. In other words, there's a helmet that has all the electrodes, and the information gets stored, and it can be reviewed over a 24 hour period. Electroencephalography or EEG is used by neurologists to diagnose whether the seizure is part of an overlying disease known as epilepsy.
What is a "CT scan"?
With regards to the diagnosis and treatment of epilepsy, a CT is basically a CAT scanner. It stands for computerized tomography. A CT is not used as much or as commonly now as MRI because the resolution of the MRI or the FMRI are much better.
What is an "MRI"?
An MRI actually stands for "magnetic resonance imaging." MRI involves some very large magnets which are imaging the water in the brain. The MRI allows you to do determine the gray matter from the white matter regions of the brain. You can actually obtain excellent resolution, down to about two to three millimeters. This will allow you to look at structures in the brain, such as the amygdala, the hippocampus. You're able to visualize these small brain areas that reside within the temporal lobe, determining whether there is any abnormality, if there is a smaller size on one side than the other side. Therefore the MRI allows us to image the brain.
What is a "PET scan"?
A PET scan analyzes the amount of glucose, or sugar uptake by the brain. One would inject in a glucose substitute that has a label on it, and then take images of the brain during a period of time shortly after the seizure. The PET scan allows us to look at regions of the brain that are either hypermetabolic i.e. using a lot of sugar, or parts of the brain that are hypometabolic i.e. using very little sugar. It turns out that for Temporal Lobe Epilepsy, the temporal lobe shows hypometabolism.
Is there a cure for epilepsy?
A cure for epilepsy is within our grasp. As it turns out, about 7 percent of people who have epilepsy keep it under control with medicines. We have a really good group of medicines that have been used for about the last 2 or 3 years. However, in the last year there have been a large number of new drugs that have been developed which have supplemented this barrage of medicines. So in terms of an absolute cure for epilepsy, we don't really have an absolute cure for epilepsy yet.
What is an "AED"?
AEDs are anti-epileptic drugs. There are currently 2 AEDs on the market, used in today's treatment of people with epilepsy.
What are the surgical treatments for epilepsy?
With regards to the diagnosis and treatment of epilepsy, in cases where the medical treatment with these drugs are not getting results and the seizures persist, then doctors will oftentimes recommend brain surgery as a surgical treatment for epilepsy. The most common brain surgery is a temporal lobectomy. This is where either a portion of the temporal lobe, in most cases it's that medial portion of the temporal lobe that contains the hippocampus and the amygdale, to which this is removed. This is done usually on one side only; it's done on the side to spare the person from losing any speech skills. Now, there are a few other kinds of surgeries that can be done. In young children, an entire hemisphere is removed, a so-called hemispherectomy. For some reason, with such a large amount of brain tissue removed, these young children are able to grow up and are reasonably free from seizures. A type of surgery that had been done in the past, a corpus callosotomy, where the corpus callosum is sectioned is not being done that often because it was thought it would prevent a seizure from generalizing from one hemisphere to the other.
What is a "vagal nerve stimulator"?
With regards to the diagnosis and treatment of epilepsy, a vagal nerve stimulator is relevant to the 30% of epilepsy suffers who are not treatable. Surgery is an option; but the other option is the vagal nerve stimulator. The vagas nerve stimulator is implanted under the skin into the chest, it causes the vagas nerve to be stimulated from time to time, interacting with lymbic region activity, apparently increasing the threshold for a person with epileptic seizures.
Can I outgrow epilepsy?
There are certain types of epilepsy that one can have during childhood, such as a febrile seizure. You could have multiple febrile seizures. It's possible that, when the person gets a little older, they stop having seizures altogether and they never have a seizure. So in that case, that individual has outgrown their epilepsy.
What is a "ketogenic diet"?
A ketogenic diet is a diet whereby young children are given a high fat, low carb type of diet, and the high fat and the high proteins supposedly are involved in shunting various metabolic pathways in cells so that seizures do not occur. This diet has been shown to reduce the frequency of seizures in some of the young children. However, it does not work in all cases.
Can people grow new brain cells?
With regards to the diagnosis and treatment of epilepsy, the brain can grow new brain cells. My current research involves the changes in the dentate gyrus of the hippocampus, where I'm looking at newly generated neurons in the adult brain. I know this goes against the old adage that the brain cells you're born with are the ones you've got the rest of your whole life. Well, that's not exactly true; there are a couple of areas in the brain where new brain cells are being made all the time, one of them is in the hippocampus: the dentate gyrus.
