Almost 3 million Americans live with epilepsy. Although living with epilepsy may seem overwhelming at times, the good news is that many people with the condition can live full, active lives. BayCare focuses on helping individuals with epilepsy reduce, eliminate or manage their seizures so they achieve as much independence and enjoyment of life as possible.
Sanjiv Sahoo, MD, discusses epilepsy, the important precautions for patient safety during a seizure, and treatment options available at BayCare.
Learn more about BayCare's neuroscience services.
This podcast is for informational purposes only, and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. This podcast does not create a physician-patient relationship. You should always consult your physician or other healthcare professional with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your physician or 911 immediately.
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Understanding Epilepsy and Seizures
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Learn more about Sanjiv Sahoo, MD
Sanjiv Sahoo, MD
Sanjiv Sahoo, MD, is board certified in neurology, clinical neurophysiology, epilepsy and electrodiagnostic medicine. He has served as an attending neurologist since 2004 and was assistant professor of neurology at Virginia Commonwealth University. Dr. Sahoo specializes in epilepsy, neuromuscular diseases, stroke and general neurology. He has extensive experience in EMG, EEG and clinical neurophysiology. Dr. Sahoo is a member of the American Clinical Neurophysiology Society, the American Academy of Neurology and the American Epilepsy Society. He is fluent in Hindi.Learn more about Sanjiv Sahoo, MD
Transcription:
Understanding Epilepsy and Seizures
Melanie Cole (Host): Although living with epilepsy may seem overwhelming at times, the good news is that many people with the condition can live full, active lives. My guest today is Dr. Sanjiv Sahoo. He’s a neurologist, specializing in epilepsy at BayCare. Dr. Sahoo, what is epilepsy? Please explain it for people that have heard this term but don’t really know what it means.
Sanjiv Sahoo, MD (Guest): So, to explain epilepsy Melanie, first I start off with probably explaining what a seizure is and for those who haven’t experienced one, a seizure is really a transient alteration in behavior, motor or sensory phenomenon that is caused by an abnormal electrical brain discharge and it manifests with people passing out and shaking or losing consciousness. Now when someone has more than one seizure that is unprovoked; we coin the term epilepsy. So, recurrent unprovoked seizures is what really epilepsy is and that definition keeps changing but in today’s era, we even understand that a single unprovoked seizure with a good enough cause to have more seizures can actually be termed as epilepsy.
Melanie: Are there certain risk factors or a genetic component to epilepsy?
Dr. Sahoo: So, that’s a very good question and three are risk factors just based on the background population. There are actually two age groups that are more affected by epilepsy; the younger generation and the older populations have higher incidence of epilepsy and it kind of values down around the 30’s and 40’s and the younger and the older populations usually have infections and strokes as the main cause, but the middle-aged people usually could have other varying causes including genetics and sometimes substances and other acute changes in their life.
Melanie: Are the seizures dangerous? Are there different types and how would somebody know that either one of their loved ones or themselves are suffering one?
Dr. Sahoo: So, seizures can be of several different types and they are not always easy to recognize. First and foremost, you obviously have to have the right diagnosis and make sure that they actually are seizures. But, you can have a focal seizure or a generalized seizure. What we really mean is in a focal seizure, only a part of the brain is seizing and therefore that person may or may not lose awareness and, in that situation; they may just experience an out of body phenomenon or they may smell something odd or have a transient aura like sensation and that’s difficult for other family members to recognize. It’s when that seizure spreads a little more across the brain that they actually lose awareness and that might manifest as a staring off or a lack of responsiveness to questioning or maybe lip smacking or some kind of automatisms that is odd but easily identifiable by family members. Now when the seizure spreads to the bilateral hemispheres or both side of the brain; that’s when they have a generalized seizure and they tend to pass out, fall to the ground, become stiff and they could shake and bit their tongue or injure themselves and in that situation; it is definitely dangerous. If they lose awareness while driving or if they fall and have a head injury, obviously a seizure can be dangerous.
Melanie: As long as we are talking about seizures and before we talk about some of the latest treatments or the complications if you do get diagnosed; let’s talk about seizure safety, because that’s very scary for people who are watching it and what do you want patients and their families to know about safety if a seizure does happen? What are some precautions Dr. Sahoo, that you encourage people to take?
Dr. Sahoo: Well right off the bat, you want to make sure the patient is safe so, obviously, if they are driving and you happen to be a passenger sitting next to them, you want to help them pull off the road or take control of the car. If they are inside the home or outside, you want to make sure that their surrounding area is safe, so you want to lower them from a higher seat, maybe lay them on the ground, roll them onto their side. Try not to put anything in their mouth because usually they go into spasm and they can clench down and it’s dangerous to stick anything in between the teeth because you could lose – you could end up injuring yourself or damaging teeth. So, after about two or three minutes, the seizures tend to cease by themselves and at that point, you can just calmly wait until the patient wakes up. But in the meantime, you can activate EMS, call 9-1-1, get help and just do what you can at that point to make sure that the patient is safe. Usually, CPR does not help in this situation because of the lockdown of the breathing apparatus and you can’t really blow air into a tight chest.
Melanie: So, what are some of the complications? If you are diagnosed with epilepsy; how does that impact the quality of life? Driving privilege, you mentioned driving or employment, even the psychosocial aspects of this condition?
Dr. Sahoo: So, actually that is an excellent question, and this is such an important disorder – such a disorder that affects you on so many levels that you can just understand that if you lose driving privileges for two years, which is the current law in Florida, it would be hard to commute to work, to any errands, meeting people and that itself is major social impact. In addition, many people get depressed. They tend to stay at home. They try to socialize less. Economically, it affects their employment. Most employers shy away from having someone with seizures frequently in their workplace. So, I think that’s just the tip of the iceberg and in addition, we know that patients with epilepsy tend to have a higher mortality. There is something known as sudden death in epilepsy. They could have a seizure in their sleep, they could injure themselves while driving, they could injure themselves simply at day to day activities, cooking, taking a shower, the hot water is running; they could get burnt. So, there are many things that can occur because of seizures.
Melanie: So, what are some of the latest treatments Dr. Sahoo? Are there newer medications that are available? Do they help with reducing the frequency or the amount of these or the severity of the seizures? Tell us about some of the treatments available.
Dr. Sahoo: So, we really have some very, very good options and some of the newer medications out there. They all perform very, very well. I think if somebody has seizures, the chances of us controlling their epilepsy just with medications alone is in the range of 65-70%. So, most patients will be controlled with some of the anticonvulsants out there and we have twenty plus different types and we tailor them to the specific kind of patient depending on what their situation is; are they planning on pregnancy, are they older, younger. There are different medications depending on the type of seizure classification and you can titrate the dose so that it actually works better with minimal side effects. Sometimes you can use a combination.
Now in addition to medications, sometimes patients will not respond despite trial of two or three different anticonvulsants and good enough combinations and good enough doses and they fall into a category known as medically refractory epilepsy. You do not need to keep trying the next ten or fifteen different anticonvulsants to see if they are going to become medically refractory. We have very good guidelines and studies to back up that. After they fail the first two or three; there is only a two or three percent chance that they will ever actually be seizure free on medications alone. And at that point, we start working them up to see if they are actually surgical candidates and epilepsy surgery is something that we do perform here at BayCare and St. Joseph’s.
There is a dedicated epilepsy monitoring unit. We bring these individuals in. There is manpower that actually monitors them via video and EEG 24 hours for seven days and during this time; we can actually watch and collect data on the kind of seizures, where they are coming from, are they coming from one side of the brain, from both sides of the brain. We can do high-level studies, nuclear spec scans, MRI’s and see if there is actually a foci that can be removed successfully to give them seizure freedom. And many a times if they have temporal lobe epilepsy; we can get a cured rate of up to 80% off medications. So, they can be cured of their seizures and we are talking about people who are refractory without this particular approach. So, that’s an option. And then in those individuals that we determine have generalized seizures, seizures coming from the entire brain, that are nonsurgical; then we can sometimes place a vagal nerve stimulator which is a device that goes underneath the chest skin and wraps around the vagus nerve and can provide a stimulus that will actually lower the seizure frequency and that’s quite effective too, at least a 50% reduction in the frequency. So, we have options and many newer options are coming out on a day to day basis.
Melanie: That’s absolutely fascinating Dr. Sahoo. How cool is that what you are doing there? What role do diet and exercise play in treatment? What do you want listeners to know about behavior and lifestyle modifications and living a healthy lifestyle if they are someone living with epilepsy?
Dr. Sahoo: I think that’s an excellent question too. I get asked this question so many times by my patients. What is it that we can do from a diet perspective that might help? And to honest, there are diets out there that are specifically treatments, but they are hard to achieve. We are talking of the ketogenic diet; Adkin’s Modified diet and they are really diets that are high in fat and protein and low or minimal on carbohydrates. But that’s usually something we achieve in small children who we can actually decide on what they need to eat, but it’s hard to achieve in adults and if you don’t maintain that diet perfectly; you lose the benefits of that, so I would just say a healthy diet, just like any other individual according to their background and according to their baseline diseases. If they are diabetic, a diabetic diet; if they are hypertensive, a low sodium diet. Anything that’s healthy. And from an exercise standpoint, I would say that exercise is good for epilepsy. If they are involved in contact sports; that’s the only thing that I would say we have to be a little bit careful about, they probably need to wear headgear, but in general, any sport, any exercise is beneficial for epilepsy and there are many articles that suggest this.
Melanie: So, wrap it up for us Dr. Sahoo and what an amazing guest you are. Such good comprehensive information. What’s your best advice for managing and living with epilepsy and what you can do for them at BayCare.
Dr. Sahoo: So, if someone has epilepsy or if you know someone who has epilepsy, I think the most important thing is to make sure that they have the right diagnosis. They need to see a neurologist who has additional qualifications in epilepsy and ideally an epileptologist, someone who can actually confirm the diagnosis, make sure it’s not a seizure mimic, they can look at the type of seizures and according to that; tailor their anticonvulsant therapy, adjust the dose, and if after a fair trial; they find that they have medically refractory epilepsy, then they can take them to the next level and at least address all the possible options to bring them back to a seizure-free state and give them back their life.
And always, it’s important to make sure that they follow up with physicians, that they are compliant with their medications. You never want to stop an epilepsy drug. You want to make sure that all the side effects are monitored, their levels are checked and then the basics. Going back to the basic seizure precautions, making sure that the patient is safe, doing some day to day things that would make such a big difference, avoiding injuries, turning down the thermostat in your home so that the water temperature is not too high so if you have a seizure in the tub, you don’t get burnt, avoiding tub baths when you are alone or swimming without supervision. If you cook, make sure you turn the handle inward so that you don’t tip over the food. Use an inner hot plate if you are cooking and then this is logical, common sense things. Stay away from high, don’t get up on ladders. So, it’s something that can be easily managed. It has a treatment and a possible cure. You need to get to the right person. We are out there to help you and there are many resources that will help.
Melanie: Thank you so much Dr. Sahoo, for sharing your expertise with us for this very important topic. You’re listening to BayCare Health Chat. And for more information please visit www.baycare.org that’s www.baycare.org. This is Melanie Cole. Thanks so much for listening.
Understanding Epilepsy and Seizures
Melanie Cole (Host): Although living with epilepsy may seem overwhelming at times, the good news is that many people with the condition can live full, active lives. My guest today is Dr. Sanjiv Sahoo. He’s a neurologist, specializing in epilepsy at BayCare. Dr. Sahoo, what is epilepsy? Please explain it for people that have heard this term but don’t really know what it means.
Sanjiv Sahoo, MD (Guest): So, to explain epilepsy Melanie, first I start off with probably explaining what a seizure is and for those who haven’t experienced one, a seizure is really a transient alteration in behavior, motor or sensory phenomenon that is caused by an abnormal electrical brain discharge and it manifests with people passing out and shaking or losing consciousness. Now when someone has more than one seizure that is unprovoked; we coin the term epilepsy. So, recurrent unprovoked seizures is what really epilepsy is and that definition keeps changing but in today’s era, we even understand that a single unprovoked seizure with a good enough cause to have more seizures can actually be termed as epilepsy.
Melanie: Are there certain risk factors or a genetic component to epilepsy?
Dr. Sahoo: So, that’s a very good question and three are risk factors just based on the background population. There are actually two age groups that are more affected by epilepsy; the younger generation and the older populations have higher incidence of epilepsy and it kind of values down around the 30’s and 40’s and the younger and the older populations usually have infections and strokes as the main cause, but the middle-aged people usually could have other varying causes including genetics and sometimes substances and other acute changes in their life.
Melanie: Are the seizures dangerous? Are there different types and how would somebody know that either one of their loved ones or themselves are suffering one?
Dr. Sahoo: So, seizures can be of several different types and they are not always easy to recognize. First and foremost, you obviously have to have the right diagnosis and make sure that they actually are seizures. But, you can have a focal seizure or a generalized seizure. What we really mean is in a focal seizure, only a part of the brain is seizing and therefore that person may or may not lose awareness and, in that situation; they may just experience an out of body phenomenon or they may smell something odd or have a transient aura like sensation and that’s difficult for other family members to recognize. It’s when that seizure spreads a little more across the brain that they actually lose awareness and that might manifest as a staring off or a lack of responsiveness to questioning or maybe lip smacking or some kind of automatisms that is odd but easily identifiable by family members. Now when the seizure spreads to the bilateral hemispheres or both side of the brain; that’s when they have a generalized seizure and they tend to pass out, fall to the ground, become stiff and they could shake and bit their tongue or injure themselves and in that situation; it is definitely dangerous. If they lose awareness while driving or if they fall and have a head injury, obviously a seizure can be dangerous.
Melanie: As long as we are talking about seizures and before we talk about some of the latest treatments or the complications if you do get diagnosed; let’s talk about seizure safety, because that’s very scary for people who are watching it and what do you want patients and their families to know about safety if a seizure does happen? What are some precautions Dr. Sahoo, that you encourage people to take?
Dr. Sahoo: Well right off the bat, you want to make sure the patient is safe so, obviously, if they are driving and you happen to be a passenger sitting next to them, you want to help them pull off the road or take control of the car. If they are inside the home or outside, you want to make sure that their surrounding area is safe, so you want to lower them from a higher seat, maybe lay them on the ground, roll them onto their side. Try not to put anything in their mouth because usually they go into spasm and they can clench down and it’s dangerous to stick anything in between the teeth because you could lose – you could end up injuring yourself or damaging teeth. So, after about two or three minutes, the seizures tend to cease by themselves and at that point, you can just calmly wait until the patient wakes up. But in the meantime, you can activate EMS, call 9-1-1, get help and just do what you can at that point to make sure that the patient is safe. Usually, CPR does not help in this situation because of the lockdown of the breathing apparatus and you can’t really blow air into a tight chest.
Melanie: So, what are some of the complications? If you are diagnosed with epilepsy; how does that impact the quality of life? Driving privilege, you mentioned driving or employment, even the psychosocial aspects of this condition?
Dr. Sahoo: So, actually that is an excellent question, and this is such an important disorder – such a disorder that affects you on so many levels that you can just understand that if you lose driving privileges for two years, which is the current law in Florida, it would be hard to commute to work, to any errands, meeting people and that itself is major social impact. In addition, many people get depressed. They tend to stay at home. They try to socialize less. Economically, it affects their employment. Most employers shy away from having someone with seizures frequently in their workplace. So, I think that’s just the tip of the iceberg and in addition, we know that patients with epilepsy tend to have a higher mortality. There is something known as sudden death in epilepsy. They could have a seizure in their sleep, they could injure themselves while driving, they could injure themselves simply at day to day activities, cooking, taking a shower, the hot water is running; they could get burnt. So, there are many things that can occur because of seizures.
Melanie: So, what are some of the latest treatments Dr. Sahoo? Are there newer medications that are available? Do they help with reducing the frequency or the amount of these or the severity of the seizures? Tell us about some of the treatments available.
Dr. Sahoo: So, we really have some very, very good options and some of the newer medications out there. They all perform very, very well. I think if somebody has seizures, the chances of us controlling their epilepsy just with medications alone is in the range of 65-70%. So, most patients will be controlled with some of the anticonvulsants out there and we have twenty plus different types and we tailor them to the specific kind of patient depending on what their situation is; are they planning on pregnancy, are they older, younger. There are different medications depending on the type of seizure classification and you can titrate the dose so that it actually works better with minimal side effects. Sometimes you can use a combination.
Now in addition to medications, sometimes patients will not respond despite trial of two or three different anticonvulsants and good enough combinations and good enough doses and they fall into a category known as medically refractory epilepsy. You do not need to keep trying the next ten or fifteen different anticonvulsants to see if they are going to become medically refractory. We have very good guidelines and studies to back up that. After they fail the first two or three; there is only a two or three percent chance that they will ever actually be seizure free on medications alone. And at that point, we start working them up to see if they are actually surgical candidates and epilepsy surgery is something that we do perform here at BayCare and St. Joseph’s.
There is a dedicated epilepsy monitoring unit. We bring these individuals in. There is manpower that actually monitors them via video and EEG 24 hours for seven days and during this time; we can actually watch and collect data on the kind of seizures, where they are coming from, are they coming from one side of the brain, from both sides of the brain. We can do high-level studies, nuclear spec scans, MRI’s and see if there is actually a foci that can be removed successfully to give them seizure freedom. And many a times if they have temporal lobe epilepsy; we can get a cured rate of up to 80% off medications. So, they can be cured of their seizures and we are talking about people who are refractory without this particular approach. So, that’s an option. And then in those individuals that we determine have generalized seizures, seizures coming from the entire brain, that are nonsurgical; then we can sometimes place a vagal nerve stimulator which is a device that goes underneath the chest skin and wraps around the vagus nerve and can provide a stimulus that will actually lower the seizure frequency and that’s quite effective too, at least a 50% reduction in the frequency. So, we have options and many newer options are coming out on a day to day basis.
Melanie: That’s absolutely fascinating Dr. Sahoo. How cool is that what you are doing there? What role do diet and exercise play in treatment? What do you want listeners to know about behavior and lifestyle modifications and living a healthy lifestyle if they are someone living with epilepsy?
Dr. Sahoo: I think that’s an excellent question too. I get asked this question so many times by my patients. What is it that we can do from a diet perspective that might help? And to honest, there are diets out there that are specifically treatments, but they are hard to achieve. We are talking of the ketogenic diet; Adkin’s Modified diet and they are really diets that are high in fat and protein and low or minimal on carbohydrates. But that’s usually something we achieve in small children who we can actually decide on what they need to eat, but it’s hard to achieve in adults and if you don’t maintain that diet perfectly; you lose the benefits of that, so I would just say a healthy diet, just like any other individual according to their background and according to their baseline diseases. If they are diabetic, a diabetic diet; if they are hypertensive, a low sodium diet. Anything that’s healthy. And from an exercise standpoint, I would say that exercise is good for epilepsy. If they are involved in contact sports; that’s the only thing that I would say we have to be a little bit careful about, they probably need to wear headgear, but in general, any sport, any exercise is beneficial for epilepsy and there are many articles that suggest this.
Melanie: So, wrap it up for us Dr. Sahoo and what an amazing guest you are. Such good comprehensive information. What’s your best advice for managing and living with epilepsy and what you can do for them at BayCare.
Dr. Sahoo: So, if someone has epilepsy or if you know someone who has epilepsy, I think the most important thing is to make sure that they have the right diagnosis. They need to see a neurologist who has additional qualifications in epilepsy and ideally an epileptologist, someone who can actually confirm the diagnosis, make sure it’s not a seizure mimic, they can look at the type of seizures and according to that; tailor their anticonvulsant therapy, adjust the dose, and if after a fair trial; they find that they have medically refractory epilepsy, then they can take them to the next level and at least address all the possible options to bring them back to a seizure-free state and give them back their life.
And always, it’s important to make sure that they follow up with physicians, that they are compliant with their medications. You never want to stop an epilepsy drug. You want to make sure that all the side effects are monitored, their levels are checked and then the basics. Going back to the basic seizure precautions, making sure that the patient is safe, doing some day to day things that would make such a big difference, avoiding injuries, turning down the thermostat in your home so that the water temperature is not too high so if you have a seizure in the tub, you don’t get burnt, avoiding tub baths when you are alone or swimming without supervision. If you cook, make sure you turn the handle inward so that you don’t tip over the food. Use an inner hot plate if you are cooking and then this is logical, common sense things. Stay away from high, don’t get up on ladders. So, it’s something that can be easily managed. It has a treatment and a possible cure. You need to get to the right person. We are out there to help you and there are many resources that will help.
Melanie: Thank you so much Dr. Sahoo, for sharing your expertise with us for this very important topic. You’re listening to BayCare Health Chat. And for more information please visit www.baycare.org that’s www.baycare.org. This is Melanie Cole. Thanks so much for listening.