Transcription:

Melanie Cole (Host): Welcome to Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole. And today we're discussing epilepsy, facts versus myths. Joining me is Emma Marr, she's a Nurse Practitioner specializing in neuroscience and epilepsy at the Carle Foundation Hospital. Emma, thank you so much for being with us today. I'd like you to just start by giving us a little brief overview of the prevalence of epilepsy and really who are the most at risk patients.

Emma Marr, NP (Guest): Hi, thanks for having me. Yeah, epilepsy is a pretty common condition. In fact, one out of every 10 people will have a seizure in their lifetime and then one in every 26 of those individuals are going to go on to have a diagnosis of epilepsy. And the diagnosis of epilepsy is a pretty easy diagnosis to get. A patient just needs to have two unprovoked seizures, more than 24 hours apart, or one seizure with a high risk of recurrence as identified on an electroencephalogram or EEG and a brain MRI. Patients who are at most risk of seizure, tend to be patients who have had a history of a head trauma or really anything that could cause a structural change in the brain, such as stroke or car accidents with head trauma or infections. There is a population of patients who have genetic forms of epilepsy that are passed down through their family. And also there is a large percentage of patients who have an idiopathic epilepsy, which means we actually can't figure out why they're having seizures, what that, that cause is from.

Host: So then give us some facts versus myths that you've heard over the years. Speak about how this has evolved and any facts and myths you wanna bring up.

Emma: I think one big myth is that individuals in the community who are outside of the epilepsy community, think that when a patient has a seizure, it means that they're shaking. You know, we kind of think of classic pictures we see in movies or on TVs where the patient loses consciousness and shakes all over.

But in fact, a patient can have a seizure and it can look like a ton of different things. It could be as simple as a sudden feeling of anxiety or deja vu. It could be staring into space and not responding. It could look like a weird sensation change. And then it could also look like losing consciousness and falling to the ground and shaking all over and afterwards looking very confused. Not everything that, that shakes is a seizure and not every seizure shakes.

Host: Well, that's certainly a good one to break up and thank you so much for that. Now speak about how treatment for epilepsy has evolved over the last 10 to 20 years, because it's been a real progress. Real advancements have been made in surgical and nonsurgical treatments. Speak about what's going on right now.

Emma: So, diagnosis of epilepsy and risk of seizure. We do electroencephalogram or EEG, and we do the MRI of the brain to help us find and determine a location of where the seizures are coming from in the brain. We can treat epileptic seizures with antiseizure medications, and currently there are over 30 antiseizure medications on the market. We individualize our patient's treatment plans, according to their specific epilepsy diagnosis, their medical history and their lifestyle. There are definitely certain medications we would prefer to use for a specific diagnosis versus another. There have been quite a few newer medications out in the last few years. The most recent medication that's come on the market is called XCOPRI or cenobamate. Cenobamate works on the sodium channels in the brain, which is not really a revolutionary way a seizure medication works, but we've seen great response rates to this new medication.

So that might be a medication that providers in the community see pop up on patient's medications list. In terms of surgical options, yeah, especially level epilepsy centers, they have epilepsy monitoring unit, where patients come and they're hooked up to the EEG for about as long as it takes for them to have multiple seizures. So we can really find the seizure focus. From there, we determine if they're a good seizure or a good surgical candidate which might include further workup with neuropsych testing, a functional MRI, or maybe a stronger MRI. From there, we have a big conference and kind of discuss through the case.

Some patients are not surgical candidates in the fact that it's not a good idea to remove that section of the brain, but could benefit from a neuro stimulation device, such as a vagus nerve stimulator or a deep brain stimulator or a responsive neurostimulator. All of those devices work in sending signals and impulses to the brain to hopefully stop the neurons from deciding to all fire at once and causing a clinical seizure.

Host: Really an exciting time in your field, Emma. So one of the things I feel like we've learned over the last decade here is diet and its role in epilepsy and its role as treatment modality. Speak about that just a little bit.

Emma: Some of our patients, I think it's more used in childhood epilepsys than adult. But the ketogenic diet can be pretty important. But it's also a very hard thing to, to follow because you have to be very strict about it. So I don't see a lot of adults doing it, but there is pretty good research out there that it can help decrease the risk of seizures and really help prevent seizure from occurring.

Host: One of the other things that I've noticed is the importance of that multidisciplinary approach and team to best treat epilepsy patients. Can you speak about your team at the Carle Foundation Hospital and why you see this type of approach as being so important for these patients?

Emma: Yeah, absolutely. So, our team consists of three epileptologists. So neurologists that are especially trained in epilepsy and reading EEG. We have two nurse practitioners, including myself, and we have numerous EEG techs who actually perform the EEGs. We have physicians who do the neuropsych testing to help with their memory and help us distinguish where that localizes to. We have social workers. We have all of our great neurosurgeons that help us do surgery if we decide to go that route. But I think It's a great team. We all have different backgrounds and different experiences within the field. And we all come to the table to talk about the patient and the best possible outcome for our patient before we, we make any decisions.

Host: It's such an important approach, really for epilepsy. Before we wrap up, do you have final thoughts about any current indications you'd like other providers to know about, what other therapies a patient might have tried before surgical intervention is even considered, anything that you'd like to share with other providers.

Emma: Yeah, I think it's just important to remember kind of what I said earlier that not everything that shakes is a seizure and not every seizure shakes. So, it's important to get a really good history about what the event actually was and how they felt before the event, during the event and after the event. When in doubt you can refer to neurology or an epilepsy provider. It's pretty easy for a patient to become what we call refractory to medication. They just need to try two medications and fail and continue having seizures before we should start thinking about a surgical intervention or a surgical option.

So when in doubt, just to refer to an epilepsy center neurologist so we can get a patient on the right track.

Host: Thank you so much, Emma, such a concise episode with great information. Thank you so much. For more information, and to get connected with one of our providers, you can visit carle.org or for a listing of Carle providers and to view Carle sponsored educational activities, visit our website at carleconnect.com.

And that concludes this episode of Expert Insights with the Carle Foundation Hospital. I'm Melanie Cole.