Auras, Space-Outs and Seizures: What is Epilepsy and How to Treat It
Epilepsy is a brain disorder that results in seizures and affects approximately three million people in the U.S. Dr. Benjamin Cunningham discusses the importance of early diagnosis and treatment as well as the latest developments in epilepsy care and management.
Featured Speaker:
Benjamin Cunningham, MD
Benjamin Cunningham, MD is the Director, Epilepsy Program Maimonides Neurosciences Institute. Transcription:
Auras, Space-Outs and Seizures: What is Epilepsy and How to Treat It
Caitlin Whyte (Host): Epilepsy is a brain disorder that results in seizures and affects approximately 3 million people in the US. Dr. Benjamin Cunningham is joining us today to discuss the importance of early diagnosis and treatment, as well as the latest developments in epilepsy care and management. He is the Director of the Epilepsy Program at the Maimonides Neurosciences Institute. This is Maimo Med Talk. I'm your host, Caitlin Whyte. So, Dr. Cunningham, what is epilepsy and who does it typically affect?
Benjamin Cunningham, MD (Guest): So, epilepsy is a disorder of the brain that causes individuals to have recurrent seizures. And so when I say the word seizure, what a seizure is, a seizure is a behavioral episode that is caused by abnormal hyperactivity of one part of the surface of the brain called the cerebral cortex. And so what a seizure looks like, what someone exhibits or experiences, is based on the part of the brain that that seizure is affecting. So, if someone's having a seizure coming from the front of their brain, their frontal lobe, it may cause them to have twitching or shaking of one side of the body versus a seizure that starts in the back of the brain, involving the visual centers, could result in visual hallucinations, like flashes of lights, colors. And seizures can also involve impairment of consciousness where somebody has a period of time that they don't remember. So, when someone has recurrent seizures produced by their brain, we call that epilepsy and epilepsy is a surprisingly common condition that affects individuals in infancy all the way up through age 100 and beyond.
Host: Now, let's talk about early diagnosis. Why is it so critical to epilepsy care?
Dr. Cunningham: So, early diagnosis is crucial for two reasons. So, number one, seizures, which are the manifestation of epilepsy, they can be very disruptive to life. So, to correctly identify a diagnosis of epilepsy and be able to treat it is a huge factor in getting individuals back to their normal day-to-day life. So, that would be the one immediate reason that early diagnosis is important. Second reason is, you know, seizures, when they are allowed to go on and on, untreated, it can form a progressively strong loop within the brain and left untreated, they become more and more difficult to treat over time. They can have eventually long-term effects on someone's cognition, their thinking, their memory, even personality over time. So, if we're able to identify and treat epilepsy early, we can prevent all of these things from happening and allow people to get back to a normal, healthy, full, long life.
Host: So, how would I know if I, myself, or my child has epilepsy? Are there common signs or symptoms?
Dr. Cunningham: So, you know, as I mentioned, seizures, which are the manifestation of epilepsy, can take on several different forms, anything from shaking of one or both sides of the body, impairment of consciousness, abnormal sensations or visual hallucinations. The symptoms can be varied. But I would say that the thing that is critical about epilepsy is an individual with epilepsy will have a highly stereotyped event each time. Meaning that one person's seizure tends to look to others and feel to them very, very similar each time. So, an episode that occurs without any external provoking factor, that happens over and over that can't otherwise be explained, but occurs in very similar fashion for similar duration each time is something that is in and of itself suspicious for seizure and a diagnosis of epilepsy and should be worked up.
Host: And then once it's diagnosed, what does care and management look like at first?
Dr. Cunningham: So, the focus initially is diagnosis. And so the process of diagnosis, the gold standard is performing what's called an EEG, electroencephalography. You can think about it as basically an EKG for the brain where there's about 20 electrodes that we put on the brain to record the brainwave activity. Once we use that test and we are able to diagnose someone with epilepsy, then we use that information that we gain from the EEG brainwave study to select an anti-seizure or antiepileptic medication that we think will be most effective and appropriate for that individual.
Host: In more serious cases of epilepsy, how does this care change, if at all?
Dr. Cunningham: So, you know, I would say that generally in two thirds of cases of epilepsy that we see, once we start an anti-seizure medicine, the seizures are well controlled. Epilepsy is under good control. In about a third of individuals, we may have to use more than one medication to get seizures under control. Some individuals, despite being on medications could have what we call a breakthrough seizure. And so if somebody shows a tendency towards that, we may prescribe an additional emergency medicine that they keep with them at all times, so that if they happen to begin having a seizure, if they recognize it or a family member recognizes it, you can use a medication such as a rapidly dissolving tablet that goes right in the mouth, or even a nasal spray that can help to terminate the seizure right away.
Host: Is surgery ever an option when it comes to epilepsy?
Dr. Cunningham: Yes. So, actually we have a lot of fascinating and effective really revolutionary surgical techniques in the field of epilepsy. So, anyone who is not 100% controlled with medications alone, would potentially be a candidate for surgery. And there's a few options within that. In some cases, someone has a part of their brain that's producing seizures causing their epilepsy. And that part of the brain is not otherwise providing them with other normal, valuable function. And so resective surgery is an option, in which that small portion of the brain is removed and can be curative against seizures resulting in little or no other functional impairment.
So, if we don't go with a resective option, there's also several new devices that are available. This ranges from something called a vagal nerve stimulator that's implanted, and it helps the brain from becoming over excitable. And it sort of reduces that fight or flight response that the brain can produce that can result in seizures. It's a device that gives us more of the rest and digest signal that dampens down the hyperexcitability to either treat or prevent seizures.
So, that's the vagal nerve stimulator. An even newer and more exciting technology is called responsive neurostimulation. And without getting into too much of the specifics about it, it's an implantable device with electric that go into the structures of the brain that are causing seizures. And it acts very similarly as a pacemaker or defibrillator for the heart, that it senses when a seizure is occurring and it can stop it in its tracks. So, these are fantastic options for patients who do not respond completely to medications, have side effects from medications and these surgical therapies can be curative.
Host: And, you know, wrapping up here, what does life, once you're diagnosed with epilepsy, look like in 2021, especially compared to care in our past?
Dr. Cunningham: So, you know, I think that there's a few important things to consider. Having a diagnosis of epilepsy for individuals often means that they have events in which they're not in total control of themselves and their bodies. And so certain precautions have to be taken, in regards to, it may mean taking a temporary break from driving or operating heavy machinery, making sure that you have someone with you when you go swimming, standing far back from subway platforms, simple things that we always tell our patients.
I would say that what it means for patients in 2021 diagnosed with or living with a diagnosis of epilepsy, I think a big drive home point is that it is very feasible and absolutely vital that they continue to receive regular care from a neurologist or epileptologist. And so, I know at Maimonides Medical Center, I'm seeing patients in person, in the office most days of each and every week. We also offer the option of virtual visits. And so, I think that despite some of the restrictions that we have living in this world here in 2021, it's important to know that epilepsy care remains vital and absolutely available. And there are a lot of options at Maimonides for us to be able to provide continued top of the line epilepsy care in all regards.
Host: Wonderful. Well, lots of good information here. Dr. Cunningham, is there anything else you'd like to add?
Dr. Cunningham: I would just like to say that again, epilepsy is an extremely common condition, more common than I think any of us realize and with that, it is a very treatable and manageable condition. So, it's something that patients may feel fearful about and have a lot of questions when they're first diagnosed with epilepsy, but just to have an understanding that there's options for fantastic care and that everyone should maintain the hope and assumption that with proper treatment, they will continue to live a full, happy, and healthy life.
Host: Great Dr. Cunningham. Well, we appreciate your time and this knowledge today. To learn more, please visit us at maimo.org/neurosciences. This has been Maimo Med Talk. I'm your host, Caitlin Whyte. Stay well.
Auras, Space-Outs and Seizures: What is Epilepsy and How to Treat It
Caitlin Whyte (Host): Epilepsy is a brain disorder that results in seizures and affects approximately 3 million people in the US. Dr. Benjamin Cunningham is joining us today to discuss the importance of early diagnosis and treatment, as well as the latest developments in epilepsy care and management. He is the Director of the Epilepsy Program at the Maimonides Neurosciences Institute. This is Maimo Med Talk. I'm your host, Caitlin Whyte. So, Dr. Cunningham, what is epilepsy and who does it typically affect?
Benjamin Cunningham, MD (Guest): So, epilepsy is a disorder of the brain that causes individuals to have recurrent seizures. And so when I say the word seizure, what a seizure is, a seizure is a behavioral episode that is caused by abnormal hyperactivity of one part of the surface of the brain called the cerebral cortex. And so what a seizure looks like, what someone exhibits or experiences, is based on the part of the brain that that seizure is affecting. So, if someone's having a seizure coming from the front of their brain, their frontal lobe, it may cause them to have twitching or shaking of one side of the body versus a seizure that starts in the back of the brain, involving the visual centers, could result in visual hallucinations, like flashes of lights, colors. And seizures can also involve impairment of consciousness where somebody has a period of time that they don't remember. So, when someone has recurrent seizures produced by their brain, we call that epilepsy and epilepsy is a surprisingly common condition that affects individuals in infancy all the way up through age 100 and beyond.
Host: Now, let's talk about early diagnosis. Why is it so critical to epilepsy care?
Dr. Cunningham: So, early diagnosis is crucial for two reasons. So, number one, seizures, which are the manifestation of epilepsy, they can be very disruptive to life. So, to correctly identify a diagnosis of epilepsy and be able to treat it is a huge factor in getting individuals back to their normal day-to-day life. So, that would be the one immediate reason that early diagnosis is important. Second reason is, you know, seizures, when they are allowed to go on and on, untreated, it can form a progressively strong loop within the brain and left untreated, they become more and more difficult to treat over time. They can have eventually long-term effects on someone's cognition, their thinking, their memory, even personality over time. So, if we're able to identify and treat epilepsy early, we can prevent all of these things from happening and allow people to get back to a normal, healthy, full, long life.
Host: So, how would I know if I, myself, or my child has epilepsy? Are there common signs or symptoms?
Dr. Cunningham: So, you know, as I mentioned, seizures, which are the manifestation of epilepsy, can take on several different forms, anything from shaking of one or both sides of the body, impairment of consciousness, abnormal sensations or visual hallucinations. The symptoms can be varied. But I would say that the thing that is critical about epilepsy is an individual with epilepsy will have a highly stereotyped event each time. Meaning that one person's seizure tends to look to others and feel to them very, very similar each time. So, an episode that occurs without any external provoking factor, that happens over and over that can't otherwise be explained, but occurs in very similar fashion for similar duration each time is something that is in and of itself suspicious for seizure and a diagnosis of epilepsy and should be worked up.
Host: And then once it's diagnosed, what does care and management look like at first?
Dr. Cunningham: So, the focus initially is diagnosis. And so the process of diagnosis, the gold standard is performing what's called an EEG, electroencephalography. You can think about it as basically an EKG for the brain where there's about 20 electrodes that we put on the brain to record the brainwave activity. Once we use that test and we are able to diagnose someone with epilepsy, then we use that information that we gain from the EEG brainwave study to select an anti-seizure or antiepileptic medication that we think will be most effective and appropriate for that individual.
Host: In more serious cases of epilepsy, how does this care change, if at all?
Dr. Cunningham: So, you know, I would say that generally in two thirds of cases of epilepsy that we see, once we start an anti-seizure medicine, the seizures are well controlled. Epilepsy is under good control. In about a third of individuals, we may have to use more than one medication to get seizures under control. Some individuals, despite being on medications could have what we call a breakthrough seizure. And so if somebody shows a tendency towards that, we may prescribe an additional emergency medicine that they keep with them at all times, so that if they happen to begin having a seizure, if they recognize it or a family member recognizes it, you can use a medication such as a rapidly dissolving tablet that goes right in the mouth, or even a nasal spray that can help to terminate the seizure right away.
Host: Is surgery ever an option when it comes to epilepsy?
Dr. Cunningham: Yes. So, actually we have a lot of fascinating and effective really revolutionary surgical techniques in the field of epilepsy. So, anyone who is not 100% controlled with medications alone, would potentially be a candidate for surgery. And there's a few options within that. In some cases, someone has a part of their brain that's producing seizures causing their epilepsy. And that part of the brain is not otherwise providing them with other normal, valuable function. And so resective surgery is an option, in which that small portion of the brain is removed and can be curative against seizures resulting in little or no other functional impairment.
So, if we don't go with a resective option, there's also several new devices that are available. This ranges from something called a vagal nerve stimulator that's implanted, and it helps the brain from becoming over excitable. And it sort of reduces that fight or flight response that the brain can produce that can result in seizures. It's a device that gives us more of the rest and digest signal that dampens down the hyperexcitability to either treat or prevent seizures.
So, that's the vagal nerve stimulator. An even newer and more exciting technology is called responsive neurostimulation. And without getting into too much of the specifics about it, it's an implantable device with electric that go into the structures of the brain that are causing seizures. And it acts very similarly as a pacemaker or defibrillator for the heart, that it senses when a seizure is occurring and it can stop it in its tracks. So, these are fantastic options for patients who do not respond completely to medications, have side effects from medications and these surgical therapies can be curative.
Host: And, you know, wrapping up here, what does life, once you're diagnosed with epilepsy, look like in 2021, especially compared to care in our past?
Dr. Cunningham: So, you know, I think that there's a few important things to consider. Having a diagnosis of epilepsy for individuals often means that they have events in which they're not in total control of themselves and their bodies. And so certain precautions have to be taken, in regards to, it may mean taking a temporary break from driving or operating heavy machinery, making sure that you have someone with you when you go swimming, standing far back from subway platforms, simple things that we always tell our patients.
I would say that what it means for patients in 2021 diagnosed with or living with a diagnosis of epilepsy, I think a big drive home point is that it is very feasible and absolutely vital that they continue to receive regular care from a neurologist or epileptologist. And so, I know at Maimonides Medical Center, I'm seeing patients in person, in the office most days of each and every week. We also offer the option of virtual visits. And so, I think that despite some of the restrictions that we have living in this world here in 2021, it's important to know that epilepsy care remains vital and absolutely available. And there are a lot of options at Maimonides for us to be able to provide continued top of the line epilepsy care in all regards.
Host: Wonderful. Well, lots of good information here. Dr. Cunningham, is there anything else you'd like to add?
Dr. Cunningham: I would just like to say that again, epilepsy is an extremely common condition, more common than I think any of us realize and with that, it is a very treatable and manageable condition. So, it's something that patients may feel fearful about and have a lot of questions when they're first diagnosed with epilepsy, but just to have an understanding that there's options for fantastic care and that everyone should maintain the hope and assumption that with proper treatment, they will continue to live a full, happy, and healthy life.
Host: Great Dr. Cunningham. Well, we appreciate your time and this knowledge today. To learn more, please visit us at maimo.org/neurosciences. This has been Maimo Med Talk. I'm your host, Caitlin Whyte. Stay well.