Nikesh Ardeshna, MD, discusses epilepsy, including causes, signs and symptoms, and treatment options.
In the interview, Dr. Ardeshna covers these questions:
1) What is epilepsy and what causes it?
2) What are the signs and symptoms?
3) Who is most at risk for epilepsy?
4) Is there a cure? If not, what is the treatment?
5) Can people live normal, full lives with epilepsy?
Living with Epilepsy
Featuring:
Nikesh Ardeshna, MD
Dr. Nikesh Ardeshna is a fellowship-trained epileptologist (neurologist who specializes in the diagnosis and management of seizures/epilepsy). He has held leadership positions in neurology departments at nationally-recognized healthcare systems. In addition to treating epilepsy patients in clinic, Dr. Ardeshna’s area of expertise includes reading short and long term EEGs in the setting of the epilepsy monitoring unit and the ICU. His contributions to the field of epilepsy include advocating for the needs of epilepsy patients to various levels of government, writing articles, delivering national lectures, and presenting education sessions for the community, nurses and EEG technologists. He serves on the professional advisory boards of the National Epilepsy Foundation and the Michigan Epilepsy Foundation. Transcription:
Bill Klaproth (Host): So what exactly is epilepsy? What causes it? How is it treated and managed over a lifetime? Let’s learn more with Dr. Nikesh Ardeshna, medical director of the epilepsy services at McLaren Health. This is McLaren’s in Good Health, I'm Bill Klaproth. Dr. Ardeshna, exactly what is epilepsy and what causes it?
Nikesh Ardeshna, MD (Guest): Well, I thank you for this opportunity as well to talk about this. So epilepsy is basically a medical condition in which an individual is predisposed to having unprovoked seizures. There are many different causes of epilepsy. In particular, a significant portion of cases of epilepsy are of unknown cause. All epileptic seizures originate from the brain. A way to paraphrase it is it is due to an electrical abnormality in the brain. Sometimes we can find a cause to that electrical abnormality. That could be a stroke, it could be a brain tumor, it could be a prior head injury. Sometimes there's no specific cause.
Host: Sometimes you're just born with it then. Is that correct?
Dr. Ardeshna: You can be born with the abnormality, but it doesn’t even have to manifest right when you're born. The interesting thing—and this is a question that’s asked a lot of times in the office by patients—is there doesn’t even have to be a family history. You could be the first one that has your first seizure at any age.
Host: Well, that’s interesting to know. Then what are the signs and symptoms? We’ve all seen on TV the person having a seizure on the ground kind of wrangling around, but there has to be varying degrees of signs and symptoms. Is that right? What should we be looking for?
Dr. Ardeshna: So you are correct. From a seizure standpoint, when you ask someone what a seizure is they will say most commonly—and that’s how it’s seen in the media—is someone who falls, they lose consciousness, their body shakes, and then they're confused afterwards, or it takes them a while to wake up. One of my jobs is also to educate people about the different types of seizures. There's many different types. In fact, so many that I probably couldn’t list them here. So to your point of what are the signs and symptoms, the easiest way to look at this is some people—not everyone—has what they call an aura. An aura is like a warning prior to their seizures, some people don’t. The auras can vary. They can vary from an unusual taste to an unusual smell to numbness or tingling.
Then when we look at what are the signs and symptoms, the signs and symptoms are so variable. It depends on where the seizure is coming from and the type. So some signs and symptoms could be body shaking or convulsing, like we talked about. Others could be numbness, tingling. Others could be hallucinations. Another one could be speech abnormality. Another one could be memory loss or even any combination of these.
Host: So that’s really interesting. I imagine there are people that have been living with these symptoms—you were mentioning somebody that has tingling—and just thinking, “Ah, this is normal. I'm just going to live with this.” Well years later they get diagnosed and it turns out they're having an epileptic seizure. Is that right?
Dr. Ardeshna: That is a great observation. That’s absolutely correct. In fact, I'm an epileptologist. So my specialty is seeing epileptic patients. We recommend that patients who have had or are suspicious for seizures that they see an epileptologist. There’s quite a big delay in the diagnosis, like you said. Many a times these things are so subtle that if you or I were to see them you’d be like maybe not or just to kind of live with it. Some people will come in actually denying that, “I'm not having these symptoms. It couldn’t be true.” So it’s the observations of the family that also make a difference. The best case that I can tell you is a lady who actually had memory loss for 20 years and they just thought it was grandma being grandma. Grandma actually had seizures for 20 years.
Host: Really interesting. So I have to ask. After she was diagnosed properly, and I would imagine given treatment, did her memory improve?
Dr. Ardeshna: So the way this works is that the memory doesn’t necessarily improve, but the decline stabilized. There was no further decline. She was seizure free. We managed to make her seizure free.
Host: Well that in itself is a win for sure. So then who is most at risk for epilepsy?
Dr. Ardeshna: So in the past—say about 15/20 years ago—they used to say that the young meaning kids and babies were highest at risk. To a certain extent, that is still true. Actually the fastest growing segment for new onset seizures is actually the elderly. If you think about the United States population or the North American population—like many other countries in the world—what's the fastest growing group? It’s the elderly.
Host: Right.
Dr. Ardeshna: Then if you go a little more in detail and you say okay well can you narrow it up? Which conditions put you at higher risk for epilepsy? Those conditions are things like people who’ve had a stroke, brain tumor, a head injury. A head injury could be as simple as a concussion to something like a more severe motor accident. Dementia is also a risk factor or a bleed in the brain.
Host: Well, I think the perception is that epilepsy strikes younger people more often. What you're saying is just as much in the older generation.
Dr. Ardeshna: That is correct.
Host: So let’s talk about treatment now. Is there a cure? If not, what is the treatment?
Dr. Ardeshna: So there is not one specific cure for epilepsy. We can't say that unlike other medical conditions, this is the one cure. There are many different treatments available and I will talk about those. The treatments that are available though have changed. They are much more advanced. There are clearly options available that were not available in the past. So originally if we go back many years, it was medications. Now I’ll put a caveat to that. A lot of people—and this is where part of my job comes in—is clearing up misperceptions about epilepsy, which you and I have indirectly already talked about today.
Host: Sure.
Dr. Ardeshna: So people used to think that there was no medications available. Well, then there were medications available and there are. The medications that are now available have less side effects than the older ones. They are more—how should I say—easier to manage for the patient. They don’t interact with other medications that they're on. So the first line of treatment is what we call anti-seizure drugs or anti-epileptic medications. Then if those don’t work, there are other options. One option is something called epilepsy surgery. Some people are eligible for epilepsy surgery. If that doesn’t work, there are other devices. One called a vagal nerve stimulator, which is a device that is implanted into the chest to control seizures. There’s another device called an RNS—responsive neurostimulation—which can be implanted into the brain to control seizures. All of those are applicable if medications don’t work.
Host: So with medications and devices and treatments, it sounds like many people can manage this and live normal full lives with epilepsy. Is that correct?
Dr. Ardeshna: Yes sir. That is a very fair statement. In fact, sometimes it’s not known that’s part of our job for advocating for these patients and educating. The goal for all epilepsy patients as epileptologists for the patient is seizure freedom, or to get as close to that as you can as quick as you can and maintain quality of life. So epilepsy patients in my opinion should get treatment as quick as they can. So you want to prevent the long-term consequences of seizures. Consequences like injuries, memory loss. Yes, it is entirely possible, and we want them to live not only quality lives but normal lives. I've got epilepsy patients I can tell you who work at major corporations, one owns his own company. In fact, in many cases as you can see from our discussion, meeting someone you would not know by looking at them that they have epilepsy.
Host: Right. Because it’s so small or non-descript if you will.
Dr. Ardeshna: Correct. It can be quite subtle.
Host: Well Dr. Ardeshna, thanks for educating us. This has been quite informative. Thank you so much for your time today.
Dr. Ardeshna: I thank you for the opportunity and your time as well.
Host: That’s Dr. Nikesh Ardeshna, medical director of the epilepsy services at McLaren Health. If you want to learn more about Dr. Ardeshna or submit a question, please visit mclaren.org/ardeshna. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is McLaren’s in Good Health. I'm Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): So what exactly is epilepsy? What causes it? How is it treated and managed over a lifetime? Let’s learn more with Dr. Nikesh Ardeshna, medical director of the epilepsy services at McLaren Health. This is McLaren’s in Good Health, I'm Bill Klaproth. Dr. Ardeshna, exactly what is epilepsy and what causes it?
Nikesh Ardeshna, MD (Guest): Well, I thank you for this opportunity as well to talk about this. So epilepsy is basically a medical condition in which an individual is predisposed to having unprovoked seizures. There are many different causes of epilepsy. In particular, a significant portion of cases of epilepsy are of unknown cause. All epileptic seizures originate from the brain. A way to paraphrase it is it is due to an electrical abnormality in the brain. Sometimes we can find a cause to that electrical abnormality. That could be a stroke, it could be a brain tumor, it could be a prior head injury. Sometimes there's no specific cause.
Host: Sometimes you're just born with it then. Is that correct?
Dr. Ardeshna: You can be born with the abnormality, but it doesn’t even have to manifest right when you're born. The interesting thing—and this is a question that’s asked a lot of times in the office by patients—is there doesn’t even have to be a family history. You could be the first one that has your first seizure at any age.
Host: Well, that’s interesting to know. Then what are the signs and symptoms? We’ve all seen on TV the person having a seizure on the ground kind of wrangling around, but there has to be varying degrees of signs and symptoms. Is that right? What should we be looking for?
Dr. Ardeshna: So you are correct. From a seizure standpoint, when you ask someone what a seizure is they will say most commonly—and that’s how it’s seen in the media—is someone who falls, they lose consciousness, their body shakes, and then they're confused afterwards, or it takes them a while to wake up. One of my jobs is also to educate people about the different types of seizures. There's many different types. In fact, so many that I probably couldn’t list them here. So to your point of what are the signs and symptoms, the easiest way to look at this is some people—not everyone—has what they call an aura. An aura is like a warning prior to their seizures, some people don’t. The auras can vary. They can vary from an unusual taste to an unusual smell to numbness or tingling.
Then when we look at what are the signs and symptoms, the signs and symptoms are so variable. It depends on where the seizure is coming from and the type. So some signs and symptoms could be body shaking or convulsing, like we talked about. Others could be numbness, tingling. Others could be hallucinations. Another one could be speech abnormality. Another one could be memory loss or even any combination of these.
Host: So that’s really interesting. I imagine there are people that have been living with these symptoms—you were mentioning somebody that has tingling—and just thinking, “Ah, this is normal. I'm just going to live with this.” Well years later they get diagnosed and it turns out they're having an epileptic seizure. Is that right?
Dr. Ardeshna: That is a great observation. That’s absolutely correct. In fact, I'm an epileptologist. So my specialty is seeing epileptic patients. We recommend that patients who have had or are suspicious for seizures that they see an epileptologist. There’s quite a big delay in the diagnosis, like you said. Many a times these things are so subtle that if you or I were to see them you’d be like maybe not or just to kind of live with it. Some people will come in actually denying that, “I'm not having these symptoms. It couldn’t be true.” So it’s the observations of the family that also make a difference. The best case that I can tell you is a lady who actually had memory loss for 20 years and they just thought it was grandma being grandma. Grandma actually had seizures for 20 years.
Host: Really interesting. So I have to ask. After she was diagnosed properly, and I would imagine given treatment, did her memory improve?
Dr. Ardeshna: So the way this works is that the memory doesn’t necessarily improve, but the decline stabilized. There was no further decline. She was seizure free. We managed to make her seizure free.
Host: Well that in itself is a win for sure. So then who is most at risk for epilepsy?
Dr. Ardeshna: So in the past—say about 15/20 years ago—they used to say that the young meaning kids and babies were highest at risk. To a certain extent, that is still true. Actually the fastest growing segment for new onset seizures is actually the elderly. If you think about the United States population or the North American population—like many other countries in the world—what's the fastest growing group? It’s the elderly.
Host: Right.
Dr. Ardeshna: Then if you go a little more in detail and you say okay well can you narrow it up? Which conditions put you at higher risk for epilepsy? Those conditions are things like people who’ve had a stroke, brain tumor, a head injury. A head injury could be as simple as a concussion to something like a more severe motor accident. Dementia is also a risk factor or a bleed in the brain.
Host: Well, I think the perception is that epilepsy strikes younger people more often. What you're saying is just as much in the older generation.
Dr. Ardeshna: That is correct.
Host: So let’s talk about treatment now. Is there a cure? If not, what is the treatment?
Dr. Ardeshna: So there is not one specific cure for epilepsy. We can't say that unlike other medical conditions, this is the one cure. There are many different treatments available and I will talk about those. The treatments that are available though have changed. They are much more advanced. There are clearly options available that were not available in the past. So originally if we go back many years, it was medications. Now I’ll put a caveat to that. A lot of people—and this is where part of my job comes in—is clearing up misperceptions about epilepsy, which you and I have indirectly already talked about today.
Host: Sure.
Dr. Ardeshna: So people used to think that there was no medications available. Well, then there were medications available and there are. The medications that are now available have less side effects than the older ones. They are more—how should I say—easier to manage for the patient. They don’t interact with other medications that they're on. So the first line of treatment is what we call anti-seizure drugs or anti-epileptic medications. Then if those don’t work, there are other options. One option is something called epilepsy surgery. Some people are eligible for epilepsy surgery. If that doesn’t work, there are other devices. One called a vagal nerve stimulator, which is a device that is implanted into the chest to control seizures. There’s another device called an RNS—responsive neurostimulation—which can be implanted into the brain to control seizures. All of those are applicable if medications don’t work.
Host: So with medications and devices and treatments, it sounds like many people can manage this and live normal full lives with epilepsy. Is that correct?
Dr. Ardeshna: Yes sir. That is a very fair statement. In fact, sometimes it’s not known that’s part of our job for advocating for these patients and educating. The goal for all epilepsy patients as epileptologists for the patient is seizure freedom, or to get as close to that as you can as quick as you can and maintain quality of life. So epilepsy patients in my opinion should get treatment as quick as they can. So you want to prevent the long-term consequences of seizures. Consequences like injuries, memory loss. Yes, it is entirely possible, and we want them to live not only quality lives but normal lives. I've got epilepsy patients I can tell you who work at major corporations, one owns his own company. In fact, in many cases as you can see from our discussion, meeting someone you would not know by looking at them that they have epilepsy.
Host: Right. Because it’s so small or non-descript if you will.
Dr. Ardeshna: Correct. It can be quite subtle.
Host: Well Dr. Ardeshna, thanks for educating us. This has been quite informative. Thank you so much for your time today.
Dr. Ardeshna: I thank you for the opportunity and your time as well.
Host: That’s Dr. Nikesh Ardeshna, medical director of the epilepsy services at McLaren Health. If you want to learn more about Dr. Ardeshna or submit a question, please visit mclaren.org/ardeshna. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is McLaren’s in Good Health. I'm Bill Klaproth. Thanks for listening.