Transcription:
Epilepsy Facts & Treatment

Prakash Chandran: Epilepsy affects about 3.4 million people in the United States. There are different kinds of epilepsy and a variety of treatment options. We're going to talk about them today with Dr. Viktoras Palys, a neurosurgeon and epilepsy specialist at the University of Arkansas for Medical Sciences.

This is UAMS Health Talk, the podcast from the University of Arkansas for Medical Sciences. My name is Prakash Chandran. So first of all, Dr. Palys, it's great to have you here today. I'd love to start by asking how exactly do you go about diagnosing a person with epilepsy?

Dr. Viktoras Palys: Thank you for inviting me. So let's just go briefly about what is seizure first. So seizure is a sudden and brief electrical storm in the brain. And if that storm is local or spreads to the entire brain, patients can have a wide variety of symptoms or manifestations. Some patients may have uncontrollable rhythmic arm twitching, for example, or somebody may stop responding for a few seconds. And by the way, such seizure would be very difficult to notice for witnesses or people around. Or some patients may lose consciousness and the whole body goes into convulsions. All depends which part of the brain is involved.

And as you mentioned, the amount of patients having epilepsy, but on the other hand, about 5% to 10% of people in their lifetime can have one seizure.

So what is epilepsy? Epilepsy is a disease, a disease when seizures happen unprovoked again and again. So as you mentioned, Prakash, epilepsy is affecting probably 1% of general population. So it's highly likely, one of us, we know somebody who has epilepsy.

So to answer your question, how epilepsy is diagnosed, it's diagnosed when a person or a patient or a witness tells us about the seizure. Then, doctors have to prove that such seizure event was associated with electrical storm in the brain. And we do that by recording brain activity using EEG, which is electroencephalography. That is when electrodes are glued to your scalp for an hour or longer and we try to capture seizure, which is not always possible given that seizure may not happen at the moment EEG is recorded.

But luckily, oftentimes, we have telltale signs such as electrical sparks on EEG. We call those spikes or sharp waves. So patient telling a story and we record EEG, that's how epilepsy is diagnosed.

Prakash Chandran: Well, Dr. Palys, I think that you have explained that very well. I'd like to expand a little bit more though and learn about the different types of epilepsy.

Dr. Viktoras Palys: Yes, indeed, there are different kinds of epilepsy. And again, it all depends which brain part is involved. So sometimes epilepsy can be small, as you mentioned, so it's called focal or partial epilepsy. Then patient may not lose even consciousness. For example, they see that that arm is twitching. Sometimes epilepsy can be generalized. Indeed, this medical term is generalized epilepsy. So then patient loses consciousness and may go even in the bad convulsions.

On the other hand, epilepsy can be classified by the cause. So is epilepsy caused by brain trauma and then brain scar? Or epilepsies caused by brain tumor or by brain blood vessel abnormality, by genetic mutation, by brain inflammation and so on can lead to epilepsy. So indeed there is lots of, lots of different kinds of epilepsy, but roughly we divide them into focal and generalized.

Prakash Chandran: Understood. So let me ask a more basic question. Can the epilepsy ever be so mild that the patient doesn't even know that it's happening?

Dr. Viktoras Palys: It can. Sometimes we call that the absence seizures, when patient just stops responding for a few seconds and then just wakes up and keeps going. So patient may not know that he or she is having seizures or even people around may not have idea of what's going on because it's very brief moments, like few seconds. So it may go unnoticed for a long time.

Prakash Chandran: Okay. So let's maybe talk about some of the different treatment options for epilepsy. And I'd also like to learn a little bit more about the risks of not treating it.

Dr. Viktoras Palys: There are mainly four treatment options and oftentimes they go together. So first of all, like in many disease processes, lifestyle modification is very important. When it comes to epilepsy, avoiding circumstances that provoke seizures and patients may know what provokes their seizures, but universally, alcohol, lack of sleep may cause seizures.

But also avoiding circumstances when the patient can get injured if seizure happens. For example, during driving the cars, swimming, climbing ladder. So avoiding those circumstances is very important, so lifestyle modification.

Number two is medications. And currently, I think there's probably around 28 medications that are approved by Food and Drug Administration for treatment of epilepsy or seizures.

Then, if that doesn't help, then the third option is highly specialized diets. And many of us probably heard about ketogenic diet, which is currently getting modern even for people without epilepsy, but strict ketogenic diet can be helpful in epilepsy. And if nothing else is helping, a fourth option is a surgical consultation. We can briefly talk about surgical treatment options as well.

So to answer your question, what's the risk of not treating epilepsy? Well, first of all, it depends how bad is your epilepsy, but you probably know that epilepsy can take your life. It causes premature death. And besides just general quality of life, you cannot drive, it's hard to get jobs, medication side effects. But to me as a surgeon, most importantly is premature death or also sometimes called SUDEP, sudden unexpected death of epilepsy and patients face this risk every time seizure happens. More people die from epilepsy than from breast cancer. Many young people are lost due to epilepsy. So treating epilepsy is important on many aspects, but most important is to preserve your life.

Prakash Chandran: That totally makes sense. So you talked about four different treatment options, the fourth being surgical. So maybe let's go a little bit more into what it looks like to treat epilepsy with surgery.

Dr. Viktoras Palys: So treatment goal regardless of which options we take is seizure freedom and no side effects. That's what we all want, what all health providers want and patient wants. Of course, treatment is started with medications, lifestyle modifications. But we know by now, if you try two medications and patients still has seizures, patient should be evaluated by epileptologist team that has epilepsy surgeon on board. And this is standard of care.

So epilepsy team I can reassure will never insist on the patient to have surgery. Epilepsy team will help patient to understand what surgical options are available so patient can choose what's best for him or her. So when it comes to surgical options, there are truly wide choices, thanks to the latest advancements of science and technologies. And thanks due to the same advancements, epilepsy surgery is considered to be the safest brain surgery with very low risk of complications.

When patient comes to see me or any other epilepsy surgeon, we look again how to achieve the same goal, seizure freedom, or curing epilepsy. Good news, it is quite possible. If curing epilepsy is not possible for this particular patient, we look for other options and namely to decrease seizure burden, that is to decrease the number and severity of seizures. Good news. It is almost always possible.

So somebody may ask, "Okay. So if you cannot cure my epilepsy, why do we need to even talk about surgery?" Again, to answer this question, I already mentioned earlier, your quality of life, risk of premature death.

So what surgical options exist? I would start with mentioning the most standard surgeries such as removing abnormal brain cells. And I would continue about listing the most modern approaches such as utilizing lasers to affect those abnormal brain cells or there are small implantable computer devices that can stimulate certain parts of the brain and change the behavior of those abnormal brain cells so they no longer start electrical storms in your brain.

Prakash Chandran: So something else I wanted to expand on a little bit, you know, you talked about lifestyle modifications like the reduction of alcohol and getting more sleep. Is there anything that you can do by way of the foods that you eat that can help prevent epileptic seizures?

Dr. Viktoras Palys: One of mentions is caffeine intake, reducing caffeine intake. But other than that, probably foods don't play a significant role unless we go strictly for so-called ketogenic diet. Then such diet, the selection of foods has to be done by specialized dieticians and with epileptologist supervision, because that's the very strict diet. But otherwise, for regular diets, foods don't have much influence on your epilepsy.

Prakash Chandran: And who exactly does epilepsy affect? Should people of a certain age or demographic be more aware than others?

Dr. Viktoras Palys: Epilepsy has probably two peaks. First peak is young age group, children, infants. They have so-called febrile seizures when they have some febrile illness, like mild infection, a fever, and then body temperature goes up, that can provoke seizures.

And the second peak is probably at the second half of your life. Then you start having different diseases, such as brain tumors, brain traumas, so that then also can lead to seizures. But to be honest, no age group is spared from having epilepsy and seizure diagnosed.

Prakash Chandran: Okay. And one of the final things I wanted to ask you about is I understand that UAMS is home to the only level four adult epilepsy center. So what does that actually mean to have that distinction?

Dr. Viktoras Palys: Four means that it's a comprehensive epilepsy center. And that means that every possible treatment option exists at such center and namely UAMS. That means we have a multidisciplinary team with epileptologist, neuropsychologists, neuroradiologists, specialized epilepsy nurses and neurosurgeons.

As a comprehensive epilepsy centers, we have all modern surgical and diagnostic equipment and beyond. For example, not every level four epilepsy center has a surgical robot, but we are lucky to have one. Not every level for epilepsy center has its own magnetoencephalography, but we do have,

So Arkansas epilepsy patients are lucky in this regard. All they need is to come to see us for consultation, to hear how specialized care can change their life. And my hope is also that every healthcare provider in Arkansas knows that such care is available and then easily accessible at UAMS.

Prakash Chandran: So just as we close, as a neurosurgeon and epilepsy specialist and everything that you've learned servicing potentially hundreds of cases, what's one thing that you wish the general public knew about epilepsy?

Dr. Viktoras Palys: I wish they knew that epilepsy surgery is definitely not the last resort, because epilepsy surgery is very safe or results are very good. And there is no patient that we cannot offer something from the whole array of surgical options. So I guarantee after talking to us, patients will feel better knowing that help is available and that many options available so they can easily choose and then pick what sounds best for them.

Prakash Chandran: Well Dr. Palys, I think that is the perfect place to end. Thank you so much for the education and for your time today. That's Dr. Viktoras Palys, a neurosurgeon and epilepsy specialists at the University of Arkansas for Medical Sciences.

For more information on this topic and to access any resources mentioned, please visit UAMSHealth.com. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thank you for listening to this episode of UAMS Health Talk. I'm Prakash Chandran, and we'll talk next time.