Transcription:
National Epilepsy Awareness Month

Melanie Cole: Welcome to Back To Health, your source for the latest in health, wellness, and medical care. Keeping you informed, so you can make informed healthcare choices for yourself and your whole family. Back To Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole. And today, we're talking about National Epilepsy Awareness Month. Joining me is Dr. Padmaja Kandula. She's the Chief in Epilepsy and Clinical Neurophysiology at Weill Cornell Medicine. Dr. Kandula, it's a pleasure to have you with us today. So let's just start for the people who really don't, you know, know what it is, but they've heard the term a million times. What is epilepsy?

Dr. Padmaja Kandula: Well, Melanie, thank you for having me on today. Epilepsy is actually repeat seizures over time without a definite obvious trigger. And when, I mean trigger something like low blood sugar, low blood sodium or salt or something like alcohol that might trigger it.

Melanie Cole: So tell us a little bit about what age you typically see this. I mean, I personally have a friend that was diagnosed in her 40s and a nephew in his 20s but I know this is typically a childhood thing, right? Am I right about that or no?

Dr. Padmaja Kandula: Well, you're nailing it on the head. You know, it can occur at any age, but younger children in particular and older persons generally are affected. And that's actually due to the increased lifespan that we're just seeing worldwide, but particularly in this country. So, you know, like we said, there's two peaks, younger children and older persons.

Melanie Cole: And now let's talk about the symptoms because we've all heard about epileptic seizures, and we've heard about the different kinds, grand mal and petit mal and all of these things, and people don't know what to do. And we're going to get into that too, Dr. Kandula. But tell us about those epileptic seizures. What are they?

Dr. Padmaja Kandula: So seizures, you know, are interesting. They can present in a variety of ways. And we typically divide those into two specific groups. And this is kind of how we like to think about it and explain it to our patients. But they're divided in those that start from a very specific part of the brain and it's named focal seizures. And that's probably the more common type of seizure that people see, particularly in adults versus those seizures that start in both sides of the brain at the same time. And those are called generalized seizures.

So there's different seizure types, depending on whether they start in a particular area or if they start in both sides of the brain. So, you know, we were talking a little bit earlier about when seizures start. So the seizures that start on both sides of the brain typically occur early in life. So we see this with children, adolescents, and potentially young adults and there's different seizure types. So I like to use, you know, the technical terminology and then I like to tell the patients these are what the seizures are called and these are the names of them.

One really common one his absence seizure. And absence is a little bit what it sounds like. People are absent for a few seconds, so they may stare for a couple of seconds and have no recollection that happened. Typically, that's seen in the young, particularly young children. There's another type of seizure type and it's called myoclonic. And the myo- part gives a clue of what kind of seizure it is. It just basically means you're jerking. So it's a jerk or twitch of the arms, and most people are awake and alert when this occurs.

And the one that I think the most people are familiar with is something called a convulsion or the other name for it is grand mal. So these are the type of seizures that you might see with really violent movements of the arms and legs. People are not alert. There's increased pulse that goes with it. The blood pressure may go up. There's some disordered breathing and people may be confused.

You know, we also have seizures like I mentioned that start in one part of the brain and, depending on what part of the brain is involved, you have different kinds of symptoms. So, you know, the brain has different parts and lobes. So there's four main lobes to keep it simple in the brain. The more common lobe, and it takes up a portion of the brain on both sides, is the temporal lobe. So this is the most seizure-prone area in the focal epilepsies. And it produces a lot of different symptoms. And some of these symptoms include hallucinations. They smell strange things, and they're called olfactory hallucinations. Or you may have gustatory hallucinations, an odd taste, or auditory hallucinations, where you hear buzzing or ringing. People may have abdominal discomfort and, in some cases, psychic sensations where they feel this uncontrollable fear, panic, racing of the thoughts, feeling a sense of familiarity or deja vu. They can have difficulty with expression of language or understanding of language. And sometimes we see these physical changes that are not purposeful. They're not voluntary. They have lip smacking of the mouth. They're using their hands inappropriately and maybe touching their clothes not purposefully. And that happens quite often in temporal lobe seizures.

Frontal lobe seizures are probably the second most common area that occurs in focal epilepsies. And patients have, you know, kind of a more strange type of symptoms. They can have a change in their motor control of their limbs. They may wander because oftentimes they happen at night, out of sleep. They can have some change in behavior and change in language expression too. And many times, these seizures cluster. So they may not just have one out of sleep, they may have two or three.

And seizures that begin in a third lobe called the parietal lobe have change in perception or sensation. So things like numbness or tingling that starts on one side and spreads. Or they can have a change in perception of temperature. So an abnormal sensation of burning or feeling of coldness in one of the limbs, either the arm or the leg, and it spreads.

And lastly, the occipital lobe, which is the back of the head or the occiput, people can have things like change in vision ,so they can see things like multiple colored shapes, circles, flashes of light, or even loss of vision for a short period of time.

So, as you can tell, you know, it's a very complicated set of symptoms, but a lot of it's based on anatomy in terms of how it presents to the clinician and other people around the patient.

Melanie Cole: Isn't that so interesting? What a mysterious disease and condition that this is. But it seems like we're learning more all the time. And before we get into a little bit of that, you mentioned for the people that might be present during one of these seizures, if it's a parent, a teacher, a friend, whoever it is, what should they do? We used to hear don't put a spoon; do, you know. It's pretty scary. So can you tell us what you want us to know about what to do if somebody is having a seizure and does it hurt the patient to have a seizure?

Dr. Padmaja Kandula: Yeah, this is a great question and very timely because seizure doesn't equal epilepsies. People can have a one-off, about one in 10 people can have a seizure. So it's important to recognize the symptoms and be able to react to it. So I think the key thing is to remain calm, which is easier said than done, but that's the key thing. And get the individual who's having the seizure away from injury. So if they're close to a sharp object or, you know, if they're not in the vicinity of space, you should get them to some clearing so they don't injure themselves. Put the person on their side. So oftentimes if it's a large grand mal seizure, they may have incomplete control of their oral secretions and spit may come out, so you don't want anyone to choke on it. So putting them on their side allows, you know, the spit, the drool, to go to the side and that's very helpful.

And lastly, you know, stay with the person and call 911. It sounds very simple, but, you know, calling 911 while staying with the patient is very key, particularly because if the seizure goes on for a prolonged period of time, you know, that becomes an emergent condition. But most seizures typically will last two minutes and we'll stop on their own. There are occasionally times where it can go on for five minutes or longer. And then it becomes an emergent state and, you know, the EMS personnel are great and adept with dealing with these emergencies and giving pretreatment in the ambulance before they even get to the hospital to try to abort or get rid of the seizure.

Melanie Cole: Well, thank you for that. That's information that I think everybody really needs to know. So as we talk about treatments, Dr. Kandula, you mentioned it doesn't necessarily start after one seizure. Tell us a little bit about treatments that are available. You can talk about surgeries, medications. What have you seen that works? And then we're going to touch briefly on diet because that's an interesting aspect of this condition.

Dr. Padmaja Kandula: Yeah, actually, these are all great questions. And, you know, treatment, you know, is key. And I think it's important to note there is treatment for this problem just like other problems in medicine. And, you know, two-thirds of people are well-controlled on medications. Over 20 medications and the list is growing day by day. And there are very good medications, ones that can be used even in pregnancy if one needed it. And those are two-thirds of the people that are controlled.

Now, there are people that may require further intervention if the medications don't work, you know. And these are patients that are about a third of the epilepsy population. So two-thirds are controlled and a third are not. In this particular case, there are quite a different number of interventions. Some are traditional surgeries. And when, I mean traditional surgery, an area of the brain, particular focus, if the seizure starts from that particular focus, then the person may be a candidate for taking that area of tissue out of the brain, which sounds strange, but there's a really long process of a workup that goes into deciding who's a candidate. So we do want to make sure that the area that's taken out doesn't have features such as motor control or language control.

There are other options as well that are more minimally invasive, where tissue is not taken out, but laser has been employed. So it's called actually laser interstitial thermal therapy, which is a mouthful, but what it comes down to is using a small laser to heat a small area of tissue that's causing the seizure and lasering it out. So nothing is actually taken out. It's just deactivated by heat sensation. So it's more easily available to many people of ages because it's less invasive, doesn't require opening up the entire skull. So all age groups, including older folks who may have a hard time with traditional surgery and anesthesia may be able to tolerate it. The downside is that you really have to have a very small focus. So if you have a very tiny focus, it's a great option.

Melanie Cole: Wow. Isn't that amazing what you can do today? Now, I mentioned diet. We're hearing more and more about diet and its role in epilepsy. Can you tell us just briefly a little bit about this and how you're utilizing it with patients?

Dr. Padmaja Kandula: Yeah. I mean, the diet is actually a great option. It's what we call adjunctive. So it works hand in hand with other treatments and that's typically medication. In some few cases, it may work almost solely on its own. But, you know, patients, these days are looking for options that can work in their lifestyle.

So there are several diets and I think the best known diet is the ketogenic. It's technically a high fat, low carbohydrate diet. And the ratio is variable. So depending on the ratio, it becomes either more strict carbohydrates or less strict carbohydrate. Maybe patients may not be able to tolerate such a high fat, low carbohydrate diet initially, then there's other options. There's something called a modified low-glycemic, which allows a little bit more carbohydrate intake.

But the main point of these diets is what ends up happening is instead of using carbohydrates or sugars as body source or primary fuel, the body then uses these good fats and these good fats can be things like avocado, low fat meats, and you get higher ketone levels in the body. And this actually leads to improve seizure control by increasing the ketotic state in the body. And most recently, you know, the Atkins diet, a modified version of it has received some interest in press. And it's a little bit easier to incorporate into lifestyle. And one of the main differences between the modified Atkins and the ketogenic diet or the modified low-glycemic is that it allows more protein content. There's no restriction on the ratio of protein. So individuals might find that a little bit easier to incorporate.

And some of these diets may have additional benefits as well. And that's what we're looking at now. Some of them have weight loss ability as well. Since it's less carbohydrates, people tend to eat healthier and more particular at what they're eating. They're also looking at these diets on secondary benefits in terms of autism in autistic patients as well. So I think there's a wide spectrum of use down the road and we're just tapping into just the beginning.

Melanie Cole: Well, we're going to have to do a podcast just on that and get into what some of those diets are like for families and keeping track of them and preparing them. And that is all so interesting. Dr. Kandula, can you wrap it up for us? What would you like patients and their families and the listeners to know about epilepsy awareness, and all of the information, great information, you've given us here today.

Dr. Padmaja Kandula: Well, I think the takeaway point is this, you know, epilepsy is a condition, just like any other medical condition, that can be well controlled. And, you know, people can be empowered, including patients, caregivers, significant others in terms of helping patients out by becoming more knowledgeable about the problem in general.

And I think, you know, this type of podcasts, conferences, reading about epilepsy is really helpful. It's helpful in terms of helping the patient out, but even the general public. You know, like I said, having a seizure is not unusual. One in 10 patients may have it at some point in their lifetime. So being able to educate yourself and understand what that is, is helpful on a global health perspective.

And I think one other thing is advocacy. The more people that, you know, come out and share their story. And we have so many of these lovely patients that have done that inspires other people who might be afraid or have reservations on seeking care to seek the appropriate care. You know, part of getting good control of seizures is, you know, getting on top of it, getting to a good specialized center and getting someone to work with you and, you know, incorporate either a diet or medications or a treatment that works for you in your lifestyle.

Melanie Cole: Wow. You've given us so much to think about doctor and really great information, and especially what to do if you see someone. As you say, this is more common than we might realize, and so important for awareness that we know what to do, and that patients and their families know where to turn. Thank you so much for joining us today.

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