Saturday, February 24, 2024

Blog #163 February: ALZHEIMER'S DISEASE AND EPILEPSY






Articles are ubiquitous in the media on Alzheimer's Disease (AD). It is estimated that Alzheimer's currently affects 5 million Americans. In 2050 ten percent of us will be affected according to Harvard.edu.

Increasing knowledge based on multiple studies (meta-analysis) shows a link between AD and epilepsy. People with epilepsy had a 1.8-fold increased risk of AD. Patients with AD had a 3.1- fold higher risk of epilepsy, both generalized and focal seizures with impaired awareness (complex partial epileptic seizures). Temporal lobe epilepsy and AD share some pathologic features such as both show hippocampal sclerosis in the temporal lobe tip. The study populations to confirm this information is interesting but it is inconclusive due to the relatively small populations in the studies.1 

Increased chemical amyloid compounds are found in the brains of patients with AD. Elderly people who may be intellectually normal all have some amyloid in their brains, too, but this chemical compound is more prolific in AD dementia. It appears that amyloid pathology increases the propensity to generalized seizures. There is an association between AD and focal seizures, too, with hippocampal sclerosis (scarring) in the temporal lobes.


1. Fang Y, Xiaoli S, Jial W, et. al. Alzheimer Disease and Epilepsy. Neurology;2023 101:e 399-e409. Doi:10.1212 


Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions

Thursday, January 25, 2024

Blog # 162: The Gamma Knife is Focused Radiation to Treat Epilepsy Without Surgery




               My followers should find this 162nd of my monthly educational blogs of interest for your own epilepsy and for those whose lives are touched by your epilepsy.

If your epilepsy is drug resistant this is a potential treatment that could benefit you and it is non-surgical. Gamma knife surgery, also known as stereotactic radiotherapy, is not actual surgery. No cutting nor opening of the skull is involved. Radiofrequency beams are painlessly concentrated on the brain area identified as the cause of your epilepsy. This technique originated in the 1950’s. The Gamma Knife can minimize damage to nearby healthy brain tissue. Your seizure frequency may be lessened; your epilepsy may even be cured without opening the skull or damaging normal brain tissue.1  

The Gamma Knife® is a powerful tool that enables the neurosurgeon to focus many weak beams of radiation energy on any location inside the brain, especially useful to treat areas difficult, or dangerous, to expose surgically. By focusing these intersecting individually weak beams together these many beams can break down tissue. The radiosurgery team can target a region of the brain while limiting damage to surrounding, normal brain tissue. While more commonly used to treat children with brain tumors and collections of abnormal blood vessels arteriovenous malformations, the Gamma Knife is also used to treat some patients with epilepsy.

 

The painless treatment effect of Gamma Knife radiosurgery occurs slowly, depending on these conditions that are often associated epilepsy:

  • Benign tumors. Gamma Knife radiosurgery keeps tumor cells from reproducing. The tumor may shrink over a period of months to years. But the main goal of Gamma Knife radiosurgery for noncancerous tumors is to prevent any future tumor growth.
  • Malignant tumors. Cancerous tumors may shrink quickly, often within a few months.
  • Arteriovenous malformations (AVMs). The radiation therapy causes the atypical blood vessels of brain AVMs to thicken and close off. This process may take two years or more.
  • Epilepsy foci. Half of epilepsy patients lack identifiable brain tissue abnormalities or scars which EEGs and brain scans identify where seizures begin. The radiation therapy can be useful in eliminating these abnormal areas.

Consider discussing Gamma Knife treatment on a brain epileptic focus your medical team has identified causing your still poorly controlled seizures with your neurologist.

1.      Lunsford LD, Kondziolka D, Flickinger JC, et al: Stereotactic radiosurgery for arteriovenous malformations of the brain. J Neurosurg 75:512-524, 1991

 

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

 

 

 


Tuesday, December 26, 2023

Blog # 161: WEEKLY EPILEPTIC SEIZURES REDUCED BY MEDICAL CANNABIS

 



A study was summarized by Robert Herpen, MA and Shenaz Bagha on the American Epilepsy WebSite. The researchers, Xintian Lyn, BS, a student in the department of experimental and clinical pharmacology at the College of Pharmacy at the University of Minnesota and her team reported on their recent poster at the American Epilepsy Society meetings earlier in December 2023 that adults with epilepsy given medical cannabis had a significant decrease in weekly seizure frequency.1

There is a paucity of data on the effects of THC (Tetrahydrocannabinol, the principal psychoactive constituent of cannabis) on seizure frequency. This researcher group in Minnesota was interested in cannabis’ effects on seizure frequency.

From 2016 to 2019 one-hundred-twelve adults with epilepsy, 70% of whom were aged 18-64 (54.5 % were male) were studied. The participants had at least four visits for treatment for at least 6 months. They may or may not have had antiseizure medications prescribed, too. The outcome of the study was that 57 participants reported fewer weekly seizures, 47 enrollees reported no change—including 34 with zero frequency seizures during the study period—while 10 patients reported an increase in their seizure frequency. In all three of these groups, participants were dispensed both CBD (cannabis) and THC. The study found a significant difference reported in CBD total daily dose among those who recorded either a decrease or no change in seizure frequency. CBD is a chemical found in marijuana. CBD doesn't contain tetrahydrocannabinol (THC), the psychoactive ingredient found in marijuana that produces a high.

Thirty patients relied on only CBD cannabis to manage their epileptic seizures. Most of this study population were also taking one to five antiseizure medications.

If your epilepsy is poorly controlled discuss adding CBD (cannabis) to your treatment with your physicians. Additionally, explore the potential of brain surgery as your epilepsy treatment if no other treatments benefit you. Several of my previous 160 monthly blogs on my website: LanceFogan.com dealt with brain surgery as a chance to improve your epilepsy when medications fail (See Blog # 89 December 26, 2017: Surgical Removal of Seizure Foci in Your Brain to Cure Poorly Controlled Epilepsy is Safe!; Blog # 103 February 26, 2019: Epilepsy—fit to drive?; Blog # 114 January 26, 2020: Epilepsy surgery in childhood and long-term employment is encouraging.; Blog # 121 August 25, 2020: If your seizures aren’t controlled epilepsy surgery is safe and really can help).

 

1.      Lyu X. et al. Medical cannabis and seizure control in Minnesota medical cannabis program. Presented at AmericanEpilepsy Society annual meeting Dec. 1-5, 2023: Orlando, FL.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.


Saturday, November 25, 2023

Blog #160: Life Expectancy Varies by Epilepsy Type

 



Overall, life expectancy is comparable to the general population.1 But in certain types of epilepsy, the risk of premature death is higher than that of the general population. Most of the increased risk is directly related to what causes your epilepsy.

Only a small number of deaths in the epilepsy patient population are epilepsy related. These are deaths caused by a seizure or accidents during or immediately after the seizure, as well as sudden unexpected death for which no cause of the death can be identified. SUDEP (see below) is one example of this. Sudden unexpected deaths are more common in patients with poorly controlled, intractable epilepsy. Improved seizure control, medical advice and avoiding the hazards that occur during a seizure are key. Regular medical follow-up care and supervision may help reduce the risks of epilepsy-related death occurring.

What causes epilepsy?

Epilepsy can be categorized into three broad groups:

Idiopathic epilepsy

Common among children, idiopathic epilepsy is an inherited type of epilepsy with a strong genetic component and no structural brain abnormalities. Provoked seizures (for example, from flashing lights) are often seen in idiopathic epilepsy.

Cryptogenic epilepsy

Cryptogenic epilepsy is the type with no known cause and often involves unprovoked seizures. This accounts for approximately 20% of seizure cases.

Symptomatic epilepsy

Symptomatic epilepsy is caused by an injured brain. Common causes: head injuries, central nervous system infections, loss of oxygen to the brain, strokes, brain tumors and brain surgery.

How can your epilepsy result in premature death?

Premature deaths in people living with epilepsy: failure to take antiseizure medications as prescribed; the seizures themselves; collateral damage related to a seizure; reduced quality of life that comes with living with epilepsy; fatal unintentional injuries (for example, falls and burns), or through aspiration pneumonia during a seizure.

Additionally:

Serious transportation accidents: Seizures — which can result in impaired awareness and uncontrolled motor activity — put people living with epilepsy at increased risk of serious transportation accidents. This increased risk doesn’t apply to just car accidents but to the increased risk of pedestrian accidents and increased risk of bicycle accidents.

Drowning: because seizures can lead to a loss of consciousness or uncontrolled motor activity, people living with epilepsy are at increased risk of drowning. The risk of drowning is much higher in people with epilepsy. Despite my warnings, one of my young surfer patients ignored this warning and continued surfing. I don’t know his current condition While cases of drowning often occur in the bathtub (Mark Twain’s adult daughter had epilepsy; she drowned in her bath, for example), less frequently patients die in the shower; the body, face-down, blocks the drain resulting in drowning in just inches of water.

Status epilepticus: status epilepticus is a condition in which a person experiences abnormally prolonged seizures (longer than five minutes in the case of generalized tonic-clonic seizures; they usually last under 2 minutes) that can lead to long-term consequences, including brain damage and death.

Psychiatric illness: people with epilepsy commonly have depression, which increases the risk of suicide. The high incidence and prevalence of psychiatric illness (including impulsivity, psychosis, and substance abuse) correlates with the duration and severity of epilepsy. Depression is also associated with not taking medications as recommended, which can increase mortality.

What is a sudden unexpected death in epilepsy (SUDEP)? Premature mortality in people with epilepsy can also be attributed to a sudden unexpected death in epilepsy (SUDEP): Blog #108: SUDEP—Sudden Death in Epilepsy—Occurs in All Types of Epilepsies; Blog #74: New Studies Reveal High SUDEP Risk of Death in Poorly Controlled Epilepsy. In the US, there are at least 2,750 cases of SUDEP per year. SUDEP refers to deaths among people with epilepsy that cannot be attributed to other known causes. Studies suggest that for every 100,000 people with epilepsy, there will be approximately 116 cases of SUDEP. While the causes of SUDEP are not yet fully understood, most cases occur during or immediately after a seizure and generally during sleep. Possible seizure-related factors contributing to SUDEP include breathing and/or heart rhythm disruptions.

Does epilepsy shorten your life expectancy? People with epilepsy are two to three times more likely to die early than those without the condition. This suggests that epilepsy can shorten life expectancy by ten years for those living with symptomatic epilepsy and by two years for those with idiopathic/cryptogenic epilepsy where no serious brain pathology can be identified. While life expectancy is reduced in cases of symptomatic epilepsy (by approximately seven years), people with cryptogenic epilepsy had an almost normal life expectancy.

SUMMARY: While epilepsy can increase your risk of premature death, it is possible, in most cases, to manage these risks with anti-epileptic drugs, appropriate mental healthcare, and lifestyle changes. Mortality in patients with newly diagnosed epilepsy is higher than in patients with chronic epilepsy due mainly to the underlying epilepsy cause.

MY ADVICE: making family, friends, and colleagues aware of the risks and how they might be able to help you reduce these risks can go a long way to keeping you safe. Be certain that you have follow-up care and observation by your physician for your best chance of thriving with epilepsy.

1.     Granbichler CA, Zimmerman G, Oberaigner W, et. al. Potential years lost and life expectancy in adults with newly diagnosed epilepsy. Epilepsia. 2017;58(11): 1939-1945.

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

 

 

Wednesday, October 25, 2023

Blog #159: DO YOU HAVE SUBTLE EPILEPSY SYMPTOMS THAT ARE UNRECOGNIZED?

 






Stacie Kalinoski is an Emmy-award winning reporter. She also is an epilepsy nurse practitioner. In the April/May 2018 issue of the patient-geared journal Brain and Life, page 56, she writes of her own epilepsy. Kalinoski pursues brain surgery and she documents this journey.

Kalinoski experienced her first convulsion in college. An avid runner, while running she noted regular episodes of déjà vu, that weird feeling like she is in some environment or is seeing something for the very first time, but it felt like that the experience had happened to her before. Most of us have experienced such a feeling once or twice in our lives but frequent recurrent episodes are abnormal. They suggest epileptic auras, a problem in our brain’s temporal lobe. Another brain phenomenon that is similar, but the opposite, is jamais vu. Here, what’s familiar to us no longer feels or seems, familiar. For example, one’s bedroom, one’s car, or familiar people—all feel new during the seconds or minutes of the episode.

Kalinoski’s hidden epilepsy flowered into multiple blank outs after a strenuous marathon run. She had had little sleep. Then she lost awareness and cut herself preparing vegetables. A neurologist diagnosed epilepsy. She started antiseizure medications. Too little sleep and strenuous running accompanied more jamais vu episodes. She became disorientated after a run. She found herself lost despite being very near her house. She required help getting home only two blocks away. Neurological testing showed an abnormal brain focus originating epileptic seizures. A temporal lobectomy followed. This decreased the number of her aura-seizures. These subsequently became episodes of strange tastes lasting a few seconds. Many people also experience auras as smells that aren’t really there—olfactory hallucinations.

In my novel, DINGS, I created a character who has olfactory hallucinations. The neurologist in the novel queried if his young patient had ever imagined smelling something that wasn’t actually there. The neurologist then offered “burning rubber” smells, a common symptom of complex partial seizure auras. The novel’s character agrees that he does perceive smells like that. A diagnosis of epileptic blank-out seizures is made, heretofore unrecognized. The mother is devastated upon learning her son has epilepsy. She conjures up public prejudices. She learns that one percent of the population has epilepsy, over three million Americans, but the epilepsy in half of them, encouragingly, is well controlled. They are free of seizures on treatment. Chief Justice Roberts of the United States Supreme Court, despite his epilepsy, has achieved a leading position in our society.

 



Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

 

 


Monday, September 25, 2023

Blog # 158: POLITICIAN BLANKS ON NATIONAL TV. HAS THIS HAPPENED TO YOU?

 




Many of my patients with epilepsy on follow-up appointments told me, “No. I haven’t had a seizure in over a year now. I’m doing very well.” What they probably are referring to is their past convulsion history. No convulsion has recurred. Is this the whole story? Are they fully aware of their condition.


They may not understand possible brief blank-outs of their awareness or halting of thinking of speaking. did they lose contact mentally with their environment while still not perceiving any focal numbness, weakness/ paralysis, incontinence nor visual problems?

 

         Family and other observers may see or hear the person stop talking, a speech arrest, just as the nation recently saw on their television screens. A prominent politician suddenly froze up, stopped speaking and did not answer the reporter's question directed at him. As this occurred, he inappropriately stared off to the side, with a vacuous expression, unmoving. after a delay of nearly half a minute while his aides mored in alongside, he began to speak again.

 

        What was that? What happened? Accounts state it was his second such

episode in two months. It suggested to me that TV watchers experienced a

man having a seizure, a non-convulsive type. Since the news reported he had 

a similar episode a month before, more than one seizure is compatible with 

epilepsy. If so, was his condition secondary to head trauma? He had fallen a

few months before striking his head. The most common cause of epilepsy in

the population is in the elderly population. See my past blogs on this titled,

Mortality in Older Adults with Epilepsy


       News reports stated that seizures and strokes were “ruled out.”

But physicians know that small strokes may not always be visualized on brains scans and neurologists recognize that approximately 50% of people with epilepsy, in whom a single EEG is performed, will have a normal EEG. In such cases, multiple EEGs or continuous EEG recording would be more apt to find an abnormality. Epileptiform abnormalities are not constant in the brain in people with epilepsy. Conclusion: a normal EEG does not rule out epilepsy. The best manner of making a diagnosis of epilepsy is based on the patients’ and observers’ histories.

 

       Physicians will also consider non-convulsive epilepsy mimics such as transient ischemic attacks (TIA) or “mini transient strokes,” low blood sugar, migraine phenomena without headache among other conditions.


       I encourage all epilepsy patients to visit their neurologist/physician with a person close to them if possible. Other people may observe phenomena, clues, of which the patient may be unaware.


 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

 

 

 

Thursday, August 24, 2023

Blog # 157: Cognition and dementia in older patients with epilepsy

 






Today’s health care practices have resulted in a substantial rise in the number of older adults with epilepsy. In America we have one percent of our population, three million, suffering with epilepsy. In the rest of the developed world, the elderly over 65 also have the highest incidence of epilepsy. It no longer is the pediatric population that develops the most cases of epilepsy (See my Blog # 15, Epilepsy is most common in the Elderly, at LanceFogan.com)

Older people are more likely to have cognitive decline with epilepsy. There seems to be a relationship between epilepsy and dementia. Epidemiological findings reveal that people with late-onset epilepsy and individuals with Alzheimer’s disease share common risk factors. Medical science isn’t conclusively settled on the cause of Alzheimer’s nor who will develop it but it seems in some people to be mediated by underlying vascular changes in the aging brain. Contributing to their development of epilepsy is their survival after brain trauma, strokes and various diseases.1

The authors  Sen, Capelli, et.al., suggest that there is considerable intersection between epilepsy, Alzheimer’s disease and cerebrovascular disease raising the possibility that better understanding of shared mechanisms in these conditions might help to ameliorate not just seizures, but also epileptogenesis and cognitive dysfunction.

 

1.     A. Sen, V. Capelli, M. Husain. Cognition and dementia in older patients with epilepsy Brain, Volume 141, Issue 6, June 2018, Pages 1592–1608,  https://doi.org/10.1093/brain/awy022

 

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.