Tuesday, February 26, 2019

Blog #101: EPILEPSY—FIT TO DRIVE?


The United States codifies legal restrictions regarding seizures and driving, but only six states have laws requiring physicians to report patients with seizures to the state authorities: California, Delaware, Nevada, New Jersey, Oregon and Pennsylvania. The other states depend on the patients reporting their epilepsy diagnosis and status themselves and/or ceasing to drive. A common restriction-determination used by some states is the person should be free of seizures for three to twelve months but other states may have different requirements. Researchers found it made little difference if states used a three-month seizure-free period or a six-to twelve month time frame.1
           
Seizure triggers such as missed medications or sleep deprivation are more commonly associated with collisions. Crashes attributed to generalized epilepsy are often preceded by the vehicle going out of control from the onset, whereas those with focal epilepsy, e.g., complex partial seizures, seventy-five percent of these crashes had a prior movement of driving straight ahead and then veering off the road.2 This latter pattern is suggestive of a brain focal aura followed by the spread of the epileptiform activity throughout both cerebral hemispheres resulting in the generalized convulsion.

Potential actions that could help prevent driving-related seizures include optimizing morning antiseizure medication blood levels, especially if seizures tend to occur then. Driving with a passenger who is aware of the driver’s epilepsy and who could take control of the wheel would help. Driverless cars offer hope, also.2

Only 1 percent of the population has epilepsy, yet people with seizures had 2.3 times the rate of fatal driver crashes as compared to people with heart or blood pressure problems and 4.6 times the rate for patients with diabetes.2

But, non-health problems cause most fatal driving accidents. Between 1995-1997, an average of 86 drivers with epilepsy died per year. Alcohol is the biggest problem accounting for 31 percent of fatal driving accidents claiming 13,400/year on average. "The total number of deaths due to alcohol-related fatal crashes is 6.6 times greater than the number of fatal crashes associated with medical conditions and 156 times greater [than] those associated with seizures." 2 Young drivers aged 16-24 were at the wheel in 24 percent of all fatal crashes.

 Fatal driver crashes due to seizures are uncommon and this supports the current public policy of permitting patients whose seizures are controlled to drive.3



  1.   Drazkowski JF, Fisher RS, Sirven JI, et.al. Seizure-related motor vehicle crashes in Arizona before and after reducing the driving restriction from 12 to 3 months. Mayo Clin Proc 2003;78:819-825.
  2. Sirven JI, Payne ET. Seizure-related crashes. Neurology; 2018: 91: 543-544.
  3. Sheth, S. Neurology, September 2004; vol 63: pp 1002-1007.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.

Friday, January 25, 2019

Blog #102: Reflex Epilepsies

            Last month’s blog, PHOTOSENSITIVE EPILEPSY (# 101), posted December 26, 2018 on LANCEFOGAN.COM, introduced the reflex epilepsies. This reflex epilepsy is seizures initiated by exposure to flashing and flickering lights. Other reflex epilepsies are seizures that develop in response to a specific motor, sensory or cognitive stimulus. Most are uncommon, some are rare. 

  •             In susceptible people, certain thoughts―the cognitive stimulus—can trigger a seizure. An example can be sequential decision-making. Reflex seizures may be generalized, or focal, and they can be associated with, or without, impaired consciousness. If consciousness is impaired it’s a ‘complex’ focal seizure. If consciousness remains intact during the seizure it is a ‘simple’ focal seizures. Reflex epilepsy can be caused by: 1) a genetic trait and some specific genes are known; if a causative gene hasn’t been recognized, it’s idiopathic reflex epilepsy, i.e., of unknown cause; or 2) symptomatic reflex seizures which are due to a structural brain abnormality such as tumor, stroke, infection, or traumatic scar. Photosensitive epilepsy is the most genetic, i.e. hereditary. The other reflex epilepsies’ causative genes are elusive and run less in families.


  •             Eating epilepsy is very rare. It occurs in fewer than one person in 1000 people with epilepsy. It is not associated with particular foods, rather, the seizure seems to come on during the act of swallowing. Additionally, some people develop seizures if they visualized, smelled or even thought of, a particular food.
  •             Musicogenic-evoked epilepsy can be associated with certain music themes or music notes. The seizures can be even be precipitated by singing voices. It was found that some singers' voices, but not other singers’ voices, were particularly epileptogenic in the sensitive person afflicted. Additionally, some songs, but not others, would precipitate a seizure in these sensitive individuals.
  •             Movement-induced epilepsy starts with certain movements in that person.
  •             Auditory-evoked epilepsy is when a seizure is evoked with startling sounds.
 
 
           We await research to reveal more about how stimuli such as these above can induce seizures.

 



Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.

Tuesday, December 25, 2018

Blog #101: FLASHING LIGHTS AND EPILEPSY

 

            It’s been known for more than a century that flickering sunlight, as with driving under leafy trees, can trigger epileptic seizures in susceptible people. Currently, flashing and flickering lights in video games and television can do the same. Warnings about the potential for seizures have been added to these games. This is PHOTOSENSITIVE EPILEPSY. Some people, usually children, can convulse or have a brief staring spell (petit mal or absence seizure) with rhythmic jerky movements of the arms lasting 5-10 seconds or have an involuntary limb jerk or have eyelid movements by looking at a television screen, a computer screen, or an electronic screen game. It is estimated that 3-10 percent of all persons with new-onset epilepsy, especially in the age range 7-19 years, are found to be susceptible to visually-induced seizures; two-thirds of photosensitivity-associated-epilepsy patients are female. Photosensitive epilepsy is reported to be familial in eight percent of cases. 1 Forty percent of siblings of photosensitive patients with epilepsy are photosensitive as well.2

            Physical exams and CT and MRI scan results are usually normal. The EEG, however, reveals epileptogenic changes (spike-and-wave and multiple-spike abnormalities) when the patient is exposed to flickering photic stimulation, usually at 9-, 10-, and 25 Hertz/second with the EEG’s own lights. During this exposure the patient will demonstrate altered consciousness as demonstrated by ceasing to count or talk accompanying the flickers with some jerks of the arms. This photo-paroxysmal response is diagnosed as Photosensitive Generalized Epilepsy. It is sensitive to the photic flicker frequency in the EEG lab. 

            The eyes may be open or closed during the test and the EEG will still demonstrate the epileptiform changes; the response does not occur if a light-occlusive patch covers one eye. A susceptible patient could cover one eye with a hand when near such light exposure to lessen chances of a seizure. Sensitivity to television stimuli can also be reduced by wearing blue eyeglasses or by not getting close to the screen, by watching under bright ambient lighting or having a table lamp on top of the TV set or computer screen. One hundred Hertz-TV screens are effective in reducing these seizures.3  Antiepileptic medications helpful for photosensitive epilepsy include valproic acid (Depakote), lamotrigine (Lamictal) and topiramate (Topamax).

            Normal individuals can develop a repetitive waveform on the EEG that is at the same flash rate of the flashing light over the patient in the EEG lab called photic following. These waves are not disorganized multi-spike complexes seen in photosensitive epilepsy. This is an EEG Photoparoxysmal Response, or “Photosensitivity,” and is not associated with physical seizure activity or loss of awareness.



 

  1. Wilkins AJ, Darby CE, Binnie CD et. al. Television epilepsy—the role of pattern. Electroencepalogr Clin Neurophysiol. 1979;47:163-171.
  2. Doose H, Gerken H. On the genetics of EEG-anomalies in childhood: IV. Photoconvulsive reaction. Neuropadiatrie. 1973;4:162-171.
  3. Ricci S, Vigevano F, Manfredi M et.al. Epilepsy provoked by television and video games: Safety of 100-Hz screens. Neurology. 1998;50:790-793.
 
 
Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audio book and soft cover editions.

 

Sunday, November 25, 2018

Blog#100: Official Review: Dings by Lance Fogan


Reviewer Page: onlinebookclub.org/reviews/by-reviewerdiksha.html
Latest Review:
 Post by ReviewerDiksha » 18 Nov 2018, 08:26
[Following is an official OnlineBookClub.org review of "Dings" by Lance Fogan.]



4 out of 4 stars

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This story starts on an unfortunate night when everything changes for the Golden family. Sandra Golden had a happy family. Her kids, Connor and Madison, were bright and playful. Her husband, Sam, was serving in Iraq. Even though she terribly missed him, she knew that, in a few months, he would be back for good and everything would go back to normal. However, before Sam’s return, she encounters some trouble with her son. She gets a call from his school where his teacher reports Connor’s inconsistent and reckless behaviour towards his studies. While this seems like a small problem, bit by bit, it starts to take shape and, after a few months, reveals itself as a monstrous crisis that changes the course of the Golden family’s life.

Dings by Lance Fogan is about a mother who has just discovered that her eight-year-old son suffers from epilepsy. Through the story of the Goldens, it covers a lot of ground about this disease, all the while, educating the audience about it. There are a lot of things that people don’t know about epilepsy, due to which, they tend to form many misconceptions about it. This book shatters such illusions and presents a clear picture, especially about the basic things. It also serves as an education for parents to keep a close eye on their children and take note of every abnormal activity, so that, if there is a problem, it can be diagnosed, and dealt with, as soon as possible. There are a handful of technical terms in the book, and some people might have difficulty understanding them. For this, the writer has added a glossary at the end of the book to give proper information about everything.

When it comes to the audience, some people might think about passing over the opportunity of reading Dings. I would strongly suggest against it. First of all, this book needs to be read because it has a very critical issue as its theme. People should know about the things that this book is talking about, and hence, they must read it. Another reason that might make people refrain from reading it is that they might think that this book is about a disease and hence, will not entertain them. I am glad to tell them that they’d be wrong in thinking this. Had the writer decided to simply write a book about epilepsy, perhaps, even I wouldn’t have read it. Non-fiction, especially about diseases, and those that don’t concern us, rarely catch our attention. Perhaps, Lance Fogan realised this and decided to add a twist to the book.

The writer has very cleverly embedded all the info about epilepsy into the story of a family. The storytelling is quite imaginative. It doesn’t follow a chronological order, and this is what makes it more interesting. At times, it feels like a crime thriller, in which the disease is the perpetrator and breadcrumbs are thrown throughout the story to reveal its identity! In truth, the writing style is the true hero of this novel. The story is told from the point of view of a mother which places its perspective at a very critical angle. There are a lot of emotions, both happy and sad, in it and parents will highly relate to the Goldens. In addition to epilepsy, this book also talks about things like PTSD, the situation of a single mother, and the struggles of raising children. So, there is a wide spectrum when it comes to the things that the author wants to focus on.

OnlineBookClub.org “My rating for this book is 4 out of 4 stars. There was absolutely nothing that I found lacking in it. It had great subject matter, its writing style was highly engrossing and its characters were acutely relatable. It wasn’t difficult to form a bond with the characters as they easily gained our sympathy with their situation, made us like them because of their strength and humanized themselves because of their flaws. It was very educational as well as an entertaining story, and I think everyone should read it.”

  

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.