Friday, June 24, 2022

Blog #143: Is Your Epilepsy Controlled? If Not, Perhaps There's a Genetic Cause



Advances in genetics have benefited epilepsy and other neurological diseases. Genetics is currently an important part of epilepsy diagnosis. A half century ago, when I was in neurological training, bacterial, fungal, and other identifiable infections and afflictions could be identified. They could be seen in the microscope and in cultures in the laboratory. When these tests and searches were negative, however, we would usually settle on an elusive virus diagnosis. Viral diseases were often difficult to prove. Then, we were so ignorant in dealing with many diseases, as patients know.

Neurogenetic advances over past decades have shown that genetic abnormalities in our bodies can be identified. These advances improve making a diagnosis and can even bring hope for treatment in previously untreatable diseases. Dr. Deepa S. Rajan, Director of the Neurogenetics Clinic at the University of Pittsburgh Medical Center Children’s Hospital teaches that genetics is currently an integral part of neurological disease diagnosis. “Epilepsy and other diseases are being looked at with fresh eyes.”1

When MRI scans and other sophisticated medical tests show no obvious cause for epilepsy, genetic testing is available. Genetics could show a reason and should be considered. Dr. David Bearden, assistant professor of neurology and pediatrics at the University of Rochester, finds: “If you take all patients with treatment-resistant epilepsy and early-onset epilepsy, we can find a genetic cause in 30-50 percent. However, in kids seizures that respond to the first-line drugs and whose seizures are controlled, a genetic cause usually is not demonstrated.”2

For example, finding the genetic underpinning in an infant with seizures might show the genetic mutation associated with increased or decreased sodium activity in cells. Sodium channel-blocking drugs could benefit one patient whereas another gene could be found associated with decreased sodium channel function; in these patients, blocker-medications should be avoided. Also, genetic knowledge may benefit prognosis and more accurately predict prognosis, “Your child is likely to grow out of this, or not.” The work of understanding the mechanism of genes and genetic pathways is far from complete.

Amyotrophic lateral sclerosis (Lou Gerhig’s disease) that wastes muscles and is usually fatal and Alzheimer’s disease are more common neurological diseases that have benefited from genetic advances.

 

1)    Rajan D.S. Neurology Today: June 2, 2022; pg 8.

2)    Bearden. D. Neurology Today: June 2, 2022; pg 8.

 

 

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 a recent Publishers Weekly, New York Times Book Review and the Los Angeles Times Calendar section. DINGS teaches epilepsy and is now available in eBook, audiobook, and soft and hard cover editions.

 


Wednesday, May 25, 2022

Blog #142: DID YOU FIND YOUR ACCESS TO EPILEPSY CARE AFFECTED BY COVID?

 



 

Did the COVID-19 pandemic affect your ability to obtain adequate care for your epilepsy? The National Association of Epilepsy Centers (NAEC) noted significant impact by the pandemic.1 Most evaluations and procedures in the United States for drug-resistant epilepsy, i.e., for persons whose epilepsy is not free of break-through seizures despite treatment, decreased in number.

 

Epilepsy centers saw pandemic-caused widespread changes in hospital practice. Access to specialty epilepsy care decreased in 2020 compared to 2019 with 21,515 fewer epilepsy monitoring unit admissions in 2020, a 23% decline. This resulted from restrictions on elective admissions, reduced staffing, and patient reluctance for elective admission.

 

Aggregate surgical treatment for epilepsy declined by 371 cases (5.7%) with the largest reduction for vagus nerve stimulation implantations (2622 and 2136 cases in 2019 and in 2020, respectively, a 19% decline). Temporal lobectomies (1465 and 1238 in 2019 and 2020, respectively, a 16% decline. All other procedure volumes increased: the number of corpus callosotomies (splitting the right and left cerebral hemispheres connections) increased from 2019 to 2020 by 35%.

 

All these studies had the limitation of self-reporting of administrative data which is subject to inaccuracies or bias.

 

1)     AM Ahrens, AP Ostendorf, FA Lado, et.al. Impact6 of the COVID-19 Pandemic on Epilepsy Center Practice in the United States. Neurology. 2022; 98 (19):e1893e1901

 



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 a recent Publishers Weekly, New York Times Book Review and the Los Angeles Times Calendar section. DINGS teaches epilepsy and is now available in eBook, audiobook, and soft and hard cover editions.

 

 

 

Monday, April 25, 2022

Blog #141: A FAMILY DEALS WITH UNRECOGNIZED EPILEPSY: Excerpted from Dr. Lance Fogan’s novel, DINGS. Chapter 24, Part 3



Continuing In the Neurologist’s office—making the diagnosis—the little boy admits to his spells under sophisticated questioning.



“Sandra.” Sam reached for my hand. I snatched it away.

I pressed my lips together and shook my head. “I don’t believe this!”

“Conner, when did these dings start?” The doctor asked. His voice was gentle and even. I looked at my lap and tried to organize my thoughts. Dr. O’Rourke continued, “Do you remember when you had the first ding, your first one?”

“I—I don’t know.”

“Well, did they start a month ago? A few months ago? Before Christmas? Did they start last year, when you were still in second grade? Or, even before that? When do you think?” He smiled at our son. “Take your time. You’re doing very well, Conner.”

“Last year…um…I think, when I was in second grade. Yeah…ahh…second grade. I think...”

“And what do you mean by what you call ‘dings,’ Conner?”

“They’re dings because…uh, uh…I guess, because they feel like, uh…like little dings. You know…I don’t know.”

The doctor nodded and regarded him for several seconds. “What does a ding feel like?”

“Um…I get this funny thing…I think it’s down here.” Conner looked down and touched his shirt right over his bellybutton. “Then I get scared…but I don’t know why because there’s nothing around to make me scared. You know. Then I smell that bad thing. And then…I don’t know! I don’t know!” He sniffed and wiped his nose with his sleeve.

Dr. O’Rourke directed a quick gaze at us and then back at Conner. “How long do the dings last, Conner?”

“I don’t know!” He started to sob again. I flashed a weak smile at the doctor as I wiped my son’s cheeks and put the tissue into his hand.

“Have you ever fallen down when a ding happens? Do they ever happen when you’re standing up?”

He sniffed. “No…um…but, yeah, sometimes I fall when I’m running or playing a game.”

Dr. O’Rourke smiled at him. “Do you think you fall because you’re having a ding?”

“No.” He snorted and wiped his nose with the tissue. “I’m just playing and…uh…I trip on something or somebody tackles me. But, sometimes I drop things…you know…when I have a…um…a ding.”

“Oh, Conner. Why didn’t you ever tell me you were having these things?” I tried to smother the panicked tone in my voice as I brushed a lock of hair out of his eyes. “Honey, have you had these dings at home? Have I ever been with you when they happen?” I turned back to the neurologist, “I can’t recall seeing anything like what he’s describing, Doctor.”

“I don’t know when they happen, Mommy.” He sniffed again and rubbed his nose with his sleeve. “I don’t.”

The office was quiet now except for his sobs. It shimmered with the vibrations of our fear and pain—a pain that pierced and gripped me completely—an agony that I would carry and remember for the rest of my life. Whatever happened to my son would change—no, it had already irrevocably changed—our lives. Just weeks ago we were having the happiest of days: Sam came home from Iraq; we pulled into our driveway with him; neighbors welcomed him home; he put on his old clothes; the gifts he gave us; that wonderful first dinner with candles…

“Has Conner had any problems with bed-wetting?” Dr. O’Rourke asked me.

“Hm? Oh, ah…bed-wetting?” I looked at Conner. This was not the time to shelter him—not here in this office. “There’ve been a few times, and he’s had a few accidents in his pants during the day. On laundry days—a few times I’ve found yellow stains on his underpants. They smelled like he had wet them.”

Conner moaned, “Mo-om!” and looked up at me, his eyes pleading.

I placed my palm on the top of his head. “Honey, I’m so sorry. I don’t mean to embarrass you, but this is important. The doctor has to know.”

“Conner, do you lose your urine—your pee—during these spells?” The doctor asked softly.

“We-ell...” Conner looked at me.

I nodded. “You can answer the doctor, Conner.”

He said, “Um…yeah.”

“Do you know that you’re going in your pants and you can’t stop it? Or is it that all of a sudden you’re wet and you didn’t know that you were going?”

“I-I d-don’t know that I-I’ve done it until I-I’ve d-done it,” Conner stammered through his sobs.

“Have you ever pooped in your pants?” Dr. O’Rourke’s voice was so low that I could barely make out what he said.

Conner gulped down a sob.

The neurologist cast a quick glance from Conner to us. “Has he had any bowel movements in his pants?”

“No, thank God.” I shook my head.

“Has Conner ever bitten his tongue or lip when he’s sleeping? Have you ever found blood on his pillow, Mrs. Golden?”

“Only on the night of his seizure, Doctor. I’ve never seen blood any other time.”

“So, it seems that he hasn’t had any other convulsions in his sleep that you and Mr. Golden had not witnessed.”

I shook my head and looked at Sam.

Dr. O’Rourke smiled at his patient and asked, “Conner, have you ever noticed any weakness in your arms or legs when you have a ding? It can be before the ding or after it, or at any other time.”

“No.” Conner shuddered.

“Good. What about tingling feelings? Have you ever had any tingling—you know, like the pins-and-needles you get if you hit your funny bone in your elbow—anyplace in your body when you have a ding?”

“Uh…no. I don’t think so.”

I wanted to know more, as I listened to their exchange. Yet, I feared more bad news.

“Conner, have you had any headaches or double-vision? You know, like seeing two things instead of one thing. And, do you ever have any trouble seeing out of one eye? Or numbness, like funny feelings that stay there on your face?”

“My face itches, sometimes.” Conner scratched his cheek.

“Well, yes. That’s normal. What about any funny or tingly feelings on your face when you get your dings?”

“No.”

“What about swallowing or hearing problems? Do you ever hear strange noises or voices when there’s no one talking and no one else around during your dings?”

“No.” Conner shook his head.

“Which hand do you write with, Conner?”

“Um, my right hand.” The boy held up his left hand, looked at it and quickly replaced it with his right. He turned toward me and gave me a tentative smile. He asked abashedly, “Is this my right hand, Mom?”

“That’s good,” Dr. O’Rourke said with a wide grin. He looked at me. “He is right-handed, correct?”

“Yes. He seems to write and draw with his right hand, Doctor.”

I looked at Sam. So, he finally spoke up.

“Since he writes with his right hand, the middle section of the left side of Conner’s brain is where his language center resides. In other words, it’s his dominant side. That suggests that there’s no serious structural problem in that part of Conner’s brain, especially since he had a normal CT scan. You see, the left side of the brain is dominant for most people. If you or your son reported that he had speaking or comprehension problems—that is, difficulties understanding speech—it could be a clue that his seizures came from that left-sided language area. However, he will need an MRI—a Magnetic Resonance Imaging scan, with—”

“What’s that? No! Will there be needles?” Conner leapt to his feet. Sam and I immediately reached up and touched his shoulders.

“Sit down, son.” Sam tilted his head in the direction of the boy’s seat.

Conner dropped hard onto his chair. He elevated his shoulders, opened his mouth and squinted at the neurologist. His voice quivered, “Will there be needles? Will there?”

“The MRI scan is just like the CT scan you had at the hospital. But, this time you’ll be in a tunnel.” The neurologist moved his gaze from Conner to Sam and then to me.

“Conner wasn’t awake when he had the CT scan, Doctor O’Rourke. He was still asleep after the seizure.”

“Oh. Okay. I see.” He nodded and turned back to his patient. “Well, Conner, there shouldn’t be any needles, but I can’t promise. That will be up to the radiologist. That’s the doctor who does the MRI. The radiologist will be evaluating the images as the scan is being done. If the doctor believes that more information is required, then an intravenous line may be started to inject a special dye, but—”

Conner pouted and crossed his arms over his chest. His swollen, red eyes welled up again.

“No. Wait, Conner! That won’t be done unless it’s absolutely necessary.” Dr. O’Rourke reached across the desk and touched our child’s hand. “The MRI shows the brain structures a little differently from the CT scan. It can give us additional, more detailed information. We—the doctors—need to be certain to rule out any problems.

“Look, Conner. We are going to become a team. From now on, we are going to be working—like playing—together, for a long time. I am going to be your coach. You are the star player. I will give you your rules and your plays. Your mom and dad will be like our team trainers. I’ll tell you what the team will do.”

I liked that metaphor. It should capture Conner’s cooperation. Brilliant. I smiled at my son and touched his back.

Dr. O’Rourke watched us momentarily, then continued, “I know this can all be confusing, but usually we don’t find any cause of epilepsy.”



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 a recent Publishers Weekly, New York Times Book Review and the Los Angeles Times Calendar section. DINGS teaches epilepsy and is now available in eBook, audiobook, and soft and hard cover editions.

Thursday, March 24, 2022

Blog #140: Blinking Lights, Flashes and Epilepsy

 


 


 

     Light flashes, light patterns and color changes can provoke seizures in 3% of people with epilepsy. This is known as photosensitive epilepsy.1 Is this you? Photosensitive epilepsy is more common in children and adolescents, especially those with generalized epilepsy and certain syndromes as juvenile myoclonic epilepsy. It lessens as children age. Relatively few cases last into their mid-twenties.

 

     Many people are not aware they are sensitive to flickering lights or to certain patterns until they have a seizure. In some individuals, their seizures occur only when triggered by certain photic, or light conditions. And in some individuals this sensitivity may never progress to develop epilepsy. Some people find they are sensitive to light exposure because they develop headache, nausea, or dizziness induced by this light exposure. They do not develop seizures and they do not have epilepsy. Brain scans usually are normal.

 

     Light triggers include flickering or rolling images on television and smartphone screens and computer monitors, emergency vehicles, intense strobe lights like visual fire alarms, natural flickering light off shimmering water, sunlight flickering through tree leaves while driving, and through venetian blinds and certain visual patterns, especially stripes of contrasting colors. Not all these visual stimuli trigger seizures. Other factors are important, e.g., frequency of the flash, the brightness of the flash, its contrast with the background, your distance from the light source, the wavelength of the light and whether your eyes are open or closed. The resulting effect of the frequency or speed of the inducing flashes varies from person to person. The frequency of light triggers generally varies between 5 to 30 flashes per second.

 

     If flashing lights are uncomfortable for you a routine EEG can help find out why. The EEG includes a period of flashing strobe lights at various frequencies positioned in front of closed eyes as you lie on the bed in the EEG lab. An abnormal EEG response to various frequencies of flashes indicates the presence of photosensitivity which is an electroencephalography (EEG) phenomenon or the photoparoxysmal response. This does not mean you have epilepsy. If you are found to have this photosensitivity, altering your daily activities can help to avoid your physical symptoms, as avoiding intense videogame playing.

 

     Helpful tips to consider if you have photosensitivity include covering only one eye and looking away. Closing both eyes will not help. Watch TV in a well-lit room to reduce light-contrasts, sit far from the screen, wear polarized sunglasses while viewing TV to reduce glare. Follow similar guides when playing video games. Do not close and open eyes in front of the videogame as blinking may facilitate seizures in sensitive people. Cover and alternate covering the right and the left eye while playing at regular intervals. If you perceive strange or unusual feelings or if body jerks occur, stop playing.

 

     Regarding computer monitors use one that is flicker-free (LCD or flat screen). Use a monitor glare-guard. Wear non-glare glasses to reduce glare. Take frequent breaks.

 

     Strobe lights are to be avoided if you can. If you can’t, cover one eye and turn away.

 

     Visually induced seizures remain significant public health hazards; they warrant public education.

 

     I hope that this blog allows you to identify certain phenomena you experience but could not explain before.

 

1.     Wirrell E, Hernandez A. Photosensitivity and Seizures published by the Epilepsy Foundation: September 30, 2019.


 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 a recent Publishers Weekly, New York Times Book Review and the Los Angeles Times Calendar section. DINGS teaches epilepsy and is now available in eBook, audiobook, and soft and hard cover editions.

 

Friday, February 25, 2022

Blog #139: WHAT ABOUT THOSE KETOGENIC DIETS?

 




 

Since the 1920s it’s been observed that a very high fat with very low protein and low carbohydrate diets benefited children whose epilepsy initially failed to respond to anticonvulsant medications (ACM). Adult epilepsy patients have found that following such a ketogenic diet can help their seizures, too. However, these adults had to deal with very, very strict diets for the ketogenic diet to be effective. They would say, “What, no bread? No sugar?”  But, when properly following the diet, they often said, “I haven’t had a seizure since I started the diet. I used to be debilitated by them.”

 

In the 1990s interest in the ketogenic diet resurfaced after the promising newer ACMs did not prevent enough seizures. The exact mechanisms for this diet’s effectiveness are not known.

 

Ketones are chemicals created in the liver from fat and fatty acids and act as fuel for the brain that can pass through the blood-brain barrier (a microscopic-diffusion barrier, which impedes influx of most compounds from the blood into the brain. A 2015 analysis of 12 relevant studies found about half of adult patients who follow the classic ketogenic diet (where they eat four grams of fat for every gram of carbohydrates and/or protein) experience at least a 50 percent reduction in seizures. 1 Even if they were a little less strict in following the diet, the restricted diet was still beneficial in some reduction in their seizures.

 

Ketones are an alternative form of energy. Normally, the body’s primary fuel source is glucose coming from carbohydrates (fruit, vegetables and grains and sodas and sweets). The typical American adult derives half of their daily calories from carbohydrates. Fasting causes the liver to convert stored fat into ketones which supply energy to our cells. A state of KETOSIS in our body is created when the diet consists of AT LEAST 90% of calories derived from fat (generous ingestion of butter, mayonnaise, and heavy cream) and only 4% from carbohydrates and 6% from protein. An iteration of the modified Atkins diet also limits carbs but involves less fat with no restrictions of proteins. This diet can be more palatable and easier for adults to continue. Typically, about half of adult patients give up the diet within 6 months because of side effects that can include constipation and kidney stones. Many stopped the ketogenic diet if the onerous diet didn’t reduce their seizures as hoped.

 

One patient whose seizures were reduced following the modified Atkins diet said her favorite meal is hot chicken wings minus the barbecue sauce (too much carbohydrate sugar).

 

I invite you to learn more about ketogenic diets and epilepsy by consulting with your neurologist and especially with a nutritionist.

 

1.     Fang Ye, Xiao-Jia Li, Wan-Lin Jiang, et.al. Efficacy of and Patient Compliance with a Ketogenic Diet in Adults with Intractable Epilepsy: A Meta-Analysis Journal of Clinical Neurology 2015; 11(1): 26-31.

 

 

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 a recent Publishers Weekly, New York Times Book Review and the Los Angeles Times Calendar section. DINGS teaches epilepsy and is now available in eBook, audiobook, and soft and hard cover editions.

 

 

Tuesday, January 25, 2022

Blog # 138: How Long Have You Been Seizure Free? When Should You Stop Antiseizure Meds?

 


An American Academy of Neurology (AAN) Guideline Subcommittee updated a 1996 practice parameter for discontinuing antiseizure medications (ASMs) in seizure-free patients. New practice recommendations for children and for adults have come forth. (1)

 

The reviewers addressed questions about patients who have been seizure-free at least 12 months and who are still on ASMs. Does stopping ASMs: (1) increase the risk of seizure recurrence, and are there factors that increase the risk for recurrence? (2) increase the risk of status epilepticus (continuous seizures without ceasing)? (3) reduce medication-related side effects? (4) change the risk of death? (5) change any of the above risks based on the speed of withdrawal? and (6) change quality of life?

 

The important quality of life questions starts with if you cut back medications, we can’t really predict if restarting the same medication will work again—there’s a small chance it won’t. Then other medications may or may not work as well and they may have their own side-effects. Discuss your driving issues: should you cease driving for a while as you discontinue ASMs? How long? Will your state’s DMV make the decision and/or your doctor? Consider seizure occurrence on the job, participation in recreation activities, etc. A discussion regarding recurrence in epilepsy patients who have had successful epilepsy surgery and who are now seizure-free still on ASM medications would be problematic.

 

The main conclusion is that after two years seizure-free, medication withdrawal can be considered in adults whereas in kids its’ more likely that it could be considered after 18-24 months seizure-free. In considering ASM withdrawal in adults there is no real way to predict outcomes. In kids we can use the EEG, as there are pediatric electroclinical syndromes that could be detected on an EEG and if present makes it unlikely that ASM withdrawal will be successful. Note that half of all epilepsy patients will have a normal EEG at any one time since abnormal epileptiform activity is not continuous. Judgement is the critical component for making decisions.

 

The AAN subcommittee concluded the risk for seizure recurrence among adults who were seizure-free for two years and who tapered off vs those who did not taper but who stopped suddenly was not statistically different (15% vs 7%). In pediatric cases the difference in seizure recurrence between those who taper off after 18 months of being seizure free vs after 24 months was probably not significant. Only in kids are recommendations for the rate of ASM-withdrawal specific, not in adults: it’s recommended withdrawal in children at a rate no faster than 25% every 10-14 days.

 

The recommendations serve as talking points between clinicians and their patients and their families. The relationship between ASM withdrawal and the risk of mortality and status epilepticus is not as strong. But if your seizures are frequent and you stop your ASMs there’s a greater risk of your having status epilepticus.

 

1)     AAN Guideline Subcommittee. Antiseizure Medication Withdrawal in Seizure-Free Patients: Practice Advisory Update Summary. Neurology Dec 7, 2021; Vol 97 (23) 1072-1081.

 

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 a recent Publishers Weekly, New York Times Book Review, and the Los Angeles Times Calendar section. DINGS teaches epilepsy and is now available in eBook, audiobook, and soft and hard cover editions.

Thursday, December 23, 2021

BLOG #137: Epilepsy: Preparing for the Holidays

 



The holidays are here. As many of us prepare to travel—and welcome—friends and family to share, people who have epilepsy should take some extra precautions to stay healthy and safe.

Covid Protection: Vaccinate! Vaccinate! Vaccinate! Booster when 6 months since your last vaccination has passed. We all know the guidelines: distance and mask when exposed to other people.

Get enough sleep: Excitement, stress and jet lag can disturb sleep patterns. Extreme sleep deprivation is known to cause seizures. For example, soldiers returning home from Vietnam during the 1960s and ’70s were so excited that they would be up for 36 hours straight. This extreme lack of sleep caused a convulsion in people who do not have epilepsy; it could certainly precipitate seizures in people who have epilepsy.

Alcohol: Alcohol is often served at holiday meals. People with epilepsy can probably tolerate a beer or a small glass of wine or spirit. However, excessive use/abuse of alcohol is more likely to bring on a seizure than in a person without epilepsy.

Nutrition and hydration: In my experience, people who have epilepsy do not need to follow a special diet; just follow routine recommendations for good nutrition and water intake.

Bring an adequate supply of anti-seizure medication when you travel: Be sure to bring enough anti-seizure medication with you to last the duration of your trip plus a couple extra days to be safe. Keep the medications in their original bottle/container with the prescription (dosage) and your doctor’s name on the label. (This information may be required if you must cross state or international borders.)

Stress: No matter how much you enjoy the festive season, holidays can be stressful for anyone. Emotional stress can definitely bring on a seizure in people who have epilepsy. If possible, minimize the amount of time you spend in a stressful environment. Meditation and light exercise are good ways to reduce stress.

Carry identification when you go out: People who have epilepsy can have a seizure at any time. During a seizure, a person cannot tell bystanders that he or she has epilepsy. When a seizure occurs, it’s usually not necessary to call an ambulance; the person will stop jerking and shaking after a minute or two and just sleep it off. A MedicAlert bracelet or necklace would reassure observers that the person has a known chronic condition that may not be that serious. This information is also useful if emergency personnel are called. Always carry a card in your wallet that states your condition (type of epilepsy) and up-to-date medications you take to control it. Be sure to include a contact address and phone number of one or two relatives that emergency personnel or a Good Samaritan can contact in an emergency. If you are away from home visiting friends or relatives, be sure to provide similar contact information about your hosts.

Wear a helmet: After eating sumptuous meals, a lot of people like to get out and exercise to work off the calories they have just consumed. Everyone—and especially people with epilepsy—should wear protective headgear (a helmet) if you ride a skateboard, bicycle, horses and even ski. A helmet will protect your precious brain from injury if you fall and hit your head while participating in one of these activities.

I wish you a happy and healthy holiday.



Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His emotionally hard-hitting 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 a recent Publishers Weekly, New York Times Book Review and the Los Angeles Times Calendar section. DINGS teaches epilepsy and is now available in eBook, audiobook, and soft and hard cover editions.