Blog #110: SHE HAD A CONVULSIVE SEIZURE. DOES THAT MEAN SHE HAS EPILEPSY?

After a first-observed convulsion causing loss of consciousness with falling and shaking, it is natural to wonder, will the person have another convulsion? If so, when? Why did it happen? Is this epilepsy or just a seizure? These are questions patients, families and doctors must deal with.

Epilepsy is diagnosed when more than one seizure occurs if the seizure is not a “reactive” seizure. Reactive seizure are caused by some transient medical condition that can disappear such as infections, toxins and drugs, or temporary loss of a body organ function (e.g., liver, kidney, lung, etc.) that then heal and further seizures do not occur. When a second convulsion occurs, even if the first and this second seizure are separated by years, epilepsy is diagnosed. Epilepsy means recurrent seizures.

Epilepsy can be caused by brain injuries, strokes, tumors, infections, degenerative diseases such as Alzheimer’s disease, Multiple Sclerosis, Parkinson’s Disease, inherited conditions, and other diseases. Recognition of genetic causes of epilepsy is rising as science improves to identify abnormal genes. However, epilepsy is not common in families. Causes for approximately 50% of epilepsy cases are never found. Currently, onset of epilepsy is no longer most common in children, rather, it most commonly occurs in those over age 60. This is because we are living longer and we are susceptible to more insults to our brains.

One percent of the world-wide population has epilepsy. Approximately half of all people with epilepsy have their seizures controlled; these people can remain seizure-free if they are on the “best” anti-epilepsy drug (AED) at the “best” dosage for that individual. They must continue this medication as they are not cures. Finding this medication is a trial-and-error process of the patient working with doctors and the AEDs. Another 30% of epilepsy patients will have a seizure every few weeks to months; they have “incomplete” control. The remaining 20% of patients have “uncontrolled” epilepsy; they experience seizures each day or every few days despite taking AEDs. Epilepsy brain surgery is the most effective treatment to decrease or even cure epilepsy for people in whom no AED works. If the brain focus causing the epilepsy can be identified on various tests then attempting its surgical removal is deemed promising for marked improvement in epilepsy control or even cure.

Brain scans (to search for abnormal areas) and electroencephalograms (EEG) may identify a seizure-causing focus. Spinal taps (if infection or other brain conditions are suspected) and blood and urine tests to screen for other conditions also help doctors identify epilepsy causes.

EEGs are normal in half of all people with epilepsy because the test of multiple wires on the scalp is done for just an hour or so and the EEG abnormalities do not always occur during that time. Ambulatory EEGs (the person has EEG wires pasted on the scalp connected to a small recording device on their body as they carry out daily activities over 24 hours) may pick up abnormalities. More sophisticated testing in special labs can be done where EEGs and video cameras are used to capture abnormalities as the monitored-person lies in bed.

Pseudoseizures-involuntary, psychological, causes of “seizures”-are not rare and can complicate epilepsy diagnosis and treatment. See my past blogs on this subject at LanceFogan.com: blog #10 (March 23, 2011); Blog#49 (August 27, 2014); Blog #99 (October 26, 2018).

The diagnosis of epilepsy depends on the clinical history of searching for, and characterizing,  “spells” patients complain of along with the above testing which commonly are all normal. Ultimately, clinical judgment and the experience of your physician are crucial.

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.

Blog #81: Elderly Adults with New-Onset Epilepsy Are Often Prescribed Older, Less Effective Anti-Epilepsy Drugs

            Approximately one percent of the population, or three million people, have epilepsy. Several decades ago the most prevalent age-group that developed epilepsy was children. Times have changed. Today, it’s the elderly who develop epilepsy just as often, if not more so. See my Blog # 15, December 14, 2011 on this website.
 

            Health-care has vastly improved over the past half-century resulting in people living longer. However, longer longevity results in potentially more brain scars—a very common cause of epilepsy. Scars result from strokes and “hardening” of the arteries, brain injuries, tumors, infections, Alzheimer’s disease and other brain degenerations. 

            Older adults diagnosed with new-onset epilepsy may not receive optimal treatment because they are too often prescribed the older anti-epilepsy drugs (AEDs). Prime examples of these are Dilantin (phenytoin), developed in the late 1930’s, and barbiturates (phenobarbital), in use for over a century. Non-neurologist physicians (e.g., emergency department doctors, and geriatricians), are often more familiar with these older drugs than with newer ones; these are the physicians who usually evaluate and initiate treatment of patients after their first seizure.

            Older drugs’ common side-effects include “brain fogginess” and drowsiness which can worsen unsteadiness that may already afflict the elderly. Dilantin promotes bone density loss more than newer AEDs. The newer AEDs developed over the past twenty years, such as Keppra (levetiracetam), Lamictal (lamotrigine), and many others are reasonably well-tolerated and can be more effective. Dilantin has many drug interactions, too, including lowering the effectiveness of some cholesterol-controlling medications. One key reason for using the older AEDs, however, can be that they cost less than the newer ones.

            I want this information to prompt patients to discuss their AED choice with their primary physician. Consider a neurologist consulting in their epilepsy care.

 

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.