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.

 

 

 

Blog # 126: MORTALITY IN OLDER ADULTS WITH EPILEPSY

As my 15^th monthly blog reviewed in December 2011 available on my website: LanceFogan.com, it’s surprising to many that the onset of epilepsy is currently most common in the over sixty-five age group versus the onset in children. While the incidence of epilepsy decreases in children over time it increases in the elderly population, in grandparents, whose brains are more apt to be afflicted with trauma and stroke scars, tumors, and other ailments (1, 2). Five to fifteen percent of patients will experience a seizure within two years after a stroke (3). Note that other ailments associated with aging, such as Alzheimer’s Disease and Parkinson’s Disease are not commonly associated with epilepsy.

Increased life expectancy has led to this larger proportion of elderly people in developed countries. Recent studies show that newly diagnosed epilepsy in older adults is associated with high 5-year mortality among Medicare beneficiaries. One study found a 5-year mortality rate of 62.8% in Medicare beneficiaries age 65 and older with new-onset epilepsy. This is more than double the 5-year mortality rate in the overall general Medicare population without epilepsy from which the sample was drawn. Death in older adults with epilepsy is common (4). Associated ailments that increased the hazard of death includes cancers, chronic heart disease, strokes, diabetes, chronic obstructive pulmonary disease (COPD) from years of smoking, osteoporosis associated with hip and other fractures, unhealthy diet, dementia, etc.

Researchers identified a total of 33,615,037 people, ages 65 and above, who had been enrolled in Medicare for at least 2 years on January 1, 2009. Of these, 99,990 (0.3%) were diagnosed with epilepsy in 2009. Nearly one third (29.2%) of the 33 million qualifying beneficiaries died during the 5-year observation period. The death rate was substantially higher in the incident epilepsy subpopulation: 62.8% (n = 62,838) died within 5 years. Future studies will use Medicare claims linked to electronic medical records to understand the interplay between race, sex, poverty, and comorbid disease on mortality and to determine the comparative effectiveness of newer epilepsy treatments in elderly patients with epilepsy (5).

Our senior epilepsy population must safeguard their health by taking current COVID-19 precautions, getting vaccinated, stop smoking and take medications as directed.

 

1. Sillanpaa, et al. Epilepsy Res. 2006; Oct: 71 (2-3): 206-15.
2. Hauser, W.A., et al. Mayo Clinic Proceedings 1996; 71: 576-586.
3. Herman, S. Neurology, 2011: 77: 1776-1777.
4. Lichtman JH, Jones SB, Leifheit-Limson EC, et.al.. 30-Day mortality and readmission after hemorrhagic stroke among Medicare beneficiaries in Joint Commission Primary Stroke Center-certified and noncertified hospitals. Stroke 2011; 42:3387–3391.
5.  Leah J. Blank, Emily K. Acton, Allison W. Willis. Predictors of Mortality in Older Adults with Epilepsy Neurology October 21, 2020

 

 

 

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 #96: Neurologists May Be Missing the Higher Risk of Suicide/Drug Overdose in Epilepsy Patients

            A troubling picture is emerging: the deadly side of epilepsy. Epilepsy patients have a higher risk of unnatural death compared with the non-epilepsy population. SUDEP (Sudden Unexplained Death in Epilepsy) is not common, but suicide and drug overdose and other unnatural causes are.

            In the general population the actual risk of unnatural death is 0.3 to 0.5 percent of total deaths. People with epilepsy are five times more likely to die because of accidental poisoning from medication and three times more likely to die from an intentional overdose of medication compared to people who don’t have epilepsy. Although the researchers were already aware that people with epilepsy are at a higher risk of death, “…we didn’t know much about the risks of different types of death.”¹

            This population-based cohort study included more than 50 000 people with epilepsy and 1 million matched individuals without epilepsy who had identified in two data sets drawn from the general populations of England and Wales. Researchers reported people with epilepsy had a 3-fold increased risk of any unnatural mortality and a 5-fold increased risk of unintentional medication poisoning. Psychotropic and opioid drugs were most commonly used in poisoning, but not antiepileptic drugs. 

            Since people with epilepsy are at increased risk of unnatural death, they and their families should be advised about unintentional injury prevention and monitored for suicidal ideation, thoughts, and behaviors. The suitability and toxicity of concomitant medication should be considered when prescribing for comorbid conditions.

            Elizabeth Donner, MD,² director of the Comprehensive Epilepsy Program at the Hospital for Sick Children in Toronto, said, “Having good seizure control doesn’t mean the person with epilepsy is otherwise trouble-free or experiencing a good quality of life.” She added that death certificates may not list epilepsy as a contributing cause in suicide or drug overdose cases.

                Psychological counseling should be recommended for our patients who are at risk. A low threshold must be entertained for preventive education and intervention. Clinicians should query patients and their families about depression and addictive/and or dangerous behaviors to attempt to avoid tragedy.              

                

1.      Gorton CH, PhD; Webb RT, PhD; Carr MJ. PhD; et al. Risk of Unnatural Mortality in People With Epilepsy. JAMA Neurol. Published online April 9, 2018.

2.      Neurology Today. Volume 18/issue 10: May 17, 2018

 

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.