Dr. Gholam Motamedi: Epilepsy and Seizure - [Video Transcription]
- What is the difference between seizure and epilepsy?
Seizure and epilepsy are used interchangeably. To be specific, if you have a one time seizure or a single seizure, then it is called seizure. If it becomes habitual and repetitive, it is called epilepsy.
- What is a seizure and what do they look like?
Seizures happen when a group of neurons or brain cells start sending repetitive or excessive electrical discharges which they normally do, but not as intense as they do during seizures. This electrical discharge may spread to the other parts of the brain. Depending upon where this electrical activity is located, it will translate into different clinical presentation. For example, if the seizure focus is in the left hemisphere that controls the right side in the right hand, then the patient may have his/her right arm stiffen up or shake. If the seizure is in the language cortex, then the patient will have speech arrest.
- What are the medical treatments for epilepsy?
Fortunately, epilepsy is treatable. There are several medications for that. In the early 1990s, we didn't have too many medications. Now, we have about twelve medications that are used to treat epilepsy. Of course, medication will have some degree of side effects, but we do our best to adjust the medical therapy to avoid side effects while we avoid seizures.
- What are the surgical treatments for epilepsy?
There is surgical treatment for epilepsy too. By surgical treatment, we are referring to finding or localizing and surgically removing that seizure focus. In other words, the bad tissue or neurons that have gone bad can be removed. That is called resective surgery. There are other types of surgery. In particular, one of the standard treatments is called vagus nerve stimulator. A generator is placed under the chest muscle and the probe/wire goes around the vagus nerve and sends impulses to the brain. In that case, we don't remove any part of the brain, but the efficacy would be less than the resective surgery.
- What can I expect as a patient coming to GUH for epilepsy?
Here at Georgetown, we have an active epilepsy clinic. We usually treat patients that who have refractory epilepsy. They are usually referred to us by our colleagues after they fail to respond to medical therapy. In such cases, we have to monitor patients in our epilepsy monitoring unit in order to record some of the seizures and find out if the seizures are coming from one focus, multi-focal, coming from one hemisphere, or from both hemispheres. That also helps to categorize the seizures, because there are some seizures that come from one focus and spread to the rest of the brain. There are seizures that come from the beginning from deep down into the brain and simultaneously spread to both hemispheres. There are different treatments for the different types of seizures. After classifying and categorizing the seizures, then we will have a plan for treatment. If the patient happens to be a surgical candidate, then our next step would be to find out exactly the seizure focus. If necessary, we will map the brain and then do the surgery. In the meantime, we always optimize the medical therapy. Medical treatment remains the mainstay treatment for epilepsy. Even after surgery for a while, we continue the medication.
- How has epilepsy treatment improved in recent years?
Fortunately in the early 1990s because of extensive research in epilepsy, there are several new medications that turned out to be much better in the terms of side effects and tolerability by the patients. Now, we use these medications as first line treatment in epilepsy with a better side effect profile.
