Understanding the Complex Nature and Makeup of Epilepsy
Dr. William W. Sutherling is the medical director of the Epilepsy and Brain Mapping Program at Huntington Memorial Hospital in Pasadena. The hospital’s research arm, the Huntington Medical Research Institute, is renowned for its work in the neurosciences.
Question: Epilepsy is one of the oldest recorded human syndromes in humankind’s history. Alexander the Great and Julius Caesar, two of the mightiest rulers of the ancient world, are believed to have had epilepsy. What strides has science made since their time?
Answer: We have more than a dozen different medications to control epilepsy. Medication controls seizures in 70% of patients. The newer ones such as Trileptal, Lamictal and Neurontin often have fewer side effects than the older medications, like phenobarbital, which can cause drowsiness. For children, I would select the medication based on the seizure type and usually use Tegretol or Depakote.
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Q: What about the other 30% of patients who suffer seizures?
A: We now have the ability to map out the brain with extreme precision to determine where the seizure is coming from, using simultaneous videotape to show the behavior of the seizure and EEG (electroencephalogram) to record the brain waves during a seizure. This, combined with imaging techniques, like MRI (magnetic resonance imaging) is effective in localizing the seizure for successful surgery. If surgery is not an option, the vagal nerve stimulator can be used as an adjunctive therapy to reduce the seizures. (This is an electronic device that is implanted in the vagal nerve near the neck.)
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Q: Can we define epilepsy?
A: Epilepsy is two or more spontaneous seizures under normal environmental conditions. The reason this is important is that a lot of other things can cause seizures. Sleep deprivation can trigger a seizure in some patients as well as going off sleeping medications abruptly without tapering, or high fever. At one time or another, 10% of the [U.S.] population will have a seizure, and 3% of the population will develop epilepsy.
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Q: Can we define seizures too?
A: A seizure is an electrical storm in the brain. Its rhythmic activity can cause signs like shaking, jerking, staring spells or unresponsiveness. It can look like daydreaming episodes and last from 10 seconds to several minutes. In children, teachers often pick it up when they notice grades going down, or when they see daydreaming that is causing problems in school or occurring during activities.
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Q: How is childhood epilepsy different from the adult version?
A: There are types of age-related epilepsy that children just grow out of. They may have only a few seizures and then with time be able to come completely off medications without any more seizures for the rest of their lives. . . . If medications don’t control the seizures, the ketogenic diet, a high-fat diet, is especially effective in certain types of childhood epilepsy. Frequently, epilepsy will go into remission.
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Q: Conversely, I’ve heard that epilepsy can lay dormant for a long time?
A: Yes. Partial epilepsy, which comes from one part of the brain, usually is caused by a scar in the brain or other lesion, such as meningitis, stroke or tumor. Epilepsy from a scar can lay dormant for many years.
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Q: If someone is having a seizure, what should you do?
A: If someone has a seizure, a convulsion, where they shake all over, place the person down on the ground, keeping the head away from sharp objects that might cause injury. Put them on their side (in case they have excess saliva or vomit) and then let the patient go through the seizure, which in the large majority of cases will stop on its own. If the seizure lasts only a few minutes, there is no need to call help. If, however, the seizure lasts for five minutes or there are two seizures in a row, call 911. . . . Do not put anything into the mouth during a seizure, which could break the person’s teeth. If the person bites the tongue, it is a muscular organ that will heal.
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Q: If one suspects epilepsy, what is the first step?
A: I advise people to check first with their physician, who will usually consult a neurologist. I recommend referral to an epilepsy specialist if seizures are not controlled in one year and to a comprehensive epilepsy center if seizures aren’t controlled in two years. Everyone with uncontrolled seizures should seek further help. I am often asked, “Why does epilepsy occur? What really causes it?” I think that is the wrong question. With the complexity of the human brain with a trillion connections of the very excitable nervous tissue--which can compose a symphony, write a novel or create a differential equation--it is remarkable that the brain does not have more seizures. The mystery is not what causes epilepsy, but that we are not all having seizures all of the time.
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The Epilepsy and Brain Mapping Program at Huntington Memorial Hospital in Pasadena can be reached at (626) 792-7300 or at https://www.epipro.com. The Epilepsy Foundation can be reached at (800) 564-0445 or at https://www.epilepsy-socalif.org.
