Epilepsy & Seizure Disorders

Transcript Speaker 1: ACTH or Acthar Gel is one of the medications that’s used as a first line treatment for infantile spasms. It’s a high dose steroid, given intramuscularly by injection, usually one or two times a day for a short period of time to stop the infantile spasms. Speaker 2: Remember that infantile spasms …

Transcript Patty McGoldrick: One of the things that we don’t often talk about to persons with epilepsy is the risk of death from a seizure. So there’s something called SUDEP which is sudden unexpected death in epilepsy. It’s a real risk. It occurs more often in males, more often young adults like 20’s to 40’s …

Transcript Patty McGoldrick: Neurontin is also known as gabapentin and it’s another medication that can be used for control of seizures and epilepsy. It’s well tolerated, it’s used for generalized, impartial seizures. It’s available both in pills that can be crushed or it’s available in an oral formulation, so a liquid for small children. Dr. …

Transcript Keppra or levetiracetam is one of the biggest medications used to control epilepsy. Its one of the newer ones that came out. It’s available by pill or intravenously. It works on what’s called an SP2 receptor. So its different than some of the other anti-epileptics and its good for both partial complex seizures as …

Transcript Vimpat or Lacosamide is another one of the newer anti-epileptic medications indicated for controlling partial onset seizures, so seizures that start in one area and spread. It is FDA approved in adults over the age of eighteen. Its main side effects are sedation and some dizziness. But it works well. We’ve had very good …

Transcript Zarontin or otherwise known as Ethosuximide is an anti-epileptic, an old one, that’s used for abson seizures. So those are those generalized ones where I stare and zone and don’t respond. And it’s one of the older medications that have been used to treat this very effectively. So there was a study done a …

Transcript Dr. Steve Wolf: Phenobarbital is one of our oldest anti-seizure medications that have been around. It’s indicated for both seizure types. The major problem with it is sedation, sleepiness. That’s why the newer medications have a lot less sleepiness and side effects and waking issues. Patty McGoldrick: Now it still is used a lot …

Transcript Dilantin is one of our oldest anti seizure medications that has been around. It’s indicated for patients who have seizures that start in one area of the brain and spread, so partial complex seizures. The problem with Dilantin is that, it works great for a rescue medication and it’s used a lot in cases …

Transcript Patty: Zonegran is another medication indicated for the treatment of epilepsy. It’s been out for a number of years. It is generic. It has five different mechanisms of action so it covers a lot of bases. It comes in capsules that can be opened and sprinkled in food for kids who can’t swallow pills …

Transcript Lyrica is another newer anti-epileptic, otherwise known as Pregabalin. It’s also indicated for partial complex seizures. It has some moderate good results in controlling seizures, except that it can cause some sedation. Dizziness, um, drowsiness, those are the biggest side effects with it. You know, but it’s a good medication. It has some other …

Transcript Topamax or Topiramate is one of the medications used to control epilepsy. Its big side effect is that it can decrease appetite, some people think that it can cause some cognitive dulling or some word finding issues, but it hasn’t been that much our experience. You know, nickname they give it is Dopamax, uh, …

Transcript A: Trileptal, otherwise known as oxcarbazepine is one of the newer anti-seizure medications. It’s based off an old medication, carbamazepine or Tegretol, as you probably heard in the past. It’s another fast sodium channel drug and very good for seizures with partial-complex seizures. B: Seizures that start in one area of the brain and …

Transcript Patty McGoldrick: Hi, I’m Patty McGoldrick. I’m nurse practitioner, specializing in epilepsy in pediatrics at Beth Israel in New York City, and the Co-director of the Developmental Disability Center at Roosevelt, and my partner, Steve Wolf, and I manage the programs together at Beth Israel and St. Luke’s Roosevelt. Steve Wolf: And hi, I’m …

Transcript There are certain medications that persons with epilepsy should really try to avoid, the most common being Sudafed, pseudoephedrine. It is what’s in allergy medication. It’s that Sudafed-D, or Zyrtec-D. That extra D that decongests you, that can cause seizures. The other medications are things like Wellbutrin, which is used for smoking cessation or …

Transcript Gabitril, otherwise known as Tiagabine, is an anti-epileptic medication that’s indicated for partial complex seizures. So seizures start in one area of the brain and spread. It’s not as commonly used right now as it used to be; in certain seizures it can actually aggravate seizures, so it’s important to talk to the people …

Transcript Lamictal or Lamotrigine is another great medication that’s used to control epilepsy. It’s been out for a number of years. In fact it is now available in a generic formalization but it’s also available in a extended release and in a o d t, which is a oral disintegrating tablet. So it’s a pill …

Transcript Onfi is one of the more recently approved medications for the treatment of epilepsy in the United States. It’s been widely used in Europe and Canada for many years, and it’s also known as Clobazam. It’s a 1,5 Benzodiazepine, so it’s similar to Klonopin and to Ativan and Valium, but less sedating and it …

Transcript Midazolam, uh, name brand is Versed, is another rescue medication that’s available for patients with intractable epilepsy. It’s not FDA approved for this indication in the United States. It’s mainly used for intravenous. But in Europe, they’re using it, if someone’s having a seizure, and it’s a prolonged seizure, to help break the seizure …

Transcript Patty: So, epilepsy dogs are a big buzzword because everybody with epilepsy would really like to have a dog if they like dogs. So epilepsy dogs are dogs that are especially trained to detect oncoming seizures in people with epilepsy. So they’re specially trained, they sort of sense an aura or feeling that a …

Transcript Felbatol or Felbamade is another medication that used in epilepsy to control seizures. It is a medication that is sorta fourth choice in most people’s armamentarium. It works well for both partial and generalized seizures. It has a black box warning so it’s not used as widely as it could be and that’s because …

Transcript Dr. Steve Wolf: Klonopin, otherwise known as clonazepam, is another benzodiazepine. Sort of the same family as Valium, Ativan, and is a good medication for some patients to control their intractable seizure. Patty McGoldrick: The problem with Klonopin or clonazepam is that you can develop tolerance to it over time, so it doesn’t work …

Transcript Steve: Potiga, one of the newer anti seizure medications, otherwise known as retigabine and ezogabine, in the United States is a new potassium channel opening medication. So it’s a new type of mechanism that we haven’t seen in anti-seizure medications. It helps to stabilize neurons and not make them as excitable. It’s an interesting …

Transcript Cerebral Palsy and Epilepsy are a common association. I mean Cerebral Palsy means that you have some kind of motor problem. Cerebral Palsy can be as mild as someone limping to someone who can’t walk at all. So a lot of people that have Cerebral Palsy, what people usually think of as Cerebral Palsy, …

Transcript Patty McGoldrick NP, MPA: So febrile seizures are seizures that are associated with fever. They usually occur in young children between the ages of one and five. Most kids outgrow them by five, which is great for the parents, because if you’re child is seizing every time they have a fever, I’d be happy …

Transcript So it’s important to try to reduce seizures is to have a very important conversation with your doctor about what medicines you’re on and what are your triggers. We know there are a number of triggers. Triggers being sleep deprivation, not taking your medication on time, alcohol, illicit drugs, and then you have to …

Transcript – Patty McGoldrick:If you should see someone having a seizure, first of all, it’s most important not to panic and get upset about it. You really need to try and help that person out. So, depending on how the seizure presents, if it’s a confusional episode, you’re just sort of following them around, making …

Transcript Banzel otherwise known as Rufinamide is one of the newer anti-seizure medications. It’s really indicated for children with Lennox-Gastaut syndrome. Lennox-Gastaut Syndrome is one of the more difficult to control epilepsies with multiple seizure types. These are kids who have drop seizures, abson seizures, as well as generalized tonic colonic seizures and this is …

Transcript – Patty McGoldrick:So, neonatal seizures are seizures that occur in brand new babies in the neonatal period, within the first few days or weeks of life. They can be difficult to control. They can be caused by different syndromes, so some devastating epilepsies appear in infancy, but some of them are quite benign and …

Transcript Let’s talk about some of the medications that we use in epilepsy. One of the big names as a rescue medication is Ativan. Ativan is in the benzodiazepine family. It’s used, again, for rescue medication, given either intramuscularly as an injection or intravenously, IV. Usually used in emergency rooms, or by EMS. So, if …

Transcript In this modern age, we’re very blessed, because we have numerous medications that are available to us to treat Epilepsy. There are new medications all the time, some with less side effects than the older medications, but with just as much efficacy, which means ability to control the seizures. What’s happened in the last …

Transcript Patty: Now when we talk about the tests that we need before epilepsy surgery, we’re doing tests to make sure that we’re absolutely certain which area of the brain the seizures are coming from, and exactly which procedure we want to do. We start with something called a video EEG, which means overnight, it’s …

Transcript So temporal lobe epilepsy is seizures that arise from the temporal lobe of the brain, either the right side or the left side. We’re gonna hold the brain for you. So where they, they come from over here or over here. And they are repetitive and why don’t you talk about what symptoms they …

Transcript So one of the most common type of epilepsy surgery is resective surgery. So that’s where we find out where the seizures come from in the brain. So first we will do a routine EEG, then we will do a video EEG which is a more extended EEG that lasts for several days so …

Transcript – Patty McGoldrick:So, one of the things you find often in people with epilepsy, especially people who’ve had a lot of seizures, is mesial temporal sclerosis, or hippocampal atrophy. So, those mesial temporal structures can be shrunken and smaller if there’s been repeated seizures. – Steve Wolf:So, what we know is patients with partial …

Transcript So there is an increased risk of seizures occurring around women’s ovulation and their menstruation. At the same time people need to be put on birth control of some form so that they are minimizing the risk of pregnancy and the risk to the fetus. Now, birth control is safe, with epilepsy and with …

Transcript – Patty McGoldrick:So, there are a lot of myths associated with epilepsy and these myths date back to well before the time of Hippocrates. So, way before Christ or before the common age. People used to think that epilepsy was caused by the moon. That it was caused by evil spirits. They thought that …

Transcript Diamox is another very mild anti epileptic medication. It’s been used in patients with menstrual issues. It’s not one of the anti seizure medications that we use commonly, it’s used in very specific cases. It is used as an adjunctive therapy. So it’s not the first seizure medication you use. You’d add it to …

Transcript Steve Wolf MD: Many families ask is there a possible diet that we could use to stop the seizures? And really there’s two different diets. One is the ketogenic diet, which is basically a high-fat, no-carb, low-protein diet. And then there’s the modified Atkins diet, which is again no carbs, but with protein and …

Transcript One of the options for treatment of epilepsy is a sort of epilepsy surgery that involves placing a pacemaker. This is called a vagus nerve stimulator. This little tiny pacemaker is placed in your chest wall and then it has leads that are threaded up around your vagus nerve. And what it does is …

Transcript Hormones play an important role in seizures and epilepsy. I guess the number one area being puberty, because when we see rapid puberty development in teenagers, we frequently see an outburst of seizures going on. Girls and women often have more seizures according to their menstrual cycle, so at the time of ovulation and …

Transcript Patients frequently ask about driving, and whether they can drive if they have epilepsy. What we know is in New York State at least if you’re a year seizure free you are allowed to drive. But the laws vary by state, so different states have different laws. The other rule that differs from state …

Transcript Depakote or Valproic Acid has been around since the 1970’s and used for the treatment of epilepsy. It is also known by other names including: Depakene, its generic name is Valproic Acid, there’s also a brand called Stavzor and it’s called other names in other countries. It’s a great anti-seizure medication because it’s indicated …

Transcript Dr. Wolf: Epilepsy centers are specialized places at different hospitals, where patients with epilepsy can come to get all their needs taken care of. So it involves not only a neurologist, a neurologist nurse practitioner, a neurosurgeon, a psychologist; basically to look at the whole patent. Patty: So they can get all the help …

Transcript One of the biggest concerns that people with epilepsy have is, their ability to hold down a job, and to be productive members of society. In the past people with epilepsy have really not been allowed to hold jobs, they’ve been fired. We’ve come a long way but these old stigmas still exist. The …

Transcript Steve Wolf: The benefits of epilepsy surgery are huge and the risks are small. You know, it’s important to know is if we don’t control your seizures it’s going to affect your job, your life, and there’s always a risk of death if your seizures are not controlled. So if we can control someone’s …

Transcript There are a bunch of different causes of epilepsy and there is a lot of research going on about this. The biggest being the human genome project. What we’re seeing a lot of is syndromes that present in infancy or in young childhood. Where we realize that there is a genetic component and then …

Transcript A frequent question parents ask is are my children going to stop having seizures as they get older. The nice thing about that is most of the time yes. If you have a normal MRI and a normal EEG, that’s a really good sign. And if it presents in childhood and it’s a known …

Transcript – Steve Wolf:The most common question parents ask is, “How do I prevent my child or my sibling from having a seizure?” And that’s a tough question to answer. – Patty McGoldrick:It is. I don’t know if you can really prevent epilepsy. You can, if a person’s been diagnosed, prevent seizures. Not always, but …

Transcript Autism is being more frequently diagnosed in our society, and epilepsy can be seen in up to 25 to 30 percent of children with autism, so it’s an important thing to diagnose. There are some cases that we feel the epilepsy can be affecting the autism in the child’s development. There are certain children …

Transcript Speaker 1: Many people, when they witness a seizure, after the seizure they’ll notice that the patient will have some weakness on one side or the other. They’re concerned that this could be from a stroke. But we know it’s something called a Todd’s paralysis. Speaker 2: Right. This occurs after a seizure, usually …

Transcript Patty McGoldrick: There is a syndrome, Tuber Sclerosis, that’s a genetic disorder that’s associated with legions on the skin, birth marks, as well as lesions in the brain, seizures, autism, developmental delays. The children that are diagnosed with it can also have problems with their kidneys, problems with their heart, problems with their eyes. …

Transcript So there‘s been a big increase in vets who are developing seizures, even long after they’ve had these penetrating head traumas; it can occur even up to ten to fifteen years after their wounds. You know, the concussions that veterans, vets, can get from a bomb going off where it shakes your brain, can …

Transcript Speaker 1: Benign Rolandic is an epilepsy that starts in childhood. The child often presents for the first time having had a seizure in the middle of the night which is really scary for parents. The child will wake out of sleep, often soon after going to sleep or soon before it’s time to …

Transcript Patty McGoldrick NP, MPA: So when do people come to discuss epilepsy surgery? The problem that we’ve had historically is that people wait a very long time before we consider taking them for epilepsy surgery. These are people with intractable seizures that have gone on for years. The mean time for epilepsy surgery from …

Transcript So, head trauma is a big concern of whether it can cause seizures or not. The most important kind of head trauma that causes seizures are the ones where the skull actually has a fracture, and that can cause damage to the brain directly. Those are the ones that we see from war veterans. …

Transcript – Patty McGoldrick:Let’s talk about the different kinds of epilepsy surgery that are available to patients with intractable epilepsy. The first one, and the one that people most commonly think of as epilepsy surgery, is resective surgery, where we go in and pinpoint what area of the brain the seizures are coming from and …

Transcript There are many things that can mimic seizures that can be confusing to us neurologists. We know of things like reflux, little babies that get, their gastric juices get up and tickle their throat can create jerking or funny movements that can look like seizures. Babies who can have breath holding spells where they …

Transcript Dr. Steve Wolf: Infantile spams is a type of seizure that presents somewhere between five months old and usually about a year old. It’s a sudden jerk, or twitch, or crunching, or bobbing that seems to make the parents notice that something else is going on. Patty McGoldrick: The problem is that they’re often …

Transcript – Patty McGoldrick:There are several types of epilepsy that present in childhood. There is a big increase in epilepsy in infancy, and then there’s another big increase at the end of the lifespan when people are older. But, there are a group that just presents in childhood, like in elementary school and middle school, …

Transcript One of the rescue medications for epilepsy is Diastat AcuDial, which is basically rectal Valium that can be used for a prolonged seizure or a cluster of seizures that can break the seizures. So if someone is having a seizure that’s longer than five minutes you really want to stop it because prolonged seizures …

Transcript Patty McGoldrick: Epilepsy is often a little more difficult and challenging to control in pregnancy because the hormones are changing, and the levels of the medication may need to be adjusted. There is a big risk to the fetus if you’re having seizures during pregnancy, so it’s very important that the medication and the …

Transcript The term, ‘non-epileptic seizures’, has a bunch of other names for it: non-epileptic seizures, pseudo seizures, schematic seizures. These are seizures that don’t have an EEG correlate, so the brain is not short-circuiting but clearly something is happening inside these patients. There’s usually a psychiatric component, there’s usually some deep seated psychological issue that’s …

Transcript Speaker 1: General risk factors for epilepsy and for seizures. There are certain populations that are much more at risk and these include people with an underlying developmental disability, particularly autism. There’s a very high percentage of seizures in epilepsy in people with autism. There’s a high percentage in people with cerebral palsy and …

Transcript Dr. Wolf: Being safe and being a person with epilepsy is a pretty frequent conversation that we have in the office. How do we tell parents to tell their children to be safe? Patty: We like to have people with epilepsy, especially children with epilepsy feel empowered so that they feel as if there’s …