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Massachusetts Medical Society's
Physician Focus

March 2011

Epilepsy: The Seizure Disorder

PROGRAM HIGHLIGHTS:

  • Epilepsy is the third most common neurological disorder in the United States, after Alzheimer’s disease and stroke.

  • Nearly three million Americans have the condition, and 200,000 new cases are diagnosed each year, according to the Epilepsy Foundation. Half of all patients are children.

  • The condition is characterized by spontaneous, recurrent seizures that produce involuntary movements, changes in awareness, altered behavior, or loss of consciousness. It can also be life threatening.

  • A recent study suggests that older adults are more at risk for developing epilepsy and more people will develop epilepsy in their lifetime than previously thought.

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 ADDITIONAL RESOURCES

The Epilepsy Foundation

Centers for Disease Control

National Institute of Neurological Disorders and Stroke

American Academy of Neurology

Epilepsy.com

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Epilepsy PSA

From left: Bruce Karlin, M.D., Catherine Phillips, M.D., Andrew Blum, M.D.
hi-res photo
promo slide

It is a major chronic medical condition, similar to arthritis, heart disease, diabetes or cancer. It can limit activity, and cause pain, anxiety or depression. But its impact can extend beyond its medical consequences, to social stigma, emotional stress, and even discrimination.

“Epilepsy is a condition denoted by a tendency to have spontaneous, recurrent seizures under conditions that would not normally cause seizures,” said Andrew Blum, M.D., Ph.D., director of the Comprehensive Epilepsy Program at Rhode Island Hospital in Providence.

The cause of the seizures, says Dr. Catherine Phillips Co-Director of the Comprehensive Epilepsy Program at UMass Memorial Health Center in Worcester, is “excessive excitability of nerve cells in the person’s brain, with neurons firing in an abnormal way. That affects the behavior of the individual.”

Dr. Blum and Dr. Phillips, board certified neurologists with a subspecialty in clinical neurophysiology and epilepsy, discussed the many aspects of this disorder as guests on the March edition of the Massachusetts Medical Society’s Physician Focus program. Among the topics discussed with host Dr. Bruce Karlin are the causes of this condition, how it’s diagnosed, how it affects patients and those around them, and what treatments are available for patients with this disorder.

“A person may fall to the ground and shake all over,” says Dr. Phillips in describing the outward appearance of the condition, “or there may be an alteration in awareness, where a person may just stop and stare or have some other behavior. Or there may be some reaction in between.” The seizure may last from a few seconds to a few minutes with confusion afterwards, and the patient many times will not even know they’ve had a seizure.

Different types of seizures may occur, depending on which part of the brain and how much of it is affected by the abnormal activity. The origin of the activity may be due to any one of a number of factors, including head trauma, infections, sleep deprivation, or genetics.

Dr. Blum emphasizes that it’s important to recognize epilepsy is characterized by spontaneous, recurrent seizures. Up to 10 percent of the population may experience a seizure sometime in their life, he says, but that doesn’t mean they have epilepsy.

The condition can be difficult to diagnose, as distinctions must be made from such conditions as migraine headaches, fainting spells, or transient ischemic attack (TIA), the last of which produces stroke-like symptoms. The first step, and perhaps most crucial says Dr. Blum, in diagnosing the condition is compiling an accurate medical history of the patient. That often means getting information from family members or witnesses who can describe the seizures and what the patient actually experienced.

The history is then followed by medical tests, which include an electroencephalogram (EEG, a test to detect problems in the electrical activity of the brain), or imaging tests such as Magnetic Resonance Imaging (MRI), or Computed Tomography (CT, or Cat-Scan) to see what is happening inside the brain and body. Treatment may include using any one of a wide array of anti-convulsive medications (with a careful eye to any side effects the patient may experience), implantable electrodes, nerve stimulation, or in some cases, surgery.

The impact of epilepsy on the patient, however, goes far beyond the physical. “The emotional impact is not to be underestimated,” says Dr. Blum, as the disorder can mean problems with memory and learning, stress, depression, and anxiety. Epileptic patients are also prohibited from driving a motor vehicle, and can only do so after a period of six months without seizures.

Social stigma and discrimination may occur as well, but the doctors see progress in these areas. Dr. Blum says “Our culture is much more attuned to epilepsy and seizures representing a disorder of the brain, much as diabetes is seen to the body.” And Dr. Phillips adds that “even though some social stigma still exists, it’s much better today."

Dr. Blum and Dr. Phillips carry their work for patients with epilepsy beyond their medical practices. Both are active with the Epilepsy Foundation of Massachusetts, Rhode Island, New Hampshire, and Maine – Dr. Blum as chairman of its board of directors and Dr. Phillips as a member of the board of directors. Their work with the Foundation includes enhancing employment opportunities for those with the disorder, advocating for patients as they encounter discrimination in the workplace, and educating the public and first responders to be more sensitive to the nuances of epilepsy – work that bodes well for their patients and all those who have this disorder. Visit epilepsyfoundation.org/local/massri to learn about the Foundation's regional activities.

Watch the accompanying video for the full discussion.

Text:
MMS/Richard Gulla