Special to the Journal By
Deana Bonno, MD
Most people are genuinely
surprised to learn that epilepsy is a relatively common disorder. One in 26
people will develop epilepsy over the course of his or her lifetime. Two
million people in the US are affected by this neurological disorder, with 150,000
new cases diagnosed each year.
What is epilepsy?
Epilepsy is a neurological
disorder that causes a person to have recurrent, unprovoked seizures. These
seizures occur when the electrical activity in the nerve cells of the brain are
disrupted. Seizures vary from person to person and can involve staring,
abnormal movements and loss of consciousness. Epilepsy can occur at any time of
life; however, it has the highest incidence in the very young and in the
elderly. Among people with epilepsy, two-thirds are able to satisfactorily
control their seizures and lead a normal life. However, one-third of those with
epilepsy are still coping with uncontrolled or poorly controlled seizures.
Are there different types of
Yes, there are two basic
categories of epilepsy: generalized seizures and focal seizures. In the
simplest terms, generalized seizures involve all areas of the brain at once and
cause loss of awareness and often loss of consciousness. This type of epilepsy
is most commonly diagnosed in children. Focal (or partial) seizures begin in
one part of the brain and may only impact the part of the body controlled by
that specific area of the brain. The onset of focal seizures can begin at any
time of life. Within each of those basic categories there are several different
types of seizures.
How is epilepsy diagnosed?
(electroencephalogram) is a painless test that monitors your brain waves and is
used to diagnose epilepsy. The EEG can reveal abnormal brain waves even when
you are not having a seizure. Depending on your age and type of epilepsy, the
doctor may order other tests, such as an MRI, to gather more specific
How is epilepsy treated?
There are several categories
of treatment for epilepsy.
1) There are about 26
different medications for epilepsy; some are better for generalized seizures
and others are more effective for focal seizures. Because we have so many
medications it is important to gain as much information as possible about the
specific type of epilepsy being treated.
2) Your doctor may recommend
treatment with a vagus nerve stimulator if medication doesn’t work. The vagus
nerve stimulator is implanted beneath the skin on your upper chest and wires
are attached to the vagus nerve in the neck, which can help control seizures.
3) When other treatment
options do not work for someone with focal epilepsy, surgeons may be able to
remove the area of the brain where seizures start. For people who cannot have
surgery, your doctor may recommend a NeuroPace® device, which is a newer
treatment option involving the implantation of electrodes on top of the brain
to control focal seizures.
4) Some people have been
able to treat their seizures with diet therapy. The best-known diet therapy is
the ketogenic diet, which is high in fats and low in carbohydrates and can
be effective for people who don’t respond to other treatments. This diet must
be supervised closely by a neurologist and a dietician. So far, the patients
who gain the greatest benefit from this diet are children, though it can be
used in adults as well.
At the Strong Epilepsy
Center in Rochester, where I did my fellowship in epilepsy, a major interest of
mine is in the implementation of a modified Atkins diet therapy. This is
specifically for adults in our region with focal or generalized seizures that
are not completely controlled with medication.
Dr. Bonno is board certified
in neurology and is in practice with Cayuga Neurologic Services of CMA, where
she can be reached at (607) 273-6757. She serves on the medical staff of Cayuga