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more articles by Bonno, Deana , MD  |  author's bio

Understanding Epilepsy

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 epilepsy?

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?

An EEG (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 information.

 

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 Medical Center.

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