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Epilepsy Content Primer - An Introduction to Epilepsy - My Perspective

Epilepsy Content Primer – An Introduction

January 28, 2019

Epilepsy is a disorder of the brain characterized primarily by one’s tendency to have recurrent, unprovoked seizures. A seizure is a transient, paroxysmal neurological event where there is a sudden onset of rhythmic and synchronous, excessive electrical discharges involving the whole cerebral cortex (as in a generalized seizure) or a portion of the cerebral cortex (as in a focal or partial seizure). There are some epileptic conditions – the epileptic encephalopathies – where people may experience both generalized and focal seizures with multiple seizure types. Common examples of these encephalopathies include Lennox-Gastaut syndrome and Dravet syndrome.

Beyond seizures, epilepsy can be considered as a syndromic disorder that falls within a spectrum of different presentations. Due to disordered, hyperexcitable generalized or focal electrical networking within the cortex – patients may also suffer from cognitive problems, psychiatric symptoms, difficulties with coordination, difficulties with the gastrointestinal system, abnormalities of cardiac conduction and/or cardiac function as well as a myriad of seemingly unrelated other symptoms. A syndrome is a condition where seemingly different signs and symptoms that do not normally associate with each other suddenly seem to correlate together into a stereotypical pattern.

It is duly important for the clinician in charge of an epileptic patient’s care to diligently work a patient up upon presentation to the clinic with the first goal being to classify the type of epilepsy. This is where the importance of obtaining a careful history and physical comes into play. For my epilepsy practice, I dedicate 1 hour with each new patient (who are seeing me for possible seizures/epileptic conditions) so that I have the time to ask my patient and his/her caregivers the appropriate questions. 95% of my diagnostic accuracy is based on the initial history and physical.

My history taking is geared towards figuring out if a patient suffers from a generalized epileptic disorder or a focal epileptic disorder. The classification is essential in order to treat a patient effectively. For example, if a patient has a generalized epileptic disorder – such as Juvenile Myoclonic Epilepsy – and a clinician were to then use a medication like carbamazepine to treat it – the patient may end up suffering more myoclonic seizures and/or generalized tonic-clonic seizures on this particular medication than on a medication like lamotrigine. The failure of proper classification of epilepsy can and does lead to treatment failure – increasing the risk for morbidity and mortality. In this example, carbamazepine is not indicated for seizures related to a generalized epilepsy, but rather is indicated for patients with focal epilepsy.

This is where the lay public, in general, does not understand what the role of an epileptologist is compared to a general neurologist. An epileptologist is adept in the PROPER diagnosis and treatment of epileptic conditions. While seizures are primarily the events that all clinicians should focus on reducing, it is doubly important to also provide care for the other symptoms of the epileptic syndrome that negatively impact a patient’s quality of life.

In my practice at Amor Mehta MD – Neurology Center for Epilepsy and Seizures, I treat patients as whole human beings with the understanding that the body and mind are just parts of a whole, eloquently built “machine.” Everything is interconnected and, with an ability to see the forest among the trees, I can home in on what the problem is for my patients as I wade through the morass of complicated symptoms.

In my next several posts, I will be describing some of the most common focal epilepsies starting with temporal lobe epilepsy. I will describe some of the most pertinent aspects of the generalized epilepsies. I will provide a comprehensive scope of epilepsy related content for all of my patients, and others, who read through my website.

I believe that patient empowerment through becoming educated about epilepsy will only serve to improve the quality of care and motivate patients to maximize their potential to achieve the best quality of life possible. My hope is that with the buildout of my original, epilepsy-related content; that I will be fulfilling a part of my lifelong passion for improving the lives of patients with epilepsy. There is little, centrally located literature on epilepsy for the lay public. I hope that my website, eventually will serve in this role.

Amor R. Mehta, MD

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