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Epilepsy Innovations: New Advances in Epilepsy Treatment Options

Epilepsy is one of the most common neurological disorders in our country, affecting approximately 2.5 million Americans of all ages and backgrounds.

This medical disorder is thought to be caused by abnormal nerve connections, genetic causes, other medical conditions, trauma, poisoning or abnormal nerve signaling chemicals called neurotransmitters.

Seizures from epilepsy can be alarming, but can be treated successfully in many cases.

These seizures may take various forms – including the type that appear to have an absence of recognizable symptoms except for stiffening of the body (tonic) and the other form of seizure involving jerks and shaking (clonic).

Seizures may range in severity from mild to grand mal seizures. Seizures can also be classified as partial, or focal seizures—both simple and complex, and the generalized seizures.

Fortunately, many seizures can be controlled through medication. When drug therapy has been tried and is not effective, epilepsy surgery is an option.

Other therapies for epilepsy treatment include the ketogenic diet and vagus nerve stimulation.Remarkable advances in the diagnosis and treatment of epilepsy have been made in recent years

MyEpilepsy app is our free educational iPad tool that allows you and your physician to effectively manage your epilepsy. Listen as the experts from Cleveland Clinic give you the most up to date information on Epilepsy and how you can get the best care for your Epilepsy.

We're Talking About Your Health with Cleveland Clinic!
Epilepsy Innovations: New Advances in Epilepsy Treatment Options
Featured Speaker:
Jorge Alvaro Gonzalez-Martinez, MD, Cleveland Clinic Neurosurgery Specialist
Jorge Alvaro Gonzalez-Martinez, MD, PhD is a board-certified neurosurgeon in Cleveland Clinic's Epilepsy Center. Dr. Gonzalez-Martinez completed his fellowship in functional and epilepsy surgery and residency in neurosurgery at Cleveland Clinic. He also completed a fellowship in stereotaxis, neuro-oncology at Wayne State University-Detroit Medical Center, in Detroit. He completed a residency in neurosurgery and received his medical degree from University of Sao Paulo Faculty of Medicine, Sao Paulo, Brazil. His specialty interests include epilepsy surgery and medical treatment of epilepsy in children and adolescents, general neurosurgery, brain malformations causing epilepsy, brain tumors, mechanism of epileptogenesis and vagus nerve stimulation.

Cleveland Clinic's Epilepsy Center
Transcription:

Melanie Cole (Host): Epilepsy is one of the most common neurological disorders in our country affecting approximately 2.5 million Americans of all ages and backgrounds. My guest is Dr. Jorge Gonzales Martinez. He's a board-certified neurosurgeon in Cleveland Clinic's Epilepsy Center. Welcome to the show, Dr. Gonzales.

Dr. George Gonzales Martinez (Guest): Thank you for having me. Epilepsy, as you said, is a disease that affects millions of Americans, and it's pretty much an abnormal discharge of the brain. When you have an abnormal discharge in the brain, you're going to have symptoms like jerking or some sensation symptoms, convulsions and things like that. So it's a disease, this abnormality in the brain. It can be focal, in one specific area in the brain, or it can be generalized in the entire brain. And depending on what type, if it's focal or generalized, there are different treatment options for both.

Melanie: Is this something typically, Dr. Gonzales, that you see in childhood, or do adults get it, too?

Dr. Gonzales: Unfortunately, we have in the kids and also in adults, although the prevalence in kids is pretty high compared to the adults. But unfortunately, it gets in both group ages.

Melanie: So what are some symptoms that would raise a red flag and send somebody to see you?

Dr. Gonzales: Well, in the pediatric population, normally, this is detected by the teachers. So if the teacher realizes that for a couple of seconds, there is a loss of attention, the child looks distracted in an excessive way, this is something that may be a seizure, we call absent seizure. So it looks like the kid does not pay attention anymore to the teacher for a couple of seconds, and then it comes back to normal. This is something that is normally detected by teachers and sometimes by the parents. Other forms of epilepsy is, as I said, like a motor manifestation: shaking of the hand or a shaking of the leg, or sometimes completely shaking of both sides of the body and with loss of consciousness. This is also something we call convulsions, and this is another manifestation of epilepsy. Epilepsy is a syndrome. That means that you can have several types of manifestations from completely subtle things like loss of attention to a very traumatic convulsion. So it's a spectrum that goes from a simple, very under-detected manifestation to a very clear and complex symptom. So definitely, there is a whole range of symptoms that can be epilepsy.

Melanie And how is it diagnosed, Dr. Gonzales?

Dr. Gonzales: The diagnosis is pretty much by history. In talking with the patient you have the sense that those changes may be seizures, those lackness of attention or the jerkings can be seizures or may be seizures. And this is confirmed by what we call an EEG, electroencephalography, which is a test which is non-invasive, where we put small electrodes in the skull, and then we record the electrical activity of the brain. And if those are seizures, we're going to see abnormal activity coming from areas in the brain. So that's pretty much the way we diagnose epilepsy.

Melanie: Once it's diagnosed, Dr. Gonzales, how is it then treated? What's the first line of defense?

Dr. Gonzales: The first line of treatment is medication. There are several options of medications. Some medications are used for focal epilepsy. Other medications are more for generalized epilepsy. And in general, around 70 percent of patients will be under control with medication.

Melanie: What are the medications intended to do, Dr. Gonzales? Do they help with the seizures? What do they do?

Dr. Gonzales: The medication will tend to normalize the abnormal brain activity.So it is said that these symptoms are caused by abnormal discharges in the brain, electrical discharges, and it can be caused by several other reasons. But what the medication does, it kind of normalizes the brain activity, the abnormal discharges from the brain cells, also known as neurons. So it normalizes their electrical activity, and with that, it will stop the seizures. And in general, around 70 percent of patients will be under control with the anti-seizure meds.

Melanie: When you say under control, that means they can lead a relatively normal life? Can they drive? Can they go about their daily activities?

Dr. Gonzales: If they are controlled, yes. In many states in the United States, it requires from six months to one year to be without seizures. So if you stay with medication and you can prove that you stay with six months or one year without seizures, this allows you to drive in most of the states in the United States.

Melanie: Tell us about what's on the forefront of epilepsy treatment today and what's on the horizon. What can we look for?

Dr. Gonzales: Really, the advantage in Epilepsy it comes from those patients who were not candidates or they failed the trials with medication. So 70 percent of those patients, they will be controlled with meds. However, in 30 percent of those patients, medication will not help. So surgery may help if we can localize from where the seizures are coming from. In general, if we know exactly from where the seizures are coming from, you can, with a small resection of this abnormal tissue, you can control the seizures and cure the patients. And in many patients, there is a lesion, there is a small tumor, there is a scar that is causing the seizures. And if you go ahead and do the resection of this abnormal area, they will become seizure free. However, in some other patients, when we do image studies like an MRI or a CT, it's completely normal. So it then becomes a difficult scenario because patients are not responding to medication, and the MRI or the CT is completely normal. So really, it's difficult to really localize from where these are coming from. So on those patients, you can perform what we call an invasive monitoring phase, where the patients will need to go ahead and go for surgery. And what we do is we implant electrodes inside the brain. We can implant electrodes on the surface or even adapt electrodes. In that way, we can record the brain activity and then localize the areas that are causing the seizures, and then propose a safer resection.

Melanie: What's on the horizon for epilepsy treatment? What are some of the new advances that you're looking forward to?

Dr. Gonzales: New advances will be developing new drugs that will be more effective in controlling the seizures, or developing new diagnostic tools that will see better the brain abnormalities and localize better the areas in the areas in the brain that are causing the seizures. In that way, you can propose some new techniques like resection, but also, some what we call neuromodulation. You can implant electrodes with pacemakers, and those pacemakers will record the seizures at a certain time it will discharge electrical activity that will control the seizures. This is a new technology that was just approved for by the FDA.

Melanie: Give us then your best advice for people living and managing epilepsy and the treatments and things on the horizon now.

Dr. Gonzales: My best advice is to patients. They need to look for an epileptologist who will prepare to make the diagnosis and also propose the best treatment options for that specific disease. And then, if it's not controlled by medication, to make sure that will be considered for candidacy for surgery and send the patient to an epilepsy center who can perform the surgical procedures that the patient needs.

Melanie: Thank you so much, Dr. Jorge Martinez. You're listening to Talking About Your Health with Cleveland Clinic. For more information, you can go to clevelandclinic.org/epilepsycenter. That's clevelandclinic.org/epilepsycenter. This is Melanie Cole. Thanks so much for listening, and have a great day.