When you think of epilepsy, you are most likely imagining someone having a dramatic seizure in which they fall to the ground with terrifying jerks and loss of body functions. These episodes, known medically as “general tonic-clonic” seizures or traditionally referred to as “grand mal” seizures, are just one of several different types of seizures that occur when the brain’s neurons and neurotransmitters misfire release that occur in epilepsy.
What is epilepsy
According to the U.S. Centers for Disease Control and Prevention (CDC), epilepsy is a brain disorder that causes a person to have at least two seizures more than 24 hours apart. In epilepsy, there is no obvious cause of the seizure, such as medication, illegal drug activity, or metabolic imbalance.
Alberto Pinzon, MD, neurologist at Baptist Health’s Miami Neuroscience Institute
Alberto Pinzon, MD, is a neurologist at the Miami Neuroscience Institute and director of the epilepsy program at Baptist Hospital, which, in collaboration with the institute, was re-certified by the National Association of Epilepsy Centers (NAEC) as the highest level 4 epilepsy care center possible – in the most recent accreditation. Dr. Pinzon and a multidisciplinary team that includes Regine Narchet, RN, ENLS Patient Care Supervisor and Epilepsy Coordinator at Baptist Hospital have all contributed to the continued success of the program.
According to Dr. Pinzon’s most definitive method of diagnosing epilepsy is using a video electroencephalogram (EEG). “An EEG measures the brain’s electrical activity and the video component records the body’s response to the abnormal brain activity,” he says. Some patients can use portable EEG monitors to track their brain activity as they go about their normal daily routines at home, he adds.
Other tests may also be done to find out or rule out other causes of the seizures, including:
- A neurological exam
- A blood test to diagnose hormonal imbalances
- CT scans or MRIs to find lesions in the brain that may indicate a stroke or a brain tumor
- A spinal tap to rule out infection
- Wada tests to assess language and memory function
“These tests help us put everything together to get an accurate diagnosis,” says Dr. Pinzon.
Epilepsy diagnosis and monitoring
The epilepsy program at Baptist Health’s Marcus Neuroscience Institute, part of Boca Raton Regional Hospital, includes two fellowship-trained, board-certified epileptologists – neurologists who specialize in epilepsy. The institute also has an Epilepsy Monitoring Unit (EMU) that assesses and diagnoses epilepsy and other seizure disorders.
Pooja S. Patel, MD, director of the epilepsy program at Baptist Health’s Marcus Neuroscience Institute in Boca Raton
“This is the only epilepsy surveillance unit from West Palm Beach to Fort Lauderdale,” says Dr. Pooja S. Patel, director of the epilepsy program at Baptist Health’s Marcus Neuroscience Institute. “During an EMU assessment, special equipment tracks a patient’s brain activity before, during, and after a seizure, giving doctors and nurses real-time feedback on seizure triggers, length, frequency, and recovery.” By monitoring seizures as they occur, doctors can develop a tailored, effective treatment plan.
Once epilepsy is diagnosed, treatment is needed to improve quality of life and prevent disability from repeated seizures. Dr. Patel says patients will benefit from new technology and treatment options will be available to our patients once they are approved and proven to be effective.
“Drugs are often the first line of treatment for new seizures or epilepsy,” says Dr. Patel. “However, patients with difficult-to-control or difficult-to-treat epilepsy may benefit from more advanced treatment options, including surgery and neurostimulation.”
Research has made significant improvements in drugs that target specific areas and functions of the brain that control the different types of seizures that occur in epilepsy.
“We now have about 20 to 25 drugs that we can use to treat epilepsy and other seizure disorders,” says Dr. Patel. “We may have to use trial and error combining drugs to find the formula that works best, but most patients have epilepsy controlled with drugs.”
Surgical options are available for patients whose seizures do not respond to medication, such as in “medically refractory epilepsy”. In addition to these patients, says Dr. Patel, surgery often helps people with epilepsy affecting an area of the brain.
Some of the surgical procedures used to treat epilepsy include laser ablation, which uses heat to destroy the area of the brain that causes epilepsy, and resective surgery, which removes brain tissue from where the seizures begin.
Marcus Neuroscience Institute of Baptist Health at Boca Raton Regional Hospital
Many patients benefit from neurostimulation, says Dr. Patel, where a small implanted device helps reduce or prevent seizures. “Neurostimulation is a highly specialized type of epilepsy treatment that is only offered at certain centers like the Marcus Neuroscience Institute and the Miami Neuroscience Institute,” she says.
According to Dr. Patel there are two types of neurostimulation treatments. “With vagus nerve stimulation (VNS), electrical impulses generated by a device implanted in the neck stimulate the vagus nerve and reduce seizures,” she says. “And with a responsive neurostimulation (RNA) device, a pacemaker-like device implanted in the skull detects abnormal brain activity and electrically stimulates the brain to actually prevent a seizure.”
Dr. Patel says these advances in technology, especially in the areas of minimally invasive procedures like VNS and RNA, greatly improve the management of epilepsy and the quality of life for patients undergoing them.
In addition to medical and surgical treatments for epilepsy, some patients have turned to alternative, complementary therapies that have shown promising results.
Patients with refractory epilepsy who used a strict ketogenic or “keto” diet, for example, have seen effective treatment for their seizures. Dr. Pinzon of the Miami Neuroscience Institute says burning fats instead of carbohydrates for the body’s fuel causes changes in the brain’s metabolism. He says the keto diet can be effective if followed carefully.
Living with epilepsy
Dr. Pinzon says it’s important to treat epilepsy to control seizures. “Our biggest fear is the risk of disability from seizures,” he said. “Seizures can even lead to death.”
He warns that the stigma associated with epilepsy needs to be addressed through educating patients, their families and the public. “Epilepsy is a disease that is manageable and treatable,” says Dr. Pinzon. “By educating others about the disease and its treatment options, and by providing social resources to help patients and their caregivers manage seizures, we can minimize stigma and improve patients’ quality of life.”
The Miami Neuroscience Institute is located on the Baptist Hospital campus (above) and is also located in the Baptist Health’s new wellness and medical complex in Plantation
According to Dr. Pinzon, the epilepsy program at the Miami Neuroscience Institute encompasses the most complex diagnostic techniques and surgical procedures available for epilepsy management, including two-step surgical procedures to locate and treat epilepsy with resection, and non-resection options such as VNS and RNA. among other.
Equally important for the patient is that the epilepsy program combine advanced treatment approaches with education and social management of the disorder. “At Baptist, patients have access to a multidisciplinary and comprehensive approach to epilepsy care, including drug optimization, full preoperative assessments, and the latest in epilepsy surgical procedures,” said Dr. Pinzon.
Baptist also provides psychosocial support to patients and their carers. In addition, there are ongoing clinical research studies in partnership with Florida International University’s engineering department that may provide additional opportunities for some patients with refractory epilepsy.
“Family involvement is critical to epilepsy care,” says Dr. Pinzon. “The Baptist Health program recognizes this and provides caregivers with the support they need. We live in exciting times to enable patients with epilepsy to lead normal lives. “