Epilepsy Awareness: What to Know About Subtle Symptoms, Advances in Treatments

Most people think epilepsy is primarily characterized by uncontrollable seizures, with jerking movements and possible fainting. While someone may be diagnosed with epilepsy when they have had two or more unprovoked seizures, many people may dismiss many symptoms entirely.

That’s because it may be hard to tell when a person is having a seizure. Seizures have many different manifestations, which can vary from appearing dazed, staring, very brief unresponsiveness, milder twitching of one side of body and some involuntary movements.

Younger adults may be more prone to ignore such episodes, explains Pooja S. Patel, M.D., director of the Epilepsy Program at Marcus Neuroscience Institute at Boca Raton Regional Hospital. “They could dismiss these episodes as falling asleep, daydreaming or just being inattentive for few seconds and delay in seeking medical attention for it,” explains Dr. Patel. “Often it takes a big convulsive event that gets patients or family and friends attention.”

The Institute offers an epilepsy monitoring unit (EMU), which is used to evaluate and diagnose seizures and other such events. It’s the only epilepsy monitoring unit from West Palm Beach to Fort Lauderdale. It tracks a patient’s brain activity before, during and after a seizure. The EMU gives doctors real-time feedback about seizure triggers, length, frequency and recovery. The Institute is accredited as a Level 2 Epilepsy Center by the National Association of Epilepsy Centers, the highest-ranking organization for epilepsy care and management.

Reducing Stigmas and Drawbacks

November is National Epilepsy Awareness Month, a designation to help bring attention to symptoms and advancements in treatments, including the newest medications and minimally invasive procedures. The annual campaign has helped reduce the stigma associated with epilepsy.

“In the past, nobody wanted to talk about it and seizures were viewed as a stigma,” explains Dr. Patel. “This is changing, and more people are aware of it and educated about it being a medical condition with many treatment options.”

Nonetheless, some drawbacks persist in getting the right medical care right away, she adds. “Much of the time, symptoms are ignored or it could be that this was only a one-time event for someone. And people are ignoring it because they're young -- and healthy otherwise -- and don't want to go to the hospital.”

Dr. Patel explains, “Even after getting the medical attention, the diagnosis, and they are put on the treatment which initially is anti-seizure medications, sometimes there's a compliance issue. We see that with especially younger generations where they just don't want to be on medication for a long time or a lifetime, even if it’s safe for them.”

Anti-seizure medications

The vast majority (about 70-80%) of patients with epilepsy are treated with medications that can help control their seizures. There have been significant improvement in medications used to treat seizures.

Most recently, two new anti-seizure medications have been approved by US Food and Drug Administration (FDA) and indications of some approved medications have been expanded. Cenobamate and fenfluramine are the most recent drugs to be approved by FDA. Cenobamate is used to control partial-onset seizures in the treatment of epilepsy in adults. Fenfluramine is used alone or with other medicines to treat seizures in patients with Dravet syndrome and Lennox-Gastaut syndrome.

Talking about cenobamate, Dr. Patel states, “It’s an add-on medication for some of the patients where seizures have been difficult to control with traditional medications”. “This has been a good approach when a patient wants to still stay on the medication route only, and not go to any interventions or surgical procedures. This medication has worked effectively without any major side effects.”

Diagnosing Epilepsy

If a patient has a seizure, the team at Marcus Neuroscience Institute will use electroencephalography (EEG) tests and MRIs to pinpoint diagnosis and determine the best treatment plan. Depending on symptoms, a patient may undergo a standard EEG test or a long-term EEG. Long-term EEGs can take between one to seven days.

“Usually, we start out with a regular 20 minute EEG,” said Dr. Patel. “But if that doesn't give us diagnosis or if it's a complicated case, we take it to the next level where we do the long-term video EEG monitoring, which is something unique to our hospital in this area. This can also be done on an outpatient setting providing more flexibility to patients.”

During inpatient long-term EEG monitoring, a patient stays in the hospital for few days while specialists monitor brain activity, which records audio and video along with brain waves. Having this detailed data can help the medical team better understand the type of seizures involved and develop a more tailored approach to treatment.

Advances in Neurosurgery and Neurostimulation Treatment

If medicine does not help with symptoms, the Institute’s team may recommend neurosurgery or neurostimulation treatment via minimally invasive surgical techniques. Marcus Neuroscience Institute is the only hospital in the region to offer neurostimulation, which may include:

• Vagus nerve stimulation (VNS) – This treatment involves implanting a small, battery-powered device on the skull. The device stimulates the vagus nerve with electrical pulses, which can reduce seizures.
• Responsive neurostimulation (RNS) – This treatment also uses a small device that is implanted on the skull. The device monitors and responds to the brain's electrical activity to prevent seizures.

Some of the surgical procedures used to treat epilepsy include cortical resection that involves craniotomy and other minimally invasive techniques include laser therapy, stereotactic radiosurgery, etc.

The COVID Pandemic’s Effect

Dr. Patel said the COVID pandemic has had two primary effects on patients with epilepsy. Many patients delayed going to the doctor or hospital even after having a seizure. The pandemic’s other impact has to do with mental health, which has always been a concern with patients with epilepsy, especially younger patients.

“COVID has taken a toll on mental health, and some epilepsy patients already have mental health issues,” said Dr. Patel. “COVID has made depression and anxiety worse especially for younger generations who already suffer from some mental health issues due to epilepsy. Now, we're seeing more and more cases where we have to treat that as a separate disease, where depression and anxiety are playing a big role.”