Treating Epilepsy: From Drug Therapy to Surgery

" Welcome to our web cat I'm David -- on the topic is epilepsy. And more typically the treatment of epilepsy. Now over -- million Americans have been diagnosed with the disease but the good news they have. That 80%. And people connector seizures controlled. With medication we're gonna get into the very treatment. For epilepsy and joining me to give us the lowdown on all of this -- doctor to my left doctor Carl W -- Up a professor of neurology at Columbia unit -- and neck and neck and doctor they'll. Is doctor -- permits also a professor of neurology not a Colombians is that in the Downstate Medical Center in Brooklyn. But here in New York welcome doctors. And let me start with you. And all -- what he's you know just very briefly what is epilepsy and they can all be treated with drugs. At a."

" He is a disease that has characterized by features which are recurrent episodes of abnormal activity in the brain. And the -- most familiar with grandma seizures with people fall down and -- all of -- most people can't have their seizures adequately controlled with medication. Nearly 80% of patient can have. I'm no seizures on anti epileptic medication."

" And -- what cut what kind of medications are we talking about -- and pills what went warm doctor. Well the medications that we use are growing sort of -- capsule oral form at least. Pretty out as being -- hospital so what we sometimes you intravenous drugs or we're really talking about is his pills. And oral medications. And -- and how do you know. If you have a seizure out of the doctor began to figure out. What happens."

" What you need for the first thing we need to do is get a good description of what happened on the patient from somebody -- the seizure that -- to decide what kind of seizure was and whether or not. It actually was a seizure there are many other things that can sometimes be used with seizures. The -- we've added that it is its seizure. Then we would do and other testing to determine what kind of seizure and we can do an electorate that program which -- of the brain wave activity we can do a cat scan and MRI of the brain to look at if there's any abnormalities that the court that had a stroke but Boyer head trauma. I'm to get a better idea what kind of seizure they have and what their risk of having another injury --"

" Now if it. They somebody had a seizure of their diagnose. With epilepsy. Give us examples -- and what somebody. Diagnose teams might be and then what the treatment would be. Well they're diagnosed -- to -- the first one for and you want to determines that the -- out going out of our net than most people there isn't there what we call -- you Patrick dangers that come from from a relatively normal appearing brain. And if so patient and then the next question and what is their chance of recurrence which is a lot of looting of and it. If you've had few unprovoked seizure your chance of recurrence without treatment a fairly high and most of the pensions will receive. Medication for it so let's start throwing out some of the treatment that might."

" Okay but you know back. And the most commonly used -- probably three and then -- in port and a towing companies have you know -- a tall and one of the older medications you know by the top. And they are the ones that are in most common use in the United States let me stop you there when -- in this or that what are we talking and led. The first when -- at Atlanta and is that it happened medication that the trade name and it at a time -- a generic name. Tell us Iowa -- at the door as an alien -- And now it plain they take one of those and explain why limitless there is -- way to Atlantic. -- thought that that means work is it decreased the activity at the brain and they'll work in somewhat similar. That an overall although they have specific activities on channels in the brain -- the way tells communicated. With each other. But because they all work on patent. Activity of the brain to decreased activity of the great to have a similar. Side effect profile they're very similar in some ways to each other and -- in the first medication is a good medication because it's very long acting you don't need to be taken one day a typical like all of their -- in the morning aren't in the evening. And it's a very effective medication and along for a long time you can that we know a lot about it how useful it is what -- to -- it works for an. And I -- them -- and sat back people can be allergic to it that I have rations. And people can develop. Some cosmetic changes come changes war pentagon. Actually a sort of stimulation could be growth of the -- that I actually can. Get very. Overgrown and sometimes. Overthrow the heat up about a percentage of people out of is that the overall the side effects are mostly cognitive side effect problems with thinking with memory trouble with being tired. That's a part of the most common in massacres and probably about 10% of people the other side effects I was talking about about -- And usually the long term -- that the medication. Now Carl."

" It was started. You know decreasing activity in the brain or seizures that your brain -- overactive in that the general cause right. Yeah as I can come from many different reasons but -- and happy that one area is that a communicating normally communicating too much like miss firing. And what the drugs to combat that they. -- to a smaller area of the or smaller hopefully a market not recognized at all or let go on and rent a and other ones -- Talk about Thailand and with another treatment procedures. The most common Medicaid and worldwide effort exactly an army attacked at all. And it chemically. It's actors and what you -- Thailand's thing. But it is different drugs out of a little bit different it doesn't cause the cosmetic changes. I can also us today and double B and -- on the doe two but the bulk of these drugs in general that tolerated very well. Tegra taught you to be taken returned today because it was short acting now they have long acting form the can be taken by that -- advantage. Note that you are on the medications can still experience seizures. It."

" He can't I'm. What we usually do as we start he allotment dose of the medication that we think will control seizures and the vast majority of people and then if the patient continues to have seizures will increase the data item until the interest Callaway or until the -- experience -- and at that point we'll know that we can't go up at a higher on the desk. And we change them to another medication."

" Now again once they reach that level of medication are -- taking for the rest of their lives. That's not a good question. Statistically most patients will spontaneously get better over -- over week probably but over years it may not take the medication. But there are a number of people need to continue taking it and there's an amber has reviewed and determined that things go. But the main thing is to keep the patient to victory. Now look -- that. Spoken about. The drugs but what about surgery to help alleviate seizures and we we have -- A model of a brain here. Nothing on my brain but that's what Carl what do you explain some of these surgeries and feel free to. You are are helpful model plug be an example -- somebody has epilepsy that they're having her current users they've -- I'm. A couple of medications that taken Thailand and to a point where they'd become tired and we know we can't take enough that the -- eaters and probably want to about the drugs have been tried. At that point we have to consider whether surgery may be an option for them. And in the best case it is. There is up to a 9% chance of her with epilepsy surgery -- very important to find that out. Ugly the best case in our care patients with temporal lobe epilepsy and that would be part of the brain. We called temporal -- sort of beside -- year you can imagine from here. This is. An important surgical type for a couple of reasons one is that -- very common in the most common type of partial -- Secondly. It's also attacked the -- your fractured and so a lot of these patients may naturally respond. And thirdly this area can generally be removed without any. -- that we can talent and how the article cut out part of your brain and not have any effect from it but we do very technical task of the nation's psychological ten and so forth. And most of the time they won't notice anything and if we need to in the -- before surgery. I had a minor now is that what surgery is all about taking part of the brain that may be the trouble spot. Right out you're not -- in -- and doing."

" Right we actually do a lot of texting before the -- person -- surgery to make sure that we have the exact area of the brain causing seizures. And make sure that that area of the brain has been involved in any other important function. I'm so there's a whole series of tests that patient would go through before they would be considered to be. A surgical candidate. As opposed to medications to suppress the symptoms of epilepsy. Surgery is secure and many of the patients who have had -- surgery. Don't need to take anti epileptic medications after the surgery -- that might."

" Got a problem not only are. They're not suffering adverse effects from hundreds we hope. But many patients are a lot better than maybe having -- all the time they're on I don't the medication. Once they have they're the surgery the bad part of the brain -- removed. And that the effect of the -- which -- affecting the entire brain. And the drugs which reflecting tiebreaker cost -- the connect with substantially better after surgery and we're almost out of time just to close what about. Lifestyle changes. Can you ever. Control seizures without the medication without surgery. Interesting and controversial question. -- there a lot of things that increase your risk of seizures. And simple ones sleep deprivation and alcoholic of people always worried about but that's not the only thing that caused cancer in general people a couple of need to do you maybe a little bit more careful about their lifestyle try to get enough sleep. Trying not to drink too much alcohol or certain recreational drugs. But they need to change their lifestyle commander -- that earlier in the goal of our treatment should be able to live a normal life."

" The final word what we usually acid -- should follow -- common -- safety measures -- they have. Frequent seizures not to go -- alone in the ocean but only in a pool with somebody supervising them more. Not to ride a bicycle traffic but unquiet. Read I'm things that are pretty common sense and keep them from injuring themselves that they should have a seizure but it is usually -- attention in a very frequent Asia if someone has -- seizures those changes may not even be necessary."

" That's all the time. We have for our topic apple in the treatment of epilepsy I want to thank might get doctor Carl. Brazil and doctor sue Hermann I'm David and Tom we'll see you next time."