Staying ahead of epilepsy
Posted on 31 October 2016
Epilepsy is in fact a group of conditions better thought of collectively as the epilepsies, explains Dr James Butler, a neurologist at Mediclinic Constantiaberg. Dr Butler stays at the forefront of the latest research and, together with a team of healthcare providers specialising in the epilepsies, ensures that patients receive the best care available.
‘There are many forms of epilepsy, many different causes and just as many ways that seizures manifest, so it is a bit simplistic to think of it as a single condition,’ says Dr Butler.
‘The current definition of so-called epilepsy is that you have more than one seizure, more than 24 hours apart and that they are not provoked. It also presents on a very broad spectrum: some people will have only a few seizures in a lifetime and some will have 200 in a day.’
‘When we think about the causes of epilepsy, we have to go through a list of questions in the patient’s history, including the early development of the brain, previous infections or injuries,’ he says.
The diagnosis of epilepsy is also based on the history of seizures from both the patient and people who have witnessed these seizures, according to Dr Butler. He adds that the advent of smartphones has been particularly useful because they can now ask friends and family members to record the seizures.
In order to arrive at a more confident diagnosis, Dr Butler explains that an EEG (electroencephalogram) measures the brain’s electrical brain activity. There are waves on the EEG that occur when a person is not having seizures that are still strongly predictive of a form of epilepsy. If there are any doubts about the diagnosis, neurologists will bring patients into the hospital and record their seizures. This usually allows them to arrive at a very confident diagnosis.
‘If the cause is still unclear, we will do an MRI scan, and often we will see “birthmarks” on the brain, scar tissues, clumps of blood vessels, old healed injuries, areas of calcification from previous infections and a host of other things that go awry in the brain,’ says Dr Butler.
Watch epilepsy patient Helena Nöthling explain how the world-class care she receives at Mediclinic makes all the difference.
The treatment options
Dr Butler offers the following statistics, revealing how often treatment can be effective for epilepsy:
• Approximately 1 in 10 people across the globe will have a seizure in their life.
• Approximately 1 in 30 people will have more than one seizure in their life.
• Approximately two-thirds of epileptic patients will have their condition well controlled on anti-epileptic drugs.
• Half of these patients will be able to be weaned off medication over time.
• This leaves a third of people who do not respond adequately to anti-epileptic drugs, and need alternative treatment.
Once it’s clear that a patient is not responding to anti-epileptic medication, a neurologist will then consider surgery as an alternative.
‘There are two other forms of treatment that we sometimes employ in cases where medication is ineffective and surgery is inappropriate: the ketogenic diet or the modified Atkin’s diet.’
These diets force the body to burn fats instead of carbohydrates. The liver converts the fat into ketone bodies, which replace glucose as an energy source in the brain. This state of ketosis can reduce the frequency of seizures.
Dr Butler explains that new epilepsy treatments are constantly being researched, and are as wide-ranging as the epilepsies themselves. Some examples of these treatments include a study on CBD (cannabis) oil and investigating implants over the surface of the brain.
The implanted electrodes would have a system to recognise when a seizure is going to occur and respond with electrical stimulation. ‘This is a new area of research which may offer some promise to people who don’t respond to medication or surgery,’ he says.