Timely Diagnosis and Treatment of Epilepsy is Important to Control Seizures and to Address Comorbidities such as Depression, says Cleveland Clinic Expert
International Epilepsy Day Falls on Valentine’s Day this year as organizers ask the public to show some love for patients living with the disease, which is often misunderstood
Sunday, February 13, 2022, CLEVELAND: The challenges of epilepsy are not limited to seizures, and can include comorbidities such as depression and anxiety, and even social stigma. However, the good news is that most of these issues can be resolved if individuals seek and receive appropriate care timeously, and if myths surrounding the disease are dispelled, says an expert from a leading global healthcare system, Cleveland Clinic, ahead of World Epilepsy Day on February 14.
Around 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally, according to the World Health Organization. It is characterized by periodic and involuntary seizures, which can range from mild to severe. A seizure might present as prolonged staring and fast blinking; unusual behavior; a strong feeling of déjà vu; having rigid muscles, or overly relaxed muscles — or, more rarely — jerking of the arms, legs, or head; falling down and/or loss of consciousness.
“If seizures can be diagnosed and controlled in a timely manner through medication or surgery, epilepsy patients can lead a full, normal life. The challenge is that people may dismiss seizures, particularly when the symptoms are subtle, or patients may be misdiagnosed. Furthermore, even those individuals who are aware of their seizures may delay seeking care out of fear or because they do not understand the importance of immediate treatment,” says Imad Najm, MD, Director of the Charles Shor Epilepsy Center at the Cleveland Clinic Neurological Institute.
He adds that seizures are most often subtle, compared to convulsions, which is why they may be ignored or misdiagnosed. “In our discussions with families, for example, we have found some children were previously misdiagnosed with Attention Deficit Hyperactivity Disorder (ADHD) when they were actually experiencing epileptic ‘psychomotor seizures’ such as staring off into space, or exhibiting uncontrolled chewing movements or smacking their lips.”
Fortunately, diagnosing epilepsy can be fairly quick and easy, he says. The diagnosis can be done through an electroencephalogram (EEG) test that records the brain’s electrical activity, and the possible cause of the disease may be assessed through a magnetic resonance imaging (MRI) scan.
“It is very important that we diagnose epilepsy and treat it properly and quickly, because if we do not control the seizures, it will lead to deterioration in the patient’s health, including damage to the affected neurons in the brain. In addition, without treatment, people who have seizures can fall, drown, have accidental burns or even suffer sudden unexpected death,” says Dr. Najm.
SUDEP, which stands for ‘sudden unexpected death in epilepsy’, occurs in about 1 in 1,000 people with epilepsy every year. Dr. Najm says the only way to prevent SUDEP is to seek treatment to completely control seizures.
“Another important reason to seek treatment straight away is that controlling the symptoms can also help to alleviate comorbidities associated with epilepsy. For example, many patients with epilepsy have depression and/or anxiety, and we often find this will be resolved once the seizures are under control.”
There are several treatments available, according to Dr. Najm, and in many cases the earlier they are implemented, the more effective they will be.
“The first and the most important treatment is with medications. There are many different medications available and anti-seizure medications may lead to long lasting seizure control in about 70 percent of epilepsy patients. If seizures do not stop with medication(s), we may have to consider surgery. For that, we first need to identify the exact location of the disease in the brain and then operate on the patient,” he says.
He adds that patients are often initially hesitant to have epilepsy surgery as they don’t realize it could save their lives, but also because they mistakenly think it is a new procedure. However, he points out that epilepsy surgery has been a mainstream treatment since the 1970s, and the chances of becoming completely seizure free after surgery is higher than 50%. In addition, some patients may qualify for new minimally invasive surgical procedures such as laser ablation of small epileptic lesions in the brain through the use of small probes.
Looking ahead, Dr. Najm says research in the field is investigating highly promising treatment options including the use of less invasive procedures such as focused ultrasound therapy, interneuron stem cells implantation, and gene therapy.
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About Cleveland Clinic
Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 67,554 employees worldwide are more than 4,520 salaried physicians and researchers, and 17,000 registered nurses and advanced practice providers, representing 140 medical specialties and subspecialties. Cleveland Clinic is a 6,026-bed health system that includes a 165-acre main campus near downtown Cleveland, 19 hospitals, more than 220 outpatient facilities, and locations in southeast Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2019, there were 9.8 million total outpatient visits, 309,000 hospital admissions and observations, and 255,000 surgical cases throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries. Visit us at clevelandclinic.org. Follow us at twitter.com/ClevelandClinic. News and resources available at newsroom.clevelandclinic.org.
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