What is your occupation and position?
I am an Epileptologist. An epileptologist is a Neurologist, but one with a sub specialty in Epilepsy. I am a Professor of Neurology at the Hospital at the University of Pennsylvania’s Department of Neurology. I am also the Associate Director of the Epilepsy Center here.
What are some of your major professional accomplishments? For example: positions, publications or awards?
My main area of interest is the development of new drugs for use in people with epilepsy. I have edited two books and written many articles on the subject. I speak nationally and internationally on epilepsy. I am on the Board of Directors of the American Epilepsy Society; and the American Society of Experimental Neuro-Theraputics, and I am on the Professional Advisory Board of the Epilepsy Foundation. I also run a symposium on drug development every other year, which is nationally and internationally attended.
What are seizures?
Seizures are electrical disturbances in the brain that cause abnormalities or alterations in behavior. They are episodic and relatively short lived; usually lasting less than 3 minutes and people recover naturally from them. The problem that they cause is the alteration of behavior when they occur. When seizures occur recurrently the condition is called epilepsy.
The main reason why epileptic seizures are so disabling is because they are completely unpredictable in their occurrence. People also may not function properly for minutes to hours after a seizure, because the brain becomes exhausted from the electrical discharge. People with epilepsy may have many seizures per day, per week, per month, or per year so it can be a chronic condition. Seizures can be dangerous if they are not controlled, because the abnormal behavior during a seizure can cause people to fall down or hurt themselves.
How many different types of seizures are there, and what are the main types?
There are too many to name, but there are 4 main types that I will tell you about. The one that everybody is most familiar with, that is if you were to see someone having a seizure on TV or were to hear about it, it would probably be something called a Grand Mal seizure, also known as a convulsion. That involves falling to the ground, losing awareness, and having generalized shaking movements of the body followed by being in a very deep sleep.
The other very common type which people are much less aware of is something called a complex-partial seizure. In this type of seizure people don’t necessarily fall down. They may retain their posture. They become less aware or unaware of their surroundings and they again have unusual behaviors which consists of just staring into space, unusual movements, pulling at their clothes, wandering, even talking. They can look and feel very different. The exact behaviors and sensations during this kind of seizure depend on what part of the brain it starts in.
The next most common type, and a more common type among adolescents, would be something called a petit mal or absence seizure. This type involves just seconds worth of staring blankly and losing track of a conversation without falling to the ground. And finally another common type in adolescents would be something called a myoclonic seizure. During this type of seizure there is just a sudden jerk or multiple jerks of the body without loss of consciousness.
Can you give an example of an interesting case of a teenager with a seizure disorder?
I had a teenager who had seizures, which to the outside world looked like a blank stare and perhaps some vague movements of her hands. To her the seizure felt like she was a child in a past life. This was caused by an electrical disruption of brain activity, but that is the way it felt to her.
Seizures can be anything at all. I have certainly had teenagers who had seizures at school which is very upsetting because obviously if other teens see you have abnormal behaviors, or fall to the ground they will look at you differently. Sometimes you may even lose your ability to hold your urine during a seizure and that can be very upsetting and embarrassing.
The major message is, I’ve seen many people like that who got on the right medicine and we were able to stop the seizures and they were able to live completely normally after that. So it’s a question of having a doctor find the right medicine and getting the proper treatment.
What causes seizures, and who is likely to get them?
The causes of seizures are many and basically anything that can injure the brain can cause a seizure. A head injury, an infection of the brain that leaves a scar, an abnormal blood vessel in the brain, a tumor all of these things can cause a seizure. Interestingly enough, for about half the people who get seizures, nobody ever knows what the cause is. So sometimes the cause is unknown and people just start having seizures out of the blue. There is also a seizure disorder that is caused by having inherited an abnormal gene.
Anybody can get seizures; the likelihood of getting seizures is somewhat higher when you are a child or adolescent than when you are an adult.
As for how often people are likely to get seizures, about half a percent or 1 in every 200 people will have a seizure disorder in their life, so it is much more common than people realize. Probably every teenager who is in High School has many teenagers in that High School who has seizures and they don’t even know it. Unless they see the seizure itself, they are not going to know the person has a seizure disorder because they would behave completely normally.
How would you know if you had seizure?
It all depends on what kind of seizure. A type of seizure disorder that starts very commonly in the teenage years that people almost never recognize as a seizure is the one that I described as the myoclonic seizure. In the morning they wake up and they have these little quick jerks of their body. It may even be severe enough to make a coffee cup fly out of their hands or have a jerk that brings them to their knees. They either think “Oh, I’m either clumsy or this is just something everybody has” they don’t realize this is unusual and it is not until they have some other kind of seizure that in retrospect they realize that these little jerks are seizures. That’s one kind of seizure that people may not realize that they are having.
Otherwise people may have an unusual feeling that pops up out of nowhere and often that’s the way epilepsy starts or a seizure disorder starts. The seizures start small and they get bigger, so they may just have the warnings to begin with. The warnings would be an emotion or an unusual feeling that just pops up and you go “Oh, where did that come from?” People may have a warning that is like a feeling of fear or impending doom is a very common one. I’ve even had people who are doctors have this type of sensation and not realize it is a seizure problem starting. Obviously once somebody has a convulsion everybody knows it’s a seizure.
What tests are available for the diagnosis of seizure disorders?
The most common test that someone would have for the diagnosis of a seizure disorder is an Electroencephalogram (EEG), which measures the brain waves. It measures the ongoing electrical activity of the brain and if there is an electrical disturbance it will show up on the EEG.
The other most common test is the Magnetic Resonance Imaging (MRI), which is a picture of the brain so that if there is a scar, a tumor, or something that’s causing the seizures one can identify it on that test.
Then there are more sophisticated tests if need be, if those two do not reveal what is causing the seizures, or whether there is a seizure disorder at all.
What types of treatments are available for seizure disorders?
The most common treatment for seizure disorders consists of medicine, which people have to take once or twice a day. For the vast majority of people with seizure disorders taking medication once or twice a day will control the seizures.
There is a small group of people for whom medicine does not work to control the seizures, but if we know where the seizures are coming from it is even possible to remove that area of the brain with an operation to make to seizures stop. That would be in the more severe cases though. Actually I have had teenagers that have had the operation and afterwards they function completely normally. So if one can find where the seizures are coming from and do an operation, that can change someone from having a lifelong chronic disease to being completely normal.
In addition there are some other treatments. Probably the 3rd most common treatment is something called the Vagus Nerve Stimulator which is an implantable device like a pace maker. It goes off every 5 minutes and stimulates a nerve in the neck and that reduces seizure frequency or sometimes eliminates it. This would also be for the more severe cases where medication is not effective.
If I saw someone having a seizure what should I do?
If they were having the kind of seizure where they just stared or were having abnormal behavior, I would try to sit them down and try and prevent them from getting into a situation where they might hurt themselves and wait for the seizure to be over.
In the meantime you can look for a medic alert bracelet because a lot of people who have seizure disorders will be wearing one. If they have one it will tell you that the person has epilepsy or a seizure disorder and that this is not their first seizure and you can be a little calmer about it because this just may be something that happens to them. If you don’t see a medic alert bracelet then this may be the first seizure that they ever had, then you want to call an ambulance and have them taken to the hospital to see why this happened.
The more urgent situation would be if you would see someone having a convulsion, where they are falling down and they are shaking and unconscious. In that case there is a possibility that the saliva they produce during the seizure would go down into their lungs and cause pneumonia so the best thing is to turn them over onto their left side and put their head down. Make sure that they are in a position where they won’t hurt themselves, you can put a pillow or something soft under their head so they don’t hit their head on the ground and turn them onto their left side so that any saliva comes out rather than going back in.
Never put anything in their mouth. People have heard that you are supposed to put a spoon in somebody’s mouth to make them not swallow their tongue, but more likely they will crack their teeth on the spoon. People do bite their tongue during a seizure, you cannot avoid that. The seizure should stop within 3 minutes and if it does not then it’s a medical emergency and you have to get some kind of help there as quickly as possible and take them to the hospital.
A seizure that doesn’t end within 3 minutes can be very dangerous. It is a condition known as Status Epilepticus and people can have permanent damage from that.
If you know somebody with epilepsy that is a teenager, what can you do to help them?
If you know somebody with epilepsy in your class or school you should treat them the same way you treat everybody else. You should not think that they are in some way defective just because they have seizures. These people really need somebody to show them the same respect that they show anyone else.
Are there any effects that a seizure disorder has on education, and are there any special educational needs for someone with seizures?
Seizure disorders can happen because somebody has had an injury to the brain, so if it is a very localized injury for whatever reason then the majority of their brain should be functioning entirely normal and they can achieve any educational goal that everyone else can.
On the other hand if there has been more damage to the brain from whatever caused the seizure disorder and that is sometimes the case, then they may have educational problems and learning difficulties as well as the seizure disorder. They may go hand in hand so in that case they may need special educational services.
People who have severe handicaps can also have seizure disorders, but that’s because whatever injured their brain has done more than just produced seizures. In addition, on a rare circumstance people will have so many seizures that they cannot be in a regular school day, just because they would be disrupted so many times and they may need special educational services
Where would a teen go to get more information about seizure disorders?
The best place to go for more information on epilepsy would be the Epilepsy Foundation website www.efa.org they have information for people of all ages. The other thing that they can do is find their local epilepsy foundation services. A lot of times the local epilepsy foundations have teen support groups, for example the one here in Pennsylvania has a support group for teens.
This Interview was made possible by an educational grant from Ortho-McNeil Pharmaceutical, Inc.