Quelling the Storms of Seizures in People with Epilepsy
SAN FRANCISCO, Calif. – An electrical “storm” in the brain causes seizures in people with epilepsy, producing symptoms that may include lapses in consciousness, twitching or jerking movements, weakened or limp muscles, spasms, blurred vision, experiencing unusual smells or tastes, and changes in sensation or emotions.
Epilepsy—a neurological disorder caused by abnormal electrical activity in the brain—impacts almost 3.4 million nationwide.1 Despite advances in epilepsy treatment, approximately one-third of adults with the illness experience recurrent seizures.2
Epileptic seizures are generally categorized into three main groups: generalized (affecting both sides of the brain), focal (seizures that start in one area of the brain), and those that could start anywhere.
The stormy weather of seizures can clear with medications called anti-epileptic drugs (AEDs). AEDs can to stop seizures from occurring, but they do not always lead to a remission or cure epilepsy. With the right AEDs, up to 70% of people with the illness may remain seizure-free, and sometimes may “outgrow” seizures or go into remission. For other people whose seizures are uncontrolled with conventional AEDs, other treatments including surgery may be an option. Surgery may involve removing part of the brain that causes the seizures.
“Knowing where seizures start in the brain provides us clues into what occurs during a seizure, what other conditions or symptoms may be seen, how they may affect someone and, most importantly, what treatment may be best for that seizure type,” says Michael Chez, M.D., a pediatric neurologist and epileptologist, and Sacramento regional director of pediatric epilepsy and research at the Sutter Neuroscience Institute.
“Life without seizures and improved quality of life is what specialists aim to provide epilepsy patients, through a treatment plan personalized to their particular type of epilepsy and seizures,” says Dr. Chez.
Two Sutter hospitals, California Pacific Medical Center and Sutter Medical Center, Sacramento are renowned for providing patients specialized Level 4 epilepsy care— a designation by the National Association of Epilepsy Centers—guided by leading-edge research. Sutter researchers are uncovering new clues about how epilepsy develops and how it can be treated more effectively.
Sutter examining new ways to ‘map’ and monitor brain activity
Epilepsy is usually diagnosed with magnetic resonance imaging (MRI) and electroencephalogram (EEG) testing. Those techniques are also used to regularly monitor brain activity in people with the illness. Sutter researchers are studying the use of novel neuroimaging techniques to visualize and track the brain’s electrical activity in people with epilepsy.
For patients with refractory epilepsy (in whom medications are not adequately controlling seizures), a new “high-density” EEG machine is being tested to locate precisely where a patient’s seizures originate in the brain.
“Use of these high-density or high-array EEG machines can help dramatically accelerate research and patient care by identifying the focal point of a seizure,” says Kenneth Laxer, M.D. a researcher in the Sutter Pacific Epilepsy Program at Sutter’s California Pacific Medical Center (CPMC).
With more than 40 years’ experience in epilepsy research, Dr. Laxer is renowned for studying neuroimaging techniques including magnetic resonance spectroscopy for the evaluation and management of the illness. With high-density EEGs, the patient wears a net over their head, and the brain’s electrical activity is recorded from 250-plus electrodes. The recordings are combined with the patient’s own high-resolution MRI scan to help localize the seizure focus. Surgeons use these precise images to remove the section of the brain that’s causing the seizures.
“If we pinpoint that abnormal area, we can remove a smaller portion of the abnormal brain tissue and therefore decrease the risk of serious complications from the surgery,” says Dr. Laxer. He notes that 50-70% of patients who undergo a focal resection may become seizure free. “Most of these patients remain on seizure medications, frequently at reduced dosages; however, the goal of surgery is to bring the epilepsy under control—not to stop epilepsy medication use. Patients who undergo such surgeries typically experience improved quality of life.” Stay tuned later this month for Part 2 of this series on Sutter epilepsy research, which will include information on neuromodulation and anti-epileptic medications.
Stay tuned later this month for Part 2 of this series describing epilepsy research at Sutter.
References: 1. Centers for Disease Control and Prevention. https://www.cdc.gov/epilepsy/about/fast-facts.htm 2. Epilepsy Foundation. https://www.epilepsy.com/learn/types-seizures/refractory-seizures SAN .