Ask the Experts
What is the difference between a seizure and epilepsy?
Dr. Chesler: Seizures happen when your nerve cells fire more rapidly and with less control than usual, affecting how you act or feel. These range from a brief lapse of conscious activity to a full loss of consciousness with the potential for falling, shaking and difficulty breathing. Epilepsy refers to a brain disorder resulting in multiple seizures.
Does having a seizure mean you have epilepsy?
Dr. Spiegel: No, seizures are not always related to epilepsy. They can be a symptom of a disruption of brain function, such as from a high fever, a head injury or lack of oxygen. Ten percent of Americans will experience a seizure at least once in their lifetime; the highest incidence occurring under the age of two and over the age of 65.
What causes epilepsy?
Dr. Spiegel: Epilepsy may be related to genetic factors, structural abnormalities of the brain or brain metabolism, and can begin in infancy and childhood. It can also occur due to infection of the brain, trauma, tumors or stroke. Sometimes, no clear cause is found on initial testing, and the neurologist has to look further.
How is epilepsy treated?
Dr. Spiegel: For most patients, antiepilepsy drugs are helpful in controlling the seizures while minimizing medication side effects. Diet can also be a treatment for some, specifically the ketogenic diet or a modified Atkins diet. The diets should be prescribed by a physician and carefully monitored by a dietitian.
Dr. Chesler: When anti-epilepsy medications and dietary modifications fail, surgery may be recommended for patients whose seizures are associated with structural brain abnormalities, such as brain tumors, malformations of blood vessels and damage related to strokes. There are basically three types of seizure surgery — the surgical removal (resection) of the lesion that is causing the seizure, ablation (using heat or ultrasound energy to burn out the lesion), and electronic modulation that delivers current to the brain before a seizure happens to control or reduce the seizure’s effect. All of these surgeries can be performed at Stony Brook.
How controllable is epilepsy?
Dr. Spiegel: Most people with epilepsy do very well when properly diagnosed and treated. Nationally, two out of three people with epilepsy can be expected to enter remission; that is, five or more years free of seizures while using medication.
What distinguishes Stony Brook’s approach?
Dr. Spiegel: In March, the National Association of Epilepsy Centers designated Stony Brook as a Level 4 Epilepsy Center. To attain this level, an epilepsy center must have the professional expertise and facilities to provide the highest level of medical and surgical evaluation and treatment for patients with complex epilepsy. Patients who have persistent, recurrent seizures or those with an unconfirmed seizure diagnosis can benefit from the advanced services and technology we offer. This includes access to positron emission tomography/magnetic resonance imaging (PET/ MRI), used to detect brain lesions that may not have been detected previously. Seizures and epilepsy can involve and affect multiple body systems, and having a team of specialists readily available helps achieve more effective treatment plans. Our team includes renowned adult and pediatric epileptologists such as Dr. Mary Andriola, neuropsychologists, radiologists, and of course neurosurgeons like Dr. Chesler, who are experts in the latest surgical techniques for epilepsy. Our center also features a seven-bed dedicated video-EEG epilepsy monitoring unit with 24/7 observation staff and a portable video-EEG epilepsy monitoring system that can be set up anywhere in the hospital for patients who may be experiencing seizures. We also have access to clinical trials of new treatments. And our patients and their families benefit from our support and education services, including a nurse practitioner and a support group co-run by one of our physicians and a social worker from the Epilepsy Foundation.
For more information about Stony Brook Comprehensive Epilepsy Center, visit neuro.stonybrookmedicine.edu.
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