What is epilepsy
Epilepsy occurs as a result of abnormal electrical activity originating in the brain. Brain cells communicate by sending electrical signals in an orderly pattern. Sometimes the brain cells communicate in an abnormal or uncontrolled manner leading to a seizure or epileptic episode.
This is where the work of a neurologist comes in. If you suffer from an epileptic seizure, you may start behaving differently. Or you may feel a brief loss of awareness. Sometimes patients would experience convulsions or even unconsciousness.
Anyone of us can have a seizure in certain circumstances - about one person in 20 has a seizure at some point in their life. However, we would only call it epilepsy only if you are likely to have recurring seizures. About one person in 200 has epilepsy, making it quite a common condition.
So how can a neurologist like myself help you with the treatment of epilepsy? Generally, epilepsy is successfully treated with antiepileptic medications. About 60-70% of people with epilepsy will be able to control their seizures by simply taking medication. The remaining 30-40% may continue to have seizures but they would occur less frequently.
There are many different antiepileptic medications. The choice of antiepileptic medication depends on a number of factors including:
- your type of seizure or epilepsy
- your age
- your gender
- your other medical conditions or general health
- your informed opinion
This is where, in my work as a neurologist in Perth, I take the time to go over your specific situation and your medical history. It’s essential to look at the bigger picture and to listen to your own story and your experiences, before making decisions about medication.
When you start taking medication to control your epilepsy symptoms, and you still have seizures, we may consider other treatment options. They can include vagus nerve stimulation or surgery.
Types of epilepsy seizures
Part of my role as your neurologist is to help you understand the type of seizures that you may be experiencing. They fall into two main groups. One group of seizures begins in a particular spot in the brain (focal seizures), while the other group starts in large areas of the brain at the same time (generalised seizures).
FOCAL SEIZURES - there are two forms:
- Focal seizures without loss of consciousness
- Alterations to sense of taste, smell, sight, hearing or touch
- Tingling and twitching of limbs
- Focal seizures with loss of consciousness
- Staring blankly into space
- Performing repetitive movements
- Confusion once the seizure is over
GENERALISED SEIZURES - there are six types:
- Tonic-clonic seizures - used to be called “grand mal seizures” (French for ‘big pain’)
- Loss of consciousness
- Stiffening of body
- Shaking of limbs
- Loss of bladder control
- Tongue biting
- Absence seizures - used to be called “petit mal seizures”(French for ‘small pain’).
- Blank stare and a brief duration of loss of awareness. There may also be repetitive movements like lip smacking or blinking.
- Myoclonic seizures
- Tonic seizures
- Atonic seizures
- Clonic seizures
Perth Epilepsy Specialist
When to see an epilepsy specialist or neurologist?
If you suspect you have had a seizure, I recommend that you see your doctor as soon as possible. A seizure can be a symptom of a serious medical issue. In order to diagnose epilepsy, your GP will most likely refer you to a neurologist. And the role of the neurologist is then to confirm the diagnosis of epilepsy, and to discuss which treatment is most appropriate for your situation.
You may wonder if there is a cure for epilepsy. The straightforward answer is no, at this stage there is no known cure for the condition. But research and the advancements in modern medicine allow us to work out the best possible treatment. And that, in most patients, leads to dramatic improvements, and to a better quality of life.
On the other hand, not seeking help or not having access to a qualified neurologist, may mean that your epilepsy is left undiagnosed, untreated, and causes complications. During a seizure, an epilepsy patient can sustain serious injuries. In other cases, we have seen that uncontrolled or prolonged seizures lead to brain damage. As we have established, epilepsy is all about abnormal electric activity in the brain, and if this abnormal situation is not treated, it causes abnormal functioning of the brain. Experts also agree that epilepsy may increase the risk of sudden unexplained death.
Epilepsy Specialist Perth
What are the causes of epilepsy?
At my practice in Perth I often get questions about the exact cause of epilepsy as a condition. Through scientific research in this area, we have learned that there are quite a few main causes:
- Genetic predisposition: something in your genes that makes certain people more prone to developing the symptoms.
- Developmental disorders of the brain: a disorder in the early stages of life, causing this abnormal electrical activity.
- Perinatal brain injury: a lack of oxygen at birth can cause this type of brain damage.
- Febrile convulsions in infancy
- Infectious diseases of the brain: infections such as meningitis or encephalitis
- Traumatic brain injury: brain damage caused by an accident, for example
- Scarring on the brain after a brain injury (post-traumatic epilepsy)
- Stroke or other vascular diseases
- Brain tumour
- Neurodegenerative disorders such as Alzheimer’s disease
Part of my role is to create clarity around the exact cause of your epilepsy. And another role your neurologist plays, is to create clarity around the triggers. They are not the direct cause, but they are specific situations that initiate a seizure.
For example: you may be tired, or suffer from some form of sleep deprivation. You may be stressed. Another trigger could be the use of alcohol. Or, simply the fact that you have been given epilepsy medication and forgot to take it.
What to expect from an epilepsy diagnosis?
To assess if you suffer from epilepsy, at my practice in Mt Lawley Perth, I may recommend one or several of the common neurological tests:
- Neurological examination
- Blood tests
- Video-EEG monitoring
- CT Scan
- Cranial MRI
The tests I recommend will be based on your personal situation. And the next important step is to make sure that you get a clear explanation of what the test has told us, so you are clear about the results and about your diagnosis.
What to expect from an epilepsy diagnosis?
Medication for epilepsy is often the recommended first line of treatment. As a Perth based neurologist, I can help you with finding the best antiepileptic medication for your type of epilepsy. The treatment of seizures depends on an accurate diagnosis. I will discuss with you the various medication options, their side-effects and what is relevant in your particular circumstances. “No seizures and no side-effects” is my goal for any epilepsy treatment. While this is not always possible, we will keep striving to get the best seizure control possible.
Epilepsy surgery is considered when focal onset seizures are particularly dangerous or debilitating, occurring many times a day and not responsive to anti-epileptic medications. Surgery is also performed if the specific cause of the epilepsy requires surgery, for example in case of a brain tumour. Epilepsy surgery requires extensive pre-surgical work-up. I will perform the initial investigations and direct you to a centre with the best expertise in epilepsy surgery.
I build on 20 years of experience as a neurologist, with a particular interest in epilepsy diagnosis and treatment. My commitment is to give you clarity about the tests that you may need, and clear communication to make sure that you fully understand the test results. Working in the complex area that is the human brain, I believe that you deserve to understand what is going on in that part of your body, and you deserve to have access to the most suitable and most personalised type of epilepsy treatment.