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Epilepsy – Know the Facts about this Brain Disorder

Dr. Sofia Dobrin May 03, 2012 12:00 PM This chat has ended. Thank you for participating.
Angela (Moderator) - 11:46 AM:
Welcome! Today’s chat: Epilepsy – Know the Facts about this Brain Disorder will begin shortly. Please start submitting your questions and Sofia Dobrin, MD will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the, Epilepsy page on our website. We will do our best to answer all of your questions, but because this is such a popular chat, the physician may not be able to answer all of your questions in the time allowed. Your understanding is greatly appreciated.

Dave (Chicago, IL) - 12:01 PM:
My father was recently diagnosed with epilepsy. Is it a genetic condition? Am I at risk of getting it now too?

Dr. Sofia Dobrin (NorthShore):
There are many potential causes of epilpsy, genetic being one of them. Without knowing more details about your father's condition including specific seizure type or syndrome, EEG and imaging results, we cannot tell someone if they have a genetic epilepsy. There are specific syndromes, for example, childhood absence epilepsy and Dravet syndrome, that have been linked to specific genes, but other causes of epilepsy include structural-metabolic and a large category of "unknowns".

Ann Marie (Evanston, IL) - 12:06 PM:
I’ve heard that even if you have epilepsy you may still be able to drive a car. Is this true? How is that safe?

Dr. Sofia Dobrin (NorthShore):
It is true. Different states have different rules about driving. In Illinois, for instance, we are not a reportable state meaning a doctor is not required to report a diagnosis of epilepsy and any driving restriction is at the physician's discretion. With that said, the general rule is typically no driving for 6 months after a seizure, although some physicians limit it to only 3. It is felt that the highest risk of a recurrence for a seizure is in that time frame, but you are right, of course, as a seizure may occur at any time.

frank (chicago) - 12:10 PM:
What testing is done to determine if you have epilepsy? I know that an EEG is one method, but I’m wondering if others can also be used.

Dr. Sofia Dobrin (NorthShore):
Epilepsy is a clinical diagnosis, meaning the detailed history of the event - what happens before, during, and afterwards, especially given by a witness, makes a diagnosis. Basic blood work, brain imaging, and EEG can help exclude other causes and help confirm the diagnosis.

Liza (Evanston) - 12:15 PM:
My good friend had epilepsy about 15 years ago. She hasn’t had a single seizure since. Is this common? What are the chances that it will reoccur?

Dr. Sofia Dobrin (NorthShore):
It is possible for someone to "outgrow" epilepsy, so to speak. This is particularly true for certain childhood syndromes that typically remain in childhood and disappear in adolescence and adulthood. In general, the longer a person remains seizure-free, the lower the risk of recurrence. However, it is also true that some people may have seizures earlier in life, do very well for many years without any events, and then go on to have a recurrence years later. Unfortunately, seizures can be very unpredictable.

frank - 12:20 PM:
Thanks for your first answer. I've had a few seizures, but have never had a witness around. I remember the afterwards, but not much of the before. How necessary are these details before I see my doctor for other testing?

Dr. Sofia Dobrin (NorthShore):
You are very welcome. The diagnosis of seizures is certainly more difficult without any witnesses. However, you would be surprised by little details a doctor may bring out by asking the right questions of the person who is having an event which may help make a correct diagnosis. Additional testing, such as EEG, is also more useful in cases where we have less information. I would try to gather as much information from those around you as possible and even have contact information that a doctor can use, but I would not delay your evaluation and potential diagnosis and treatment without these details. Hope that helps.

Marie (Glenview) - 12:25 PM:
My mother recently suffered from a stroke. I’ve heard that she may be at a greater risk of being diagnosed with epilepsy. Is this true? Are there other pre-existing conditions that can cause epilepsy?

Dr. Sofia Dobrin (NorthShore):
I am sorry to hear about your mother and wish her the best. It is true that stroke can increase your risk of epilepsy, but moreso for certain types of strokes. Small strokes that affect deep parts of the brain likely have minimal if any incresed risk. Larger strokes further out in the brain, and especially bleeding strokes (brain hemorrhage), raise the risk more. Because epilepsy is caused by abnormal neuronal activity in the brain, anything that disrupts those brain neurons, such as congenital malformations, tumors, strokes, etc, can increase your risk for future epilepsy.

Catherine (Wilmette, IL) - 12:31 PM:
How do you know the difference between infrequent seizures and epilepsy?

Dr. Sofia Dobrin (NorthShore):
That's a very good question. The term epilepsy refers to recurrent unprovoked seizures. Once you have 2 seizures that are unprovoked, you meet the criteria for epilepsy. A person can have several seizures without a diagnosis of epilepsy if they are felt to be provoked by some other cause such as medication or drugs, alcohol withdrawal, certain metabolic abnormalities, and so on. The distinction is important as the implication and treatment is very different. We treat epilepsy with anticonvulsant medication, whereas in provoked seizures we try to eliminate the provoking cause.

Chris (Skokie) - 12:36 PM:
If someone is having a seizure near me, what can I do to help?

Dr. Sofia Dobrin (NorthShore):
That's an excellent question, and because 10% of the population will have a seizure at some point in their life, there's a good chance you may be in a position to help. First and foremost, try to stay calm. If the person is on the ground, make sure there is nothing near them with which they can harm themselves. You can gently place something soft like a jacket under their head if they are convulsing. Do NOT place anything in their mouth. Do NOT restrain them. It is best to turn them on their side, especially if they have secretions coming from their mouth, so that they do not choke. It is good to time a seizure. Most seizures resolve on their own in about 1-2 minutes, but when you see one, it may feel much, much longer. When the person awakes, reassure them and let them know what just happened. You can always call for help at any time.

Paige (Chicago) - 12:42 PM:
I suffer from seizures and am hoping to become pregnant in the near future. I have already been in conversation with my physician about this, but am wondering what I can do now to limit any risk. Will I have to discontinue my medication? Will my baby be affected if I am to have a seizure while pregnant?

Dr. Sofia Dobrin (NorthShore):
This is one of the most challenging areas of epilepsy. The good news is that over 90% of women with epilepsy have normal, healthy children. It is best to have your seizures under good control well before trying to get pregnant; I typically recommend a good year. In some cases it is possible to withdraw medication, but this, too, should be attempted well in advance. All women of childbearing age, and especially those with epilepsy should take at least 0.4mg of folic acid daily prior to conception and during pregnancy to decrease the risk of major congenital malformations. I recommend even higher, up to 4mg a day. Certain medications, such as valproate, also seem to raise the risk of malformations even higher, and are best avoided in this population. We always try to avoid seizures during pregnancy as there are some risks to the fetus, including lack of oxygen, so we often continue seizure medications with very close monitoring and in conjunction with a high risk OB.

Angela (Moderator) - 12:49 PM:
Thank you everyone for your great participation. The chat will be ending in approximately 10 minutes. Please submit your final questions.

Adrianne (Evanston) - 12:49 PM:
My daughter starts middle school next year and I am wondering what advance planning my husband and I should consider for educating her teachers on her condition. I know she worries about having a seizure in class and being picked on. What might you recommend? Should she talk to her teachers or is it best for us to do so?

Dr. Sofia Dobrin (NorthShore):
I would ask your daughter what she is most comfortable with, but I think having the parents involved is helpful. The Anita Kaufman Foundation has a wonderful middle school program where they educate students and teachers about epilepsy. I have done it myself in a few different classrooms and it has been a huge success. There is a lot of educational material available through different organizations and websites and the teachers could even incorporate some of this learning into their classroom. A health class is another wonderful way to discuss seizures, particularly from the standpoint of first aid. Purple Day is another program started in Canada to help educate schools about epilepsy. It can be implemented in your daughter's school as well. What I have found in doing these programs is that there are more people than you realize touched by this condition and people are much more understanding and supportive when they are educated.

Jennifer (Evanston) - 12:56 PM:
Do most seizures occur during the day or can they also occur in your sleep? My mom seems to suffer most from seizures in the evening. What safety precautions should I consider?

Dr. Sofia Dobrin (NorthShore):
Seizures can occur at any time, day or night. You could take a look at your mother's sleeping environment and make some adjustments such as a low bed if she has fallen off, soft rugs or carpeting, for example. There are certain devices available which you can find on the web including monitors and oxygen devices, however these have many associated problems including excess artifact which may cause more worry than reassurance to some.

Angela (Moderator) - 1:00 PM:
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