Neurology Services at TGMC consists of a wide array of services from epilepsy monitoring, diagnostic test such as EEG’s and MRI’s and then as a last resort neurological and spinal surgeries. The most common condition and treatment for neurological services pertain to epilepsy.
Epilepsy is a complex and often misunderstood brain disorder and is one of the most common neurological diseases in the U.S. However, Terrebonne General Medical Center (TGMC) is dedicated to better understanding and treating this complex condition.
According to Neurologist Christopher Wright, M.D, epilepsy is “an ‘electrical storm’ of the brain which results in some clinical event that typically results in alteration of consciousness, loss of consciousness, or some other minor symptom. “ The symptoms of the storm are collectively called a seizure. One seizure does not mean a person has epilepsy. “Clearly not everyone who has a seizure will develop epilepsy,” said Wright. “The recurrence of seizures is the key and that will tell us whether or not to treat.”
Epilepsy is, however, even more complex. Seizures take many forms depending on where in the brain they start. They can last from a few seconds to a few minutes and cause many symptoms. Some people just seem to “zone out” or become distant. Others have convulsions or uncontrolled movements.
The importance of rapid diagnosis and treatment is imperative.
What to do after your first seizure
When a person has his or her first seizure, doctors usually take a wait and see approach. Some people may never have a second seizure. If they do, the patient may have to have an electroencephalogram (EEG) test. A neurologist can look for patterns on an EEG to help determine what kind of problem a patient may have.
Neurologist also rely on magnetic resonance imaging (MRI) tests. An EEG is a measurement of electrical activity of the brain. There are certain EEG findings that show up in patients with epilepsy and not in the general population. Patients may have to undergo the test several times to give doctors a clear picture of what is happening in the brain.
“About half of patients with epilepsy will have normal EEG's because brain waveforms can change with time. A repeat EEG may be necessary until I find an abnormality, or until I'm satisfied the EEG is in fact normal,” Wright said. He also relies on magnetic resonance imaging tests, commonly known as an MRI to look for lesions or abnormalities in the brain structure and thorough patient evaluation. Wright said it is important to understand what other factors may have caused a seizure, such as head injuries, infections or high fevers, even conditions such as hypoglycemia can cause seizure-like symptoms.
TGMC's Cutting-Edge Technology
“We are lucky at TGMC to have two beds in the main hospital that are wired for continuous video EEG monitoring. Many patients with diagnostic questions can be electively admitted to determine if they are having epileptic events or some other problem. It allows us to drive treatment aggressively and in the proper direction,” Wright explained. He went on to say, “If it is determined a particular patient is having epileptic seizures, we can begin therapy immediately. If there is some other issue besides epilepsy, we can do other appropriate diagnostic testing such as cardiac monitoring, blood glucose analysis and more that would be difficult outside the hospital.”
In addition, TGMC has a portable video EEG machine that can be used to test patients who are not admitted or used in other parts of the hospital like the pediatric unit. The intensive care unit also has a bed outfitted with an EEG video monitor.
Types of Epilepsy - Pinpointing the Problem
Once a diagnosis is confirmed, the real work begins the neurologist. The ‘brain storms’ of epilepsy can start in many parts of the brain. They can remain localized or spread to the entire brain. Treatment options will heavily depend on what kind of storm a particular patient has. There are two broad types of epilepsy: general or partial.
Generalizes vs. Partial Epilepsies:
“It is important to define generalized epilepsies versus partial epilepsies because the treatments are vastly different,” said Wright. In fact, he said some medications used to treat partial epilepsies can be dangerous for those with general epilepsy.
“Partial, or focal, epilepsies are defined by the location of seizure onset (inside the brain). It is important to get a clinical story from the patient to get clues as to the location,” he said. The seizures caused by this kind of epilepsy have some commonalities, according to Wright.
Temporal Lobe Epilepsy:
Temporal lobe epilepsy (TLE) patients often describe an aura that may have a wide range of clinical manifestations. This may include the feeling of deja vu, jamais vu, olfactory or gustatory (smell or taste) hallucinations, a feeling of anxiety/panic, or a rising feeling in the abdomen. The temporal lobe contains pathways for memory, emotion, smell and taste, so the clinical manifestations make sense.
Frontal Lobe Seizures:
Frontal lobe seizures typically happen at night and may result in bizarre stereotyped, repetitive behaviors with rapid return to consciousness. Parietal lobe seizures may begin with a painful sensation.
Occipital Lobe Epilepsy:
Occipital lobe epilepsies often begin with visual hallucinations followed by loss of consciousness. The most dramatic type of seizure is one which spreads to the whole brain, causing a generalized tonic-clonic event. The tonic phase means there is generalized stiffening of the extremities, followed by generalized rhythmic jerking of the extremities.
Partial-onset epilepsies are further defined by the International League Against Epilepsy (ILAE) classification system. Symptomatic partial epilepsies are defined by a lesion that can be seen on MRI, CT scan of the brain, or clinical examination. Scar tissue, cerebral atrophy, tumor or vascular anomalies would be typical examples. Idiopathic partial onset epilepsies are typically inherited and are known as epilepsy ‘syndromes’ as defined by certain clinical and EEG characteristics. Most of these are disorders of childhood that are outgrown by puberty. Cryptogenic partial onset epilepsies are those where a lesion should be present, but cannot be clearly seen on clinical examination or imaging studies.”
Generalized epilepsies involve electrical discharges affecting the whole brain simultaneously. They also exhibit common types of seizures. Absence seizures, which used to be called petit mal, result in brief 8-10 second episodes of behavioral arrest and associated staring. Myoclonic seizures result in brief lightning-like jerks of the arms, legs, or whole body. They most often occur at bedtime or upon waking in the morning. Drop attacks, sometimes known as astatic seizures, result in rapid loss of body tone and falls. Patients with this can also have tonic-clonic events.
According to the Epilepsy Foundation, drugs used to treat epilepsy are taken by mouth. Many have side effects and dosing can be complicated, so each patient must work with his or her doctor to come up with the most effective treatment plan. According to the Epilepsy Foundation, a majority of seizures which happen after diagnosis happen because the patient did not stick to his or her medicine schedule. Patients should never suddenly stop taking their medications.
Surgery can also be an option. If the seizures are originating in certain parts of the brain, doctors can carefully remove just a little bit of tissue to short-circuit the problem. This approach is usually taken only after someone has tried other kinds of treatment without success.
“Seventy percent of patients with temporal lobe epilepsy and a particular MRI/pathological finding called mesial temporal sclerosis (MTS), and unilateral temporal lobe seizure onset can be ‘cured’ of their seizures with temporal lobectomy. Patients often react with horror when this is discussed, but it with modern surgical techniques, recovery time is quick,” said Wright.
Other patients with refractory epilepsy may be candidates for other novel procedures such as vagal nerve stimulation (VNS). In VNS, doctors implant a device in a patient which sends electrical signals to the brain at regular intervals. If a patient feels a seizure starting, he or she can wave a magnet over the device to send extra impulses in an effort to head-off the seizure.
Leading a normal life
Epilepsy is one of the most common neurological diseases in the U.S. The Epilepsy Foundation says about 3 million Americans have the disorder. It is more common in children younger than 2 and in people older than 65. Wright explained this is about one or two percent of the population has epilepsy. So if there are 120-thousand residents in Terrebonne Parish, on average 1200 will have epilepsy. Wright believes that number may be even higher, but he is upbeat about treatment options and the quality of life his patients can enjoy. “Seventy percent of patients with epilepsy are normal functioning members of society. They work, drive, go to school, have families and are in general productive. “
For more information on Neurology Services at TGMC, please call 1-888-543-TGMC(8462).