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Expert Answers to Epilepsy Treatment FAQs


Imad Najm, MD

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Epilepsy can be a devastating diagnosis for patients and their families, but with the right treatment, epilepsy can be controlled. Neurologist Imad Najm, MD, answers the most common questions he gets from patients and their families.  

Q: How is epilepsy defined and definitively diagnosed?

A: Epilepsy is a neurological disorder characterized by sudden, recurrent seizures. Once a seizure occurs at least twice, or if there is a known lesion on the brain, then epilepsy is suspected, but not definitively diagnosed.

Epilepsy is not truly confirmed until we get a recording of the brain waves during a seizure using an electroencephalogram (EEG), a test that detects electrical activity in your brain. When we suspect epilepsy in patients due to seizures but they don't respond to medication, we monitor them at the hospital for up to five days, attempting to capture a seizure with an EEG. The EEG will remain completely normal if it is a nonepileptic seizure.

2.     Q: What causes epilepsy?

A: There are multiple potential causes for epilepsy, but I like to categorize them as one of three things: genetic, congenital or acquired.

First, genetic is when there’s a particular problem with one of the several genes that leads to epilepsy.

Second is congenital, which means we have a predisposition to getting the disease due to brain malformations that we are born with, also known as cortical dysplasia.

Third, there is acquired epilepsy, which is caused by something that happened to us after birth, such as an infection in the brain like encephalitis or meningitis, an abscess or tumor, or a traumatic brain injury from a car accident or other head wound.

3.     Q: How is epilepsy treated?

A: The main treatment, which is successful in controlling seizures in up to 70% of patients, is an antiepileptic seizure medication. Brain surgery is a widely accepted second option for those patients whose seizures continue to happen after two or more antiepileptic medications have been tried, and the diagnosis is confirmed as epilepsy by an EEG. In that case, we’ll identify which area of the brain is causing the seizures using Magnetic Resonance Imaging (MRI), and find out if it’s safe for us to go in and remove that particular area. While brain surgery sounds very high risk, epilepsy surgery is probably one of the safest that we do in neurology, with a risk of less than 1% for any complication. And 70 to 80% of patients who receive epilepsy surgery remain seizure-free.

Other less common and less effective treatments include responsive nerve stimulation and vagus nerve stimulation. These treatments are done by devices that stimulate nerves in the body or the brain itself. Ketogenic diets, which are extremely high-fat diets, are used rarely to treat children with highly severe cases of epilepsy, because ketones in the body can sometimes decrease the risk of seizures. It’s not used very often in older adults, primarily because that type of diet can have negative health effects on an adult’s body.  

4.     Q: What are the different types and levels of severity in epilepsy?

A: Epilepsy can be divided into focal epilepsy and generalized epilepsy.

Focal epilepsy is epilepsy that leads to seizures that are generated in a one area of the brain, usually the cortex or outer layer. Generalized epilepsy usually happens more often in children, and typically the start or the pacemaker of the seizure is deep inside the brain in an area called the thalamus.

THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.

Imad Najm, MD

Imad Najm, MD, is Director of Cleveland Clinic's Epilepsy Center at the Cleveland Clinic Neurological Institute and has over 22 years experience in clinical and basic mechanisms of epilepsy. View his Healthgrades profile >

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Publish Date: Dec 18, 2015

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