Dr. Juan Ochoa, associate professor of neurology at the USA College of Medicine and medical director of the epilepsy monitoring unit (EMU) at USA, said that in patients with epilepsy, the electrical acivity of the brain goes out of control, causing recurring seizures.
"Patients with epilepsy have an area of the brain where the circuitry is damaged and disrupts the remaining network of the brain, causing it to shut down,” he said.
When this happens, Dr. Ochoa said patients become unresponsive and can display a number of behavior changes. “They may stare into space or they may have a full convulsion where the body becomes stiff and they start shaking,” he said. “Or the seizure may involve a little part of the brain that controls one arm and the arm will be jerking.”
Dr. Ochoa said that typically, a seizure will only last for about a minute. “The brain has a lot of safety mechanisms trying to bring down this abnormal electrical activity,” he said.
But, Dr. Ochoa said that one minute is enough to impair the person affected for that period of time.
“You could go a week, one month, three months, or even six months with no seizures and then have another seizure,” he said. “If someone is impaired one minute a month, you don’t know when that minute is going to be – you could be driving or swimming. You don’t want to live in fear that the minute will come at any time.”
Dr. Ochoa said that if you have seizures, you have approximately a 64 percent chance that you can completely control your seizures with one single epileptic medication. If someone has tried two medications and is still having seizures, he said, the chances of being controlled on the epileptic medications are very low.
Those patients may be referred for epilepsy surgery, an operation on the brain that can control seizures and ultimately improve quality of life.
In surgical candidates, the proper identification of a seizure focus is essential for optimal patient outcomes. “In treating patients, we must find the focus in the brain where the seizures originate and successfully remove the focus without causing undue brain damage,” he said.
The first step in treating someone with epilepsy surgery involves a pre-surgical evaluation, including a video and EEG monitoring at the epilepsy monitoring unit (EMU) at the USA Medical Center. At the EMU, seizures are monitored over a period of days – allowing them to be localized.
“We are the only comprehensive epilepsy program in the entire Gulf Coast region,” Dr. Ochoa said. “This treatment option can truly change the life of many patients suffering from epilepsy.”
Dr. Ochoa said about 72 percent of patients who have epilepsy surgery are seizure free for more than 10 years. In addition, if a patient doesn’t have a seizure for an entire year after the surgery, the chances that they will remain seizure free for 10 years would be up to 92 percent. “You cannot get these outcomes with medication,” Dr. Ochoa said. “This makes a difference in someone becoming completely independent.”
According to Dr. Ochoa, the future of epilepsy involves working on new ways to predict when the next seizure will occur. “This is important because when you know the seizure is going to happen, you can stop and lie down and wait for the seizure or you can do some type of intervention – such as taking additional medication,” he said. “It will completely change the way we treat seizures.”
In addition to seizure prediction, another procedure that is currently being researched is called deep brain simulation, where an electrode is implanted deep in the brain that is connected to a generator in your chest. With this device, you may be able to stimulate the brain at will.
“Every time the electrode predicts a seizure,” he said, “it will send a stimulus to the brain and disrupt it.”
Dr. Ochoa said this technology should become available within the next 5 to 10 years.
“The technology is already there, and it is being researched,” he said. “It’s a bright future for those who suffer from epilepsy.”
Dr. Ochoa recently gave an overview of epilepsy and new treatments available at the July Med School Café lecture. To view the lecture in its entirety, click here.
The Epilepsy Monitoring Unit (EMU) at the USA Medical Center is a collaborative environment that provides unique and highly specialized care with state-of-the-art technology for patients with epilepsy and other neurological conditions. To learn more about the EMU, click here.