Chaten Malpe, MD – Neurologist
Epilepsy is a neurological condition characterized by recurrent seizures that are caused by abnormal brain activity. Our epilepsy center offers a monitoring unit and specialized treatment programs for adult patients with epilepsy.
Cleveland_Clinic_Host: Today's Live Web Chat, "Epilepsy" with Chaten Malpe, MD and Adriana Rodriguez, MD will begin at 12 noon EST. Please submit your questions by typing them below and then clicking 'Ask'.
Cleveland_Clinic_Host: Welcome to our Online Health Chat "Epilepsy" with Chaten Malpe, MD and Adriana Rodriguez, MD. We are thrilled to have him here today for this chat. Let’s start with the questions.
RaffTaff: Exactly what is a seizure? How can you be prepared when a friend or family member starts to convulse?
Adriana_Rodriguez_MD: A seizure is caused by abnormal neuronal discharges in the brain. It can have many different clinical manifestations. When you see someone having a seizure: Stay calm. Call 911 if this is that person's first seizure or is pregnant. Time the seizure - if the seizure is lasting longer than 3 minutes, call 911. If the person is standing, prevent them from falling by helping them gently onto the floor. Move the person away from furniture or other objects that might injure the person. If the person is having a convulsive seizure and he/she is on the ground, position him/her on their side so that saliva and vomit can leak out of the mouth rather than be swallowed or aspirated. Do not put anything, including the fingers, into the person's mouth while they are seizing - as you could chip their tooth or have your finger bitten. Do not hold the person down.
Carrie: My father had complex partial temporal lobe seizures starting at about the age of 80 and one of his four siblings had seizures starting at about the age of 40, both without known causes. None of their children (now age 40-60) have had seizures yet. Are we at greater risk of developing them and is there anything we can do to prevent them?
Adriana_Rodriguez_MD: It used to be that temporal lobe epilepsies were considered acquired. Now we know that there are some genetic temporal lobe epilepsy syndromes. Most aging, as in the case of your father and uncle is normal. Its inheritance pattern is thought to be autosomal dominant, but with incomplete penetrance. There is really nothing you can do to prevent them and genetic testing is not routine at this time.
Djl578: Why is there a correlation between epilepsy and behavioral issues in children?
Chaten_Malpe_MD: Behavioral issues may be related to medication side effects, and some antiepileptic medications are more likely to cause mood-related symptoms (e.g.: levetiracetam). Also, in the postictal state (immediately after a seizure) children can have transient confusion, disorientation, and even dysphoria, which can contribute to behavior. Depression and anxiety are common co-morbidities in patients with epilepsy. These are just some considerations to mention.
Gabbygives4epilepsy: Can being on Depakote for a long period of time harm you?
Adriana_Rodriguez_MD: Depakote is a broad spectrum AED - excellent for primary generalized epilepsies. People are often on it for years without any particular problems. Common side effects include weight gain, hair loss, and acne. We monitor basic lab-work on a yearly basis, including CBC and CMP (liver function tests). Long-term use has been associated with osteoporosis and you should check a dexa scan.
Gabbygives4epilepsy: The Diastat that I currently have is expired (last month) would it still work if given, or shelf life is accurate?
Adriana_Rodriguez_MD: Usually, medications are considered safe to take even if expired a few months. This is often a problem we run into with Diastat, since it is a rescue medication, infrequently used. I usually write a script for monthly refills.
RaffTaff: How do you treat it? Is it curable, or just treatable with medications?
Chaten_Malpe_MD: Epilepsy is often treated with antiepileptic medications, and the specific medication chosen often depends on the type of seizures a patient has. Some epileptic syndromes occur in childhood only, and go into "remission" at a certain age. In patients with focal epilepsy (in which seizures begin in a focal area of the brain), antiepileptic medication is effective in about 70% of patients. In the remaining 30% of patients, in whom medications are not as effective, epilepsy surgery may be an option in carefully selected patients.
Lynn359: Are there any known connections between hormones and have a seizure?
Chaten_Malpe_MD: In women with epilepsy, circulating levels of estrogen and progesterone during the menstrual cycle may contribute to seizure activity. Estrogen is considered to have a proconvulsant effect, while progesterone is considered to have an anticonvulsant effect. Surges in these hormone levels during the menstrual cycle can affect seizure control and seizure frequency in women with epilepsy.
ChrisT53: What is the difference between complex partial and tonic-clonic seizures?
Adriana_Rodriguez_MD: Briefly, you can categorize seizure into focal or generalized. Focal implies that the seizures are coming from one particularly area of the brain. Generalized implies that the seizure activity is diffuse, coming from "all" regions of the brain.
Adriana_Rodriguez_MD: Within the focal epilepsies you can have simple or complex partial seizures. Simple focal/partial seizures imply that there is no alteration of consciousness or awareness. Complex partial seizures imply that there is some alteration to your awareness or consciousness. Both of these seizure types can "spread" to other areas of your brain and appear as convulsive or generalized tonic-clonic seizures. Tonic-clonic seizures involve an increase in tone to the extremities, followed by a rhythmic jerking of the extremities. These seizures usually are associated with a loss of consciousness.
Djl578: My son's epilepsy has had an effect on his memory and learning. Is there anything we can do to improve these areas?
Chaten_Malpe_MD: I feel the best approach would be optimal seizure control (seizure freedom if possible), in addition to minimizing the number of antiepileptic medications. Repeated seizures can affect hippocampal function over time (the area in the brain important in memory and learning), and polypharmacy can have additive effects on cognitive function.
Gabbygives4epilepsy: My daughter is 6 yrs old, and she was diagnosed on June 6, 2010. She has been seizure free since July 2011. What are the chances she could out grow epilepsy?
Adriana_Rodriguez_MD: This all depends on what type of epilepsy your daughter has. Some are referred to as benign childhood epilepsies and may not even require AEDs. Others will persist. Undergoing an EEG, sometimes a prolonged EEG, would be helpful.
Bdawson: Is it safe to do everyday activities and even play sports if you have been diagnosed with epilepsy?
Adriana_Rodriguez_MD: Let me preface this answer by saying that millions of people with epilepsy lead completely normal lives. What matters is how well controlled your epilepsy is. If you are not having seizures then it is safe to engage in everyday activities and you can participate in sports. Seizure precautions apply, in regards to, for example swimming. Before participating in any activity, stop and think what could happen to you or those around you, if you had a seizure. With swimming in a pool, you want someone with you. When swimming in murky water, you need someone with you and a life jacket. If your epilepsy is uncontrolled, you would have to discuss with your physician on an individual basis.
Cleveland_Clinic_Host: I am sorry to say that our time with Chaten Malpe, MD and Adriana Rodriguez, MD is now over. Thank you again, Doctors, for taking the time to answer our questions today about epilepsy. To make an appointment with any of the specialists in our Epilepsy Center or any other specialists at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at vanity clevelandclinicflorida.org.
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