Six fellowship-trained neurologists from the Epilepsy Center at the University of Cincinnati Gardner Neuroscience Institute recently shared their expertise at the center’s annual symposium for patients at the Daniel Drake Center for Post-Acute Care. The epileptologists were:
• Michael Privitera, MD, director of the UC Epilepsy Center
• David Ficker, MD, associate director of the UC Epilepsy Center
• Mark Callow, MD
• Jennifer Cavitt, MD
• Heather McKee, MD
• Brian Moseley, MD
Here are 20 facts drawn from their presentations about this common neurological condition.
1. A person has epilepsy if he or she experiences a seizure and is found upon evaluation to be at significant risk of having a second seizure.
2. There are two basic types of seizures, focal and generalized. Focal seizures start in one specific spot, while generalized seizures start in all areas of the brain.
3. A generalized, tonic-clonic seizure is also sometimes called a grand mal seizure.
4. Up to 3 million Americans have epilepsy, and there are 70,000 to 130,000 new cases in the United States each year.
5. The risk of developing epilepsy peaks in childhood and again in the elderly.
6. Thirty percent of epilepsy cases have a known cause, such as a tumor, a prior brain infection, a vascular abnormality or trauma. Seventy percent of epilepsy cases have no known cause.
7. There are 23 drugs available to treat epilepsy. The newest is Brivaracetam, approved in 2016.
8. Epidiolex, a new drug made from purified cannabidiol, may be approved for the treatment of severe forms of epilepsy as early as 2018.
9. Medications can completely control seizures in 60 to 70 percent of people who take them.
10. Although old epilepsy drugs work, newer drugs have new mechanisms of action and have fewer side effects and fewer interactions with other medications. As a result, patients require fewer labs to monitor liver and kidney function.
11. Among people diagnosed with epilepsy, 47 percent will be seizure-free after being treated with their first medication. Another 13 percent will be seizure-free after being prescribed a second medication. A third medication will work for only 1 percent of patients, while a combination of two medications will work for 3 percent.
12. Patients who still have seizures after trying two different medications should be seen at a comprehensive epilepsy center that has epilepsy experts and advanced technologies to accurately diagnose and treat epilepsy.
13. People whose seizures are not controlled by medications are said to have refractory epilepsy. Epilepsy specialists may treat them with surgery, implanted devices or a strict dietary regimen.
14. There are more than one million women of reproductive age with epilepsy in the United States. They give birth to 24,000 babies each year.
15. The risk of birth defects is 1 to 2 percent in the general population, compared to 2 to 9 percent for pregnant women who have epilepsy. The risk may be higher for pregnant women who are on multiple anti-epileptic medications.
16. The risk of birth defects is 19 percent for pregnant women with epilepsy who take a combination of antiepileptic drugs when that combination includes valproate.
17. There are risks to having continued seizures. They include the risk of injury, cognitive decline, social and psychological impairment and SUDEP (sudden unexplained death in epilepsy). Doctors do not know what causes SUDEP.
18. The American Academy of Neurology recommends surgery as the most effective treatment for patients with refractory epilepsy whose seizures begin in the temporal lobe. In patients whose seizure focus can be removed, seven in 10 can expect to be seizure-free.
19. Among people with epilepsy, up to 30 to 35 percent have depression (compared to 6 to 7 percent in the general population) and from 25 to 50 percent have anxiety (compared to 18 percent of the general population).
20. Depression and anxiety can be effectively treated with medications in most people with epilepsy, without significant risk of increasing seizures.