Epilepsy is a generic term used to define a family of seizure disorders affecting more than three million people in the U.S. The Iowa Comprehensive Epilepsy Program (ICEP) provides specialty services to patients who have epilepsy and related conditions. Mark Granner, MD, director of the Iowa Comprehensive Epilepsy Program at University of Iowa Hospitals and Clinics, talks about Iowa's comprehensive program:
What causes epilepsy?
Epilepsy is caused by a number of different things. Some people are born with the tendency to have it. That is it's genetically based and they may start having seizures as a child or teenager. But more people acquire epilepsy at any age of life—childhood, early adult years, later adult years—through a variety of brain injuries like head trauma, tumor, stroke, brain infection. Basically anything that can injure the brain can potentially cause seizures and epilepsy.
What is the difference between seizures and epilepsy?
The seizure is an episode that the patient either experiences or that people see them having. In America, about 10 percent of all of us will have at least one seizure during our life, but most of these are caused by something else going on in the body, such as low blood sugar, reaction to medication; illness that's severe enough to cause somebody to be hospitalized, for example. So not all seizures come from epilepsy.
Epilepsy is the tendency to have seizures that are recurrent, meaning the tendency to have more than one in your life, and are unprovoked—meaning there isn't some other obvious cause or other illness going on in the body. Epilepsy is a brain condition where the brain contains the risk of having seizure all on its own.
How is epilepsy diagnosed?
Some people come into the ICEP clinic and we ask them about the episode. We ask them about risk factors, such as fever, convulsions early in life, brain infections, brain injury, and family history of seizures. We ask about the episodes themselves, and the patient may not know about that. They may be unaware of their events, so it's very important to get information from an eyewitness such as a friend or family member about how long they last, what they look like, and what happens before, during, and afterwards.
We supplement this information with testing like an EEG, (electroencephalograph) a brainwave test where we measure irritable brainwave activity. We also use imaging studies such as MRI scans. We put those things together and try to come up with a diagnosis.
Can people with epilepsy prevent seizures?
I think the best thing people with epilepsy can do is maintain regular follow-up with their doctor, take their medicine on schedule, and report any new symptoms or any ongoing concerns about seizures. It's probably true that for some people, they can reduce their risk of having a seizure by attending to regular sleep, eating meals on time, eating healthy, avoiding too much alcohol, avoiding too much caffeine, and seeing their doctor when sick. So there are some things that people can themselves control.
How is epilepsy treated at the Iowa Comprehensive Epilepsy Program?
The first thing is to make the diagnosis with as much accuracy as possible. Epilepsy involves seizures of two basic sorts. Some that come from the entire brain called generalized seizures, and some that come from part of the brain called partial seizures. We treat those with slightly different sets of medicines. There's a group of medicines that work well for one sort, another group that works well for another sort.
If we can't determine that in clinic, we might have a person come in the hospital for inpatient video EEG testing—recording some seizures on the EEG machine and seeing what they look like on video.
We try to find the best treatment, and most often that will be medicine. And most often that's successful. Medicine works about 70 percent of the time to completely control seizures. But when it doesn't, we move on to other options like the electrical pacemaker device, known as the vegus nerve stimulator, or with even the prospect of brain surgery. The surgery is done by neurosurgeons to remove the area of brain where the seizures are coming from.
What specialties are included in the team that makes up the ICEP?
It's actually a large team. We have:
- Pediatric and adult epilepsy-specialist neurologists
- Neurosurgeons
- Nurses
- Physician assistants
- Neuropsychologists to help us test memory and other cognitive brain functions
- EEG technologists that help us record seizures
- Neuro radiologists to do the imaging like MRI scans
- Psychiatrists
- Social workers
- And others
What are the breadth of services available at the ICEP?
A comprehensive program offers not only medicine treatment but other treatment modalities like the vegus nerve stimulator and epilepsy surgery.
It also includes experimental programs where we work on new medicines and other new treatments. We use a multidisciplinary approach. We have the ability to treat not only the seizures themselves, but things that affect the person's quality of life like psychological factors and other social sorts of issues
Why are services like video EEG important in a comprehensive program?
I think that the video EEG is most important because it's sometimes hard to learn everything about a person's seizures by talking to them in clinic and by getting a story from someone who's witnessed them. It's often very helpful for me and others to actually see the seizure, see what it looks like, see how it starts on the EEG, and then use that information to make better treatment decisions.
Aside from educating the patient, does the staff also educate the family of an epileptic?
Absolutely, family and other care givers if the person is living at a group home or situation like that. That's a big part of our emphasis and our nurses and physician assistants and others help tremendously with that.
Can patients seen in the ICEP take part in any studies with regard to epilepsy?
Yes, we have a number of studies going on from time to time, including studies of new medication, studies of other treatment possibilities, surgery-related things, the vegus nerve stimulator -elated things. We also do studies of brain function or cognition through the neuropsychology group that looks at what the effects of seizures might have on a person's memory and other brain function. So we have, from time to time, a number of things going on.
If someone wanted to be evaluated in the ICEP, how would they make an appointment?
Appointments can be made by calling 319-356-2571. I'd also encourage them to talk to their primary care doctor about a referral and doctors are welcome to call this number as well. And they can also get some more information from our Web page. |
