Chapters Transcript Video Epilepsy 101 Types of Seizures, Diagnosis & Treatment Options My name is Carlos Milan. I am a physician, a neurologist, and epileptologist at Baptist Health at the Miami Neuroscience Institute. Epilepsy is, I would like to think more as a syndrome. Because it's a manifestation of something that is wrong in your brain basically in the electricity in your brain so when there is too much electricity and synchronized at the same time epilepsy is just repetitive seizures from that excessive electric activity in the brain a seizure is an episode in which. There is synchronized meaning many neurons at the same time. Firing excessive electrical activity. There are two different types of seizures actually focal seizures and by focal you you you meaning is coming from a particular part of the brain and then you have focal aware in which the patient is totally aware they don't lose awareness for instance like shaking in one arm that can be a seizure, but the patient is aware, cannot control the arm but the patient is aware, totally aware. The other one is focal and aware. So it's again on a part of the particular area of the brain but it causes losing awareness and then there are generalized seizures. So in generalized we have the generalized tonic-clonic seizures which are the ones that we usually see in the movies. Uh, people fall to the floor and start shaking and it's very dramatic myoclonic seizures. Uh, we have tonic, we have a tonic. There are many, many, many different types of seizures that, that we, we can also, you know, classify as generalized. Epilepsy is a clinical diagnosis. There are many, many patients out there. That have a diagnosis of epilepsy and are on medications and they don't have epilepsy we pay detailed attention to. Uh, what we call paroxysmal symptoms, that means symptoms that are short lasting in time, every episode, if you will, is very similar one to the other, so that's telling us that is coming from a certain part of the brain. And then duration seizures are very short lasting. They last anywhere between 60 to 90 seconds, sometimes a little bit less, a little bit more, but about that duration is what's telling us, OK, we, we are in front of, of most likely seizures. The best would be an MRI with and without contrast, what we call 3 Tesla, with special sequences in which we do very thin cuts through the brain. So we don't miss any um abnormalities anatomical abnormalities that's one thing and the other one is neurophysiological so neurophysiological meaning the electroencephalogram or what we call EEG that's basically when patients get connected with cables in the scalp and we take a look at the brain waves, basically the electrical activity of the brain, and we assess for excessive amounts of electrical activity. There is many treatments that can go in. To play with epilepsy, 60 to 70% get control with medications. So when you start your first medication, you have a 50% chance of becoming seizure free. If you don't, you can add a second medication and you increase that chance by 10%. There are more than 30 medications right now for epilepsy, so it depends on every particular patient. To pick the right medication so we minimize the side effects and maximize for the epilepsy. When you have a patient that is drug resistant that is on 2 medications or more, then you have the surgical option. Rarely patients that get surgery are off medications. Most of the time they're still on medications, but they're on less medications than they were previous to surgery. At that point when patients are taking 2 medications for epilepsy, they should come to an epilepsy center. Such as ours and we can do a workup for epilepsy surgery and we can offer for epilepsy surgery we can go from resections. To neuromodulation. Is basically devices with electrodes that go into your brain and can modulate that excessive electrical activity so you don't have seizures. One of them is the oldest one is called VNS. VNS means vagal nerve stimulator that consists of an electrode that goes to your vagal nerve and it sends pulses of current so it modulates the abnormal electrical activity in the brain. The second device is called DBS, deep brain stimulator, and it's been used before for movement disorders, but now we use it in epilepsy to stimulate the thalamus. Certain areas of the thalamus to also uh modulate the epileptogenicity and the third one is called RNS responsive neurostimulator so. In that one we put 2 electrodes in the areas that are causing epilepsy. And we modulate the electrical activity in that particular area of the brain for that one it's important too that we localize very well where the seizures are coming from, which sometimes we cannot but we do all. That is within our hands to localize it so we can either resect that portion of brain that is causing seizures or we can modulate with with a device like the RNS what makes Baptist health special is the. Resources that we have a group of epileptologists we are not just trained in neurology but trained specifically in epilepsy cutting edge technology that is available. We have it available here at Baptist Health Miami Neuroscience Institute. Created by
