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Posted November 03, 2021
Listen to this episode of the Healthy Vitals Podcast.
Dr. Marvin Rossi leads a discussion on epilepsy, covering symptoms, treatment, as well as new practices in care.
Scott Webb: Nearly three and a half million adults and children suffer from epilepsy in the US. It's a chronic disorder and the related seizures affect safety, school, work, driving and more, and those who suffer from it. And I'm joined today by Dr. Marvin Rossi. He's a board-certified neurologist who specializes in epilepsy at Summa Health.
This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. So Dr. Rossi, thanks so much for your time. I think that many of us think we know at least what epilepsy is, but it's great to have an expert on today and have you explain it to us, get your advice, talk about the latest treatment options and so on. So as we get rolling here, just have you start here, what is epilepsy?
Dr. Marvin Rossi: Epilepsy is a chronic disorder. It's not a disease. Its hallmark is recurrent unprovoked seizures. So a person who is diagnosed with epilepsy can experience two unprovoked seizures or one unprovoked seizure with the likelihood of more. So, when I say that, seizures are not caused by some known and reversible medical condition like low blood sugar or alcohol withdrawal or organ failure. So, it's important to emphasize here that safety, school, work, driving and more are impacted in both children and adults who experienced seizures and epilepsy.
Scott Webb: So doctor, let's talk about the symptoms and treatment options.
Dr. Marvin Rossi: The signs and symptoms are many. So signs can include simply being distractible or zoning out. We all have that tendency, but when you see it in situations such as school throughout the day or at work, this becomes a problem and it may be a sign that there is an epilepsy or some type of a small type of seizure that one is experiencing, and this should be evaluated by a qualified physician.
This really is on a continuum from those sorts of signs, all the way to convulsive or generalized seizures where we typically think of epilepsy as someone falling to the ground and shaking, but there are many variations to what a seizure looks like. Often a patient or a person can be walking through the day and coming back home that night or after a long vacation and have very little recollection of the day or the entire vacation. And in part or almost entirely, this is due to seizing. And sometimes people are referred to psychiatry and, you know, given meds and where the simple procedure called an electroencephalogram or EEG can actually diagnose that patient as seizing sub clinically, we say.
Scott Webb: I can see how this would be alarming for people and that they would want to reach out to their doctors. So let's assume that somebody has, they've gone to the doctor and the doctors maybe referred them to a specialist, so let's talk about some of the treatment options for epilepsy.
Dr. Marvin Rossi: First, one wants to make sure that these are not provoked seizures. So for example, does the patient have early diabetes or is there another underlying medical condition that needs to be treated? If these are unprovoked seizures and, again, epilepsy is two unprovoked seizures separated in time or the propensity of a second seizure occurring after a first unprovoked seizure, then one does look at treatments and often we think of medications as first-line treatments.
With that said, triggers for seizures include high sugar foods, which can cleanly and clearly trigger seizures. So we look at diets as decreasing the likelihood of propensity for one disease. Sleep is also another trigger, that is sleep deprivation. So we triy to make sure that people can rest and not actually actually sleep irregularly like in shift workers who may work third shift and have a very irregular sleep schedule.
So simple triggers include over-the-counter meds like Benadryl. If somebody has a propensity for seizures, Benadryl or diphenhydramine can also trigger seizures. So I think one should stay away from simple meds like that and go with alternative antihistamines if people have allergies like Claritin or other similar drugs.
So there are many treatments now medically. Medications before 1993 were very few. There are only about five medications. Now, there are over 30. And when one goes to an epilepsy neurologist, truly one can look at many options and customize that medical treatment and, again, often medications and diet control with the individual in partnership to come to a nice patient-specific treatment regimen.
Scott Webb: Yeah, I like that, patient-specific. That sounds good. And I really didn't know that, that some medications could actually bring on a seizure, especially some of the over-the-counter things that you're mentioning. I think the follow-up here is what is an epilepsy monitoring unit? That sounds pretty interesting.
Dr. Marvin Rossi: Sure. Yeah. You know, the minimum function of an epilepsy monitoring unit or EMU is to systematically monitor patients over at least 24 hours to diagnose epilepsy or related spells. So not all spells are epilepsy. It is also a useful place in the hospital as an inpatient unit to rapidly titrate anti-seizure medications or withdraw medications to capture seizures for pre-surgical evaluations. There are a number of surgical procedures that are available today.
And EMU is often incorporated into an epilepsy center. And so the highest epilepsy center level also known as a level three or level four center, level four being the highest designation, also includes a set of criteria before one can be credentialed as such. These include an interdisciplinary care team approach, appropriate facilities for electrodiagnostic equipment like an EEG, safety protocols, education for patients, an EEG technologist, nursing, and also those in training like fellows and residents, and also a pertinent translational clinical research initiative.
Scott Webb: Yeah, and I can see how important an EMU, you know, the unit itself would be to these centers. And I'm wondering what kind of team is involved at Summa Health for caring for epilepsy patients?
Dr. Marvin Rossi: First, I have to say that the pandemic has energized a mandatorily driven model that incorporates population health across the board, across the country. And Summa Health is a population health-driven institution. Our next generation comprehensive presence in the area is designed for treating epilepsy-related challenges.
You know, about 3.4 million people in the US are afflicted with epilepsy and over a million are uncontrolled and 70% in this group live with comorbid mood disorders. It's important for me to emphasize that mood disorders, predominantly anxiety disorders and depression, co-occur with uncontrolled or medication-resistant epilepsy. And again, that's about 1 million of the 3.4 million in this country suffer from the condition.
Next generation comprehensive epilepsy centers must wrap around the latest integrative therapies. These range from diets, as I mentioned earlier, behavioral health and an understanding of pediatric and adult care, and really what's necessary to transition from childhood to adult care. As importantly, women's issues, as they relate to hormonal shifts of puberty during monthly cycles, pregnancy, and medicines compatible with those going through menopause and older adult populations are important to understand. And this clearly includes medication adjustments in the elderly.
A comprehensive epilepsy center must also understand and incorporate new medical treatments, devices that are implantable to control epilepsy and the expertise evaluating and performing surgeries. And as I alluded to earlier, these surgical procedures range from what we call laser ablation therapy and respective surgeries, where we can actually take out a piece of non-functional seizing brain to implanting and programming implantable stimulators, such as the vagus nerve stimulator or VNS, the newer NeuroPace implantable stimulator and deep brain stimulator. Our center is now equipped to do all of that. And additionally, our translational research arm at Summa brings clinical trials, new visualization techniques, and involving immersive telehealth initiative.
It's important to consider a comprehensive epilepsy center when seeking help with challenging and uncontrolled epilepsy and it's co-occurring conditions. Again, Summa Health is committed and actually has done an impressive job at realizing that next generation epilepsy center.
Scott Webb: Yeah, they definitely have, and it's really fascinating just to learn kind of what everybody's doing and then what you're specifically doing there at Summa. Really amazing. And as we wrap up here, doctor, just wanted to ask you what's life like when folks have to live and deal with epilepsy?
Dr. Marvin Rossi: I want to emphasize this piece as well, and I said this a couple of times prior, there are 3.4 million people in this country who suffer from the condition. However, many of them can be controlled well and lifelong on one med. And with that said, many genetic epilepsies evolve and actually resolve early to midlife where one can actually go off of their medicines.
With that said, of those 1 million plus who suffer from epilepsy and they live with it daily, they can lose their lives from accidents, suicide, or underlying causes of their condition. They really have poor quality of life that we have to address and some of them actually develop what we call a new-onset status epilepticus. Basically, it's defined as a medication-resistant type of seizure episode that's prolonged. And the importance here is to address epilepsy early. And, you know, it's really critical that patients be referred to epilepsy specialists or epilepsy neurologists or they're also called epileptologists when their seizures can not be controlled within a short timeframe of between six to twelve months for those being seen in primary care.
And lastly, I cannot emphasize this enough as well, the leading cause of epilepsy-related death is believed to be what we call sudden unexpected death in epilepsy, also known as SUDEP, and this often occurs in one's sleep. The risk can range from one person in 1000 with uncontrolled epilepsy. Please listen to that, to as frequently as one in 1000 patients with uncontrolled epilepsy.
Scott Webb: Well, doctor, this has been a really educational today, to learn more about epilepsy, what folks are dealing with, what you're doing there at Summa Health. I really appreciate your time. You stay well.
Dr. Marvin Rossi: Thank you so much, Scott.
Scott Webb: Visit summahealth.org/epilepsy to learn more. And if you found this podcast to be helpful and informative, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.