Epilepsy

How is Epilepsy Diagnosed?

Diagnosing epilepsy involves a thorough review of symptoms, medical history, and specialised tests. These evaluations help pinpoint the cause of seizures and determine the most effective treatment plan.

Neurological Examination

A neurological exam assesses behaviour. This evaluation helps identify the type of epilepsy and its impact on brain function. Certain types of epilepsy syndromes may cause progressive deterioration in cognitive function. However, most epilepsy causes have normal physical and cognitive functions.

Blood and Genetic Testing

Blood tests can detect infections, genetic conditions, or metabolic disorders linked to seizures. Genetic testing may also provide insights into specific epilepsy syndromes, particularly in children or adults with hereditary forms of the condition.

Brain Imaging and Monitoring

Advanced imaging and monitoring techniques are crucial in diagnosing epilepsy. These include:

• Electroencephalogram (EEG): The most common diagnostic tool, EEG records brain wave patterns to detect abnormalities even when seizures are not occurring. High-density EEG offers more precise localisation of seizure activity.
• Computerised Tomography (CT) Scan: CT scans detect structural abnormalities like tumours or bleeding in the brain.
• Magnetic Resonance Imaging (MRI): MRI provides detailed images of the brain, identifying potential causes of seizures. Functional MRI (fMRI) maps critical brain functions to guide surgical planning.
• Positron Emission Tomography (PET): PET scans visualise metabolic activity in the brain, highlighting areas with low metabolism that may trigger seizures.
• Single-Photon Emission Computed Tomography (SPECT): SPECT creates 3D maps of blood flow during seizures, pinpointing seizure origins. SISCOM, a variation of SPECT, combines these results with MRI for enhanced accuracy.

Additional Diagnostic Techniques

Other advanced methods include:

• Statistical Parametric Mapping (SPM): Compares blood flow in seizure-prone areas to healthy brain regions.
• Electrical Source Imaging (ESI): Combines EEG data with MRI for detailed seizure localisation.
• Magnetoencephalography (MEG): Measures magnetic fields generated by brain activity, offering higher accuracy than EEG.

These diagnostic tools, available at (SJMC), ensure a comprehensive evaluation of epilepsy for precise treatment planning.

Treatment Options for Epilepsy

Effective epilepsy management focuses on reducing seizure frequency and improving overall well-being. Treatment plans are tailored to each patient’s condition and may include medications, surgery, or alternative therapies. 75% of seizures can be well controlled with medications. Some types of epilepsy are curable with surgery. Certain types of epilepsy in children can resolve in their teenage years.

Medications for Epilepsy

Anti-seizure medications, also known as anti-epileptic drugs, are the first line of treatment for most patients. With over 20 available options, the choice of medication depends on seizure type, age, and other health conditions.

Common Side Effects:

• Fatigue or drowsiness
• Dizziness or imbalance
• Weight gain or appetite changes
• Skin rashes
• Memory or attention issues

Rare but serious side effects:

• Depression or mood changes
• Suicidal thoughts
• Liver or kidney inflammation
• Severe allergic reactions like Stevens-Johnson syndrome or DRESS syndrome.

To achieve optimal seizure control:

• Take medications exactly as prescribed.
• Do not stop or switch medications without consulting your neurologist.
• Inform your doctor about any unusual side effects or mood changes.
• Discuss interactions before starting supplements, herbs, or over-the-counter drugs.

At least 50% of newly diagnosed epilepsy patients achieve seizure control with their first prescribed medication. For those who do not respond well to medications, additional options such as surgery, neurostimulation, or dietary therapy may be considered.

Surgical Options for Epilepsy

Surgery may be recommended when seizures originate from a specific brain area and medications are ineffective. Common surgical approaches include:

• Resective Surgery: Removes the brain area causing seizures.
• Minimally Invasive Surgery: Techniques like MRI-guided laser ablation offer less risk and faster recovery.

Post-surgery, patients may require reduced medication dosages. While complications are rare, they can include changes in cognitive abilities. Discuss risks and benefits with your surgical team to make an informed decision.

Alternative Therapies for Epilepsy

For patients who cannot undergo surgery or achieve seizure control with medications, alternative therapies may be effective:

• Vagus Nerve Stimulation (VNS): A device implanted in the chest sends electrical signals to the brain, reducing seizures by 20-40%.
• Deep Brain Stimulation (DBS): Electrodes implanted in the brain deliver pulses to control seizure activity.
• Responsive Neurostimulation (RNS): Devices detect seizure onset and deliver immediate electrical stimulation to prevent progression.

Ketogenic Diet

A high-fat, low-carbohydrate ketogenic diet can help some patients reduce seizures. This diet alters brain chemistry, making it less prone to seizures. Side effects, such as dehydration or kidney stones, are rare with proper medical supervision. Less restrictive alternatives, like the modified Atkins diet, may also provide benefits.

Emerging Treatments for Epilepsy

Research continues to explore innovative treatments, including:

• Subthreshold Stimulation: Continuous low-level brain stimulation to prevent seizures.
• Minimally Invasive Surgery: Techniques like MRI-guided focused ultrasound offer safer alternatives to traditional surgery.
• Transcranial Magnetic Stimulation (TMS): Non-invasive magnetic fields target seizure-prone brain areas.
• Transcranial Direct Current Stimulation (tDCS): Electrical stimulation through the scalp reduces seizure frequency over time.

These advancements hold promise for patients with treatment-resistant epilepsy.

Why Choose SJMC for Epilepsy Care?

Subang Jaya Medical Centre (SJMC) is equipped with state-of-the-art diagnostic tools and a multidisciplinary team of neurologists, neurosurgeons, neuro radiologists, nuclear medicine physicians, and dietitians. Our patient-centric approach ensures personalised care for epilepsy management, from diagnosis to advanced treatments. Trust SJMC to guide you on your journey to better health.

Reference:

1. Mayo Clinic Epilepsy: Diagnosis and Treatment
2. World Health Organization (WHO) Epilepsy Fact Sheet
3. Centers for Disease Control and Prevention (CDC) - Treatment of Epilepsy
4. Cleveland Clinic - Epilepsy: Causes, Symptoms, Diagnosis, and Treatment
5. Johns Hopkins Medicine - Diagnosing Seizures and Epilepsy
6. Epilepsy Foundation - How is Epilepsy Diagnosed?