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Webinar: Adult Epilepsy: Common Clinical Issues and New Therapies

Mon. Nov 2, 2015 at 1:00 pm CDT

A webinar featuring Mayo Clinic neurologists Jeffrey Britton, MD, Gregory Cascino, MD, Jerry Shih, MD, and Joseph Sirven, MD. The physicians discussed a variety of adult epilepsy topics including:

  • Seizure medications: when to start and when can they be stopped.
  • Maximizing safety for patients with epilepsy.
  • Indications for admission to epilepsy monitoring unit.
  • New surgical therapies such as laser thermoablation.

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Tags: Epilepsy

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Great information. Was patient of Dr Britton many years ago. Since I saw him I have been seizure free 8 years!!! Found the right treatment for me!! For that, I will be forever thankful!! Seizures no longer control my life.

Posted Fri, Apr 8 at 10:19pm CDT

tessa.cadle

tessa.cadle wrote:

I was diagnosed with epilepsy when I was 15. I am now 23 almost 24, and have been seizure free for almost 8 years. I have yearly appointments with my neurologist. I am on 3 different seizure medicaitons, Lamictal, generic [...] View full text  

Posted Mon, Nov 2 at 1:07pm CDT

LaurenSpiceland

Lauren Spiceland replied:

Congratulations on being seizure free for so long, Tessa! And it’s great you’re making plans for a healthy pregnancy now. The odds of a positive pregnancy are overwhelmingly in your favor.

Before you try to conceive, schedule appointments with the health care provider who'll be handling your pregnancy and your neurologist to talk about any treatment changes you might need to make before pregnancy begins. Take your anti-seizure medication exactly as prescribed. Don't adjust the dose or stop taking the medication on your own. Remember, uncontrolled seizures likely pose a greater risk to your baby than does any medication. It's also important to make healthy lifestyle choices, like eating a healthy diet, taking prenatal vitamins, and getting enough sleep.

You may find this page useful: http://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy/art-20048417.

Posted Tue, Nov 3 at 11:01am CDT

THANK you! This has been amazing!

Posted Mon, Nov 2 at 1:05pm CDT

Kaia

Kaia wrote:

Thank you for addressing the questions. Yes she has had several video eeg's and we were always told that they were seizures - not all of the movements but majority. Thank you again. How does one get an appointment and [...] View full text  

Posted Mon, Nov 2 at 1:02pm CDT

LaurenSpiceland

Lauren Spiceland replied:

Kaia, you can schedule an appointment at any of our three campuses by clicking on the link located on this page below the webinar video or by calling 800-446-2279 for our Arizona campus, 904-953-0853 for our Florida campus, 507-538-3270 for our Minnesota campus or 855-MAYO-KID for our Children’s Center. We don’t offer phone consultations at this time.

Most brief focal seizures do not lead to clinically significant damage to the brain. The seizure types most likely to be associated with brain damage include generalized tonic-clonic (grand mal) seizures and prolonged focal seizures (i.e. those going on for several minutes at a time).

Posted Tue, Nov 3 at 8:39am CDT

The webinar has concluded. In the following week Dr. Shih, Dr. Sirven, Dr. Cascino and Dr. Britton will work on answering questions they didn't get to during the webinar.

Posted Mon, Nov 2 at 12:59pm CDT

missybrenton

Missy wrote:

Does epilipsey/seizures cause memory loss/ recall or is it more likely to be caused by medication? I take Depakote and have been on it for about 27 years.

Posted Mon, Nov 2 at 12:55pm CDT

LaurenSpiceland

Lauren Spiceland replied:

Missy, recurrent seizures, temporal lobe damage from seizures, and anti-seizure medication can all affect memory. Memory loss or trouble processing information can be a side effect with Depakote. I am not aware of Depakote causing permanent memory loss. Since there are multiple factors that can cause or lead to memory loss or cognitive problems in patients with epilepsy, it will be important to discuss your concerns with your neurologist. Further testing may help to differentiate between the possibilities. Another option is to switch from Depakote to another anti-seizure drug that does not have the memory side effects – however, this should only be done if your doctor feels this is a safe approach for you.

Posted Fri, Nov 6 at 12:10pm CDT

Anonymous wrote:

When considering persons who do not have epilepsy, what are precautions for them to take from having a seizures in their lifetime? I have been cured for over 24 years and like to have family/friends to take precautions.

Posted Mon, Nov 2 at 12:54pm CDT

LaurenSpiceland

Lauren Spiceland replied:

Congratulations on being seizure free for 24 years! The likelihood of an additional seizure after 24 years of seizure freedom is quite low. Having stated that, the only precautions to take are ones that we would recommend to all patients: get sleep, exercise, and practice stress management.

Nearly 10 percent of individuals may have a single unprovoked seizure. However, a single seizure doesn’t mean you have epilepsy. Of those individuals who have a single seizure, 60 percent never experience another.

Posted Tue, Nov 3 at 10:58am CDT

sbruce

Sherrie Bruce wrote:

Why does fever or illness lower the threshold of seizures?

Posted Mon, Nov 2 at 12:52pm CDT

LaurenSpiceland

Lauren Spiceland replied:

A seizure threshold is the level of stimulation at which your brain will have a seizure. People with epilepsy may be considered to have a lower-than-normal seizure threshold. This means that only slightly increased brain stimulation may induce a seizure for someone with epilepsy. One’s seizure threshold is mostly determined by genetics, but other factors can lower your threshold. Fever and illness may lower one’s threshold. This may be most important in pediatric patients with a genetic predisposition to febrile seizures in childhood.

Posted Tue, Nov 3 at 8:39am CDT

Anonymous wrote:

Are there any particular supplements or over the counter medicines that have been shown to be more active at causing seizures?

Posted Mon, Nov 2 at 12:52pm CDT

How does a patient get an appointment/consultation with Mayo neurologists/neuroendocrinologists at the same time? What is required?

Posted Mon, Nov 2 at 12:31pm CDT

LaurenSpiceland

Lauren Spiceland replied:

There are no neuroendocrinology subspecialists on staff in the Mayo Clinic Department of Neurology at the present time. Members of the Department of Neurology work in collaboration with the Division of Endocrinology and Metabolism when caring for patients with endocrinologic issues. While appointments can be coordinated between the Department of Neurology and Division of Endocrinology and Metabolism, there are no Endocrinology staff who are considered neuroendocrine subspecialists per se at this time. A clear understanding as to the patient needs referable to the request for a neuroendocrinologist would need to be assessed in order to see if an appropriate appointment would be available.

Posted Tue, Nov 3 at 8:38am CDT

Kaia

Kaia wrote:

conversations with doctors go no where anymore.

Posted Mon, Nov 2 at 12:22pm CDT

Kaia

Kaia wrote:

Have you used Charlottes Web oil? I hear a lot of good about it for some. Others (like my daughter) would probably need the whole indica plant oil. Living in a state that does not allow it is very hard.

Posted Mon, Nov 2 at 12:15pm CDT

LaurenSpiceland

Lauren Spiceland replied:

There has been a lot of interest and attention paid to the therapeutic possibilities of a marijuana extract called cannabidiol (CBD) for epilepsy. While there are well-publicized examples of individual patients who appear to have benefitted from this treatment, there is a shortage of clinical data establishing its effectiveness and safety. Mayo Rochester does have a clinical trial of CBD for a specific form of epilepsy called Lennox-Gastaut syndrome, so that we can learn more about its therapeutic use and limitations. Mayo is open to use of any therapy that has established effectiveness and safety.

Given CBD is derived from marijuana, and marijuana is still considered a Class 1 narcotic by federal law, it is difficult to perform research on its use in epilepsy and other conditions. State laws regulate whether a physician can use CBD and other forms of medical marijuana in clinical care, and this patchwork of state-by-state variability has created a very confusing situation for patients and physicians. This link provides information from Mayo Clinic regarding this issue: http://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/medical-marijuana/art-20137855.

Posted Tue, Nov 3 at 8:38am CDT

can you talk about the effects of seizures on the brain. i.e. do they damage the brain. Do seizures increase the occurrence of seizures. Do uncontrolled seizures increase the risk of SUDEP?

Posted Mon, Nov 2 at 12:14pm CDT

sbruce

Sherrie Bruce wrote:

What is your opinion on Charlottes Web oil?

Posted Mon, Nov 2 at 12:11pm CDT

LaurenSpiceland

Lauren Spiceland replied:

There has been a lot of interest and attention paid to the therapeutic possibilities of a marijuana extract called cannabidiol (CBD) for epilepsy. While there are well-publicized examples of individual patients who appear to have benefitted from this treatment, there is a shortage of clinical data establishing its effectiveness and safety. Mayo Rochester does have a clinical trial of CBD for a specific form of epilepsy called Lennox-Gastaut syndrome, so that we can learn more about its therapeutic use and limitations. Mayo is open to use of any therapy that has established effectiveness and safety.

Given CBD is derived from marijuana, and marijuana is still considered a Class 1 narcotic by federal law, it is difficult to perform research on its use in epilepsy and other conditions. State laws regulate whether a physician can use CBD and other forms of medical marijuana in clinical care, and this patchwork of state-by-state variability has created a very confusing situation for patients and physicians. This link provides information from Mayo Clinic regarding this issue: http://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/medical-marijuana/art-20137855.

Posted Tue, Nov 3 at 8:38am CDT

Can we get some info on catamenial epilepsy? Or seizures that seem to be leaning towards drug-resistant?

Posted Mon, Nov 2 at 12:02pm CDT

LaurenSpiceland

Lauren Spiceland replied:

For some women with epilepsy, the occurrence of seizures correlates to their menstruation and ovulation cycles. This is called catamenial epilepsy. Progesterone dominates the hormonal cycle for women, except during ovulation and menstruation when estrogen is higher. Estrogen tends to excite the brain, whereas progesterone calms the brain. To treat catamenial epilepsy, we may consider increasing seizure medications around the time of ovulation and menstruation to help control the seizures. This video may be of help to you: https://www.youtube.com/watch?v=SOt8SqX4spA.

At least half of all people newly diagnosed with epilepsy will become seizure-free with their first medication. If anti-epileptic medications don't provide satisfactory results, your doctor may suggest surgery or other therapies. You'll have regular follow-up appointments with your doctor to evaluate your condition and medications. Learn more about surgery and other therapies: http://www.mayoclinic.org/diseases-conditions/epilepsy/diagnosis-treatment/treatment/txc-20117241.

Posted Tue, Nov 3 at 8:37am CDT

Kaia

Kaia wrote:

My daughter has seizures daily. She is on a lot of medicine and has tried just about all medicines. She has a VNS. Now the docs say they are not all seizures there are some movements that might be dystonia [...] View full text  

Posted Mon, Nov 2 at 12:00pm CDT

missybrenton

Missy wrote:

starts in 3 min

Posted Mon, Nov 2 at 11:57am CDT

ydjay

ydjay wrote:

hw soon is the program starting any one guide me

Posted Mon, Nov 2 at 11:56am CDT

LaurenSpiceland

Lauren Spiceland replied:

2 minutes!

Posted Mon, Nov 2 at 11:58am CDT

also, can you comment on what a pseudo-seizure actually is and symptoms? Is this a default dx used on patients who have co-occurring seizure and bi-polar disorder?

Posted Mon, Nov 2 at 11:56am CDT

Drs in Florida are increasingly diagnosing Epilepsy pts with "pseudo- seizures" which they say is not related to Epilepsy. They appear to be using this diagnosis when not able to produce a seizure under Veeg or regular 3 minute in [...] View full text  

Posted Mon, Nov 2 at 11:53am CDT

LaurenSpiceland

Lauren Spiceland replied:

From Dr. Shih: At Mayo Clinic Florida, I use the term Non-epileptic Events or NEE (rather than the term pseudoseizures). I do not have any specific information on how doctors in Florida outside of the Mayo Clinic diagnose NEE, or why they may be doing so more frequently. In our hands, NEE is not a default diagnosis, but rather a diagnosis usually made after testing in the epilepsy monitoring unit (EMU).

Dr. Shih also provided me with a great pdf describing the symptoms, causes, risk factors and treatment of this problem. If you'll send me an email at spiceland.lauren@mayo.edu, I'll forward the pdf to you.

Posted Fri, Nov 6 at 12:12pm CDT