Epilepsy

Epileptic seizures are sorted into three types:

Generalized Onset

Affects both sides of the brain at the same time. This type of seizure can present with rhythmic jerking, weak or limp muscles, tense or rigid muscles, brief muscle twitches, or spasms. Or, you may have brief twitches in one part of your body or staring spells.

Focal Onset

Affects one side of the brain. Focal onset seizures can be “aware,” where you are aware of what you are doing (but cannot control it) and awake; or “impaired,” where you are unaware of what is happening or confused. Symptoms can be similar to generalized onset, but also include repetitive automatic motions such as lip smacking and hand clapping. Or, your motor functions may not be affected, but you may experience waves of heat or cold, or a racing heart, or a change in cognition or emotions.

Unknown Onset

If the symptoms occur without being remembered or observed, there is not a way of determining its beginnings.

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Epilepsy has no identifiable cause in about half the people with the condition. In the other half, the condition may be traced to various factors, including:

• Genetic influence
• Head trauma
• Brain conditions
• Infectious diseases
• Prenatal injury 
• Developmental disorders 

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There are two very important — and complementary — sides to living better with epilepsy.

The first factor is that it’s critical to get the condition itself under control, because unpredictable seizures can cause other health problems. Follow the medication or other treatment plans that you and your physician at St. Luke’s Epilepsy Center have determined to be best for your condition.

Some people realize that there are certain triggers, whether food, hormonal, or time of day, that can cause a seizure. If your epilepsy has known triggers, you can seek to manage them and plan accordingly. Follow common sense living tips, too, such as getting enough sleep and exercise.

The second factor is that it’s important to make your condition known to those around you, whether they are family members or people you work with.

At St. Luke’s Epilepsy Center, there are other professionals who can help you develop the best way to live with your condition. You can talk to psychologists and psychiatrists about any challenges you encounter because of your condition or treatment. Social workers may be able to advise you on the best way to approach your associates in the workplace. Vocational specialists can help as well. You may want to draw on the skills and talents of occupational, physical, and speech therapists for any rehabilitation efforts you need to make, if there are lasting effects after a seizure.

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Epilepsy Monitoring Unit

The EMU is a specialized inpatient unit is designed for computer-based 24 hours continuous video-EEG monitoring with the patient’s safety in mind. The objective of this unit is to trigger and record a seizure or event in a safe and controlled environment, which is then used to make a diagnosis, determine the type of epilepsy, localize the onset of focal seizures, or medication adjustment.

Your doctor may recommend and EMU admission if you have intractable seizures, spells that are concerning for seizures but difficult to diagnose, or for pre-surgical evaluation. Your length of stay depends on how long it takes to record seizures or spells. The typical admission varies between three to seven days, which can be shorter or longer. The treatment team involves the epileptologist, EEG technologists, and EMU nurses.

Patients are admitted to a private room. During this admission, patients are under 24 hours of continuous observation by a technologist, intercom and direct communication, and audio-video-EEG recording. Patients are connected to an EEG machine to help determine the source of the seizures. To increase the chance of recording a seizure, your treatment team may decide to reduce the dose of your anti-epileptic medication(s), sleep deprivation, or other triggers of seizures. If you have a warning or aura to your seizure, there is a button for you to push to activate an alarm for immediate response and attention.

At the end of the admission, your physician will discuss with you the result of the study. Sometimes, in spite of the length of stay for this study, we are unable to record a seizure or event to provide a diagnosis or some focal epileptic seizures may be too short to be visible on scalp EEG. Your physician will provide options as to treatment recommendations and/or further testing.

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The first line of defense after a diagnosis of epilepsy is medication. In seven out of 10 patients, this kind of help is the most beneficial. There are many kinds of medications available, and each works differently; the types of seizures you have will be a major factor in the class and sort of medication that works best for you. Sometimes that is a combination of different kinds. Any side effects need to be manageable, as well.

Sometimes, a special kind of food regimen is used in conjunction with medicine. Eating a ketogenic diet, which is a specific type of high fat/low carbohydrate diet, has been proven beneficial for some patients.

Another kind of treatment that might be used, also in conjunction with medicine, is vagus nerve stimulation. This consists of a device implanted in your chest that delivers electrical energy through the vagus nerve to your brain to help inhibit seizures; it’s been called a “pacemaker for your brain.”

Epilepsy surgery may be an option for patients with intractable epilepsy. St. Luke’s is first in the greater Lehigh Valley region to perform a revolutionary epilepsy surgery - temporal lobectomy - that eliminates seizures in most patients. Previously, patients with a common type of epilepsy, temporal lobe epilepsy, could only find the treatment at large institutions outside the region.

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