Lance Fogan's Blog, page 2

Blog #168: Suicidality ˗˗˗ Epilepsy

 

 

 

H. M.Clary and F. Gilliam addressed this topic in a Neurology publication.1People with epilepsy are prone to depression and anxiety. This is not news forour friends afflicted with seizures. People with epilepsy have a 22% higherrate of epilepsy than the general population.2

The riskof suicidality is highest shortly after the onset of epilepsy. TheInternational League Against Epilepsy practice recommendation calls forneurologists to identify and manage depression and anxiety in their patients atevery clinic visit.

 

Mood andanxiety diagnoses and suicidality among 347 adults with newly diagnosed focalepilepsy diagnoses were evaluated from the multicenter Human Epilepsy Project.An analysis revealed a high prevalence of psychiatric diagnoses that may go undetected:bipolar disorder, panic disorder, and agoraphobia stood out. There were strongassociations of these diagnoses with suicidality, no different from those withestablished epilepsy.3  

 

What is Suicidality?The American Psychological Association defines suicidality as “the risk ofsuicide, usually indicated by suicidal ideation or intent, especially asevident in the presence of a well-elaborated suicidal plan.” It also to includessuicidal thoughts, plans, gestures, or attempts.

 

Bipolardisorder was more common than major depressive disorder. Sixteen percent hadthis diagnosis. Panic disorder was nearly as common as generalized anxiety,present in 11.5% of all participants. Nearly 39% had a mood or anxiety disorderand more than one-third of these had suicidality.

 

Thisoverall assessment has implications for the clinical care of people withepilepsy as newly diagnosed focal epilepsy and established epilepsy may havesuicide risk associated with psychiatric diagnoses not routinely screened forin epilepsy clinics. This knowledge elevates the need to better detect bipolardisorder, panic disorder and agoraphobia in our clinics.

 

Do not hesitate to consult withyour physicians and caregivers if you, the patient, or the patient within yourcircle exhibits suicidal thoughts/actions. Do not fear that if you query thepatient of possible suicidality thinking your mentioning the topic could beharmful. No, it’s almost always welcomed and helpful. As always, I recommendsignificant others of the patient accompany the patient to the clinicappointment. Much useful information often comes to light.

1.     Clary H.M., Gilliam F. Suicidalityin Epilepsy. Neurology. 2023: Vol 100; No. 11, p 499-500.

2.     Tian N, Cui W, Zack M et.al. Suicideamong people with epilepsy: a population-based analysis of data from the U.S.National Violent Death Reporting System, 17 states 2003-2011. EpilepsyBehav. 2016, 61:210-217.

3.    KannerA., Saporta A., Kim D, et.al. Mood and Anxiety Disorders and Suicidality inPatients with Newly Diagnosed Focal Epilepsy. Neurology. 2023: vol 100; No.11 p 508-509.

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His  hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now  available in eBook, audiobook, soft and hard cover editions.

 

Blog # 167: WHAT ABOUT NON-EPILEPTIC SEIZURES, THE PSYCHOGENIC, CONVERSION AND SOMATIC SYMPTOM DISORDERS?

 

Neurologistshave long been aware of fake seizures. People would fall and shake and evenlose control of urine. Called pseudoseizures or psychogenic nonepilepticseizures, they can be involuntary due to psychological disturbances. Frighteningto witness as family and observers can attest. Yet the patient can still biteand lacerate lips and tongue and be incontinent of urine and bowel despite the EEGbrain waves remaining normal.  Pseudoseizure can also be voluntary-malingeredfaked seizures of which the patient is very aware. These can serve some practicalpurpose in the person’s life e.g. avoiding stressful situations. Thesepseudoseizures occur in up to a third of patients evaluated in epilepsyclinics. One-third of patients who suffer from true epilepsy have additionalpseudoseizures typically occurring during Their psychogenic nonepilepticseizures tend to occur when other people are present and during times ofheightened emotional stress when secondary gain is available. Patientsexhibiting feigned, or pseudoseizures, tend to have significant emotionalproblems. Schizophrenia, hysteria and hypochondriasis are common diagnoses.

 

Veteranswith psychogenic nonepileptic seizures tend to have higher rates of anxiety,post-traumatic stress disorder and chronic pain, as compared with veterans withtrue epileptic seizures. Civilians with psychogenic nonepileptic seizuresusually attribute their seizures to a past head injury, usually mild ones.

 

SelimBenbadis, MD reviewed this topic in Neurology 2019;92: 311-312.1 Psychogenicnonepileptic seizures (PNES) are so very common in epilepsy centers in the U.S.that they account for 30-40 percent of referrals.2

 

Treatmentresults of pseudoseizures are not encouraging. Adherence to psychotherapy andcognitive behavioral therapy was poor. Minorities and victims of abuse tend notto adhere to these therapies, but a better outcome is seen if they do adhereover time.

 

Anticonvulsantmedications are usually disappointing. Convincing psychiatrists/psychologiststhat their patients are sufferingpseudoseizures and not true epilepsy by neurologists can be difficult. Combinedpsychological and organic neurological on-going cooperative care can lead tosuccess.

 

 

1)   BenbadisSR. Psychogenic noonepileptic seizures, conversion, and somaic symptomdisorders. Neurology 2019;92: 311-312.

2)   BenbadisSR. The Problem of psychogenic symptoms in the psychiatric community indenial? Epilepsy Behav 2005;6:9-14.

 

LanceFogan, M.D. is Clinical Professor of Neurology at the David Geffen School ofMedicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view.“DINGS” is his first novel. Aside from acclamation on internet bookstoresites, U.S. Report of Books, and the Hollywood Book Review, DINGS has beenadvertised in recent New York Times Book Reviews, the Los Angeles TimesCalendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard covereditions.

 

 

Blog #166: POST-TRAUMATIC EPILEPSY IS ASSOCIATED WITH HIGHER RISK FOR DEMENTIA

 

 

 

 

AsI have written in earlier monthly blogs, most people are surprised to learnthat the commonest onset of epilepsy is in the older age-group and not in the pediatricpopulation Why? We are living longer.

 

Theepilepsy population is one percent of all people. In only half of these peoplecan a cause for their epilepsy be identified. In the other half no cause can befound, in other words, these people have idiopathic epilepsy. In those for whoma cause can be identified, they have what is called symptomatic epilepsy. Usually,the cause is a structural abnormality in the brain associated with scars fromtrauma, scars from strokes, brain tumors, brain infections, abnormal bloodvessels etc.

 

Thisblog highlights a summary edited by Susan Kreimer in the Neurology TodayApril 4, 2024, issue. It addresses the higher incidence of dementia in thosewith post-traumatic epilepsy1. Post-traumatic epilepsy (PTE) isassociated over a 25-year follow-up of developing dementia compared withepilepsy without a history of head trauma. A combination of epilepsy and headinjury places the person at an increased risk of developing dementia.

 

Althoughsome patients experiencing significant head injury are placed on anticonvulsantmedications even before a seizure occurs, usually for short periods, as seizureprophylaxis, this has not been found to alter the risk of eventually developingPTE. Even mild traumatic brain injury can result in PTE up to a year after thehead injury.

 

Researcherscollected 12,558 individuals aged 45-64. The average age at baseline was 54years. Nearly 58% were female and 28% were Black. Of this group 14.4 reportedpast head injury, 5.1% had seizure/epilepsy and 1.2 % had PTE. After follow-upspanning a median of 25 years, 19.9 of the participants developed dementia.Dementia risk factors may vary among population subgroups. The researchersadjusted for vascular and genetic risk factors.

 

Approximately5-8% of the American population over 65 has dementia. Neurologists areencouraged to have a lower threshold to suspect cognitive impairment anddementia in their patients with PTE. Screen the patients themselves rather thanrely on reports of caregivers to identify such patients for greater diagnosticaccuracy. Have them undergo neuropsychological testing to confirm dementia ifit appears.

 

Weconclude that being aware of this group of PTE patients and of assessing them periodicallyfor their higher risk of developing dementia can lead to better healthoutcomes.

 

 

1)    SchneiderKCA, Law CA, Gottesman RF et. al.  Post-traumaticEpilepsy and dementia risk. JAMA Neurol 2024; Epub 2024 Feb 26

 

 

Lance Fogan, M.D. is Clinical Professor ofNeurology at the David Geffen School

ofMedicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is

toldfrom a mother’s point of view. “DINGS” is his first novel. Aside fromacclamation

oninternet bookstore sites, U.S. Report of Books, and the Hollywood Book Review,

DINGShas been advertised in recent New York Times Book Reviews, the Los Angeles

TimesCalendar section and Publishers Weekly. DINGS teaches epilepsy and is now

availablein eBook, audiobook, soft and hard cover editions.

Blog # 165: COMMUNICATIONS WITH YOUR EPILEPSY DOCTOR

     

     You understand that your decisions for your epilepsy care are critical to the quality of your life. A study was published examining in-office patient-neurologist conversations that focus on identifying your type of epilepsy, sharing decisions about your care and continuing plans for your condition.

     A study of transcripts and audio recordings of conversations between patients and neurologists were analyzed focusing on epilepsy diagnosis, treatments, and prognosticconsiderations. The strategies for eliciting this information were assessed for strategies of information elicitation, word-level information, identification of topics discussed, quantificationof questions probed, and types of questions asked.1

     Neurologist-patient interactions were analyzed in the United States, in Spain and in Germany. Neurologists tended to utilize event-based language. They referred to seizures in patient-friendly vocabulary. In the United States the term “epilepsy” tended to be avoided. This is cultura-based like Americans avoiding saying someone died. Rather, we say they “passed away.”

    In all three countries it was the neurologist who were unilaterally responsible for the treatment decision and choice of medication. A team effort is sometimes appropriate in medication decisions. When new medicines were described neurologists most often discussed potential side effects but did not review potential benefits. “Seizure control” rarely was defined. Patients were not asked what seizure control meant to them. Did I mean absolutely seizure-free or a very infrequent seizure may be acceptable to be “free” of seizures because “My last seizure was 8 months ago, or a year ago”. I would not consider this to be seizure-free.

     This paper identified opportunities related to vocabulary, decision making, and treatment goal setting. All these facets can improve communication about epilepsy.

     I recommend that you as the patient bring along your significant other to attend your meetings with your neurologist. That person should participate in all the discussions and ask pertinent questions along with you. Certainly, “two or more heads are better than one” in your doctor’s office. When I was in practice, I would often create the scenario after complex discussions I had with the patient who had come alone, “So, when you get home and your wife/husband asks, “What did the doctor say?” I often heard the patient respond, “Nothing” or “nothing new” or something completely off the mark.

     I urge you all to bring someone along to be in the office/treatment room, if appropriate, whenever you visit a physician/clinic. You’re bound to get more for “your buck.” 

1) Stern JM, Cendes F, Gilliam F, et.al. Neurologist-Patient communication about epilepsy in the Unites States, Spain, and Germany. Neurology Clinical Practice. 2018; vol 8 (2), pg 93-101. 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions.

Blog #164: MEMORY: SUBJECTIVE COMPLAINTS VS ACTUAL OBJECTIVE DEFICITS IN EPILEPSY

 

 

Who amongst us doesn’t find faultwith our own memory? But are memory concerns and complaints due to actual brainpathology or are they within the normal age-spectrum? Over half of patientswith epilepsy complain of impaired memory. Are they actual memory deficits,though? We know that anticonvulsant medications commonly have deleteriouseffects on memory as can depression, other medications and illnesses.

Exploring memory researchersrecruited patients with Temporal Lobe Epilepsy (TLE).1 TLE diagnosiswas based on abnormal EEG and clinically typical seizures. Our temporal lobes arewhere memory is generated and preserved. Damage there does affect memorywhereas damage to other parts of the brain does not have as serious effects onmemory. Generalized epilepsy, which does not focus on temporal lobes, seems tohave less deleterious effects on memory as compared with TLE.

Researchers recruited 47 patientswith TLE. Age and sex-matched 35 healthy controls were similarly studied.Self-evaluation memory questionnaires were used to assess the magnitude ofmemory complaints. All were then studied with neuropsychological examinations.A surprise recall testing 3 weeks later occurred. No significant differences onstandard testing were found between the performance of patients and controls.

The two groups were then brought backthree weeks later. The surprise recall tests 3 weeks later revealed significantdifferences between the two groups. They were assessed if they recalled simpleevents that occurred during that original testing 3 weeks before. For example,was there a memory of a water glass being offered? Did the examinerleave the room and change what they wore? Did the subject recall the phoneringing twice during the visit, or recall being asked to retrieve aquestionnaire from a shelf, etc.? In the absence of spontaneous recall withoutcues, cues were then provided by the researchers followed by recognitionquestions such as “did the phone ring once or twice? Were you offered wateretc.? Scores were generated.

The standard neuropsychological battery wehave relied on to test cognition and memory has some blind spots; an adequateassessment of autobiographical memory and our “long term” memory assessmentsoccur 10 to 30 minutes after the information is encoded. Traditionally thesetests haven’t been performed. It is these blind spots that have been addressedin this study. People with subjective memory complaints that were corroboratedby family members had normal performance on standard neuropsychological testing.But scores 3 weeks later were significantly lower in the epilepsy group.

This information is another reminder that we need to listen closely toour patients’ complaints, and that our gold standards need to be updated as ourunderstanding of memory evolves.

1)    Lemesle B, Barbeau EJ, Milongo Rigal E, et al.Hidden objective memory deficits behind subjective memory complaints inpatients with temporal lobe epilepsy. Neurology. 2022;98(8): E818-E828

 

LanceFogan, M.D. is Clinical Professor of Neurology at the David Geffen School ofMedicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view.“DINGS” is his first novel. Aside from acclamation on internet bookstoresites, U.S. Report of Books, and the Hollywood Book Review, DINGS has beenadvertised in recent New York Times Book Reviews, the Los Angeles TimesCalendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard covereditions.

 

Blog #163 February: ALZHEIMER'S DISEASE AND EPILEPSY

Articles are ubiquitous in the media on Alzheimer's Disease (AD). It is estimated that Alzheimer's currently affects 5 million Americans. In 2050 ten percent of us will be affectedaccording to Harvard.edu.

Increasing knowledge based on multiple studies (meta-analysis) shows a link between AD and epilepsy. People with epilepsy had a 1.8-fold increased risk of AD. Patients with AD had a 3.1-fold higher risk of epilepsy, both generalized and focal seizures with impaired awareness(complex partial epileptic seizures). Temporal lobe epilepsy and AD share some pathologic features such as both show hippocampal sclerosis in the temporal lobe tip. The study populations to confirm this information is interesting but it is inconclusive due to the relatively small populations in the studies.1 

Increased chemical amyloid compounds are found in the brains of patients with AD. Elderly people who may be intellectually normal all have some amyloid in their brains, too, but this chemical compound is more prolific in AD dementia. It appears that amyloid pathology increases the propensity to generalized seizures. There is an association between AD and focal seizures, too, with hippocampal sclerosis (scarring) in the temporal lobes.

1. Fang Y, Xiaoli S, Jial W, et. al. Alzheimer Disease and Epilepsy. Neurology;2023 101:e 399-e409. Doi:10.1212 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in recent New York Times Book Reviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hard cover editions

Blog # 162: The Gamma Knife is Focused Radiation to Treat Epilepsy Without Surgery

               Myfollowers should find this 162nd of my monthly educational blogs ofinterest for your own epilepsy and for those whose lives are touched by your epilepsy.

If yourepilepsy is drug resistant this is a potential treatment that could benefit youand it is non-surgical. Gamma knife surgery, also known as stereotacticradiotherapy, is not actual surgery. No cutting nor opening of the skull is involved.Radiofrequency beams are painlessly concentrated on the brain area identifiedas the cause of your epilepsy. This technique originated in the 1950’s. TheGamma Knife can minimize damage to nearby healthy brain tissue. Your seizurefrequency may be lessened; your epilepsy may even be cured without opening theskull or damaging normal brain tissue.1  

The Gamma Knife® is a powerful toolthat enables the neurosurgeon to focus many weak beams of radiation energy onany location inside the brain, especially useful to treat areas difficult, ordangerous, to expose surgically. By focusing these intersecting individuallyweak beams together these many beams can break down tissue. The radiosurgeryteam can target a region of the brain while limiting damage tosurrounding, normal brain tissue. While more commonly used to treat childrenwith braintumors and collections of abnormal blood vessels arteriovenousmalformations, the Gamma Knife is also used to treat some patientswith epilepsy.

 

The painless treatmenteffect of Gamma Knife radiosurgery occurs slowly, depending on these conditionsthat are often associated epilepsy:

Benign tumors. Gamma Knife radiosurgery keeps tumor cells from reproducing. Thetumor may shrink over a period of months to years. But the main goal of GammaKnife radiosurgery for noncancerous tumors is to prevent any future tumorgrowth.Malignant tumors. Cancerous tumors may shrink quickly, often within a few months.Arteriovenous malformations (AVMs). The radiation therapy causes the atypical blood vessels ofbrain AVMs to thicken and close off. This process may take two yearsor more.Epilepsy foci. Half of epilepsy patients lack identifiable brain tissue abnormalitiesor scars which EEGs and brain scans identify where seizures begin. Theradiation therapy can be useful in eliminating these abnormal areas.

Consider discussingGamma Knife treatment on a brain epileptic focus your medical team hasidentified causing your still poorly controlled seizures with your neurologist.

1.      Lunsford LD, Kondziolka D, Flickinger JC, etal: Stereotactic radiosurgery for arteriovenous malformations of the brain. JNeurosurg 75:512-524, 1991

 

 

 

Lance Fogan,M.D. is Clinical Professor of Neurology at the David Geffen School of Medicineat UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from amother’s point of view. “DINGS” is his first novel. Aside fromacclamation on internet bookstore sites, U.S. Report of Books, and theHollywood Book Review, DINGS has been advertised in recent New York Times BookReviews, the Los Angeles Times Calendar section and Publishers Weekly. DINGSteaches epilepsy and is now availablein eBook, audiobook, soft and hard cover editions.

 

 

 

Blog # 161: WEEKLY EPILEPTIC SEIZURES REDUCED BY MEDICAL CANNABIS

 

A study was summarized by Robert Herpen, MA and Shenaz Bagha on theAmerican Epilepsy WebSite. The researchers, Xintian Lyn, BS, a student in thedepartment of experimental and clinical pharmacology at the College of Pharmacyat the University of Minnesota and her team reported on their recent poster atthe American Epilepsy Society meetings earlier in December 2023 that adultswith epilepsy given medical cannabis had a significant decrease in weeklyseizure frequency.1

There is a paucity of data on the effects of THC (Tetrahydrocannabinol,the principal psychoactive constituent of cannabis) on seizure frequency. Thisresearcher group in Minnesota was interested in cannabis’ effects on seizurefrequency.

From 2016 to 2019 one-hundred-twelve adults with epilepsy, 70% of whomwere aged 18-64 (54.5 % were male) were studied. The participants had at leastfour visits for treatment for at least 6 months. They may or may not have hadantiseizure medications prescribed, too. The outcome of the study was that 57participants reported fewer weekly seizures, 47 enrollees reported nochange—including 34 with zero frequency seizures during the study period—while10 patients reported an increase in their seizure frequency. In all three ofthese groups, participants were dispensed both CBD (cannabis) and THC. Thestudy found a significant difference reported in CBD total daily dose amongthose who recorded either a decrease or no change in seizure frequency. CBD isa chemical found in marijuana. CBD doesn't contain tetrahydrocannabinol (THC),the psychoactive ingredient found in marijuana that produces a high.

Thirty patients relied on only CBD cannabis to manage their epilepticseizures. Most of this study population were also taking one to fiveantiseizure medications.

If your epilepsy is poorly controlled discuss adding CBD (cannabis) toyour treatment with your physicians. Additionally, explore the potential ofbrain surgery as your epilepsy treatment if no other treatments benefit you.Several of my previous 160 monthly blogs on my website: LanceFogan.com dealtwith brain surgery as a chance to improve your epilepsy when medications fail(See Blog # 89 December 26, 2017: SurgicalRemoval of Seizure Foci in Your Brain to Cure Poorly Controlled Epilepsy isSafe!; Blog # 103 February 26, 2019: Epilepsy—fitto drive?; Blog # 114 January 26, 2020: Epilepsysurgery in childhood and long-term employment is encouraging.; Blog # 121August 25, 2020: Ifyour seizures aren’t controlled epilepsy surgery is safe and really can help).

 

1.      Lyu X. et al. Medical cannabis and seizurecontrol in Minnesota medical cannabis program. Presented at AmericanEpilepsySociety annual meeting Dec. 1-5, 2023: Orlando, FL.

 

Lance Fogan, M.D. is Clinical Professor of Neurology at the David GeffenSchool of Medicine at UCLA. His hard-hitting emotional family medical drama,“DINGS, is told from a mother’s point of view. “DINGS” is his first novel.Aside from acclamation on internet bookstore sites, U.S. Report of Books, andthe Hollywood Book Review, DINGS has been advertised in recent New York TimesBook Reviews, the Los Angeles Times Calendar section and Publishers Weekly.DINGS teaches epilepsy and is now available in eBook, audiobook, soft and hardcover editions.

Blog #160: Life Expectancy Varies by Epilepsy Type

 

Overall,life expectancy is comparable to the general population.1 But incertain types of epilepsy, therisk of premature death is higher than that of the general population. Most ofthe increased risk is directly related to what causes your epilepsy.

Only a small number of deaths in the epilepsy patientpopulation are epilepsy related. These are deaths caused by a seizure oraccidents during or immediately after the seizure, as well as sudden unexpecteddeath for which no cause of the death can be identified. SUDEP (see below) isone example of this. Sudden unexpected deaths are more common in patients withpoorly controlled, intractable epilepsy. Improved seizure control, medical adviceand avoiding the hazards that occur during a seizure are key. Regular medical follow-upcare and supervision may help reduce the risks of epilepsy-related deathoccurring.

What causes epilepsy?

Epilepsycan be categorized into three broad groups:

Idiopathic epilepsy

Commonamong children, idiopathic epilepsy is an inherited type of epilepsy with astrong genetic component and no structural brain abnormalities. Provokedseizures (for example, from flashing lights) are often seen in idiopathicepilepsy.

Cryptogenic epilepsy

Cryptogenicepilepsy is the type with no known cause and often involves unprovokedseizures. This accounts for approximately 20% of seizure cases.

Sympto matic epilepsy

Symptomaticepilepsy is caused by an injured brain. Common causes: head injuries, centralnervous system infections, loss of oxygen to the brain, strokes, brain tumorsand brain surgery.

How can your epilepsy result in premature death?

Prematuredeaths in people living with epilepsy: failure to take antiseizure medicationsas prescribed; the seizures themselves; collateral damage related to a seizure;reduced quality of life that comes with living with epilepsy; fatalunintentional injuries (for example, falls and burns), or through aspirationpneumonia during a seizure.

Additionally:

Serious transportation accidents: Seizures— which can result in impaired awareness and uncontrolled motor activity — putpeople living with epilepsy at increased risk of serious transportationaccidents. This increased risk doesn’t apply to just car accidents but to theincreased risk of pedestrian accidents and increased risk of bicycle accidents.

Drowning: because seizures can lead to a loss ofconsciousness or uncontrolled motor activity, people living with epilepsy areat increased risk of drowning. The risk of drowning is much higher in peoplewith epilepsy. Despite my warnings, one of my young surfer patients ignoredthis warning and continued surfing. I don’t know his current condition Whilecases of drowning often occur in the bathtub (Mark Twain’s adult daughter had epilepsy;she drowned in her bath, for example), less frequently patients die in theshower; the body, face-down, blocks the drain resulting in drowning in justinches of water.

Status epilepticus: status epilepticus is a condition inwhich a person experiences abnormally prolonged seizures (longer than fiveminutes in the case of generalized tonic-clonic seizures; they usually lastunder 2 minutes) that can lead to long-term consequences, including braindamage and death.

Psychiatric illness: people with epilepsy commonly havedepression, which increases the risk of suicide. The high incidence andprevalence of psychiatric illness (including impulsivity, psychosis, andsubstance abuse) correlates with the duration and severity of epilepsy. Depressionis also associated with not taking medications as recommended, which canincrease mortality.

What is a sudden unexpected death in epilepsy (SUDEP)? Premature mortality in people with epilepsy can also be attributed to asudden unexpected death in epilepsy (SUDEP): Blog#108: SUDEP—Sudden Death in Epilepsy—Occurs in All Types of Epilepsies; Blog#74: New Studies Reveal High SUDEP Risk of Death in Poorly Controlled Epilepsy.In the US, there are at least 2,750 cases of SUDEP peryear. SUDEP refers to deaths among people with epilepsy that cannot beattributed to other known causes. Studies suggest that for every 100,000 peoplewith epilepsy, there will be approximately 116 cases of SUDEP. While the causesof SUDEP are not yet fully understood, most cases occur during or immediatelyafter a seizure and generally during sleep. Possible seizure-related factorscontributing to SUDEP include breathing and/or heart rhythm disruptions.

Does epilepsy shorten your life expectancy? People with epilepsy are two to three times more likely to die earlythan those without the condition. This suggests that epilepsy can shorten lifeexpectancy by ten years for those living with symptomatic epilepsy and by twoyears for those with idiopathic/cryptogenic epilepsy where no serious brainpathology can be identified. Whilelife expectancy is reduced in cases of symptomatic epilepsy (by approximatelyseven years), people with cryptogenic epilepsy had an almost normal lifeexpectancy.

SUMMARY: While epilepsy can increase your risk of premature death, it is possible,in most cases, to manage these risks with anti-epileptic drugs, appropriatemental healthcare, and lifestyle changes. Mortality in patientswith newly diagnosed epilepsy is higher than in patients with chronic epilepsy duemainly to the underlying epilepsy cause.

MYADVICE: making family, friends, and colleagues aware of therisks and how they might be able to help you reduce these risks can go a longway to keeping you safe. Be certain that you have follow-up care andobservation by your physician for your best chance of thriving with epilepsy.

1.    Granbichler CA, Zimmerman G,Oberaigner W, et. al. Potential years lost and life expectancy in adults withnewly diagnosed epilepsy. Epilepsia. 2017;58(11): 1939-1945.

 

LanceFogan, M.D. is Clinical Professor of Neurology at the David Geffen School ofMedicine at UCLA. Hishard-hitting emotional family medicaldrama, “DINGS, is told from a mother’s point of view. “DINGS” is his firstnovel. Aside from acclamation on internet bookstore sites, U.S. Reportof Books, and the Hollywood Book Review, DINGS has been advertised in recentNew York Times Book Reviews, the Los Angeles Times Calendar section andPublishers Weekly. DINGS teaches epilepsy and is now availablein eBook, audiobook, soft and hard cover editions.

 

 

Blog #159: DO YOU HAVE SUBTLE EPILEPSY SYMPTOMS THAT ARE UNRECOGNIZED?

 

Stacie Kalinoski is an Emmy-award winning reporter. She also isan epilepsy nurse practitioner. In the April/May 2018 issue of thepatient-geared journal Brain and Life, page 56, she writes of herown epilepsy. Kalinoski pursuesbrain surgery and she documents this journey.

Kalinoski experienced herfirst convulsion in college. An avid runner, while running she notedregular episodes of déjà vu, that weird feeling like sheis in some environment or is seeing something for the very first time, but itfelt like that the experience had happened to her before. Most of us haveexperienced such a feeling once or twice in our lives but frequent recurrentepisodes are abnormal. They suggest epileptic auras, a problem in ourbrain’s temporal lobe. Another brain phenomenon that is similar, but theopposite, is jamais vu. Here, what’s familiar to us nolonger feels or seems, familiar. For example, one’s bedroom, one’s car, orfamiliar people—all feel new during the seconds or minutes of the episode.

Kalinoski’s hiddenepilepsy flowered into multiple blank outs after a strenuous marathon run. Shehad had little sleep. Then she lost awareness and cut herself preparingvegetables. A neurologist diagnosed epilepsy. She started antiseizuremedications. Too little sleep and strenuous running accompanied more jamais vuepisodes. She became disorientated after a run. She found herself lost despitebeing very near her house. She required help getting home only two blocks away.Neurological testing showed an abnormal brain focus originating epilepticseizures. A temporal lobectomy followed. This decreased the number of heraura-seizures. These subsequently became episodes of strange tastes lasting afew seconds. Many people also experience auras as smells that aren’t reallythere—olfactory hallucinations.

In my novel, DINGS, Icreated a character who has olfactory hallucinations. The neurologist in thenovel queried if his young patient had ever imagined smelling something thatwasn’t actually there. The neurologist then offered “burning rubber” smells, acommon symptom of complex partial seizure auras. The novel’s character agreesthat he does perceive smells like that. A diagnosis of epileptic blank-outseizures is made, heretofore unrecognized. The mother is devastated uponlearning her son has epilepsy. She conjures up public prejudices. She learnsthat one percent of the population has epilepsy, over three million Americans,but the epilepsy in half of them, encouragingly, is well controlled. They arefree of seizures on treatment. Chief Justice Roberts of the United StatesSupreme Court, despite his epilepsy, has achieved a leading position in oursociety.

 

hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view.“DINGS” is his first novel. Aside from acclamation on internet bookstoresites, U.S. Report of Books, and the Hollywood Book Review, DINGS has beenadvertised in recent New York Times Book Reviews, the Los Angeles TimesCalendar section and Publishers Weekly. DINGS teaches epilepsy and is now available ineBook, audiobook, soft and hard cover editions.