Epilepsy is often misunderstood, and misconceptions about it persist. It is crucial to recognize that epilepsy is not contagious and can affect individuals of all ages, backgrounds and genders. Epileptic seizures, which are the hallmark of the condition, occur when signals in the brain experience a ‘short-circuit’, leading to a variety of symptoms.
A seizure can be life-threatening, especially if it occurs in an environment where an individual might get hurt when they lose control of their limbs during the episode. However, its risk to an individual’s safety can be significantly minimized.
Dr. Eugene Achi, Staff Physician at the Neurological Institute of Cleveland Clinic Abu Dhabi, describes epilepsy as a ‘lightning storm’ in the brain. The body responds by going into a seizure.
Seizures can take various forms, but the most recognized type is known as a generalized tonic-clonic seizure, characterized by whole-body convulsions and rigid muscles. Other seizure types are more subtle. Common signs to look out for include prolonged staring, repetitive movements like eye blinking, lip-smacking or chewing motions, hand rubbing, finger motions, rigid or relaxed muscles, jerking of the limbs or head, falling, and loss of consciousness.
The causes of epilepsy are diverse, ranging from structural and genetic factors to infections, metabolic issues, and immune-related triggers. Cleveland Clinic Abu Dhabi’s Epilepsy Program recognizes the complexity of this condition and offers multidisciplinary care to address its various aspects. It is also closely integrated with the Epilepsy Center at Cleveland Clinic in the U.S. and this collaboration allows for the thorough evaluation and discussion of patient cases between experts on both campuses.
Dr. Achi elaborates: “Within the Epilepsy Program, our team of dedicated healthcare professionals – encompassing the expertise of neurologists, epilepsy physicians, neurosurgeons, neuroradiologists, psychiatrists, neuropsychiatrists, occupational and physical therapists, and allied health professionals – unite their diverse skills and knowledge in a collaborative network of care to treat this chronic condition. Interventions include personalized diets, targeted medications, complex surgeries, and neurostimulation, including vagus nerve stimulation.”
Roughly two-thirds of people with epilepsy can attain control over their seizures with medications. However, as many as one-third of patients continue to have recurrent seizures despite following their medication regimen. This subgroup of patients, referred to as those with drug-resistant epilepsy, requires additional specialized evaluation to find out if they may benefit from surgical intervention or neurostimulation therapy.
Such evaluation may include:
- Epilepsy Monitoring Unit (EMU): This specialized unit is designed for the evaluation of patients with epilepsy. Patients are admitted to this unit to have their seizures recorded and evaluated. This helps in identifying seizure types and figuring out where seizures originate in the brain.
- Epilepsy protocol MRI: This is different from a standard brain MRI in that it provides more detailed images of brain structures where seizures often originate, such as the deep parts of the temporal lobes.
- Ictal SPECT and SISCOM: These imaging techniques measure blood flow in the brain during seizures, aiding in the localization of the seizure focus.
- PET Scans: Positron Emission Tomography scans provide images of brain function, helping identify abnormal brain activity in epilepsy patients.
- Functional MRI with DTI imaging: These imaging modalities help map brain functions and study brain networks and connectivity.
- Electrical Source Imaging (ESI): This advanced technique helps localize the source of abnormal electrical activity in the brain and is useful for localizing the seizure and focusing on planning surgical interventions in epilepsy patients.
- Stereo-EEG: This is a surgical procedure where electrodes are implanted in different locations in the brain to pinpoint the area where seizures originate.
Based on the result and this evaluation, the epilepsy specialist may recommend one of the following treatments:
- Epilepsy surgery: This may include surgical resection of the seizure focus in the brain or its disconnection from the remainder of the brain.
- Vagus nerve stimulation (VNS): This involves the surgical implantation of a device that sends electrical pulses to the vagus nerve in the neck, thus indirectly stimulating the brain to reduce seizures.
- Deep brain stimulation (DBS): This intervention implants electrodes deep within the brain to provide electrical pulses that can help reduce seizures.
While the condition can present challenges in daily life and impact an individual’s overall physiological development and quality of life, the right diagnosis, treatment, and support can empower individuals living with epilepsy to lead fulfilling lives.
Dr. Eugene Achi Staff
Physician at the Neurological Institute of Cleveland Clinic Abu Dhabi
