Epilepsy care starts with the right diagnosis

Epilepsy can develop in anyone at any age, although most cases occur in children under age 10 and adults over 60. Overall, 3-7 percent of people will experience a seizure at some time in their lives; seizures will reoccur in about one-third of cases.

There are different types of epilepsy that impact people in different ways. Someone might have odd feelings, such as fear, euphoria or déjà vu, which may be accompanied by staring or a shaking arm or a stiff hand. Another individual may lose awareness and have a vacant stare. Some people with epilepsy fall to the ground, lose consciousness and have convulsions.

Diagnosing epilepsy isn’t always easy because the tests aren’t perfect. An EEG, a test that measures electrical activity in the brain, is helpful 30-50 percent of the time. An MRI scan, which produces detailed pictures of the brain, shows an abnormality about 25 percent of the time and is useful in detecting problems in the brain that can lead to seizures.

Because of the difficulty with diagnosis, often people are only diagnosed after they have a convulsion or they are treated after an accident that occurred during a seizure.

Inpatient monitoring: a tool for diagnosis

The Epilepsy Monitoring Unit at Christiana Hospital is an exciting addition to the tools we already have for diagnosing epilepsy. It’s the only adult monitoring unit in the state and is a resource for people whose epilepsy has not been precisely diagnosed or has not been controlled.

Monitoring allows the medical team to quantify how many seizures patients are having. We also can learn precisely which type of epilepsy it is, so we can prescribe the most effective medications. In addition, some people who are considering surgery for their epilepsy are monitored to learn the area of their brain where the seizures begin.

The two-bed Epilepsy Monitoring Unit opened in January 2018 in the Transitional Neurological Unit. Patients stay in the unit from three to seven days. Throughout their stay, we record their EEGs, video and EKGs so we can determine what kind of seizures they are suffering from.

Most of the time in order for us to study seizures, the patient has to have one. So we reduce anti-convulsion medications and deprive them of sleep to try to bring on a seizure. Each patient wears a vest that is attached to the bed lift so they don’t fall while they are having a seizure.

Getting the right treatment

Sometimes, we learn that seizures are not caused by epilepsy. There are a variety of other causes of seizures, such as fainting, low blood sugar and conversion disorder. Conversion disorder is a psychiatric disease, and often these people are helped by cognitive therapy rather than medications.

Getting effective treatment for epilepsy is important. Epilepsy too often causes people to miss important milestones in their lives, such as playing sports, dating or going to college.

Once people are treated in the appropriate way they can get on with their lives. And the earlier the treatment, the better.

Whatever the cause, diagnosis is the first step to effective care.