Do You Know the Difference Between Seizures and Epilepsy?

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Kendra:

We’re joined for an important conversation with Dr. Supriya Kohli of Baptist Health Medical Group Neurology to understand the condition that affects more than we originally thought. One in 26 will develop epilepsy in their lifetime. And if you’re like us, this statistic made us pause with concern. And it’s natural to wonder could it happen to me and my family? So thank you for joining us today, Dr. Kohli.

Dr. Kohli :

Thank you so much, Kendra and Kerri for having me today. Yes, you are absolutely right Kendra, there are about 50 million people worldwide that have epilepsy and about 70% could be seizure-free if properly diagnosed and treated.

Kendra:

We’ve produced a lot of content surrounding behavioral health in particular, our response to COVID-19, and how we’re adapting and evolving stress. As we prepared for this discussion. Kerri and I took note of this, the symptoms of anxiety, particularly panic attacks can look and feel a lot like the symptoms of some types of an epileptic seizure. Isn’t there a concern that both conditions can be misdiagnosed?

Dr. Kohli :

Yes, surely there is an overlap between seizures and panic attacks because prior to a seizure, one could have paranoia or anxiety as well. But loss of awareness can be a key differentiating feature between the two. So for example, in a seizure, you may lose awareness and become confused, but in a panic attack, you can retain awareness. And then also, further testing such as a long-term EEG monitor could be useful to differentiate between the two.

Kendra:

Tell us more about the relationship between anxiety, extreme stress and seizures, in those with epilepsy.

Dr. Kohli :

Stress and anxiety can definitely trigger seizures, especially if the patient is extremely sleep deprived. Sleep deprivation or insomnia can be seen in people who are extremely stressed out. Also, if someone is severely depressed, they are more likely to miss their medications, even abuse drugs and alcohol more which can eventually lead to seizures and then stress can make the blood pressure shoot up and then subsequently cause seizures because of changes in the brain. But there is another very important entity that I wanted to speak about today called PNES or psychogenic non-epileptic spells where patients can have spells that look like seizures, but are not true seizures. And these episodes can be brought on by one’s subconscious mind, especially if they have had a history of abuse or anxiety or depression, and essentially in the brain these will be normal. Unlike a true seizure. We see a lot of PNES in our clinic as well.

Kerri:

Let’s back up a bit when is it typically diagnosed and who’s most at risk for this condition suffering from seizures?

Dr. Kohli :

First of all, it can be diagnosed at any age and about 1.2% of the total US population, which is roughly around three-and-a half million people have epilepsy. And there is a 3.6% risk of experiencing at least one seizure during one’s lifetime. So like I said, it can be diagnosed at any age. Babies can have it if they have prenatal or perinatal birth trauma, then there can be genetic causes. Young people can have it with certain brain infections such as meningitis or head injuries or drug and excessive alcohol use. And then once again, it can become more prevalent in the elderly above age 65 due to stroke or brain tumors or dementia, which can cause some structural changes in the brain causing seizures.

Kerri:

Can you provide an overview of treatment options?

Dr. Kohli :

We have made excellent progress in the past 10 years as there are now over 15 medications that we can choose from based on the types of seizures that they have, or the side effect profile. About 70% will have the seizures well controlled by medicines alone. But sometimes, if the seizures are not well controlled by medications, then certain devices can be used such as a VNS or Vagus nerve stimulation which is a pacemaker-like device that goes in the chest and stimulates the vagus nerve to control the seizures. Or there are Intracranial devices which go inside the brain and directly stimulate the brain like DBS or Deep brain stimulation and RNS, which is also called a Responsive Neurostimulation. And then, another option. But this is sort of like a last measure is brain surgery which is performed after thorough testing is done where we can pinpoint the seizure focus and then remove it.

Kendra:

The terms Epilepsy and seizure are often interchanged, but they can really be two very different things. What is the difference between seizures and epilepsy?

Dr. Kohli :

So seizure is basically a symptom of epilepsy. seizure is a single episode, which is essentially an abnormal electrical discharge in the brain that can cause symptoms such as loss of awareness or confusion or shaking. Epilepsy on the other hand is two or more unprovoked seizures where no provoking factor is found. Some of the provoking factors, could be fluctuations in blood sugar or alcohol withdrawal, cocaine use, or any infection in the body, head injuries, sleep deprivation, or sometimes even flashing lights. There was this case in Japan where flashing lights from video games trigger seizures in so many children and then even hyperventilation. So yeah, these are some of the things that could trigger seizures

Kerri:

That reminds me of febrile seizures. When you see a child who has a particularly high fever from an illness, again, they may have an incidental seizure along with the fever, an example of when they may have a one-off seizure, but they don’t necessarily have epilepsy.

Dr. Kohli :

And Febrile seizures are actually extremely common. As one in five children can have a febrile seizure and sometimes it may just be a one-off event, but in some children they can also go ahead and develop epilepsies in the future,

Kendra:

Let’s start by breaking down epilepsy first. What is it? Are there different kinds? What are the symptoms we need to be looking for?

Dr. Kohli :

There are actually several different types of epilepsies and amongst the seizures too, there are many different types, but I will touch upon the two broad categories of seizures. One is a partial seizure, which can found from one part of the brain where, they can have symptoms of confusion, loss of awareness, where they stare off into space or look around. And sometimes during the event, they can actually continue to talk. And sometimes partial seizures can have warning signs or auras prior to a seizure, such as a rising sensation in the stomach, déjà vu or a feeling of fear or a funny movements that we call us. Automatisms such as lip-smacking movements or handpicking movements. So all of these let the patient know that they are about to have a seizure.

Dr. Kohli :

And then the second broad type is a generalized seizure where, well, in some ways the whole brain throws off the electrical discharge at the same time. And during this, patients can stiffen up and have whole body shaking with or without a tongue bite and bowel and bladder incontinence. And sometimes these are also known as one of the older terms actually used for this was a grand mal seizure, generalized tonic clonic shaking. And then there can be other generalized seizures, such as whole body jerks are called as myoclonic jerks and absence seizures, which are commonly seen in children where they stare off into space.

Kerri:

How is epilepsy diagnosed? Is it a fairly easy condition to identify?

Dr. Kohli :

The first tool in diagnosing epilepsy would be careful medical history to differentiate it from other causes. And then once the patient or a caregiver recognizes the symptoms, they should talk to the doctor right away. And if possible, try to get a neurology referral. And also for a family member or colleague, if the patient has episodes, they should try to record it on their smartphone if they can bring it for the doctor to see. I tell all my patients and their relatives to record the events if they are able to, then they can also keep an event diary where they can write their symptoms in detail. After the doctor gets a prior history further testing can be ordered such as an EEG or electroencephalogram, which is very useful where leads are placed on the brain to recall the brainwaves and then imaging modalities can also be very useful, such as a CT scan of the head to rule out a bleed or MRI scan of the brain to rule out structural problems inside.

Kendra:

Are there other conditions that can make epilepsy difficult to pinpoint?

Dr. Kohli :

So seizures, like I explained can vary and there are definitely mimickers of seizures. The most common would be passing out or fainting spells that can be seen well due to cardiac arrhythmias or fluctuations in blood sugar and blood pressure. And then non-epileptic seizures, or what I had previously described, PNES can look like true seizures. And then some people have body jerks with extreme fatigue or exercise, or just hypnic jerks that night, while they’re sleeping, that can look like the measures. Then there are certain sleep disorders such as sleep paralysis or sleep walking, which can be confused for night seizures. And then of course, tremors in the hands or certain movement disorders.

Kerri:

Is there anything people can do to prevent epilepsy or at the very least maybe lower their risk of developing it?

Dr. Kohli :

So we can reduce the risk of epilepsy by reducing the risk factors. So for example, in children, good prenatal care during pregnancy can avoid complications during childbirth and prevent seizures in babies. Getting vaccinations can reduce the risk of certain diseases and reduce seizures. Then in the young people to prevent head injuries, which is the big cause of seizures between ages 15 to 25, people can wear seat belts or use car seats for infants or children, and then wear helmets. And then for the elderly, I would say the biggest risk factor is having a stroke. So we can educate them about the different risk factors for a stroke, such as high blood pressure or high cholesterol, diabetes, or smoking.

Kerri:

Let’s look now at seizures, as we learned with you, not everyone who has seizures necessarily has epilepsy. What are some of the telltale signs of a seizure?

Dr. Kohli :

Most common symptoms of seizures can be staring ahead in space with loss of awareness where they have no recollection of the event later on.confusion or sometimes even speech changes seizures coming from the back of the brain can sometimes cause visual aura or visual symptoms just like a migraine can. And then of course there are the generalized seizures with the whole body shaking with tongue bite or bowel and bladder incontinence. And then simple partial seizures without loss of awareness can just present with wanting signs of auras. Like I described like a feeling of déjà vu, or a rising sensation in the stomach, or a feeling of fear or some odd movements like lip-smacking movements or hand picking movements.

Kerri:

Can you provide our listeners with tips on how to provide aid to someone if they find themselves in a situation where they think or they know that someone around them is having a seizure

Dr. Kohli :

First and foremost get the patient to a safe place. So for example, you can make them lie down, preferably in the sideways or lateral position to open the airway and never ever put your finger in their mouth to clear the airway because they will bite down on your hand. Finally, you can call 991 if a seizure is prolonged say over five minutes, or if someone is having repetitive seizures or if there are any injuries or any respiratory compromise. But yes, if a person has frequent seizures, and if it is a short episode lasting for a few seconds to a minute, then it can be managed at home with the measures that I mentioned.

Kendra:

Let’s Wrap up this episode with a round of true or false, addressing some of the common misconceptions around epilepsy and seizures. So true or false? You can swallow your tongue during a seizure.

Dr. Kohli :

That is absolutely false. you can bite your tongue during a seizure, but the tongue retains its stone. So it does not fall back into your throat. It stays in place

Kendra:

True Or false? You should force a leather wallet or something into the mouth of a person having a seizure for assistance.

Dr. Kohli :

So that’s a complete no-no because they can actually choke on the object that you put in their mouth. Please don’t put any foreign objects or your finger inside the mouth

Kendra:

True or false? You should attempt to restrain someone who is having a seizure to protect them from it.

Dr. Kohli :

No, because restraining them could hurt them further. So like I mentioned earlier, get them to a safe spot to make them lie down and remove any sharp objects close to them, but do not try to restrain them.

Kendra:

True or False? Epilepsy is contagious.

Dr. Kohli :

Absolutely false. It is in no way, transmitted through touch

Kendra:

True or False? Epilepsy severely limits a person’s abilities to participate in daily life.

Dr. Kohli :

Sometimes epilepsy can affect the activities of daily living especially if someone has intractable epilepsy, that is not well controlled with medications, but in most people, if their seizures are well controlled with medicines, then they can do all of the activities that their friends can and it will not limit their participation and things.

Kerri:

Well, Dr. Kohli, thank you so much for this valuable information. I know I’ve certainly learned a lot today. How can people get in touch with you to schedule an appointment or to visit your office?

Dr. Kohli :

First of all, it was an extreme pleasure to speak to both of you about this. Iam glad that people will be able to hear it and get educated about seizures. Because as you know, there are a lot of misconceptions about seizures and epilepsy and people can call our neurology office here on Nicholasville Rd. And the number here is (859) 260-4330. And we do accept self referrals.

Kerri:

This certainly has been an interesting conversation for both Kendra and I, we appreciate your time. Thank you again for joining us.

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