Stomach cancer (also called gastric cancer) can develop in any part of the stomach, and may spread throughout the stomach and to other organs. It may grow along the stomach wall into the esophagus or small intestine.

The cancer may also extend through the stomach wall and spread to nearby lymph nodes and organs, such as the liver, pancreas and colon. It may spread to distant organs, such as the lungs, the lymph nodes above the collarbone and to a woman’s ovaries.

Stomach cancer happens when cells start behaving abnormally, growing and proliferating uncontrollably. The stomach, a hollow organ that collects food and breaks it down, has five different parts—from the top of the stomach, which connects to the esophagus, to the bottom of the stomach, which connects to the small intestine:

• Cardia, the area nearest to the esophagus
• Fundus, the upper stomach
• Corpus, the main body of the stomach
• Antrum, where food gets broken down by stomach acid
• Pylorus, which connects to the small intestine

There are also five layers of tissue and muscle that surround the stomach and make up the stomach wall. Going from inner to outer, the layers are:

• Mucosa
• Submucosa
• Muscularis propria
• Subserosa
• Serosa

Stomach cancer progressively spreads through these different layers. Establishing how far within the stomach wall the cancer has spread is a part of the staging process (LIKE all cancers), which determines how serious the cancer is and how best to treat it.

The mucosa layer, which produces stomach acid, is where most stomach cancers begin.

A less common type of stomach cancer is caused by gastrointestinal stromal tumors (GISTs), which start in immature cells called interstitial cells of Cajal.

Other rare stomach cancer types, such as lymphoma and neuroendocrine tumors, start in different cell types in the stomach.

Different types of stomach cancer include:

• Adenocarcinomas develop within the cells of the innermost lining of the stomach. The majority of stomach cancers are classified as adenocarcinomas.Most stomach cancer cases, about 90 percent to 95 percent, are adenocarcinomas, according to the American Cancer Society (ACS).Adenocarcinomas are broken down into two categories:
  • Intestinal adenocarcinomas are usually slow-growing and more treatable. Oftentimes, these cancers may be treated with therapy drugs that are designed to target specific mutations in cancer cells. This type most often occurs in men and older adults.
  • Diffuse adenocarcinomas are less common than intestinal adenocarcinomas and usually more aggressive. They tend to be faster growing, often spreading (metastasizing) to other parts of the body quickly. This type is more common at a younger age than intestinal adenocarcinomas.
• Lymphoma is a cancer of the immune system tissue that may start anywhere there are lymph tissues, including the stomach. However, lymphomas in the stomach are rare, accounting for about 4 percent of all stomach cancers.  MALT (mucosa-associated lymphoid tissue) lymphoma is a type of non-Hodgkin lymphoma that typically occurs in the stomach. The cancer starts in lymph tissue that lines the stomach.
• Gastrointestinal stromal tumors, or GISTs, are a rare type of stomach cancer that starts in a special cell found in the lining of the stomach called interstitial cells of Cajal (ICCs). Under a microscope, GIST cells look similar to muscle or nerve cells. These tumors may develop throughout the digestive tract, but about 60 to 70 percent occur in the stomach.  In the United States, 4,000 to 6,000 new GIST cases throughout the GI tract are diagnosed per year, according to the ACS.
• Carcinoid tumors typically start in the hormone producing cells of the stomach. These tumors usually do not spread to different organs and account for only about 3 percent of stomach cancer incidence.  About 8,000 gastrointestinal carcinoid tumors are diagnosed in the United States each year, according to the ACS. Not all of these cancers start in the stomach—they may also occur in the intestines, appendix, colon and rectum.

Early stage cancers especially adenocarcinoma(s) may cause:

• Indigestion
• Bloating
• Nausea
• Poor appetite
• Heartburn

As these cancers advanced, they may cause:

• Bloody stool
• Vomiting
• Unexplained weight loss
• Belly pain
• Jaundice (yellowing of the skin and eyes)
• Difficulty swallowing

“An estimated 65 million people worldwide have epilepsy, and one in 26 Americans will develop epilepsy in their lifetime. Most of these people are able to control their seizures with medications, but approximately 30% to 40% have what’s called drug-resistant or medically refractory epilepsy, in which they don’t respond to standard anti-seizure medications.  There are a few options available for people with drug-resistant epilepsy who need alternative RXs. The most common alternative one is epilepsy surgery, which has been performed since the 1940s.  For a patient with focal epilepsy, where the seizures are being caused by one part of the brain, you try to remove the seizure focus.  Somewhere between 60% and 70% of patients with drug-resistant epilepsy who have this surgery become seizure-free, which is the standard of care if the medications were not to work.  Open brain surgery is effective but also carries higher risk for complications, pain and psychological impacts. Recently, minimally invasive epilepsy brain surgery has advanced quite significantly, particularly a procedure called laser ablation for patients with epilepsy. In that surgery, inserted is a small laser fiber and burn away the seizure focus in the brain but an opening up of the skull is not needed.”

UChicago Medicine (https://www.uchicagomedicine.org/forefront/neurosciences-articles/new-treatment-options-for-people-with-drug-resistant-epilepsy)

Epilepsy is a medical disorder in which seizures can occur anytime, anywhere. An epileptic seizure is an excessive, uncontrolled burst of electrical activity from nerve cells in the brain –  essentially an electrical storm. There are many types of seizures that cause symptoms ranging from lightning-fast muscle jerks lasting less than a second to full body convulsions lasting two or three minutes.

Epilepsy, if not well-controlled, can greatly worsen a person’s quality of life and can cause severe injury or death. And every person with epilepsy responds in a unique and often unpredictable way to treatment, so we need as many treatments as possible.

The medical community continually tests and approves new treatments. Here are 10 treatments, both basic and advanced, that I’ve tried to rank from least to most envasive. However, almost all treatments involve some degree of risk. Discuss your options carefully with your neurologist to pick the best treatment for you as you should for any condition.

Request an appointment to discuss your epilepsy treatment options.

1. Lifestyle changes and complementary or alternative treatments

This topic is too often neglected but can have a major, positive impact on seizure control. Though there is little evidence for the effectiveness of most complementary and alternative medications, healthy lifestyle changes can go a long way toward reducing the risk of having a seizure.

Your neurologist should address these questions with you before developing a treatment plan:

● How is your sleep quality?

● Do you have chronic anxiety, depression, or excessive stress?

● Do you take other medications that may affect your epilepsy medication or directly increase the risk you will have a seizure?

● Does your use of alcohol, caffeine, or herbal remedies affect your seizure control?

The complementary and alternative therapies below can be added to your treatment plan. Because there is not a lot of medical research on their effectiveness for epilepsy, it’s important to discuss each treatment with your neurologist:

● Acupuncture

● Aerobic exercise

● Biofeedback (training to voluntarily control seizures)

● Meditation

● Yoga

I don’t hesitate to recommend aerobic exercise and meditation for all my patients — both usually are win-win treatments! It’s rare that doctors would recommend only lifestyle changes or complementary/alternative treatments for epilepsy; however, these might work sometimes.

I recently had a patient who, after experiencing a single seizure, was diagnosed with a genetic form of epilepsy. She was a student whose seizure occurred after several nights of staying up late studying and

drinking alcohol excessively. It was clear that her risk of having a seizure was higher than normal. However, it was possible that in the setting of a healthier lifestyle this might not occur. After discussing options, she and her parents decided to delay taking medication and first try to make lifestyle changes, including getting more sleep and minimizing or avoiding alcohol.

There is not much evidence that herbal remedies help with epilepsy. But medical marijuana, which is number four on this list, proves that plants have chemicals that can stop epileptic seizures (see below). At this time, we know of no other natural herb that helps with seizures. In fact, some herbs, such as the Chinese herb ma huang, can trigger or worsen seizures. Ma huang is a natural ephedra, which is similar to a stimulant hormone in our bodies. Stimulants tend to worsen seizures, so doctors are hesitant to recommend any herbal remedies at this time.

2. Diet

For many years, a special diet has been used to control certain types of epilepsy. One in particular – the ketogenic diet – gained public attention with the 1997 movie “First Do No Harm.” In this film, which is based on a true story, Meryl Streep plays the mother of a son whose epilepsy fails to respond to conventional treatments, including epilepsy surgery. She takes him to Johns Hopkins Medical Center, which pioneered the use of the ketogenic diet and demonstrated its effectiveness. Her son responded wonderfully to the diet and became seizure-free.

The ketogenic diet is strict. It severely limits carbohydrates and maximizes fats and proteins. This low-carbohydrate diet triggers ketosis, an alternate metabolic pathway in the body that somehow works against seizures. Variations in the amount of fats and proteins relative to the amount of carbohydrates are allowed. One such variation is the Modified Atkins Diet.

The ketogenic diet is challenging and is used mostly for children. A few studies have shown its effectiveness in adults, but, as one might expect, it’s difficult for most adults to maintain such a strict diet. Choosing this type of therapy requires support from experienced nurses, dietitians, and physicians who can help guide food and drink choices.

Although it may seem like the ketogenic diet has been recently created, it’s not a newly discovered way of eating. In fact, the ketogenic diet was first put into practice in the 1920s as a treatment for people with epilepsy after research demonstrated that fasting reduced seizure activity.

What exactly is the ketogenic diet? The ketogenic diet is an eating pattern that includes high amounts of fat, low to moderate amounts of protein, and very little carbohydrates. The keto diet is typically rich in foods like butter, cheese, eggs, meat, nuts, oils, seafood, and seeds. It does not allow much, if any, room for fruits, vegetables, grains, potatoes, sweets, or other carbohydrate-rich foods.

Although there are variations to the ketogenic diet, they all share a primary objective of restricting carbohydrate intake. A typical ketogenic eating plan aims for about five percent of calories from carbohydrates, 20 percent from protein, and 75 percent from dietary fats. On a 2,000-calorie-per-day ketogenic diet, this equates to about 100 calories (25 grams) of carbohydrates, 400 calories (100 grams) of protein, and 1,500 calories (167 grams) of dietary fat.

4. Medical marijuana

Medical marijuana is a term that now refers to one of more than 80 chemical compounds found in the cannabis plant – cannabidiol oil or CBD oil. This treatment came to national attention in 2013 with the story of Charlotte, a child living with Dravet syndrome in Colorado. Dravet syndrome is a severe form of genetic epilepsy, and Charlotte was having many seizures every day. CBD oil helped effectively manage Charlotte’s seizures, which has led to formal clinical studies that have proved its effectiveness.

CBD oil lacks the compound tetrahydrocannabinol (THC), so it does not appear to cause any significant mood-altering effects (“getting high”), at least compared to smoking the marijuana leaves. As of May 2018, there have been two major, scientifically rigorous clinical studies that have shown that Epidiolex, a form of CBD oil pending FDA approval, is relatively safe and effective in Dravet Syndrome and the Lennox-Gastaut Syndrome. It has been approved by the scientific advisory committee of the FDA, but final approval is pending. At this time, CBD oil is expensive. We need more research to assess its efficacy for other types of epilepsy and its possible long-term effects.

5. Medication trials

At any time, a patient may be invited to participate in a trial of an experimental medication. Since about 1993, this is how all medications have received FDA approval. Often, patients are invited to join a trial after they have failed a number of other FDA-approved medications.

The advantages of participating in a clinical trial include:

● Access to new medication

● Close support and follow-up with the epilepsy team

● The opportunity to help medical researchers develop new treatments

The goal of medication clinical trials is to make sure the drugs are safe and effective. Clinical trials are experimental studies, so there is some risk involved with participating. However, clinical research teams follow extremely strict federal, state, and hospital guidelines to ensure that the risks are minimized.

6. Extracranial neurostimulators

Neurostimulators deliver electrical stimulation to the brain. Some stimulate nerves that are not in the brain, which then transfer the electrical stimulation to the brain; we refer to these as extracranial stimulators.

The first and most common stimulation of this type is the vagus nerve stimulation (VNS), in which an electrode is wrapped around the vagus nerve on the left side of the neck and a computer battery is implanted under the skin below the collar bone. We start with the stimulator set to deliver a 30-second electrical impulse every five minutes. Each patient has a magnet that activates the device immediately and at a higher intensity if a seizure occurs. Newer versions of the VNS also can trigger a stimulus when the patient’s heartbeat goes too fast, which often happens with an epileptic seizure.

Another type of neurostimulation currently being investigated is external trigeminal nerve stimulation. This therapy stimulates a nerve on the face and does not require surgery.

7. Immunotherapy

Occasionally, epilepsy is caused by the patient’s immune system attacking the brain. Autoimmune epilepsy is a relatively recently recognized cause of epilepsy that cannot be controlled with anti-seizure medications alone.

Typically, the patient produces antibodies that attack parts of the brain, and these antibodies can be identified with a blood test. Some patients have autoimmune epilepsy, but no antibody can be identified at this time.

Treatment options include:

● High-dose steroids

● Administering a collection of human antibodies through the veins

● Plasma exchange to filter the blood of disease-causing antibodies

● Other medications that suppress the overly active immune system

8. Responsive neurostimulation (RNS®)

If epileptic seizures are coming from one specific region of the brain, and they cannot be stopped with medications or other therapies we have discussed, the patient can be a candidate for intracranial neurostimulation.

This first requires identifying exactly where the seizures are coming from – the seizure focus. Sometimes this can be done by recording the patient’s seizures with electrodes on the scalp using video-EEG. Often, however, we need to use intracranial electrodes to confidently determine the location of the seizure focus.

If the patient does not want surgery, if there is more than one seizure focus, or if it would be too risky to remove the seizure focus, the patient can choose intracranial automatic neurostimulation, a system developed by NeuroPace Inc.

The neurosurgeon inserts electrodes within one or more brain regions where seizures start. The electrodes detect the onset of a seizure and trigger an immediate electrical impulse in the seizure focus, which we hope will stop the seizure. It’s like fighting fire with fire. This is similar to automatic heart defibrillators for patients with potentially fatal heart arrhythmias. The main risks are scalp infections and bleeding when the electrodes are inserted.

9. Deep brain stimulation (DBS)

DBS is similar to RNS®, but the electrodes are implanted in a deep brain region called the thalamus. It has been shown effective for focal seizures, which start consistently in one specific area of the brain. Unlike RNS, it stimulates on a regular basis rather than triggering only when a seizure starts. The stimulation is directly within the brain. Also unlike RNS, it is not necessary to localize where the seizure starts. As of May 2018, the FDA has approved DBS for patients with focal epilepsy. 

10. Brain surgery

Brain surgery to remove the seizure focus is the most effective method to completely stop seizures. First, we must find the seizure focus and make sure it can be safely removed. This always involves a stay in the epilepsy monitoring unit to record seizures with simultaneous video and EEG.

Sometimes the seizure focus cannot be determined with electrodes on the scalp, and we need to put electrodes directly within the brain. This is called intracranial EEG. The most common location in the brain for epilepsy surgery is the temporal lobe. About 60 percent to 80 percent of patients become seizure-free with this type of surgery.

A new technique is laser surgery, which involves destroying the seizure focus with heat rather than removing it. This technique is especially useful for seizures coming from deep structures in the brain and is much less invasive. Other types of surgeries include “disconnections,” in which the seizure focus is not removed but rather is prevented surgically from spreading to other areas of the brain.

The goal is to stop all seizures and to avoid any side effects that would affect the quality or safety of the patient’s life. The process sometimes can be a struggle, but we will never give up. By the time you read this, I hope there will be more treatments approved and in testing. Be sure to have a detailed discussion with your neurologist about an up-to-date treatment plan that works best for you.

Treatments for Epilepsy:

1.) Medications:

Anti-seizure medication works best if taken regularly, around the same time each day. The aim of treatment is to stop all of your seizures with the lowest dose of the fewest number of ASMs and with the least side effects. Usually treatment starts using a single ASM at a low dose, which is increased slowly (called titration), until your seizures are controlled.  Titration meaning the MD first starts you on a therapeutic dose for you age and body weight.  If the dosage is not working he or she will increase till control of the seizure is accomplished. If your seizures are not controlled with this drug, a different ASM is usually tried (by adding in the new drug and then slowly withdrawing the first one, again doing titration-you can never stop ASMs abruptly since you would be at a high risk of a seizure). If your seizures are not controlled with a single drug, another drug might be added, so that you take two different ASMs each daye, which is not uncommon.

Most people’s seizures last the same length of time each time they happen and usually stop by themselves. However, sometimes seizures do not stop or one seizure follows another without the person recovering in between. When a seizure goes on for 5 minutes or more it is called status epilepticus (or ‘status’ for short).

Status during a tonic clonic (convulsive) seizure is a medical emergency and needs urgent treatment. Emergency medication is usually prescribed(like Valium through a IV site to do a intravenous push) to stop seizures once they have started and if they are going on longer than usual, or if someone has one seizure after another without recovering in between they maybe on a IV drip with IVPs till controlled. Specialist training is needed to give emergency medication.

Than there are also Medication trials:

At any time, a patient may be invited to participate in a trial of an experimental medication. Since about 1993, this is how all medications have received FDA approval. Often, patients are invited to join a trial after they have failed a number of other FDA-approved medications.

The advantages of participating in a clinical trial include:

● Access to new medication

● Close support and follow-up with the epilepsy team

● The opportunity to help medical researchers develop new treatments

The goal of medication clinical trials is to make sure the drugs are safe and effective. Clinical trials are experimental studies, so there is some risk involved with participating. However, clinical research teams follow extremely strict federal, state, and hospital guidelines to ensure that the risks are minimized.

Since there are so many anti-epilepsy drugs (AEDs) out there, it can get confusing talking to your doctor and pharmacist about them.  Here is a list of seizure medications listed to help you understand the seven most widely used Anti-epileptic Drugs-AEDs in the US that are FDA approved. 

7 most common seizure medications used for epilepsy:

When you are first diagnosed with epilepsy, your doctor will usually try to treat the condition with medication. The seven AEDs in this list are the most common ‘first line’ medications used for different kinds of epilepsy.

For some people, these ‘first line’ drugs work right away. But for others, the AED either doesn’t work, or the seizure medication side effects are very unpleasant. If so, their doctor will normally try an alternative medicine. For about one-third of people with epilepsy, medication doesn’t work. Fortunately, there are other treatment options available.

1. Valproic Acid

Brand names: Depakote, Depakene

Form: Can be taken as tablets, liquids, or granules (sprinkled on food)

Treats: Generalized, focal, absence – effective with most kinds of epilepsy

Since being introduced in 1978, Valproic Acid has become the most widely prescribed AED in the world. You will usually take it once or twice per day, in varying doses, depending on your age and weight.

Valproic Acid works by making it hard for your brain cells to work as fast, which means they can’t ‘fire’ off as much during a seizure.

2. Lamotrigine

Brand names: Lamictal

Form: Comes as tablets you can swallow or chew

Treats: Generalized (tonic clonic) seizures; atonic seizures

Lamotrigine is a widely used seizure medication among people with generalized epilepsy. You’ll take the tablets once or twice per day. It works by slowing down the bursts of electrical signals in the brain that happen during a seizure. Lamotrigine appears to be one of the safer AEDs to take during pregnancy – unlike many other AED medications.

3. Topiramate

Brand names: Topamax

Form: Comes as tablets to swallow

Treats: Generalized (tonic clonic) seizures; atonic seizures; Lennox-Gastaut syndrome

Topiramate is mainly used to treat generalized epilepsy. You’ll usually take the tablets twice per day. Like with other AEDs, it works by slowing down how fast your brain cells work, which helps stop seizures from developing. It should not be used if you are pregnant.

4. Carbamazepine

Brand names: Tegretol, Curatil

Form: Comes as tablets, liquids and suppositories

Treats: Focal seizures

Carbamazepine is a sodium channel blocker which was first approved to treat epilepsy in 1968. Sodium ion channels work a bit like gates in the brain, so by blocking them carbamazepine slows down how quickly signals get sent. It should not be used if you are pregnant.

5. Phenytoin

Brand names: Dilantin

Form: Comes as tablets for swallowing or chewing tablet and as a liquid

Treats: Focal seizures

Phenytoin was first approved by the FDA in 1939. It is believed to work by blocking sodium ion channels in the brain, and therefore stops high frequency firing of electric signals in the brain.

6. Oxcarbazepine

Brand names: Trileptal, Oxtellar XR

Form: Comes as tablets form, or as a liquid

Treats: Focal seizures

Oxcarbazepine is used to treat focal seizures and comes in quick and slow release forms. It’s not fully known how this AED works, but it’s believed that it blocks sodium channels in the brain.

7. Ethosuximide

Brand names: Zarontin

Form: Comes as tablets for or as a liquid

Treats: Absence seizures

Ethosuximide is a seizure medicine which is mainly used for the treatment of absence seizures, especially for children. We still don’t know quite how it works, but it seems to stop brain cells from firing so fast.

Over the past hundred years, scientists have discovered many powerful and effective AEDs which help many people lead seizure-free lives. These advances are great news for the epilepsy community as a whole. But many people who take AEDs find that they just don’t work for them – about one third of people have “refractory epilepsy”, which means they’ve tried two or more AEDs without being able to control their seizures.  So about 30 percent or slight more of epilepsy patients unfortunately do not respond to their AED meds.

The good news is that there are several alternative ways of treating epilepsy if AEDs don’t seem to work. These include special diets and medical devices.  Ending line alternate treatment levels of controlling Epilepsy!  That is this weekend’s topic, Hurray!

“Epilepsy is a chronic noncommunicable disease of the brain that affects people of all ages.  Around 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally.  Nearly 80% of people with epilepsy live in low- and middle-income countries.  It is estimated that up to 70% of people living with epilepsy could live seizure-free if properly diagnosed and treated.  The risk of premature death in people with epilepsy is up to three times higher than for the general population.  Three quarters of people with epilepsy living in low-income countries do not get the treatment they need.  In many parts of the world, people with epilepsy and their families suffer from stigma and discrimination.”

World Health Organization-WHO (https://www.who.int/news-room/fact-sheets/detail/epilepsy)

Symptoms of Epilepsy:

Seizure symptoms vary depending on the type of seizure. Because epilepsy is caused by certain activity in the brain, seizures can affect any brain process. Seizure symptoms may include:

• Temporary confusion.
• A staring spell.
• Stiff muscles.
• Uncontrollable jerking movements of the arms and legs.
• Loss of consciousness.
• Psychological symptoms such as fear, anxiety or deja vu.

Sometimes people with epilepsy may have changes in their behavior. They also may have symptoms of psychosis.

Most people with epilepsy tend to have the same type of seizure each time. Symptoms are usually similar from episode to episode.

Warning signs of seizures = AURAS for some not all people diagnosed with Epilepsy.

Some people with focal seizures have warning signs in the moments before a seizure begins. These warning signs are known as aura.

Warning signs might include a feeling in the stomach. Or they might include emotions such as fear. Some people might feel deja vu. Auras also might be a taste or a smell. They might even be visual, such as a steady or flashing light, a color, or a shape. Some people may experience dizziness and loss of balance. And some people may see things that aren’t there, known as hallucinations.

Seizures are classified as either focal or generalized, based on how and where the brain activity causing the seizure begins.

Etiologies or Causes of Epilepsy:

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. Some types of epilepsy run in families. In these instances, it’s likely that there’s a genetic influence. Researchers have linked some types of epilepsy to specific genes. But some people have genetic epilepsy that isn’t hereditary. Genetic changes can occur in a child without being passed down from a parent.For most people, genes are only part of the cause of epilepsy. Certain genes may make a person more sensitive to environmental conditions that trigger seizures.
• Head trauma. Head trauma as  a result of a car accident or other traumatic injury can cause epilepsy.
• Factors in the brain. Brain tumors can cause epilepsy. Epilepsy also may be caused by the way blood vessels form in the brain. People with blood vessel conditions such as arteriovenous malformations and cavernous malformations can have seizures. And in adults older than age 35, stroke is a leading cause of epilepsy.
• Infections. Meningitis, HIV, viral encephalitis and some parasitic infections can cause epilepsy.
• Injury before birth. Before they’re born, babies are sensitive to brain damage that could be caused by several factors. They might include an infection in the mother, poor nutrition or not enough oxygen. This brain damage can result in epilepsy or cerebral palsy.
• Developmental conditions. Epilepsy can sometimes occur with developmental conditions. People with autism are more likely to have epilepsy than are people without autism. Research also has found that people with epilepsy are more likely to have attention-deficit/hyperactivity disorder (ADHD) and other developmental conditions. Having both conditions may be related to genes.

Complications

Having a seizure at certain times can be dangerous to yourself or others.

• Falling. If you fall during a seizure, you can injure your head or break a bone.
• Drowning. People with epilepsy are 13 to 19 times more likely to drown while swimming or bathing than people without epilepsy. The risk is higher because you might have a seizure while in the water.
• Car accidents. A seizure that causes either loss of awareness or control can be dangerous if you’re driving a car or operating other equipment.Many states have driver’s license restrictions related to a driver’s ability to control seizures. In these states, there is a minimum amount of time that a driver must be seizure-free before being cleared to drive. The amount of time may range from months to years.
• Trouble with sleep. People who have epilepsy may have trouble falling asleep or staying asleep, known as insomnia.
• Pregnancy complications. Seizures during pregnancy pose dangers to both mother and baby. Also, certain anti-seizure medicines increase the risk of birth defects. If you have epilepsy and you’re considering becoming pregnant, get medical help as you plan your pregnancy.Most women with epilepsy can become pregnant and have healthy babies. You need to be carefully monitored throughout pregnancy. Your medicines may need to be adjusted. It’s very important that you work with your healthcare team to plan your pregnancy.
• Memory loss. People with some types of epilepsy have trouble with memory.

Emotional health issues

People with epilepsy are more likely to have mental health conditions. They may be a result of dealing with the condition itself as well as medicine side effects. But even people with well-controlled epilepsy are at increased risk. Emotional health problems that may affect people with epilepsy include:

• Depression.
• Anxiety.
• Suicidal thoughts and behaviors.

Other life-threatening complications of epilepsy are not common but may happen. These include:

• Status epilepticus. This condition occurs if you’re in a state of continuous seizure activity lasting more than five minutes. Or it may occur if you have seizures without regaining full consciousness in between them. People with status epilepticus have an increased risk of permanent brain damage and death.
• Sudden unexpected death in epilepsy (SUDEP). People with epilepsy also have a small risk of sudden unexpected death. The cause is unknown, but some research shows that it may occur due to heart or respiratory conditions.People with frequent tonic-clonic seizures or people whose seizures aren’t controlled by medicines may be at higher risk of SUDEP. Overall, about 1% of people with epilepsy die of SUDEP. It’s most common in those with severe epilepsy that doesn’t respond to treatment.

How Epilepsy is Diagnosed with a Epilepsy Assessment:

There are several different types of epilepsy, characterized by seizures, with symptoms causing changes in awareness, muscle tone, emotions, behavior and sensory experience. Proper treatment starts with a careful assessment of the person’s seizures, which may include:

• Medical and seizure history and neurological examination, particular a neurological doctor-a neurologist and in some cases with the neurologist being the attending doctor a neurosurgeon may be following also as a consulting doctor, if needed.  Remember having a neurologist, particularly one majored in epilepsy is what you want!  This is so nothing is over looked in the care for you or your family, you want only the best.
• Neuroimaging: magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), positron emission tomography (PET), functional MRI (fMRI)
• Electroencephalogram (EEG), including outpatient video-EEG monitoring and long-term video-EEG monitoring-The diagnosis involves conducting a careful neurological history, a 30-minute brain wave study (electroencephalogram or EEG), and imaging of the brain (magnetic resonance imaging or MRI).Sometimes we need a longer period to monitor the brain. For example, we sometimes request a 72-hour EEG which usually is performed at home. If the diagnosis is unclear, we’ll admit the patient to an epilepsy monitoring unit (EMU), where we use video and EEG to observe the patient’s seizures. Once we fully understand the patient’s type of epilepsy  the neurologist chooses the right treatment medication but if doesn’t work than the alternative treatment best for that patient.
• Wada testing
• Neuropsychological, speech and hearing evaluations
• Physical and occupational therapy
• Counseling and support services for patients and caregivers

“Epilepsy is NOT contagious. You simply can’t catch epilepsy from another person.  People with epilepsy CAN handle jobs with responsibility and stress. People with seizure disorders are found in all walks of life. They may work in business, government, the arts, and all sorts of professions. If stress bothers their seizures, they may need to learn ways to manage stress. But everyone needs to learn how to cope with stress! There may be some types of jobs that people with epilepsy can’t do because of possible safety problems. Otherwise, having epilepsy should not affect the type of job or responsibility that a person has.  Epilepsy is a chronic medical problem that for many people can be successfully treated. Unfortunately, treatment doesn’t work for everyone. AT LEAST 1 million people in the United States have uncontrolled epilepsy.   Seizures can occur due to epilepsy or other conditions.  Epilepsy is NOT rare and can occur as a single condition or may be seen with other conditions affecting the brain, such as cerebral palsy, intellectual disability, autism, Alzheimer’s disease, and traumatic brain injury.”

Epilepsy Foundation (https://www.epilepsy.com/what-is-epilepsy/statistics)

**With how long it can take a ambulance to get to their destination and than get the pt to the hospital I recommend CALL 911 Immediately if never diagnosed before or if diagnosed with after 1 minute or so in the seizure.  Since the braisn can die with NO oxygen in 7 seconds.  Keep in mind the person in a seizure does not mean they have no oxygen immediately but status epilepticus (one seizure after another) going on minutes can cause that condition.  John Travolta’s son died due to a blood disorder caused Kawasaki Disorder and the son was taken off epileptic medications 1 wk by the parents but no fault on that was proven as the reason for the child’s death by coroner’s report. 

Seizures vary from person to person depending on what type of epilepsy they have. A seizure occurs when normal signals in the brain are interrupted. With epilepsy, it is usually a burst of abnormal brain activity that causes the disruption.  There are many different types of epileptic seizures.

Types of epileptic seizures:

Remember epileptic seizures vary from person to person and their are many different factors that could have caused it.

Recently in 2017, there was a new system established to describe the different types of seizures, aimed at making it clearer for doctors to notice and understand the onset and characteristics of different seizures and treat them effectively. It is still quite complex, but the types are named based on 3 characteristics:

• Where in the brain the seizure begins, whether it is on 1 or both sides of the brain, and another factor is how much of the brain is affected, a localized area or 1/2 the brain or the entire brain. Generalized seizures usually affect both sides, while a focal seizures affects a portion of the brain.
• How aware the person is during the seizure, partially or entirely unconscious.
  
• How much movement, or ‘jerking’ there is during the seizure

Tonic clonic seizures

These are the ones most people think of when they think of fits, that people use to call them. They affect both sides of the brain and are therefore generalized seizures, the person will not be aware during the seizure and may not remember it at all, and there is considerable movement. This also used to be known as a ‘grand mal’ seizure. A person will become suddenly stiff, then usually collapse, after which the muscles will tense and relax rhythmically. This can cause shaking, grunting, foaming at the mouth, and biting as the person has no control over the muscles in the body.  The person is unconcious.

Tonic and atonic seizures

A tonic seizure involves all the muscles suddenly becoming stiff, but doesn’t have the repetitive tensing and relaxing. An atonic seizure is the opposite, where all the muscles suddenly relax and the body goes floppy. Both these types are usually very quick and the body will probably fall over, and both are considered generalized seizures affecting both sides of the brain.  Again the person is unconcious.

Clonic seizures

Clonic seizures involve the rhythmical jerking without the initial stiffening of the muscles. They can be generalized, affecting the whole body, or focal, where only one side of the body is affected.  The

Myoclonic seizures

These are smaller jerking movements, similar to the feelings some people get when falling asleep. They can happen in clusters, with a series of jerks all at once. Although the person is conscious throughout, these are considered generalized seizures, as they are usually accompanied by other generalized seizures and often affect both sides of the brain.

Absence seizures

These generalized seizures are more common in children, and involve temporary absences, almost like daydreaming. The person may miss pieces of information in a conversation, all of a sudden garbled words – not making any sense and may blink rapidly or stare into space.  You snap your fingers in front the person’s eyes and no response of the person till they come out of the seizure.  The person is unconcious temporarily.

Focal onset aware seizures

A focal seizure begins in 1 part of the brain rather than both sides or the entire brain being affected, and as such rarely involves jerking or convulsions. Focal aware seizures occur when the person is aware and not unconcious of what is going on, but may feel a strange sensation. This can be an upset stomach, a wave going through the body, or deja vu, among many other things. They are often undetectable to anyone else, although can sometimes involve movement such as lip smacking or noises.

Focal onset impaired seizures

These similarly only affect a part of the brain, but they leave the person impaired in some way. They may be confused, have a loss of memory, or be unable to communicate or understand. Recovery periods can vary as well, with some needing to sleep or rest afterwards, while others recover almost immediately.

Focal to bilateral tonic clonic seizures

Focal seizures can sometimes spread to the whole brain, resulting in a tonic clonic seizure.

Unknown onset seizures

Sometimes the origin of the seizure is unknown, usually because the seizure was not seen by anyone else or occurred during sleep. This is then called an unknown onset seizure, and future seizures may help to understand more about this person’s epilepsy.

As you can see there are many different types of epileptic seizures that occur for many different reasons as well, and within this many symptoms or possible reactions for the body and brain.  We will cover causes and symptoms this week in one of our topis for epilepsy.  Understanding the type of seizure with how a seizure starts and how a person behaves while having a seizure can help determine how best to treat the epilepsy.  People also get to know any triggers that can cause their epileptic seizures. The most common triggers are flashing lights, stress, anxiety and sleep deprivation. As we said earlier, some people stop having seizures after a while, although the reasons behind this are as unknown as the causes for many people with epilepsy,  in the first place others.