Magazine
A seizure can occur in any individual at any age and can negatively impact day-to-day living.
However, a dedicated treatment centre at Mediclinic Bloemfontein is geared to offer patients who have epilepsy the best care possible.
Anyone can develop epilepsy, at any time of life,” says Dr Rowan Nichol, a neurologist at Mediclinic Bloemfontein and the founder of the Naledi Epilepsy Centre. “Although it is most commonly diagnosed in children and people over the age of 65, it affects people of all ages, races and social classes.”
Interestingly, in more than 70% of cases, the cause of epilepsy isn’t known. But some of the main causes of this condition include: low oxygen during birth; head injuries during birth; youth or adulthood; brain tumours; genetic conditions (such as tuberous sclerosis) that result in brain injury; infections such as meningitis or encephalitis, stroke and abnormal levels of substances such as sodium or blood sugar.
The Naledi Centre at Mediclinic Bloemfontein is designed to provide patients who have epilepsy with the “next level” of care. “Typical epilepsy treatment involves initiating appropriate medication and adjusting according to the patient’s response,” Dr Nichol says. “This unit allows us to refine that process, which helps us settle on the best course of treatment more efficiently.”
“This ensures that we have the comprehensive clinical overview we need to fine-tune our treatment plans – to identify where seizures originate, and adjust medications accordingly.” This continuous monitoring is impossible to provide in a general hospital unit.
“When we talk about adjusting treatment, what we also mean is possibly withdrawing medication,” she says. “We need to monitor where in the brain the seizure activity is coming from, and for that we need to watch the patient very carefully around the clock.”
For this very same reason a health care worker provides constant clinical monitoring and care in the unit. Another part of that next level is the potential of brain surgery. “Patients who don’t respond to treatment will require advanced treatment,” says Dr Nichol. “Especially patients who have been on two drugs for more than two years, and are still experiencing uncontrolled seizures – in those cases, surgical intervention might be considered.”
Continual patient support is the Centre’s watchword. “Our aim at Naledi is to try to help find answers, to bring hope and new light to these patients,” says Dr Nichol.
SEIZURES EXPLAINED
A seizure occurs when a burst of electrical impulses in the brain escape their normal limits. “They then spread to neighbouring areas and create an uncontrolled storm of electrical activity,” Dr Nichol explains. “The electrical impulses can be transmitted to the muscles, causing twitches or convulsions.” Of course, there are a number of reasons why someone may su er a seizure, and not everyone who has seizures is diagnosed with epilepsy.
DID YOU KNOW?
Epilepsy is more properly known as “the epilepsies”, as there are dozens of different seizure disorders and syndromes. However, it is basically classified into three main categories: Focal, Generalised or Unknown Onset.
FOCAL ONSET These start in, and affect, just one part of the brain. Sometimes, a focal onset seizure can spread to both parts of the brain.
GENERALISED ONSET This is when abnormal excessive electricity occurs throughout the whole brain at once, with no apparent focal point of onset or warning beforehand. Generalised seizures quickly spread across the left and right hemispheres of the brain. Many, but not all, generalised seizures are associated with a loss of consciousness. They can be convulsive or non-convulsive.
UNKNOWN ONSET Seizures may be of unknown onset if the beginning of the seizure is not clear. As more information becomes available over time or through testing, this type of seizure may be changed to a generalised or focal onset seizure.
HOW IS EPILEPSY DIAGNOSED?
Blood tests indicate signs of infections or other conditions that may be associated with seizures.
Specialised tests include:
AN ELECTROENCEPHALOGRAM (EEG) is a test used to evaluate the electrical activity in the brain. During this procedure, electrodes attached to the scalp analyse electrical impulses in the brain and send signals to a computer that records the results.
A COMPUTERISED TOMOGRAPHY (CT) SCAN uses X-rays to obtain cross-sectional images of your brain. CT scans can reveal abnormalities that might cause seizures, such as tumours, bleeding and cysts.
A MAGNETIC RESONANCE IMAGING (MRI) uses magnets and radio waves to detect lesions or abnormalities in your brain that could be causing your seizures.
SURGICAL OPTIONS FOR EPILEPSY
Temporal lobe resective surgery involves removal of a part of the temporal lobe and is the most common type of surgery for treating epilepsy. Another option is Deep Brain Stimulation (DBS) therapy, which may be appropriate for people who aren’t responding to medication and who aren’t good candidates for other resection surgery. During DBS, a neurosurgeon uses magnetic resonance imaging (MRI) to place two leads deep inside the brain. These leads are attached to a neurostimulator that is implanted under the skin in the upper chest (under the collar bone). The neurostimulator is programmed to stimulate specific areas of the brain with regular electrical impulses. It can take several months to find the right level of stimulation as this varies from person to person