Buffalo News (May 14, 07:29 AM) Q: My wife was recently diagnosed by a neurologist with temporal lobe epilepsy. After she came home, she didn't remember very much about the disease. Please tell us about what causes them and how to treat them.
-- M.S., Brockton, Mass.
A: I can provide you with some background information, but you and your wife need to talk with the neurologist to make sure you understand her condition fully. This column should help you know what questions to ask.
A seizure is a sudden, transient electrical disturbance of brain function resulting in uncontrollable nervous actions. It is sometimes accompanied by loss of consciousness. Recurrent seizures are called epilepsy.
Seizures start most frequently at the extremes of life. Incidence is highest in infants and young children, and in the elderly. They are caused by anything that can irritate the brain.
Common causes of seizures include: brain abnormalities present at birth, trauma, tumors, strokes, fever, infections and adverse reactions to drugs or toxic chemicals. Seizures are characterized as either symptomatic (cause is known or suspected) or idiopathic (cause is unknown).
In determining the cause of epilepsy, it's important to try to look at what was happening at the time the first seizure occurred. For example, did the seizure follow a head injury in a child or did the first seizure follow a stroke.
However, the cause is only found in about one-quarter of people with recurring seizures. In the remaining cases of idiopathic seizures, no other neurologic abnormality can be found.
The key to diagnosis is a detailed medical history, including family history of seizures. Answers to questions about events occurring just prior to, during, and after a seizure episode can be very effective in classifying the seizure disorder.
What happens during a seizure depends on the area of the brain affected -- in your wife's case, the temporal lobes of the brain. These are located just below the temples. They are responsible for memory, emotions and recognition of people and objects. They handle the retrieving and processing of long-term memory and initiating communication or action.
Symptoms of temporal-lobe seizures can include hallucinations of images, taste and smell; complicated repetitive behavior, such as walking in circles; chewing movements and lip smacking; and visual and auditory illusions. Depression is a common psychiatric complication.
Many tests are recommended for a person with seizures. These may include blood tests, urinalysis and CT and MRI scans. One test is routinely recommended: the electroencephalogram, which measures the electrical activity of the brain.
The EEG done during a seizure confirms the diagnosis of seizures and can pinpoint a lesion for possible surgical removal. It may also help classify the seizure disorder. Classification is important for determining which anticonvulsant drug to try first.
The first step in treatment of seizures is to identify the cause and remove it or avoid it if possible. A few people may be candidates for special surgery -- temporal lobectomy -- to control seizures. This surgery is performed in only a few specialized medical centers and, like the drugs, is not without risk. Gamma knife radiosurgery has been reported to be effective in some types of tumors.
Drugs are the usual treatment for epilepsy, and the type and dose of drug depends on the type of seizure or epilepsy. This is a long- term treatment; the drugs are usually recommended until no seizures are seen for at least four years.
All drugs used to treat the seizures have side effects, and it is important to monitor them on a regular basis. Monitoring the amount of drug in the bloodstream is also very important to assure a steady drug dose.
Depending on the severity of your wife's seizures, you may want to check with the neurologist about notifying friends and family of potential symptoms so they can respond to them appropriately.
Write to Dr. Allen Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611; or contact him at DRFamily@aol.com. This column is not intended to take the place of consultation with a health-care provider.
