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Welcome to My Doctor Online, a web site that my colleagues and I developed to make it easier for you to take care of your healthcare needs. On this site you will find answers to many of your questions about my clinical practice. Also included are several online features that will allow you to e-mail me, check your laboratory results and refill prescriptions. I hope you find its content informative and useful.
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Epilepsy is a seizure disorder that affects about 1 out of 200 people. It is marked by recurrent convulsions, or a sudden, temporary, or uncontrollable loss of consciousness. Convulsions may also be called epileptic seizures, fits, spells, or attacks. Epilepsy is the result of abnormal electrical activity in the brain and may be inherited or caused by injury to the brain. Once seizures are controlled by medications, epileptics can usually do just about everything those without epilepsy can do, including driving a car. Epilepsy is not contagious.
Non-epileptic seizures resemble epileptic seizures but are not caused by abnormal electrical discharges in the brain. Non-epileptic seizures are often called "psychogenic" because they can be caused by stressful psychological experiences or emotional trauma. Psychogenic non-epileptic seizures can be one way that the body copes with excessive stress.
For some people, these seizures may result from sexual or physical abuse, either recent or in the past, especially in their childhood. Others may have experienced a major life event such as a divorce, or the death of someone close to them. We diagnose non-epileptic seizures by observing the seizures and listening to observers descriptions of them.
Often, we need to perform a simultaneous EEG and video monitoring of the seizures to arrive at an accurate diagnosis. If we decide that you do not have epilepsy, we will recommend an evaluation by a psychologist or psychiatrist to help sort through any stress or trauma that may be the underlying cause of your seizures.
A grand mal seizure, otherwise known as a generalized motor convulsion, is what most people think of when they hear the word "seizure." People with epilepsy often notice a warning signal right before a grand mal seizure such as a familiar feeling in the stomach or an involuntary jerking in the hand or foot. They may stiffen and fall down. Next, the person's body will begin jerking. The seizure usually lasts 60 to 120 seconds. After the attack, the person may appear confused and may fall asleep. Although 95 percent of the time these types of seizures are over within 2 minutes and cause no permanent harm, the shaking can be frightening to those not familiar with seizures.
Petit mal seizures, also called "absence seizures," usually start around grade school age. They commonly cause a brief lapse of consciousness with only slight facial twitching or fluttering of the eyelids. Sometimes the person may seem to be daydreaming. These types of seizures typically come without warning and are not followed by confusion or sleepiness.
Partial seizures are classified as "simple" or "complex" and involve involuntary movements without a complete loss of consciousness.
Your medical history, including your history of previous seizures, helps us to make a diagnosis. For example:
We will evaluate the information you give us to rule out other conditions that may be causing your symptoms. For example, many cases of loss of consciousness are due to simple fainting, known as syncope. It is not always easy to tell the difference between syncope and a seizure. As a general rule, a simple faint usually lasts less than a minute whereas a seizure lasts longer. Also, patients usually recover quite quickly after fainting (often within seconds), but seizures often cause periods of confusion or even sleepiness that can last 20 minutes or longer.
A single seizure does not mean that you have epilepsy, which is defined as a tendency to have recurrent seizures. In fact it is about 10 times more common to have a single isolated seizure in your life, than it is to have recurrent seizures, or epilepsy. As well as evaluating your medical history, we may also recommend further tests, including:
At present, there is no cure for epilepsy. However, in most cases, antiepileptic medication can prevent all, or nearly all, of your seizures. Determining exactly the right medication and dose can take time because each person reacts differently. We prefer to treat this condition with a single drug prescribed in increasing doses until the seizures are controlled. Occasionally, seizures cannot be completely controlled with medication and we need to consider other forms of treatment. The choice of drug depends on the kind of seizures you have. We will also consider the following factors before deciding on a medication regime for you:
If you are female between the ages of 18 to 44, we take family planning into consideration, for example:
For some patients, controlling seizures may require such a high dose that side effects become problematic. If that is the case, we will change the drug or try to find the right combination of drugs to control your seizures and minimize side effects.
If you have been taking antiepileptic medication for more than 2 years and have been seizure free, we can consider discontinuing your medication. This decision will depend on a number of factors including your type of epilepsy, initial response to medication, EEG results and age. There is a risk that if you discontinue the medication, seizures will recur. However recent studies indicate that more than 50 percent of patients who have been seizure free for more than 2 years can stop medication without experiencing further seizures. Do not stop taking your medication before discussing it with us. Sudden withdrawal can cause new seizures or episodes of severe, prolonged or continuous seizures.
Medications do not effectively control seizures for all epileptic patients. For some patients, surgery to remove the part of the brain causing the seizures may be a more effective way to minimize these episodes. Surgery is most appropriate for patients with temporal lobe epilepsy or other kinds of epilepsy, where the seizures originate in one specific area of the brain. If you are a candidate for epilepsy surgery, we may monitor you in a specialized hospital unit, called an epilepsy monitoring unit, in order to observe and better understand the nature of your seizures and which part of the brain is affected.
Vagus nerve stimulation (VNS) is a different kind of surgical procedure that is used to help control seizures. VNS directs short bursts of electrical energy into the brain via the vagus nerve, a large nerve in the neck. The energy comes from a small battery, which is surgically implanted under the skin, usually on the chest.
Tell friends and family about your seizures and ask them to review the following First Aid advice in case they are with you, or anyone else, during a seizure.
Epilepsy can be a chronic long-term condition. Either I, or another neurologist in our department, will manage your ongoing epilepsy care. I will work closely with your personal physician, who will continue to oversee your care for non-epilepsy health issues. Our electronic medical record system allows us to review your medical records together at any time and work in partnership to treat your symptoms.
If you were first seen in the Emergency Department after a seizure, the Emergency Department physicians may refer you directly to our department. If you are having epilepsy symptoms, and you have not yet been diagnosed with epilepsy, your first contact will typically be with your personal physician. S/he will evaluate your health and symptoms and determine whether specialty care may be needed.
Your personal physician can connect you with me or one of my colleagues in Neurology in a variety of ways. Depending on your symptoms, s/he may schedule a specialty appointment before you leave the clinic, or s/he may send a referral and my staff will contact you to make the appointment. In some cases, your personal physician may call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after our discussion by phone, we can usually schedule it the same day.
During your first appointment, I will ask you about your medical history and symptoms. I will also review any lab tests ordered by your personal physician, and order any further tests that may be necessary. If we determine that you need an EEG, we will make a separate appointment for you to have an EEG. We perform EEGs in the Neurology Department.
If you were taken to the Emergency Department after a seizure, you may have had a brain scan while you were there. Otherwise, I may order a CT scan or an MRI to look for any abnormality in the brain that may be causing your seizures.
I may order lab tests to look for electrolyte or other metabolic abnormalities that could trigger seizures. I will order these tests during your visit and you can have them done at any Kaiser Permanente laboratory. When the results are ready, you can view them from my home page. I will review the results and contact you by phone, letter, or e-mail to explain them.
If you are a candidate for epilepsy surgery or vagus nerve stimulation, I will refer you to our Neurosurgery Center at Redwood City Medical Center for an evaluation. You will be contacted by the Neurosciences Department at Redwood City Medical Center. You may need to stay in the hospital for more detailed brain evaluation before surgery takes place.
After you have seen me, if you have follow-up questions, please call my office and leave a message. You can also e-mail me from my home page whenever it is convenient for you. Our Appointment and Advice line is available for general medical advice 24 hours per day, 7 days per week.
From my home page, you can also take advantage of a variety of convenient online services offered by Kaiser Permanente. In addition to the ability to e-mail me, you can view and refill your prescriptions, view test results and summaries of prior visits, check the status of your preventive screenings, and find health information and interactive health tools.
If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.