My Doctor Online The Permanente Medical Group

Are you having back pain with any of the following?

  • Severe pain, weakness or tingling in your leg(s).
  • Difficulty stopping urination or loss of control of bladder or bowels.
  • Unexplained fever, nausea or vomiting.
  • A history of cancer or unexplained weight loss.

We understand that you are experiencing one or more of the health issues that might be impacting your back pain.

We recommend that you discuss these health issues with your doctor before proceeding with this program.

Once you are cleared by your doctor to do this program, we hope it helps you find relief from your back pain.

Provider photo for Josiah Ambrose

Josiah Ambrose, MD

Neurology

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.

My Offices

Redwood City
Appt/Advice: 650-299-2290

See all office information »

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Overview

Epileptic seizures

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

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.

Symptoms

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.

  • The "simple" partial seizure, also called a "focal motor seizure," can involve twitching of the face, hand or leg on one side of the body. The patient's consciousness and memory are usually unaffected during simple partial seizures.
  • During a "complex" partial seizure, also called a "psychomotor seizure," patients may look dazed, confused, or puzzled. They may smack their lips, make sucking, drooling, or swallowing movements, or pick at their clothing. They may also appear to behave normally, however if asked questions, they will be unable to respond appropriately. These attacks last for several minutes. After they are over, the person is often confused and unable to remember anything about the seizure.

Diagnosis

Medical history

Your medical history, including your history of previous seizures, helps us to make a diagnosis. For example:

  • Make sure to tell us about your seizures and any incontinence, extreme sleepiness, and/or amnesia that followed. 
  • If you have a family member or friend who witnessed one or more of your seizures, it's a good idea to bring them with you to your appointment. They will be able to describe features of the seizure that you may not be able to recall.

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:

  • EEG or Electroencephalogram is a recording of electrical activity generated by the brain.  This test can be helpful but cannot always confirm epilepsy.  We may perform the test after a period of sleep deprivation to encourage you to fall asleep during the test. Some seizure patterns are much more visible during sleep.
  • CT scan or MRI are imaging studies that can show an abnormality of the brain.
  • Blood tests can help us identify an electrolyte or other metabolic abnormality that could trigger your seizures.

 
Additional References:

Treatments

Medication

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:

  • Age
  • Gender
  • Other health issues
  • Side effects
  • Other medications that you are taking
  • What you wish to gain from the treatment

If you are female between the ages of 18 to 44, we take family planning into consideration, for example:

  • We may recommend that you take folic acid if you are planning on starting a family.
  • If you are on birth control medications, we will consult with your Ob/Gyn physician before you start medications for seizures. Medications for epilepsy may decrease the effectiveness of birth control medications.
  • Some antiepileptic medications increase the risk of birth defects.

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.

Discontinuing medication

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.

Surgery

Epilepsy surgery

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

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.

Lifestyle Management

First Aid during a seizure

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.

  • Stay calm.
  • Move objects out of the way that could hurt them, for example, sharp and heavy items.
  • Don't attempt to restrain the person or prevent their arms and legs from moving.
  • Monitor how long the seizure lasts.
  • Loosen clothing, especially anything around the neck, such as a tie or scarf, that may prevent breathing.
  • Protect the head by placing a jacket, pillow or other soft, flat item underneath it.
  • Turn the person gently onto their side to ensure the airway is open.
  • There is no need to protect the person’s tongue.  Do not try to force the mouth open in any way.
  • Make sure someone stays with the person until the seizure ends.
  • Allow the person to regain consciousness at their own pace.  Be there to reassure and comfort them.
  • Offer to help the person get home, or call a friend or relative to assist them, especially if s/he seems confused or tired.
Check before you drive
  • We are required to report lapses of consciousness to the Department of Motor Vehicles in California.
  • The DMV will decide if you may continue to drive.
  • The DMV requires a form from your physician that documents your compliance with medication and how long you have been seizure free.
Get enough sleep
  • In some cases, lack of sleep may trigger seizures.
  • We recommend that everyone, especially epilepsy patients, get eight hours sleep a night.
  • If you have epilepsy, it's particularly important to avoid staying up late on a regular basis.
Keep a seizure log
  • Keep a detailed record of your seizures to help us to understand your condition better and make appropriate treatment decisions.
  • Include the date and time of day of each seizure, description of the seizure (you will need help from a witness, if available) and how long it lasted.
  • Note down any other observations that may be relevant. For example, what were you doing when the seizure occurred? Were you under stress? Had you changed your medication recently? Were you tired?

Your Care with Me

Epilepsy can be a chronic long-term condition. Either I or another neurologist in our department will manage your care. I will work closely with your personal physician, who will continue to oversee your care for nonepilepsy health issues.

If you are having symptoms and you have not yet been diagnosed, your first contact will typically be with your personal physician, who will evaluate your health and symptoms and determine whether specialty care may be needed.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might 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 that discussion, we can often schedule it the same day or soon thereafter. If you were first seen in the Emergency Department after a seizure, the Emergency Department physicians may facilitate the process of scheduling an appointment with our department. 

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will also review any lab tests ordered by your personal physician and order any further tests that may be necessary to look for electrolytes or other metabolic abnormalities that could trigger seizures. We may decide that you need an EEG performed in the Neurology department, or I may order a CT scan or an MRI to look for any abnormality in the brain.

I will explain the findings of your exams and answer any questions or concerns you may have. We will discuss treatment options, and together we will create a treatment plan that is right for you.

If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line, available 24 hours a day, 7 days a week. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

Coordinating Your Care

Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit
  • At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
  • At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
  • To help you prepare for your visit, please see additional details under Office Visit. 
If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:
  • Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
  • Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.
If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

If surgery or a procedure is a treatment option

I will recommend that you review educational information and tools to help you prepare for your procedure or surgery. The information will often help you decide whether surgery is right for you. If you decide to have a surgery or procedure, the information will provide details about how to prepare and what to expect.

If we proceed with surgery, I will have my Surgery Scheduler contact you to determine a surgery date and provide you with additional instructions regarding your procedure. Once your surgery is scheduled, a medical colleague of mine will contact you to conduct a preoperative medical evaluation that will assure that you are properly prepared for your surgery.

Convenient Resources for You

As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely
  • View and compose secure e-mail messages.
  • Manage your prescriptions.
  • View your past visits and test results.
  • View your preventive services to see whether you are due for a routine screening or updated immunization.
Learn more about your condition
  • Read about causes, symptoms, treatments, and procedures.
  • Find interactive health tools, videos, and podcasts to help you manage your condition.
  • View programs to help you decide on or prepare for a surgery or procedure.
Stay healthy
  • Locate health education classes and support groups offered at every medical center.
  • Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
  • View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Related Health Tools:

Podcasts

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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.

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