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 Medical Center
Appt/Advice: 650-299-2290

See all office information »

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Overview

Epilepsy is a seizure disorder that affects about 1 out of 200 people. It’s the result of abnormal electrical activity in the brain. People with this condition have:

  • Recurrent convulsions. These are sometimes called epileptic seizures or fits. Some people call them spells or attacks.
  • Sudden, temporary, or uncontrollable loss of consciousness. 

Epilepsy may be inherited or caused by a brain injury. Once seizures are controlled by medications, people with epilepsy 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 are not caused by abnormal electrical discharges in the brain. However, they often look like epileptic seizures. Non-epileptic seizures are often called "psychogenic" because they can be caused by stressful psychological experiences. These events can be one way that the body copes with excessive stress.

For some people, these seizures may result from:

  • Sexual or physical abuse. This may be recent or in the past, especially during childhood.
  • A stressful event such as divorce or death of a loved one.

Symptoms

Grand mal seizure

A grand mal seizure is what most people think of when they hear the word "seizure." People with epilepsy often notice a warning sign right before a grand mal seizure. This could be a feeling in the stomach or an involuntary jerking in the hand or foot. Once the seizure begins:

  • The person may stiffen and fall down.
  • Their body may begin jerking. 

After the attack, the person may appear confused and may fall asleep. Most seizures are over within a minute and cause no permanent harm. However, the shaking can be frightening to those not familiar with seizures.

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. Most patients will stop having absence seizures once they reach adult age.

Partial seizures are classified as "simple" or "complex" and involve involuntary movements without a complete loss of consciousness.

Simple partial seizures, can involve twitching of the face, hand, or leg on one side of the body. The patient's consciousness and memory are usually unaffected.  These are also called focal motor seizures.

Complex partial seizures.  The person may: 

  • Look dazed or confused
  • Smack their lips
  • Make sucking, drooling, or swallowing movements
  • Pick at their clothing
  • Behave normally but be unable to respond appropriately to questions
  • Be unable to remember anything about the seizure once it is over

Diagnosis

Epileptic seizures

We’ll ask you about: 

  • Your medical and family history.
  • Your seizures, including 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, bring them to your appointment to help you explain the seizures.

This information will help us rule out other conditions. For example, fainting can cause a loss of consciousness. People usually recover quickly after fainting (often within seconds). Seizures often cause periods of confusion or sleepiness that last 20 minutes or longer.

A single seizure does not mean that you have epilepsy. Epilepsy is defined as a tendency to have recurrent seizures. It’s more common to have one seizure in your life, than it is to have recurrent seizures, or epilepsy. 

Non-epileptic seizures

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 determine that you do not have epilepsy, we will recommend an evaluation by a psychologist or psychiatrist to help you with any stress or trauma that may be causing your seizures.

Tests

We may 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 help you 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:

Medications

Currently, there is no cure for epilepsy. However, in most cases, medications can prevent all, or nearly all, of your seizures. 

Finding the right medication and dose can take time because each person reacts differently. We usually treat this condition with a single drug prescribed in increasing doses until the seizures are controlled. Sometimes, seizures cannot be controlled with medication and we will consider other forms of treatment. The choice of drug depends on the kind of seizures you have. 

Treatments

Surgery

Medications do not effectively control seizures for all epileptic patients. For some, surgery to remove the part of the brain causing the seizures may be needed. Surgery is most appropriate for people with seizures that originate in one specific area of the brain. Temporal lobe epilepsy is an example. 

If you may need surgery, we  monitor you in a specialized hospital unit, called an epilepsy monitoring unit. This helps us to observe and better understand your seizures and which part of the brain is affected.

Neurostimulators

Neurostimulators may be used to control seizures if medications alone are not working. These devices include the vagus nerve stimulator (VNS) and the responsive neurostimulator system (RNS). They send bursts of electrical energy to the brainstem (VNS) or the brain surface (RNS) that result in a reduction in how often seizures occur. 

Neurostimulators are often a good option for seizure control when medications are not working and surgery is not a safe alternative.

Other Treatment

Neurostimulators may be used to control seizures if medications alone are not working. These devices include the vagus nerve stimulator (VNS) and the responsive neurostimulator system (RNS). They send bursts of electrical energy to the brainstem (VNS) or the brain surface (RNS) that result in a reduction in how often seizures occur. 

Neurostimulators are often a good option for seizure control when medications are not working and surgery is not a safe alternative.

First Aid during a Seizure

Tell friends and family about your seizures. 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 that could hurt the person out of the way, such as 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.
  • There is no need to protect the person’s tongue. Never put your hands near the mouth and never force any objects into the mouth.
  • Make sure someone stays with the person until the seizure ends.
  • Turn the person gently onto their side to ensure the airway is open once the seizure has stopped.
  • Allow the person to regain consciousness at their own pace. Be there to reassure and comfort them.
  • Offer help to get home, or call a friend or relative to assist, especially if the person seems confused or tired.

Living with Your Condition

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.
  • Require a form from your physician that documents your compliance with medication and how long you have been seizure free.

If seizure medications are changed or stopped, this often requires that you stop driving for a period of time determined by your physician.

Get enough sleep

In some cases, lack of sleep may trigger seizures.

We recommend that everyone, especially epilepsy patients, get 8 hours of 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 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).
  • Length of time the seizure lasted.

Note any other observations that may be important, such as: 

  • What you were doing when the seizure occurred
  • Any stress you were under
  • Recent changes to your medication
  • Energy level (tired or sleepy)

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

See more 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.

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