Meet Dr James Butler, a neurologist at Constantiaberg Mediclinic who specialises in treating people with epilepsy.
What is a seizure?
There are different types of seizures, including epileptic seizures and non-epileptic seizures. The latter are usually caused by emotional or psychological distress. Occasionally, reduced blood flow to the brain may cause neurological events (‘faints’) that resemble epileptic seizures. A blocked artery to the brainstem or ‘mini-strokes’ (transient ischemic attacks) may also cause episodes that resemble epileptic seizures.
How does a neurologist know whether I have had an epileptic seizure?
By obtaining a good history from patients and people who have witnessed the event, doing an EEG (which may show evidence that one is prone to seizures, even when not having a seizure) and doing an MRI scan (which may show the cause of a seizure), the neurologist can often arrive at a diagnosis. In some instances, it may be necessary to record seizures on simultaneous video-EEG recordings during a period of hospitalisation to be sure of the diagnosis.
How are epileptic seizures treated?
The mainstay of treatment is medication(s), but where this fails to control seizures, surgery is frequently considered. Special diets may sometimes be tried. Is surgery a last resort? No, if seizures can be cured (when they are not likely to remit spontaneously), it is better to do it earlier in life, to ensure the maximal number of years with a good quality of life.
Is surgery not dangerous?
Surgery will only be considered where the benefits considerably outweigh any risks. There are risks of not doing surgery (the small risk of sudden death due to seizures, the risks of accidents and injuries, and the reduced quality of life of having seizures). The risks of surgery are usually very small. Individualised risks are discussed explicitly with each person, and are dependent upon where in the brain surgery is to be performed.
How does the neurologist decide what to do?
It is imperative to understand where someone’s seizures start and how they spread in his or her brain. This requires admission to hospital, to record seizures on video-EEG. Medications are usually weaned. Other investigations like MRI, functional MRI and neuropsychological tests are usually required.
How long does the process take?
From the time of admission until discharge after surgery may require anything from 10 days to a month.
Where can I find out more information?
Visit www.epilepsysurgery.co.za or post your question here or on our Facebook page. Read more
This article was sponsored by Mediclinic
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