The way I think of epilepsy is, epilepsy is an electrical storm of the brain. When Nathan is describing or was describing his common, when people first developed epilepsy or seizures, oftentimes they don't recognize it, they describe a lot of vague symptoms. It maybe a nausea, a déjà vu, funny tastes in their mouths, or spaced out, a feeling unusual and by-and-by as the epilepsy becomes more defined and evolved, they then recognize it as a seizure disorder.
Also I would say patients, and every patient is different, expressions and manifestation of a seizure depends very much on where the seizure is coming from or originating in the brain.
Many patients will do quite well with medications, but I think if you take patients with epilepsy who don't have a brain tumor or vascular malformation, about one-third will break through on medications; meaning they are medical failures and in that case a surgical evaluation needs to be performed. Again, the question becomes identifying the site location of the seizure, origination or the epileptic zone and then asking the question, could a resection on that area be carried out an acceptable neurological risk to the patient? So that would be the appropriate thinking if a patient fails medications.
Things that are coming on the horizon include new medications. There are certain types of neurosurgical procedures where we are implanting devices to stimulate the brain, we leave those operations for patients who have a seizure disorder, but it becomes apparent that trying to move the specific site will cause neurological harm so instead we're implanting stimulating devices as an alternative, the hope is to help seizures and not cause harm.
Then there are now some clinical series looking at other ways to treat seizures, using focus radiation such as the gamma knife. The concept there is if you identify a seizure focus, seen if you could radiate it to obliterate that abnormal discharge as oppose to performing an operation. But at this time if you have an epileptic zone, surgery is still the gold standard.
When I see patients like Nathan at the clinic, I think it's very important to recognize that there are many, many excellent options for patients suffering from epilepsy ranging from good medications, to very excellent surgical interventions and I would be very positive with patients who have epilepsy and encourage the appropriate evaluation just try to delineate and determine what's going to be the best management. It's far better to deal with it upfront, then to live with it.
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