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Ask the Doctor: James Park, D.O.

Q. What causes seizures and what are my treatment options?

A. A seizure is a sudden surge of abnormal electrical activity in the brain. When people think about seizures, what typically comes to mind is “grand mal” seizures, which includes loss of consciousness and violent shaking of the extremities, or “petit mal” seizures with staring and unresponsiveness. In reality, however, seizures are much more varied in terms of symptoms.

The brain controls everything in your body so depending on where a seizure starts, you may experience different symptoms, including abnormal sensations, movements or behavior, and altered levels of awareness and consciousness. When a patient has two or more unprovoked seizures or a tendency for recurrent seizures, they are usually diagnosed with epilepsy.

Just as there are a variety of ways seizures can present, there are multiple potential causes. First, there is genetics. Our genes hold the information necessary to form every cell in our body. An error in that code can lead to more excitable neurons, abnormalities in the way cells use energy or break down products, and even how the brain is formed. Second, structural abnormalities in the brain can be a cause. This could be from genetic causes and be present from birth, but can also be acquired later in life if a patient has had strokes, tumors, and/or traumatic brain injuries. Lastly, the exact cause could be unknown or cryptogenic. A small number of these cases are now being identified with autoimmune causes.

In the early 1900s there were only a handful of anti-epileptic drugs (AEDs) available, but since the 1980s there has been an explosion in the development of new AEDs. Now, there are more than 20 medications available with many new ones on the horizon. Most patients are able to gain control of their seizures with the first or second medication they try. However, up to a third of patients may continue to have seizures despite adequate therapy. Studies have shown that when patients don’t have relief from seizures with two or more drugs, the likelihood that another drug will control seizures gets very low.

At this point, patients are considered to have refractory epilepsy and surgical options are considered. Epilepsy surgery has also changed significantly over the years. Today, there are minimally invasive surgeries and various devices that can be used to treat seizures in addition to the traditional resection and disconnection surgeries that have been done.

Given the complexities of this disease, being under the care of, or seeking advice from, an epileptologist (a neurologist who specializes in epilepsy) is usually recommended. Having a comprehensive epilepsy center nearby, such as at Hoag, is also advantageous since this gives patients access to the best care, and all the tests and treatment options available. Epilepsy is a debilitating disease and is scary for both patients and their families. Our goal is to try and achieve seizure freedom so that patients can live their lives without the constant fear that a seizure could occur at any moment.

James Park, D.O., specializes in neurology and has a practice located in Irvine.