Epilepsy Treatment Options [Interview][Transcript]

dr_ahmed_abdelmoity_epilepsy_treatmentGuest: Dr. Ahmed Abdelmoity
Presenter: Neal Howard
Guest Bio: Dr. Ahmed Abdelmoity currently serves as Associate director, division of Neurology, Section Chief of epilepsy and neurophysiology at Children’s Mercy Hospital. He is also the Director of Children’s Mercy Hospital’s level 4 epilepsy center, which is one of the few level 4 pediatric epilepsy centers in the country. He has developed and is directing the clinical Neurophysiology Fellowship at Children’s Mercy Hospital. He has also developed and is directing the Neurodiagnostic Program. He finished his medical degree at Cairo University in Egypt. Dr. Abdelmoity then started molecular neurobiology research at UT Southwestern at Dallas, where he later started his pediatric Neurology residency.

Segment overview: Dr. Ahmed Abdelmoity, MD, Director of Children’s Mercy Hospital’s level 4 epilepsy center, talks about the treatment gap and how options like VNS therapy (Vagus nerve stimulation) can help.

Transcription
Health Professional Radio – Epilepsy Treatment Options

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Neal Howard: Hello and welcome to the program, I’m your host Neal Howard here on Health Professional Radio. Thank you so much for joining us today. November is Epilepsy Awareness Month and our guest in studio is returning to speak with us, Dr. Ahmed Abdelmoity, Director of Children’s Mercy Hospital Level Four Epilepsy Center in Kansas City, Missouri and he’s here today to talk with us about some of the misconceptions surrounding epilepsy and some of the treatment gaps that exist and how some option such as VNS therapy can help to improve quality of life. Welcome to the program doctor.

Dr. Ahmed Abdelmoity: Thanks so much. Thanks for having me.

N: Thank you. When we were here before we talked a little bit about some of the causes of epilepsy. I personally learned that anybody is a candidate for an epileptic seizure either maybe one a year or maybe hundreds a day. I learned also that there are many age groups that are affected from the low end of the spectrum to the first couple of years of life to the high end of the spectrum, in your 70’s. We’re here today to talk about some of the misconceptions about epilepsy. Maybe dispels some of those myths and talk about some of the treatment options that exist even though there is a treatment gap. Talk about, first of all, what epilepsy is?

A: So epilepsy is tendency to have more than one unprovoked seizure. After the patient has their first seizure, that’s when we can keep an eye and look at the whole context. Is that patient has normal development, has had a normal exam, imaging is not impressive as far any abnormality. In that case, we’ll continue to watch and observe and see how the patient will continue to do. I supposed, somebody who’s had an underlying known etiology, for example a known genetic disorder that would carry high likely having epilepsy with it or a known underlying Hypoxic-Ischemic Encephalopathy or stroke, or sometimes tumors, or a known metabolic disorder that again would be more likely to cause seizures. Even after the first seizure, going to the new definition of epilepsy that which has tendency to have more than one unprovoked seizure that’s when diagnosis is made, even with one seizure and between this…

N: As I said when I introed you, there was a lot that I’ve learned speaking with you the last time that we were here. Some of the misconceptions that surround epilepsy, they’ve must be many because there are so many different types and causes of epilepsy. What is maybe the one huge misconception that you keep running in to when you’re talking with your patients or with loved ones of patients about this disorder?

A: You know, that’s a really, really good question and thank you for bringing this up because one of the misconception, what I think that actually even stand in the in the way of the treatment, is patients with an epilepsy cannot live a normal life, which is a big huge misconception. A lot of patients with epilepsy when the proper treatment is picked and when the patients go through the proper treatment algorithm, patients can live a normal life as possible and some of the misconceptions unfortunately that patients with epilepsy cannot hold a job, cannot live independently, they cannot do a lot of things where other healthy people can do, and I always tell my patients, “You have epilepsy but epilepsy don’t have you”. And it’s a really an important thing to highlight to tell the difference where one properly treated. And that again, brings the importance of when do we choose treatment, how do we set expectations, and how do we measure those expectations against what the patient is doing. Most patients with epilepsy, some will have limitations not necessarily related to their seizure and epilepsy but related underlying etiology other seizure and epilepsy but might help seizures when properly handle them, properly treated and most patients, I think all patients, but most patients, they’ll be able to gather academic performance as wished, get their job and live a good life. Some of the other misconceptions unfortunately about epilepsy is that, people, some patients and some people will treat epilepsy and seizures synonymously. Meaning that they will think that seizure is epilepsy and epilepsy is seizure and that’s a huge misconception. Seizure is a part of the epilepsy syndrome. Epilepsy is a big, huge syndrome including quality of life as a part of it. Patients with seizure or with epilepsy, it’s not in common to have depression, to have migraine headaches, to have an anxiety. It’s not in common to have other mood disorders. So, missing that and treating epilepsy as only seizure and think only attention to the seizures and overlooking those other components of epilepsy. I just did my patient a … by not addressing something that is a big part of epilepsy and it’s actually an important part for the patient themselves. It’s that, the seizure is a very important part of the epilepsy syndrome but equally important are those other quality of life, measures that are super, super important to the patient because that’s what it gets them up in the morning to do their job or go to school and get their …vacation

N: Used the word proper before treatment several times. Having to use that word implies that there are improper treatments. In your experience and in your opinion, how often is epilepsy misdiagnosed and what do you think contributes to those misdiagnosis?

A: That’s a beautiful question. So epilepsy, there are a lot of epilepsy and seizures mimickers. So this was even before we start talking about epilepsy treatment. There are a lot of things that can mimic seizures and would look like seizures. The importance of proper diagnosis of seizures is very, very super important. So, there are sleep disorders that can mimic and look like seizures, there are other behavioral problems that can look like seizures. Some tics and other movement disorder that can look like seizures. So, number one is make sure that we are actually dealing with seizure and with epilepsy. Second part is inside epilepsy as we talked last time, there are different types of seizures and different type of epilepsy, so the proper treatment and typically the first line of treatment for most seizures, for most epilepsy will be a medication. So, with different medications available that can address different seizure type and different epilepsy type, picking the proper class of medication for that patient, can really make a big difference in controlling seizures and getting a better quality of life. But the unfortunate reality is that, with medications we can take care about 2/3 of the patient where their seizure can be more controlled than their seizures can stop. But what about passed a point, how do we set that expectation, can we just go on and say, ” Well, we’ve done all what we can or should we move on to non-pharmacological treatment or non-medication treatment”, and those, there are number of them as we mentioned last time, there are certain epilepsy survey, respective survey that will identify and target the focus where the seizure is coming from and resect it either surgically or by laser ablation or some sort of ablation to get rid of that focus, or by special proper diet, or by normal dilation. So, talking about a proper treatment, it would be the proper move after a two or three seizure medications that are properly chosen for that patient, meaning, from the right class for that proper seizure, while tolerated with patients by having too many side effects just like we agreed. Epilepsy is not just a right seizure. I didn’t do my patient any favor if I stop all their seizures. I left them with a lot of depression, a lot of kidney problems, a lot of bone problems, and a lot of liver issues. I really didn’t do them a favor by just stopping their seizures but left all those other problems. So, there’s timing and timing is really, really a key as we’re talking about the proper treatment of seizures and epilepsy. So, maybe to use your medications that are properly chosen past which we know that is in literature and science have shown us that’s over and over and over. Past three seizure medications the chance of getting seizures further better controlled is not gonna be that high and we need to move on to a different treatment modality, the ones that we talked about depending on the patient’s …and what type of seizure, and what type of epilepsy and the work up and so forth. But again, that would be the next proper move. And there’s really an important thing when we’re talking to our families and in our patients, as by setting expectation. So, where the patients should not really settle, should not deal that, “You know what, I’ve done my two seizure or three seizure medications, I’m so having a seizure every three months or every four months, that’s it! I’m switching different seizure medications would be there.” Because a lot of time, that is not the proper treatment, the proper treatment is really get out of the box of pharmacological treatments and so doing non-pharmacological treatments for those patients. And that’s why again level four epilepsy centers and other centers can help make that distinction for who can go to which direction. Also part of the proper epilepsy treatment is like I mentioned, expectations. What do I put for our patients with epilepsy of expectations? We just agreed that seizure and epilepsy are not the same thing. So putting the expectations for the best quality of life, the sweet spot and what are the treatments to get me there, is really a key thing. One last thing about that proper treatment is timing. What are the things that you used to be controversial which is becoming not controversial anymore is something we called kindling. Kindling, it means that more seizures can bring more seizures. So, what I’m waiting on my patient who’s having a seizure after a seizure, it can be once every day or even once every six months. Still, there are some of those evidence that shown that every seizure, sets the stage or sets the tone for the next seizure to be more likely to happen. So, if I leave that vicious cycle happening without the proper timing of intervention with the next step in treatment, if that is adding the second seizure medication or going to the epilepsy surgery or normal dilation, whatever the next step will be according to the patient with epilepsy. That is an added component to the proper timing and the proper treatment of epilepsy.

N: I’m hoping that you’ll come back and talk with us about some of the treatment options that are available to improve quality of life to those that are living with epilepsy. Will that be okay doctor?

A: Absolutely! I’ll be happy to, I’d love to.

N: Thank you so much. You’ve been listening to Health Professional Radio, I’m your host Neal Howard, with Dr. Ahmed Abdelmoity, Director of Children’s Mercy Hospital Level Four Epilepsy Center in Kansas City, Missouri and we’ve been talking about some of the misconceptions about epilepsy and some of the treatment options that are available to improve quality of life of those who suffer. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also hpr.fm, and you can subscribe to this podcast on iTunes.

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