Epilepsy: Diagnosing Epilepsy

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Guest:  Dr. Jonathan Edwards - Neurology

Host:  Dr. Linda Austin – Psychiatry

Dr. Linda Austin:  I’m Dr. Linda Austin, talking today with Dr. Jonathan Edwards who is Associate Professor of Neurology at MUSC and Director of Comprehensive Epilepsy Program here.  Dr. Edwards, earlier we were talking about what a seizure is and you described that, I think, really beautifully.  When, though, as a neurologist, do you make a diagnosis, not just of a single seizure, that a patient actually has epilepsy?

Dr. Jonathan Edwards:  Epilepsy is a condition of recurrent unprovoked seizures.  Earlier, when we were talking about seizures, we gave some examples of how seizures can be provoked, low glucose or alcohol withdrawal.  If someone has a seizure from one of those causes, that is not epilepsy.  Even if someone has a seizure from one of those causes and then has another seizure from that same cause, that’s not epilepsy.  

Epilepsy is a condition in which you have recurrent unprovoked seizures.  Now, the condition of epilepsy may be caused by a wide array of factors.  Some patients may have epilepsy that was caused by having had meningitis, which may have damaged part of the brain, and now the patient may have seizures on their own, whether they have an infection at that time or not.  It is possible that someone could have head trauma, which can damage or cause an irritation in the brain, and that patient, now, may have seizures whether they have head trauma from that point on or not.  

Dr. Linda Austin:  But, in other words, what may have had cause to begin with, takes on a life its own, and is it usually because of some sort of damage, or are there times when you may not even, as a doctor, know what the damage was, but it just occurs?

Dr. Jonathan Edwards:  With most patients, we can find the underlying cause.  That’s often the case with head trauma or nervous system infections, such as meningitis or encephalitis.  But some forms of epilepsy are inherited; they’re genetic conditions.  Some, even now, with our modern technology, we cannot always find the cause.

Dr. Linda Austin:  I would think that as you go through the lifespan there would be different causes that are more likely at one age than another.  Can you walk us through the lifespan, starting with babies, what causes epilepsy in babies and so on?


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