Polk experts: Early detection of epilepsy essential especially with variety of symptoms – The Ledger

How epilepsy manifests itself varies, hitting some patients more severely than others. There are various classifications and types. It affects all ages, racial and ethnic groups.

Dont expect a funny answer if you ask a neurologist what stroke, head-injury trauma and infectious diseases have in common.

Theres no punchline, because the question isnt a joke.

Each can lead to epilepsy, a complex neurological disorder with abnormal brain activity that produces seizures. Genetics, dementia, some developmental disorders and prenatal brain damage also can cause it.

An estimated 3 million adults and 470,00 children had epilepsy in 2015, with 223,900 of them in Florida. That number, 720,000 higher than it was in 2010, keeps increasing.

How epilepsy manifests itself varies, hitting some patients more severely than others. There are various classifications and types. It affects all ages, racial and ethnic groups.

More obvious symptoms like shaking, falling and foaming at the mouth can make epilepsy easier to diagnose, but not all seizures show up that way.

"Most people dont know there can be very subtle forms of seizures," said Dr. Jaivir Rathore, a Watson Clinic neurologist who specializes in treating epilepsy.

Although it can occur at any age, large upward curves occur about age 2 and at 60 or older, he said.

Its important to find epilepsy early, Rathore said, because it can become more treatment resistant over time. Multiple places in the brain can become sites where seizures originate.

The good news is that about two-thirds of epilepsy patients respond well to anti-epilepsy medications. Some can get rid of their seizures and even get off medication after a few years. Others need medication for life.

The medications typically do have side effects.

"For those whose seizures are well controlled or fully resolved, we try to keep medications at lower doses," Rathore said.

For the approximately one-third whose epilepsy resists medicines, devices and various surgical procedures are other ways to thwart seizures.

Some patients need all the technology available.

Rathore is working with an epilepsy team at Tampa General Hospital for a Lakeland patient to receive stereotactic electroencephalography to better determine where her seizures begin. That will involve inserting electrodes through burr holes in the skull, with the help of a robotic arm, into her brain.

Theyre also working on a potential laser procedure for her that currently cant be done in Polk County, he said.

Polk isnt devoid of epilepsy care. Local doctors treat those patients, particularly the ones whose seizures are controlled by medicines.

Some forms of brain monitoring, surgery and other treatments are done here. Patients may be put on a ketogenic diet, low in carbohydrates with adequate protein but high in fat.

Whats lacking is a comprehensive certified epilepsy treatment center, a missing element Rathore wants. His desire to get one established is why he moved to Lakeland from Johns Hopkins Hospital in Baltimore, he said.

Lakeland Regional Health is interested, although the financial impact of COVID-19 adds uncertainty as to when one might come.

"Medication, procedures and monitoring of seizures have advanced in so many promising ways in the last decade," said Dr. Timothy J. Regan, president of LRH Medical Center and LRHs chief medical officer.

"We are pleased to collaborate with Watson Clinic and USF (University of South Florida) to discover innovative solutions for providing leading-edge neuroscience treatments to those with epilepsy."

Dr. Tsz Lau, on staff at Lakeland Regional since 2013, is director of neurosurgery for USFs Lakeland division.

He can do some epilepsy related procedures now at Lakeland Regional, such as surgery to remove part of the brains temporal lobe, often done if other treatments arent sufficient.

Another he can do there is implant a vagus nerve stimulator into a patients chest, with wires touching the nerve in the neck, to help block aberrant electrical signals.

RNS, responsive neurostimulation therapy, is a newer method that uses a device placed within the skull. It detects abnormal electrical activity and delivers pulses of electrical stimulation to prevent seizures.

RNS isnt at Lakeland Regional yet, Rathore said, but he and Lau are trained in it.

Another treatment not at LRH is laser interstitial thermal therapy, which the Lakeland woman is awaiting. A neurosurgeon uses a laser to ablate or burn off small portions of brain tissue.

"We are currently sending some patients out (of the county) because we dont have the equipment," Lau said "I personally would love to be able to do these services here at the hospital so we can provide better care to patients here."

New robotic equipment, the latest electroencephalography machines with high-definition cameras and a designated epilepsy monitoring unit would be among additions needed for an epilepsy center, the doctors said.

Expanded pediatric ICU capacity and a pediatric intensivist would be needed for one serving both adults and children, Lau said.

The volume of cases for an epilepsy center definitely is here, Lau added.

Lakeland Regional is scheduled Sept. 1 to become a community intensive pediatric unit, treating a broader range of acute conditions. Neurological diseases and trauma would be among them.

Thats one step toward many changes needed for epilepsy center status. Tampa, Orlando and other Florida cities have centers with that designation. National Association of Epilepsy Centers, http://www.naec-epilepsy.org , has more information.

Robin Williams Adams can be reached at robinwadams99@yahoo.com

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Polk experts: Early detection of epilepsy essential especially with variety of symptoms - The Ledger