Q&A with Dr. Akila Venkataraman

NEXT UP: Part I of “When Seizure Types Change”  by Dr. Shahin Nouri

The team at EFMNY would like to thank you for your questions! After each post, we’ll post answers from our experts to the most frequently asked questions we receive.  Please note that these Q&A post, like our provider articles, should not be taken as medical advice.  Each patient is unique.  For medical advice regarding your specific condition, please consult your doctor.

Q&A with Dr. Akila Venkataraman:

1. I was diagnosed with epilepsy at age 9 and I’ve continued to have seizures for more than a decade in spite of seeing a number of doctors and taking several medications. My parents and siblings are all healthy. Why are some people predisposed to have seizures while others are not? I’ve never even had a head injury.

While many people who have seizures may have a family history of epilepsy, having seizures depends mostly on the nature of an individual’s brain cells. Some people have been found to have genes that make them more susceptible to having seizures than others, even if they are otherwise healthy.

2. You mentioned the social implications of being unable to drive due to seizures. I’ve been seizure free for 8 months, so my doctor cleared me to drive again. I was thrilled, but now every time I get behind the wheel, I’m paralyzed. I’m so afraid that this could be the day it comes back. How can I be sure I won’t have another seizure while driving?

While there is no way to absolutely guarantee no further seizure activity, the longer one is seizure free the less likely the chance of having seizures. If there were known triggers to your seizures previously, avoiding them can go a long way in making sure you don’t have another seizure while driving. Overall good driving habits such as only driving when well rested and not driving very long distances without any breaks also help.

3. I’m a busy, high functioning person who occasionally has seizures. The period after is often the most difficult for me. I’m exhausted, unfocused and unproductive. Is there any way to treat this part of the disorder?

The period after a seizure or the ‘post-ictal’ period is usually the time while the brain is recovering from the intense electrical activity that just occurred during the seizure. The length of this post-ictal period and the severity of symptoms during this period vary among individuals, as much as seizures themselves do. Ideally, no seizures should logically mean no post ictal symptoms. But complete seizure control, and consequent post-ictal control may require further testing and medication adjustment by your doctor.

4. I’ve had uncontrolled seizures for years. I’m concerned that I may have suffered some brain damage as a consequence. Is this something my doctor can confirm? Are there tests? Is it reversible or can this damage heal over time once your seizures are under control?

This is a complicated question. While there are many consequences of uncontrolled epilepsy, it may be difficult to confirm the entire extent of any possible damage. It may even be a ‘chicken or the egg’ situation, where the seizures may be occurring and uncontrollable due to some brain insult. There are many tests that can be done to check the structural and functional ability of the brain. The type of seizures, the possibility of brain damage and the reversibility of such damage are different for different people. You and your doctor may be able to find out more information about your concerns after testing.

5. I’ve been experiencing memory problems over the past year. My medication has reduced the frequency of my seizures, but I read that it may also affect memory. How can I know if my problem is caused by my seizures or the medication?

Memory problems can occur due to seizure activity, but unfortunately they can also be a side effect of many of the medications taken to control seizures. While neuropsychological testing can figure out the extent of these memory problems, the only way to positively find out the cause of your memory problems may be switching you off your current medication and testing your memory while you do not take the medication and seeing the difference. Sometimes it may be one type of anti-seizure medication that may cause more side effects than others in any given individual.

6. How long should I keep trying medications before I talk to my doctor about alternative treatments? 

While research shows that chances of total control of seizures become much lower after a trial of two antiepileptic medications, there is no absolute time period that you have to wait to start thinking about alternative treatments. Some seizure types may do better with alternative treatment options than others. But it is important to make sure that the medications are tried to their full potential before giving up on them. Most importantly, you should always openly talk to your doctor about any of your concerns about your seizures and treatment plans.