Dr. Michael Privitera Answers 6 Common Questions about Epilepsy

Photo of Michael Privitera, MD, by UC Academic Health Center Communications Services.

Seizures are among the most puzzling mysteries in medicine. They can occur any time, at any age and without any warning. Michael Privitera, MD, Director of the Epilepsy Center at the University of Cincinnati Gardner Neuroscience Institute, one of four institutes of the UC College of Medicine and UC Health, has developed a national reputation for explaining the mystery of seizures to the general public. After recent reports that the rapper Lil Wayne was hospitalized because of seizures, Dr. Privitera explained to MTV.com why a 30-year-old might suddenly develop an epileptic condition. Dr. Privitera was also recently interviewed by People magazine after Kelley Osbourne, the English singer and actress, suffered a seizure. Below, Dr. Privitera answers six of the most commonly asked questions about seizures.

Q: What happens when I have a seizure?
A: A seizure starts in the brain as an electrical disturbance in which nerve cells all fire at the same time instead of in a smooth, coordinated manner. The area in the brain where this electrical activity occurs will determine the seizure’s clinical appearance, or manifestation. For example, if the seizure starts in the part of the brain that controls motor function in the hand, the shaking may start in the hand. If it starts in a part of the brain that involves consciousness, the person may just blank out. And if the seizure discharge spreads to involve the entire brain, the individual may have a convulsive seizure, which is also known as a grand mal seizure.

Q.  Why does a person develop seizures?
A: This is a difficult question because in about 50 percent of people we cannot tell. We simply will not be able to tell them what caused their seizure. The most common causes are related to head trauma or a severe infection that involves the brain, such as meningitis or encephalitis. Sometimes stroke or tumors can cause seizures. But in about half of patients, the MRI scan is normal and we do not really know why they have seizures. Sometimes there is a genetic factor in seizures, but this is less common than most people might think. The causes also differ substantially by age of onset.

Q: What triggers a particular seizure?
A: If someone has not had a seizure for six months and then has one out of the blue, they invariably want to know why it happened. And again, we have some ideas. Major triggers of seizures include sleep deprivation, not taking one’s medication or drinking alcohol. We believe that stress is another potential trigger. But very often we do not see a particular trigger, and the seizure has just happened. This is one of the research areas that we are keenly interested in: what makes people have seizures at a particular time, what is the role of stress as a trigger, and how can we predict when seizures will occur?

Q: Why do I need to take medication every day if I have only had one or two seizures?
A: This is a question we frequently hear from our patients who have been newly diagnosed, and the answer is related to the one above. Unfortunately, seizures are unpredictable and we do not have a good idea of exactly when one will occur. A seizure could happen when you are sitting down to dinner, but it also could happen while you a driving on a busy highway or walking down a flight of stairs. Because of that, people need to take medication every day to help protect the brain against future seizures.

Q: Is it safe to have a baby if I have epilepsy?
A: This is an area of research that Dr. Jennifer Cavitt is leading at the Epilepsy Center. As far as we know right now, all of the available seizure medicines have the potential to increase the risk of malformations for the baby. What is very clear is that some medicines are worse than others. We have identified the worst ones, and we know that women should almost never take them during pregnancy. We know that there are some medicines that seem to be less risky, and we try to use those whenever we can. Because the other problem is that having seizures during pregnancy is also a risk. The medicine has a risk to the baby, but not taking the medicine could increase the risk of seizures, which could be bad for the baby as well. That is the balance we have to strike.

The UC Epilepsy Center was part of a major study that looked at the rate of serious birth defects in babies whose mothers were taking seizure medicine. The study also looked at IQ problems in those children. This was the first time anyone had done the most rigorous research necessary for IQ, because you have to check the mother’s IQ as well as the child’s. The IQ of the child is more closely correlated to the mother’s IQ than the father’s. Our study showed that the medicine, valproate (or Depakote) on average reduced children’s IQ by 9 points, which is a huge number. The other medicines either had no effect or one that was very small. The dose also played a role: the higher the dose, the greater the effect. We are doing a follow-up study now with the newer anti-seizure medicines.

Q: How does my doctor know which medicine to prescribe for me?
A: Most of the available medicines are approximately equal in their effectiveness at stopping seizures, as long as the main epilepsy syndrome is correctly identified. But their side-effect profiles are very different. So I talk to my patients and determine the side-effect profile that is best suited to them. For example, some seizure medicines can amplify depression, while others can make it better. So if a patient has a history of depression, I absolutely want to choose a seizure medicine that has a positive effect on depression. Other side-effects include slowed thinking, unsteadiness when walking, sleepiness, dizziness and enhanced alertness. Those are the primary side-effects that we think through. Interactions with other medications the person is taking are also important to consider. If the person with seizures is a woman, then we consider many other medication factors like interactions with oral contraceptives, effects on ovarian function, and risks during pregnancy.

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