33) Know Your Brain Neurology (part 1)
Specializing in seizures and epilepsy, neurologist Diego Tovar-Quiroga, MD explains that often people are bewildered by symptoms that can affect mental health. He provides ways to successfully recognize and treat this brain disorder.
Diego completed medical school in Bogotá, Colombia and his fellowship at the Mayo Clinic. He is a certified neurologist at Austin Epilepsy Care Center and is dedicated to treating and diagnosing people with seizures and epilepsy.
➤RESOURCES
Austin Epilepsy Care Center: http://www.austinepilepsy.com
Epilepsy Foundation: 1-800-332-1000
National Association of Epilepsy Centers: https://www.naec-epilepsy.org
Free Worksheet: https://www.YourTruthRevealed.com
➤SUMMARY
What happens neurologically in the brain during a seizure?
* A seizure is a sudden, uncontrolled electrical disturbance in the brain. It can cause changes in your behavior, movements, feelings, and levels of consciousness.
* Seizures can be provoked by many different factors. They’re classified as either epileptic or non-epileptic seizures.
* Epileptic seizures – dysfunction of the electrical networks in the brain.
* Non-epileptic seizures – enhanced neural networks in the brain.
* Because these two different types of events can look alike, sometimes people get the wrong diagnosis and are treated wrongly for decades.
How do you discovery the correct diagnosis?
* The diagnosis is confirmed by capturing the events with electroencephalogram (EEG), ideally with simultaneous video recording. This test allows us to determine if there is abnormal electrical activity in the brain at the time of the event, which is the hallmark of epileptic seizures.
* When patients have non epileptic seizures, the majority of the times there is a pain syndrome that is not well controlled.
* Part of my role is to guide the patient to see the correlation and explore the treatment options.
How might someone who has seizures experience an impact on their mental health?
* Epileptic seizures are a brain malfunction, and so are major depression, anxiety disorders, and psychoses. Although epilepsy is not a psychiatric disorder, its psychiatric dimension is important for treatment and research.
* The symptoms of focal seizures, especially, can be mistaken — by the patient or the doctor — for psychiatric symptoms, especially panic attacks, flashback memories, or dissociative experiences (involving, for example, altered consciousness or a feeling of unreality).
* About a third of people with focal seizures also suffer from anxiety disorders, especially agoraphobia. But the psychiatric disorder most notoriously associated with epilepsy is depression. As many as a third of people with epilepsy suffer from periodic depression, and depression is 4–7 times more frequent than average among them.
* Seizures themselves can cause lasting changes in mood and thinking.
* A condition called interictal dysphoric disorder occurs in some patients with epilepsy. The definition includes eight symptoms, of which the patient must have at least three: depression, lack of energy, pain, irritability, anxiety, fear, and, oddly, euphoria.
How does culture impact how seizures are treated?
* All cultures have health beliefs to explain what the cause of a disease is, how it should be treated or cured, and who should be involved in this process.
* I did part of my medical education in Colombia, where still, in many parts of the country (especially rural areas) there is a strong belief and use of non “traditional” western medicine, based on herbal treatments, massages etc.
* Working there I got to see cases of people who became very ill or died because they did not received proper treatment (eg abdominal pain “treated” treated by a local “healer” with massage and herbal remedies, which turned out to be a ruptured appendicitis).
* Another observation is that patients trust healthcare providers (traditional and nontraditional) more which in general makes patients less involved in their healthcare.
* Another big difference is how we use resources. In Colombia, because resources are limited, less is spent in diagnostic testing and families are more involved in the care of their loved ones.
How do you counsel people effected by seizures on lifestyle changes?
* There are many aspects of lifestyle which, when improved, can help manage their condition. Medications are useful but are not the only aspect of treatment of epileptic seizures.
* Sleep quantity and the amount of sleep
* Exercise is extremely important
* Diet – gets a bit tricky. There may be benefit of low carbohydrate diets. Different ways of advocating with little animal products.
What is the relationship between pain and non-epileptic seizures?
* Somatic pain – migraines, fibromyalgia, lower back pain, and irritable bowel syndrome.
* Pain can be emotional. Abuse in childhood, toxic relationships. Traumatic experience will mark you for life.
* Look for a mental health specialist to learn the skills to control the episodes at will. You can retrain your brain.
What is some of the neuroscience research that is being done for epilepsy?
* Epilepsy is one of the areas of neuroscience where more research is done.
* There are multiple treatments for these conditions including medications, surgical treatments, neurostimulation/neuromodulation, and diet.
* On the other hand, research on non-epileptic events/seizures is an area that has been, in my opinion, neglected in terms of research.
* There’s no product, no medication, there’s no evident “profit” derived from understanding better and treating these conditions. Therefore, we have little insight into the exact mechanisms involved in this condition.