Could It Be Epilepsy?
According to the American Epilepsy Society, epilepsy affects 2.7 million people in the United States. Epilepsy is a neurological disorder in which nerve cells in the brain send abnormal signals to other nerve cells and muscles throughout the body. These signals can cause seizures, unusual sensations, or different behaviors. People of all ages live with epilepsy, however, the first seizure or manifestation occurs most often in childhood or in older adulthood. This year, another 200,000 people in the United States will be diagnosed with epilepsy.
There are many different reasons why an adult may have a seizure. Epilepsy monitoring can help your doctor make a diagnosis of epilepsy or rule it out.
At The Valley Hospital's Adult Epilepsy Monitoring Unit, we carefully evaluate and monitor patients over the course of several days while they stay in our comfortable, state-of-the-art private rooms. After the monitoring has been completed, our medical director/epileptologist will interpret the results and make a diagnosis. If it is epilepsy, there are many different treatment methods to manage it, including medications, diet, electrical stimulation and surgery.
Seizures and Epilepsy*
Seizures can be convulsions, brief periods of unconsciousness, or altered behavior. When seizures recur, a person may have epilepsy or a seizure disorder. Epileptic seizures are caused by a sudden and unusual discharge of electrical energy to the brain. Our brain cells need electrical energy to make us move, sense, think, remember, feel and live. But sometimes these bursts of energy become unregulated and chaotic and a seizure results.
There are several types of seizures:
- generalized tonic-clonic (grand mal) seizures, when all muscles and motor functions are affected, and the person loses consciousness, falls, stiffens, and begins to jerk
- absence (petit mal) seizures, when the person loses consciousness briefly and stares blankly for short periods of time
- atonic seizures, which cause a sudden loss of muscle tone
- myoclonic seizures, which are brief involuntary muscle jerks
- partial seizures, which do not cause a loss of consciousness, but result in jerking movements of one part of the body. The person may appear to be in a dream or trance-like state and unable to respond.
In most cases, the origin of epilepsy is not known, but there may be a genetic influence, and it has been linked to other conditions, such as alcoholism, Alzheimer's disease, brain tumor, stroke, and head trauma.
*Medical information from the Epilepsy Foundation of New Jersey
Monitoring Defines the Cause
Epilepsy is just one medical condition that can cause recurrent seizures in adults. Seizures can also be caused by an acute or chronic medical condition, such as a stroke, anxiety, head injury, brain tumor, heart condition, or problem with blood pressure. An electroencephalogram (brain wave EEG) combined with video camera monitoring performed by specialists at the Adult Epilepsy Monitoring Unit can be used to diagnose epilepsy or rule it out. Adults who develop epilepsy may have experienced a medical condition in childhood that put them at risk, including a developmental delay, meningitis, measles, or a malformation of the brain. Monitoring can also clarify what type of seizures a patient is having so that the most appropriate medication can be prescribed.
We Specialize in Epilepsy Monitoring
The Adult Epilepsy Monitoring Unit is under the medical direction of John T. Nasr, M.D., a board-certified neurologist and clinical neurophysiologist who specializes in epilepsy. He is joined by a team of registered nurses who specialize in caring for patients with neurologic conditions. There is 24-hour coverage by board-certified neurologists.
Our monitoring team is led by a technologist who is registered by the American Board of Registration for Electroencephalography and Evoked Potential Technologists. The team consists of highly qualified and experienced technicians who work both in the adult and pediatric departments. These technicians perform such studies as long term monitoring in the adult intensive care unit, ECI (brain death study), sleep deprived, neonatal EEGs, portables and routine testing. All these studies help in diagnosing epilepsy, seizures and abnormal brain waves.
A Comfortable Atmosphere
The Adult Epilepsy Monitoring Unit has been designed for the comfort of patients. Patients generally spend two to five days in a private room in the unit. An around-the-clock EEG test (electroencephalogram) and video camera technology provide Dr. Nasr with information to make a diagnosis. The EEG measures brain waves through electrodes placed on the scalp and can detect abnormal changes that signal seizures. The video camera provides constant views of the patient for Dr. Nasr and the nursing staff. Patients may also undergo blood testing and an imaging study of the brain (MRI, SPECT, or PET scan) while they are here.
Patients do not have to remain in bed. They may sit up in a chair, leave their rooms for a nearby walk on their floor, wear their own clothes and pajamas, and eat food brought from home. They are encouraged to bring books, craftwork, puzzles, laptop computers and any other items for their enjoyment.
Network Monitoring for Patients
Network monitoring equipment in The Valley Hospital allows the epilepsy team to evaluate and monitor acutely ill patients who are in intensive care units throughout the hospital so that they don't have to be moved to the Adult Epilepsy Monitoring Unit.
Multiple Treatment Options
Physicians associated with the Adult Epilepsy Monitoring Program interpret the patient's epilepsy study and formulate a treatment plan. Patients may continue under the care of a physician associated with the program or be referred back to their own neurologist. Treatment options include:
- vagal nerve stimulation, which involves the use of a small device implanted in the chest and attached to the vagal nerve (in the lower neck) that acts like a pacemaker to regulate electrical impulses in the brain and decrease the frequency of seizures;
- a ketogenic diet that has been proven to help patients with severe epilepsy; and/or
- referral, when appropriate, for surgery to treat seizures that cannot be controlled any other way.
The Adult Epilepsy Monitoring Unit is participating with several pharmaceutical companies in clinical research to evaluate the effectiveness of new medications.
Valley's Advanced Services
If epilepsy is ruled out and another medical condition is suspected, The Valley Hospital offers the complete range of services needed to diagnose and treat these other problems. Valley is one of only several hospitals in New Jersey to be designated a Primary Stroke Center by The Joint Commission on Accreditation of Healthcare Organizations. The Valley Columbia Heart Center integrates the skills and expertise of cardiologists and cardiothoracic surgeons at Valley and its affiliate, the NewYork-Presbyterian Healthcare System's Columbia University Medical Center. At Valley's Daniel & Gloria Blumenthal Cancer Center patients receive diagnostic and treatment services for brain tumors, including the use of non-surgical stereotactic radiosurgery to destroy cancerous tumors.
John T. Nasr, M.D., Director, Adult Epilepsy Monitoring Unit
Dr. Nasr received his medical degree from the American University of Beirut in Lebanon. He was chief resident during his neurology residency at the State University of New York-Stony Brook, New York. After graduation, he stayed on to complete a fellowship in neurophysiology. He has been on the medical staff of The Valley Hospital since 2000 and director of the Adult Epilepsy Monitoring Unit since 2001. Dr. Nasr's professional memberships include the American Academy of Neurology, the American Epilepsy Society, and the American Clinical Neurophysiology Society.
For More Information
Patients are usually scheduled for an epilepsy study by their referring neurologist or Dr. Nasr. For more information about the Adult Epilepsy Monitoring Unit at The Valley Hospital, please call 201-447-8311.