Tag: seizures

Driving with epilepsy: when to start?

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One of the big ways in which epilepsy and seizures negatively affect quality of life is by the restrictions they impose on driving. So should patients with epilepsy be allowed to drive and if so when? Is it safe from them to drive?

All these are genuine questions for which patients frequently seek answers. Well lets tackle them one by one. Normally if you have a new onset seizure (your first seizure ever) and present to the hospital, your doctor shall ask you not to drive at least till the seizure work up is complete. The seizure workup shall determine what is the cause of your seizure, do you need to be on a seizure medication, if yes for how long and what are the chances that you are going to have another seizure.

If the cause of seizure is found to be reversible, lets say for example you are diabetic and have a seizure when your blood sugar suddenly fell down as you took your insulin shot but missed a meal. Now this is a reversible cause of seizure and the patient does not have epilepsy. If his blood sugar does not fall down again, he may never have a second seizure. In this case the answer is simple and yes the patient can drive.

Lets take another example, a patient has poorly controlled epilepsy and is brought to the hospital after a seizure at work. In this case, the doctor shall rightly advise the patient not to drive. A patient like this is liable to have another seizure and may injure himself or hurt others if he is behind the wheel.

But this does not mean, that a patient with epilepsy can never drive. If your seizures have been well controlled on medication for a period of 2 years, you may discuss driving again with your doctor. Drving laws with respect to epilepsy vary from state to state in USA. In the state of New York, as a physician I am not mandated by law to report my patient with epilepsy to the DMV. It is left to the patient’s own good judgement that he or she shall surrender their driving license and not drive. In the state of New Jersy though, physicians are mandated by law to report seizure patients to the DMV.

You should be aware of the laws in your state and should discuss the same with your doctor. Most of the bylaws can be found on the DMV website and are listed for each state.

I hope you found this information useful. Its wednesday night and the clock strikes 10pm. I think my bed is calling. Have a good night everyone.

Personal Regards,

Nitin Sethi, MD

Infantile spasms and hypsarrhythmia: what do we know?

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One of my readers emailed me and asked me to talk a little about infantile spasms and hypsarrhythmia as he has a niece who has been diagnosed with this condition. So in this post we shall talk about the same.

First and foremost the term hypsarrhythmia does not refer to a disease, it actually refers to a characteristic EEG pattern seen in some infants who have infantile spasms (their EEG shows some special features and is characteristic for their disorder). So what do we mean by infantile spasms. Infantile spasms as the name suggests are spasms which occur in infants (by infants I mean less than one year of age). These are special kind of seizures in which the infant is noted to have spasm like movements. It is hard to describe what spasms look like clinically but they can be of 2 types: extensor spasms and flexor spasms (the infant is noted to have sudden abduction of the arms and legs, a good example would be to imagine what you would do if some one suddenly frightens you: you shall suddenly jerk and abduct your arms and legs).

In infantile spasms, infants have flexor and extensor spasms. They usually occur in clusters and sometimes an infant may have as many as 15-20 spasms in 5 mins. These spasms represent seizures and when you do an EEG on these infants you do find characteristic EEG findings suggestive of seizures. This now brings us to the term hypsarrhythmia. As I stated earlier this refers to the EEG of a child with infantile spasms (the EEG is disorganized, of very high amplitude and shows multi-focal epileptiform activity. By multi-focal I mean, that there are many spots/ areas in the brain which shows signs of epileptogenicity). Infants who have infantile spasms may also have other types of seizures as they grow up. They may have seizures characterized by sudden jerks (we call these myoclonic jerks) and other more typical seizures where-in they have jerks of the arms and legs.

Etiology/ causes of infantile spasms: an infant may have infantile spasms and no cause may be determined even after a good work up. In that case the condition is referred to as idiopathic infantile spasms (idiopathic meaning for which no cause is determined). Usually though in most infants a cause for infantile spasms can be determined after a thorough work up. Work-up for infantile spasms usually should be carried out in a big center where the doctors have sufficient experience in dealing with these complicated cases. The doctor shall order many tests. Some of them include an EEG (at times the doctor might admit the infant and do a more prolonged EEG test. This is called a video-EEG monitoring test). Other tests which may be carried out include imaging studies of the brain such as an MRI (children and babies usually have to be sedated prior to the MRI test), tests of the blood to rule out any metabolic and storage diseases etc.

Once the diagnosis is secured and the etiology determined, then the question of management arises. Management involves 2 issues, one is the management of the underlying condition which is the cause of the infantile spasms (if the spasms are idiopathic we do not have to deal with this issue), the other is the management of the spasms/ seizures itself.

Infantile spasms usually respond to ACTH (adrenocorticotrophic hormone), a type of steroid preparation. It has been seen that when infants are started on ACTH, their spasms may completely stop and their EEG may also normalize (that is the hypsarrhythmia pattern goes away). There are other drugs which can be used too and your doctor shall help you in deciding the best option. It has been noticed that in some infants as the ACTH is stopped the spasms come back.

It is important that infantile spasms be detected and treated in time because ongoing spasms effect the cognitive development of the child and may lead to developmental arrest.

I hope this shall be helpful to some of you. If you seek more information, please do let me know.

Personal Regards,

Nitin Sethi, MD

Radiation therapy: some facts

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Hello everyone, it is Memorial day as I sit down to pen this. Thought since we were on the topic of management of brain tumors, I should give you all some information about radiation therapy. As I stated earlier, radiation therapy is one of the modalities we use in the treatment of brain tumors apart from surgery (debulking the tumor) and chemotherapy (anti-cancer drugs).

So how does radiation therapy work? Well put in a simple form, radiation is given to the tumor to kill the tumor cells. Either you can irradiate the whole brain or just the tumor site. Radiation of the whole brain is done when there are multiple metastasis or when you are worried that microscopic spread of cancer might have already occurred.

Advantages of radiation therapy: one of the biggest advantages of radiation therapy is the ease of administration. Usually you go to a radiation oncology center and it is an outpatient procedure. But we are jumping ahead of ourself. Before radiation is administered, the radiation oncologist in consultation with your neurologist and neurosurgeon shall look at your MRI scans and then determine which shall be the best protocol for you. How much radiation to give over how much time and sittings. Should the whole brain be radiated and then a boost of radiation given to the tumor itself? As you can imagine it is very technical and involved expertise. How to give the radiation without affecting any neighbouring cells (remember radiation by itself cannot differentiate between healthy and tumor cells. It shall kill all cells in its path). If the tumor is near the visual pathways (the optic nerve), then you have to be careful that you do not irradiate the optic nerve as it shall lead to blindness. All such issues are looked at and considered before the protocol is decided.

By studies on animals we now know approximately how much radiation we can safely give to the brain and spinal cord over how much time.

Points to remember: when radiation is started, it leads to death of tumor cells. This increases the edema and swelling in the brain initially. Your doctor may prescribe you steroids or additional steroids if you are already on them to make the swelling go down. Also as the brain swells after radiation, some patients can have seizures and it may make sense to be on an anti-epileptic drug at the time of radiation.

What are the long term side-effects of radiation: Radiation does have some side-effects. In adults and especially in children it can lead to cognitive deficits and affect memory. That is why we try to avoid radiating a developing brain of a child. Also radiation itself at times can lead to a secondary tumor ( we try to avoid this by using the lowest radiation dose as possible). There is an entity called post radiation necrosis which at times can cause some diagnostic problems. About 12-18 months after radiation, necrosis of brain tissue occurs. This at times can present with seizures and be confused with recurrence of brain tumor.

I hope I have been able to shed some light on radiation therapy with respect to brain tumors. It is a lovely Memorial day here in NYC. Plan to head to Central Park and read with the sun on my back. Life is beautiful, I try to remind myself everyday. I wish you all a restful and enjoyable day.

Personal Regards,

Nitin Sethi, MD

 

Brain tumors: malignant glioma

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Since the diagnosis of Ted Kennedy with a malignant glioma, the focus has again turned to brain tumors. Let me discuss in this post a little about malignant gliomas. Glioma are one of the most common primary brain tumors. They are called gliomas because the tumor arises from the glial cells (the tumor does not arise from neuronal cells, rather from glial cells which form the structural supporting cells in the brain).

The WHO (world health organization) grades gliomas into 4 classes:

1) Grade I and II gliomas: are also what are called low grade gliomas. These are slow growing tumors, usually seen in the younger age groups. As they are slow growing, they are less malignant and compatible with a longer survival. They ususally present clinically with a seizure (when they irritate the underlying brain) or when they grow in size and become large, they present with mass effect (the mass and bulk of the tumor presses on surrounding structures and patients may present with weakness on one side). How are low grade gliomas treated?

Treatment of low grade gliomas; as these tumors are slow growing, they are at times amenable to surgical resection. This is because these tumors are usually well encapsulated and its margins are well defined. So in children or adults, if we catch these tumors in time and if the tumor does not involve the eloquent cortex (parts of the brain which subserve speech, or control the hand and leg movements), one may be able to resect the entire tumor out enbloc. In some patients, that is all what may be needed and we usually like to avoid radiation in children ( since radiation has its own problems and may cause cognitive deficits in the young child later on). You doctor may also put you on an anti-seizure medication for a short while to prevent you from having seizures.

Grade III and IV gliomas: or high grade gliomas. This includes glioblastoma multiforme or GBM. Since these tumors are high grade, they are usually fast growing and invade the surrounding brain tissue. Hence it is impossible to resect the entire tumor out usually. Even if you resect the entire tumor you see macroscopically (that is with the naked eyes), the tumor has already caused microscopic metastasis and spread in the brain. Here in lies the fact why these tumors are so hard to treat and patients usually have a poor prognosis. In the best centers in the world, we treat these tumors with a combination of surgery ( try to debulk the tumor and remove some of it and decrease the pressure in the brain), radiation (you may either radiate just the tumor or irradiate the entire brain to prevent metastatic spread) and chemotherapy. Radiation and chemotherapy may either be used concurrently  to supplement each other or one after the other. Again usually these tumor present at first with seizures and your doctor may start you on an anti-epileptic drug to prevent it.

I shall build on this discussion in my next post. Enjoy the weekend everyone, it is a beautiful day here in NYC.

Personal Regards,

Nitin Sethi, MD

Epilepsy surgery: just what is it?

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Let us divert our attention for a few minutes to the topic of epilepsy surgery. Usually when one talks about epilepsy and its treatment, one thinks about medications. You are right, most of the patients with epilepsy shall have their seizures controlled by anti-epileptic drugs. However there are a few patients who have what we call medically refractory epilepsy, that is they have seizures which are refractory to anti-epileptic drugs (even if you use multiple drugs their seizures remain uncontrolled). Usually these are the patients whom we consider epilepsy surgery on.

So what is epilepsy surgery and what does it involve. In simple terms, we first try to map the seizures coming from the brain. By mapping I mean, we try to determine where exactly in the brain the seizures originate from (that is the seizure focus). Once we determine the seizure focus and are reasonably sure that all the seizures come from that focus only, then we open up the skull and the neurosurgeon resects that focus out ( kind of chopping off that part of the brain from which the seizures arise, once you remove the focus, the patient ideally should become seizure free and may be even able to come off his seizure medications).

While this procedure sounds good, it is way more complicated than what I explained above. First off all to meet the criteria for epilepsy surgery, a patient  should meet some criteria. What are these? Well first and foremost, we should be able to identify the seizure focus and be reasonably sure that all the seizures come from that very focus only. How do we do this you may ask. Well usually the patient is admitted for video-EEG study. We hook the patient to the EEG monitor and record the seizures. From the EEG we are able to localize the seizure focus. At times though the seizure focus cannot be identified for sure from the surface. In that case we do what is called intracranial monitoring. It is similar to the EEG except here we open up the skull and place the recording electrodes right on the surface of the brain itself.

Once we have localized the seizure focus, we have to make sure of a couple of things. One does that part of the brain serve any useful function? We are mostly worried about memory and speech issues. Secondly if it does house some memory or speech function, would it lead to any deficits if we take that part of the brain out. You do not want the patient to wake up from the surgery and not able to talk or have problems with memory. We test for this by a special test called the WADA test. This test helps us in determining the memory and speech localization in the brain.

Your doctor may also order additional tests again to aid in localizing the seizure focus. Some of these tests include special scans like the PET (positron emission tomography) and SPECT (single photon emission computed tomograpy) scans.

I hope this brief overview of what epilepsy surgery involves shall be helpful to some of you, we can go into more details if any of you requests it.

Nitin Sethi, MD

Seizures, convulsion, fit, epilepsy

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  • Seizures/ Convulsions/ Fits/ Epilepsy

      

    Let us now talk a little about seizures. Seizures are among the most common neurological conditions encountered by physicians.  What is a seizure? Simply put it is a short-circuit of your brain. Brain cells also called neurons communicate with each other via electrical charges.  This communication process is highly organized and smooth most of the times. Rarely for various reasons ,which I shall elaborate later on in the article, things go awry and the result is a seizure ( lots of brain cells firing at the same time in a disorganized manner). So seizure is nothing but a hypersynchronous discharge of brain cells.

    Is there any difference between a seizure and a convulsion?  Well the answer is yes and no. The terms can be used interchangeably and essentially  mean the same thing. But usually as neurologists when we use the term convulsion we mean the patient was “shaking” visibly. The type of seizure you see in a movie–lot of thrashing around, person losing consciousness, falling down, drooling, biting his tongue or lips, losing control of his bladder ( many people may pee on themselves during a big convulsion) and then is confused and disoriented as help arrives. Pretty dramatic, you cannot miss it. You see someone doing that and you know he is having a convulsion and you call for help.

    Seizures though can be very subtle, so subtle that even an attentive and doting parent might miss it.  Short arrest of behavior ( staring spells), losing train of thought in the middle of a sentence, sudden speech arrest, short rapid jerks of the arms and legs on waking up in the morning, a strange smell ( the classical smell described is that of burning rubber), abnormal behavior at night while sleeping: these may all represent seizures.

    It is important to recognize these myriad manifestations of seizures. Sometimes these may be missed and people continue to suffer from seizures for years.

    So that brings me to the next point I want to discuss with you. HOW DO WE DIAGNOSE SEIZURES??  Easy, most of the time it is by a good history. A thorough history taken by a physician ( need not be a neurologist or an epileptologist) can usually give the physician a pretty good idea if you indeed did have a seizure. So when asked try to give as thorough a history as possible: how did the episode start? what were you doing at that time? did it occur during sleep? did you smell something strange? did you lose consciousness and completely black out or were you just confused and disoriented? could you understand people around you at that time? did you shake? if yes did the whole body shake or one side shook? did you bit your tongue or pee on yourself? were you confused after the episode and if yes how long did it take for you to come back to normal?

    As you can see lots and lots of questions. Sometimes you may not know the answer to all of them by yourself ( you were passed out, how can you know!!!!) well in that case we try to get information from family and friends, a bystander who saw the episode, the emergency medical service people who were called to help you.

    Once your physician feels that you may have had a seizure, then come the questions:

    1) Why did you have a seizure and what was the cause of the seizure.

    2) what kind of seizure was it ?( I shall come to this later)

    3) was the seizure a one time event or can it occur again?

    4) Does it need to be treated?

    5) if it warrants treatment what medication is required?

    6) will the medication ensure that you do not have a seizure again?

    7) how long do you need to take this medication?

    8) can you drive? does the seizure place any restriction on your lifestyle?

    9) if the medication does not work: what do you do then?

    I shall tackle these questions one by one. Enough information for now, I need a break!!!

    Personal Regards,

    Dr. S

      

    Seizures/ convulsions/fits/Epilepsy

      

    So we take off from where we left and discuss about the different types of seizures. Broadly there are two types of seizures: generalized and partial.

     

    1) Generalized seizures as the name suggests come from the whole brain, that is the whole brain malfunctions and misfires. As the whole brain is malfunctioning it is but natural that the person shall lose consciousness and is amnestic for the event and for some period of time afterwards. These are the classical big seizures you see in movies with the falling, frailing arms and legs and tongue biting. What many people do not know is that generalized seizures can be more subtle: staring spells seen in children are a type of generalized seizures called Absence Seizures.

     

    2) Partial seizures or focal seizures as the name suggests come from one part of the brain i.e. only a part of the brain has the seizure. As a result consciousness is usually retained albeit it may be impaired. The patient may have his or her eyes open and one part of his body the arm or leg may be shaking but he is not able to respond adequately if you call out to him. Focal seizures are further subdivided depending upon whether the manifestations are primarily motor, sensory, autonomic or psychic.

     

    3) Partial seizure with secondary generalization: the name is self explainatory. The seizure starts off from a focal area in the brain and then spreads and soon the whole brain is involved. Most of the seizures are partial with secondary generalization but patients and even attentive bystanders might not volunteer the history that initial symptoms were focal. It is very important you tell your doctor exactly what happened right at seizure onset: did you smell something strange? did you have a funny taste in your mouth or a strange sensation in your belly? did one part of the body shake first and then the seizure spread to other body parts.  The strange feelings noted at seizure onset are called auras and they help us in localizing where in your brain did the seizure come from. It is very very important that you give a good history about this because the medications used to treat generalized seizures are at times different from the ones effective against partial seizures. I shall come back to the medications at a later date.

     

    Numerous other types of seizures have been described especially in children and there quite a few epileptic syndromes seen in the pediatric age-groups. I shall comment on these briefly as we go along.

    Enough typing for now. Its freezing outside here in New York City and I think I need a cup of coffee to jump start my brain.

     

    Dr. S

     

    Seizures/ Convulsions/ Fits/Epilepsy

    Now that we know a little something about seizures in general, lets turn to managment of seizures and epilepsy. As a work-up of why one had a seizure and to determine its cause, your physician may order a few tests. The mostly commonly ordered tests include something called an electroencephalogram or EEG in short and an imaging test of the brain either a CT scan also called a CAT scan or more commonly a MRI scan (MRI stands for magnetic resonance imaging).

    Let us talk a little about these tests. An EEG is actually very similar to an EKG (electrocardiogram). Basically electrodes are placed on the surface of your head (completely painless procedure) and then one looks at the brain waves for about 30 mins and tries to find out if and where does the brain misfire. An imaging study like a CT scan or MRI scan is done to rule out the presence of anything structural inside the brain that might be the cause of the seizure like a brain tumor or a vascular anomaly. It is important to rule out a structural cause for a seizure as its presence guides the managment.

    You have something inside the brain which does not belong there, you may need a neurosurgical opinion to get it out. Most of the times in people who have epilepsy no structural cause is found on neuroimaging and then the treatment turns to how to manage/control/prevent further seizures. It is thought in these patients the problem is at the cellular level, something which we cannot see on imaging studies. If there is nothing to be seen, there is nothing to be taken out.

    Let me lay down some basic tenents of treatment:

    1. A single provoked seizure may not warrant treatment. What does that mean? Well basically if you had a seizure which was  because of something you did like used a drug of abuse (cocaine etc), alcohol  in excess ( a drinking binge with the buddies may cause what we doctors call “rum fit”), did not sleep for a couple of nights, some antibiotics and anti-depressants have been known to cause a seizure: then you may not need to be treated. Just do not abuse the drug again and you shall be fine. No more seizures no need to be on long term anti-seizure medications.

    2. A single unprovoked seizure may not warrant treatment. Sometimes a person may have a single seizure for which no provoking cause can be found inspite of a thorough search for one. Your EEG and scan is normal.Your doctor may decide just to observe you and not start any drug treatment. Why you may ask we do this? Well the reason is simple. Studies have shown that as many as 70% of single unprovoked seizures may not recur ever. So why treat someone with anti-seizure medications with their risk of side-effects. It is better at times to just watch. If seizures recur your doctor at that time might decide to treat you.

     

    We shall stop now, the sun is out, central park is calling, I am going to head out for a run.

     

    Personal Regards,

    Dr. S

     

    Seizures/fits/convulsions/ epilepsy

     Management/ treatment of seizures: let us now turn to the treatment of seizures. I shall discuss this broadly under two headings:

    1) acute management of seizures: what do you do and what happens in the hospital setting if one has a seizure?

    2) management of seizures over the longer term or rather I should say ongoing treatment of someone who has epilepsy.

     

    Let us start with acute management of seizures. Some of us have seen people around us have a seizure either at home, outside or in the workplace. What do you do? Whom do you call? Is the person who is having a seizure going to die if we do not do something? Crude as it may sound here, the seizure itself never kills a patient it is the circumstances surrounding the seizure which may prove lethal. Let me explain further. Most of the seizures stop by themselves in a few minutes (though it may seem hours to the person witnessing the seizure). More often than not, the seizure has already stopped by the time  EMS (emergency medical services) arrive on the scene. The patient has stopped shaking and is just confused or may have even fallen asleep. So more often than not there is no active intervention needed on the part of the EMS. All they may do is check the patient’s vitals, maybe give him some supplemental oxygen and then transport him to the nearest hospital for further evaluation. There that was simple wasn’t it? However let me paint another scenario. Person is standing by the side of the subway track waiting for the train. Has a seizure and falls onto the tracks. Cracks his skull open, may get run over by the train if not pulled out by someone. There-in lies the problem with seizures and epilepsy and which patients find the most unsettling. The uncertainity, the possibility of having a seizure at the wrong place and at the wrong time. Deaths have occurred when people have had a seizure while driving, swimming or even while taking a bath in the tub.

     

    So if you see someone having a seizure, do not panic and follow some simple guidelines. I shall list them out for you.

    1. Do not try to physically restrain the patient. You try to hold down his arms or legs you may cause more harm than good like a dislocated shoulder.

    2. Just try to ensure that the patient is not hurting himself: like if he is hitting his head on the hard floor while having a seizure you may try to gently hold his head or put a cushion under it.

    3. Remove anything from the surroundings which has the potential for causing injury: things like a hot stove, sharps,

    4. Do not put anything like a spoon or your finger into the patient’s mouth to prevent it from shaking. The patient may bite your finger off or may choke.

    5. If possible gently turn the patient’s head to the side, this causes the tongue to fall away opening the airway and lets the oral secretions (saliva) drip out from the side of the mouth and prevents aspiration.

    6. I have encountered people with certain misconceptions like having the patient smell something pungent (smelling salts, a stinking shoe) aborts the seizure. These things do not work, you are wasting your time and not helping the patient.

    7. Once you have made certain the patient is safe, better to utilize the time to call EMS. Tell them clearly what you saw and did. Give a good history. Usually once the seizure stops the patient is not immediately responsive, you may hear sonorous respirations as if he is in a deep sleep.

    Time for a break!!! This took longer than I thought.

    Dr. S

    So lets pick up from where we left off a couple of days ago. Lets talk about the acute managment of a seizure in the hospital setting. A person is brought to the hospital by the EMS and is still having a convulsion as he is wheeled into the ER. We call this Status Epilepticus ( a potentially life threatening condition when a patient has been having a seizure for greater than 30 mins or has had multiple seizures in near about the same amount of time without regaining consciousness inbetween).

    There are a couple of things which doctors do in this setting. I shall list them out.

    1) Protect the airway, check the vitals, maintain the circulation and oxygenation/breathing (ABC). We make sure that the patient is breathing and oxygenating well ( no obstruction to his airways), sometimes when the patient is not breathing well on his own, the doctors might put a tube down the throat into the trachea and put the patient on a ventilator ( a machine which does the work of breathing for the patient until he/she can breathe on his own). If the blood pressure is low, intravenous fluids may be administered.

    2) A quick search is made for the cause/etiology of seizures. Blood is checked for the blood sugar level, electrolytes ( sodium, calcium, magnesium etc). One of the common causes of seizures especially in people with diabetes is low blood sugar. Either the patient takes too much of his diabetic pills/ insulin or the patient may have missed a meal letting his blood sugar fall to a dangerously low level.

    In such a case intravenous dextrose ( a form of sugar) stops the seizure immediately.

    3) To stop the seizure acutely certain medications may be administered. These commonly belong to the benzodiazepines group of medications with names like Diazepam (valium) or Lorazepam (ativan) followed by a longer acting anti-seizure medication like Dilantin (phenytoin).

    4) Once the seizure stops the work-up begins to find the etiology of the seizure ( remember the MRI and EEG I talked about before).

     

    Depending upon the cause of the seizure, its risk of recurrence, the type of seizure ( partial Vs generalized), the doctor may prescribe an anti-seizure medication ( we call them anti-epileptic drugs or AEDs).  There are many different AEDs in the market. Each drug has its own mechanism of action, the kind of seizures it is most effective in controlling, side-effect profile and recommended dosage for seizure control.

     

    Your doctor shall discuss this with you in detail. Please remember a number of AEDs can potentially interact with other medications which you may be taking for blood pressure etc. So remember to tell your doctor a complete list of your medications. Also some AEDs lower the efficacy of birth control pills, thus women with epilepsy may be advised to use alternate methods of contraception.

    An important point here especially for pregnant women with epilepsy. Some AEDs have been linked to cause major congenital malformations in babies like cleft lip, cleft palate and spinal column deformities (spina bifida). Pregnant women with epilepsy remain a high risk group-they need close supervision by a doctor well versed with the use of AEDs during pregnancy. Some AEDs are best avoided in pregnancy while others have a relatively safer track record when it comes to the incidence of major congenital malformations.

    I hope this small discourse on seizure is informative. I shall tackle brain tumors next.

    Personal Regards,

    Dr. S

      

Questions about epilepsy?

Ask Dr S:

neurologistnyc@yahoo.com

 

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