Epilepsy Diagnosis and Treatment: Achieving Seizure Freedom with Expert Care

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• Epilepsy Treatment Goals: No Seizures, No Side Effects
• When to Seek an Epilepsy Specialist Referral
• A Case Study in Epilepsy Misdiagnosis and Correction
• The Expanding Arsenal of Anti-Epileptic Medications
• The Critical Importance of Expert Epileptologist Care
• Full Transcript

Epilepsy Treatment Goals: No Seizures, No Side Effects

Dr. Tracey Milligan, MD, defines the primary goal of epilepsy treatment with clarity. The objective for every patient is to achieve complete freedom from epileptic seizures. This goal must be accomplished without the burden of medication side effects. Dr. Tracey Milligan, MD, states this directly to her patients. She tells them, "Our goal in treatment is no epileptic seizures and no side effects." This dual target is fundamental to restoring a patient's quality of life.

When to Seek an Epilepsy Specialist Referral

Many patients with epilepsy never see a specialist, a finding supported by a major UK clinical trial. Dr. Tracey Milligan, MD, notes that some patients may not even see a general neurologist. She provides clear criteria for when a referral to an epileptologist is absolutely necessary. Patients should seek expert care if they continue to experience seizures on their current regimen. A referral is also critical if side effects from anti-epileptic drugs are problematic. Any treatment that impairs a patient's overall quality of life warrants a specialist evaluation.

A Case Study in Epilepsy Misdiagnosis and Correction

Dr. Tracey Milligan, MD, shares a dramatic story from her practice that underscores the consequences of diagnostic uncertainty. She describes an elderly female patient in her early 80s. This woman had lived with a diagnosis of epilepsy her entire life. Her husband maintained a detailed notebook logging every seizure's date and time. Dr. Milligan's expert assessment, including EEG, revealed a specific type of epilepsy. The patient had been treated with the wrong anti-epileptic medication for decades.

Dr. Anton Titov, MD, expresses amazement at this timeline. Dr. Milligan confirms the patient was in her 80s before receiving a correct diagnosis. After Dr. Milligan changed the epilepsy medication, the patient's seizures stopped completely. She never experienced another epileptic seizure for the rest of her life. This case powerfully illustrates how expert intervention can transform a life burdened by chronic illness.

The Expanding Arsenal of Anti-Epileptic Medications

The treatment landscape for epileptic seizures has evolved dramatically. Dr. Tracey Milligan, MD, highlights the current availability of over 20 different anti-epileptic medications. This is a significant increase from decades past when only a few options existed. Dr. Anton Titov, MD, notes that these medications have different efficacy and side effect profiles. They are also designed to target specific types of epileptic seizures. This variety makes choosing the correct medication a complex decision that requires specialized knowledge.

The Critical Importance of Expert Epileptologist Care

The complexity of modern epilepsy treatment necessitates a high level of expertise. Dr. Tracey Milligan, MD, stresses that selecting from over 20 medications requires significant experience. An expert epileptologist possesses the deep knowledge needed to match the right drug to the right patient. They understand how to use each anti-epileptic seizure medication effectively. Dr. Anton Titov, MD, concurs that finding the cause of seizures and the correct specialist is paramount. Pursuing the best possible explanation for epilepsy is always a worthwhile endeavor for achieving seizure freedom.

Full Transcript

Dr. Anton Titov, MD: Epilepsy is a complex and very serious disease. But epileptic seizures could be just a symptom of other serious medical problems.

A major clinical trial in the UK found that "55% of the population of adults receiving treatment for epilepsy have never received specialist advice." Reassessment of epilepsy patients uncovers diagnostic uncertainty and failure to diagnose correctly. It leads to suboptimal therapy. There is a lack of information and advice about all aspects of epilepsy treatment.

Dr. Anton Titov, MD: How to make sure that a patient with epileptic seizures is diagnosed and treated appropriately?

Dr. Tracey Milligan, MD: Yes. Many patients with epilepsy do not see a specialist like myself. I am an epileptologist. Patients may not even see a neurologist.

But every patient with epilepsy should have a goal in their treatment. Epilepsy treatment goal is this: patients should have no epileptic seizures and no side effects of therapy. That is what I tell all of my patients: "Our goal in treatment is no epileptic seizures and no side effects." Patients should have an overall really good quality of life.

Sometimes a patient has epilepsy—another word for epilepsy would be "epileptic seizure disorder"—and they are continuing to experience epileptic seizures. Or they are having side effects of treatment. Or epilepsy treatment is impairing the patient’s quality of life. Then they should absolutely try to see an epilepsy specialist.

An expert might be able to help patients with epilepsy get to the goals of treatment. The therapy goals are: no epileptic seizures, no side effects, and an overall good quality of life.

I will tell you a story about a patient that I saw. She actually happens to be the patient who made this jewelry box for me. She was an elderly woman in her early 80s. She came to see me with her husband. She had had epilepsy her entire life.

He brought a notebook detailing all of her epileptic seizures, the dates, and the times when epileptic seizures happened. It turned out that she was being treated with the wrong anti-epileptic seizure medication.

Dr. Anton Titov, MD: All her life?

Dr. Tracey Milligan, MD: All her life!

Dr. Anton Titov, MD: She was in her early 80s by the time she really saw you, an epilepsy specialist?

Dr. Tracey Milligan, MD: Correct. She came to see me. Through the use of EEG, I was able to diagnose her with a specific type of epilepsy. I changed her epilepsy medication.

When she came back to see me, she had no epileptic seizures. She never had another epileptic seizure in her life. I wish correct treatment could be found for everyone with epilepsy. That is not true, unfortunately.

But often there was a correct epilepsy medication that patients didn't know about. An expert epileptologist would find it. Then patients could become epileptic seizure-free. I shared that story because it was so dramatic. It is so memorable to me.

This change in epilepsy medication could make such a profound change in a patient's life. She had been living with epilepsy for decades.

Dr. Anton Titov, MD: Well, that is an amazing story! But it also underscores that there are so many different anti-epileptic medications for different types of epileptic seizures. Medications have different profiles of side effects and efficacy.

Many medications against epilepsy are now available to patients. It is really worthwhile to pursue the best possible explanation for the epilepsy. Patients must find the cause of epileptic seizures.

Dr. Tracey Milligan, MD: Patients must find the correct specialist to assess the epilepsy situation.

Absolutely! We are so fortunate now. There are over 20 different anti-epileptic medications to treat epilepsy. Decades ago there were very few medications.

But with all of those anti-epileptic medications available, it does require a certain level of experience and knowledge. An expert must select epilepsy anti-epileptic medications.

Dr. Anton Titov, MD: Only an epilepsy expert can know well which medications are the best. An expert epileptologist knows how to use each anti-epileptic seizure medication.