Leading epilepsy expert, Dr. Tracey Milligan, MD, explains how a precise diagnosis can stop lifelong seizures. She shares a clinical case of an elderly woman misdiagnosed for decades. An EEG test revealed a specific epilepsy type. Changing her anti-epileptic medication eliminated all seizures. Dr. Tracey Milligan, MD, emphasizes the treatment goal is zero seizures and zero side effects. Over 20 medications are now available. Many patients never see a specialist. Expert reassessment is critical for optimal therapy and quality of life.
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Correct Epilepsy Diagnosis and Treatment to Stop Lifelong Seizures
Jump To Section
- Clinical Case of Lifelong Misdiagnosis
- EEG for a Precise Epilepsy Diagnosis
- Correct Medication Leads to Seizure-Free Life
- Goals of Modern Epilepsy Treatment
- Importance of Specialist Reassessment
- Full Transcript
Clinical Case of Lifelong Misdiagnosis
Dr. Tracey Milligan, MD, recounts a powerful clinical case of an elderly patient. The woman was in her early 80s and had experienced epileptic seizures her entire life. Her husband brought a detailed notebook logging every seizure's date and time. Dr. Anton Titov, MD, notes the profound impact of this decades-long struggle. Despite a lifetime of treatment, she was on the wrong anti-epileptic medication. This story highlights a critical failure in her diagnostic journey.
EEG for a Precise Epilepsy Diagnosis
Dr. Tracey Milligan, MD, utilized an electroencephalogram (EEG) to achieve a precise diagnosis. This test measures electrical activity in the brain. It is essential for identifying the specific type of epilepsy a patient has. In this case, the EEG revealed a distinct seizure disorder that had been previously missed. A correct diagnosis is the fundamental first step toward effective treatment and stopping seizures.
Correct Medication Leads to Seizure-Free Life
Changing the anti-epileptic medication was the key to a seizure-free life. Dr. Tracey Milligan, MD, selected a new therapy based on the precise EEG findings. The patient returned for a follow-up appointment with a remarkable outcome. She had experienced no further epileptic seizures after the medication change. Dr. Anton Titov, MD, underscores the dramatic transformation correct treatment can provide for quality of life.
Goals of Modern Epilepsy Treatment
Dr. Tracey Milligan, MD, defines the clear goals for epilepsy treatment. The primary objective is for patients to have no epileptic seizures. The second crucial goal is to have no side effects from medication. Together, this leads to an overall excellent quality of life. With over 20 anti-epileptic drugs now available, achieving these goals is more possible than ever. An expert epileptologist possesses the knowledge to match the right medication to the specific seizure type.
Importance of Specialist Reassessment
Many patients with epilepsy never see a specialist for reassessment. Dr. Tracey Milligan, MD, cites a major UK trial finding that 55% of adults treated for epilepsy lack specialist advice. This leads to diagnostic uncertainty and suboptimal therapy. Dr. Anton Titov, MD, discusses the need for expert evaluation. Any patient continuing to have seizures or side effects should seek an epileptologist's opinion. A specialist reassessment can uncover diagnostic errors and open doors to more effective treatment options.
Full Transcript
Dr. Tracey Milligan, MD: 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.
Dr. Anton Titov, MD: An expert epileptologist would find it. Then patients could become epileptic seizure-free.
Dr. Tracey Milligan, MD: 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 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.
Dr. Tracey Milligan, MD: 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. Anton Titov, MD: Patients must find the correct specialist to assess epilepsy situation.
Dr. Tracey Milligan, MD: 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. Only epilepsy expert can know well which medications are the best.
Expert epileptologist knowns how to use each anti-epileptic seizure medication.
Dr. Anton Titov, MD: A major clinical trial in the UK found that "55% of 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."
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 a really good quality of life.
Sometimes a patient has epilepsy. Another word for epilepsy would be "epileptic seizure disorder”. Patients are continuing to experience epileptic seizures. Or they are having side effects of treatment. Or epilepsy treatment is impairing 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 goals of treatment.
Dr. Anton Titov, MD: The therapy goals are: no epileptic seizures, no side effects, and an overall good quality of life. Imprecise diagnosis of epilepsy and wrong treatment can cause life-long seizures.
Precise type of seizure diagnosis leads to correct epilepsy therapy. Stopping epileptic seizures. Leading epilepsy expert tells an epilepsy patient’s story that is touching and instructive.