Old woman with epileptic seizures all life. Wrong diagnosis and treatment. Clinical case. 3
I will tell you a story about a patient that I saw. Dr. Tracey Milligan, MD. 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? All her life! 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. Dr. Tracey Milligan, MD. 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. 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. Well, that is an amazing story! Dr. Anton Titov, MD. 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. Absolutely! Dr. Tracey Milligan, MD. 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. Tracey Milligan, MD. 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.” Dr. Anton Titov, MD. How to make sure that a patient with epileptic seizures is diagnosed and treated appropriately? Yes. Dr. Tracey Milligan, MD. 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. Dr. Tracey Milligan, MD. 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. Dr. Tracey Milligan, MD. 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.
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