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Care for epileptic seizures

12/13/2018

​By Mark Oswell

WRNMMC PA Specialist


​Recently, a young Naval rescue swimmer was referred to Walter Reed National Military Medical Center following several strange episodes of being confused, disoriented, and even missing from duty, according to Army Maj. (Dr.) Abraham “Abe” Sabersky, director of Epilepsy and Functional Neurosurgery at Walter Reed National Military Medical Center’s Department of Neurosurgery.

Through a previous brain scan and EEG (electroencephalogram), it was discovered that the patient had small lesion on the left side of his brain, near the portion that controls speech. This lesion was causing him to have these disorienting epileptic seizures.


Seizure First Aid

There are many types of seizures.

These are general steps to help someone who is having any type seizure:

·   Stay with the person until the seizure ends and he or she is fully awake. After it ends, help the person sit in a safe place. Once they are alert and able to communicate, tell them what happened in very simple terms.

·   Comfort the person and speak calmly.

·   Check to see if the person is wearing a medical bracelet or other emergency information.

·   Keep yourself and other people calm.

·   Offer to call a taxi or another person to make sure the person gets home safely.

 

What Not to Do

Never do any of the following things:

·   Do not hold the person down or try to stop his or her movements.

·   Do not put anything in the person’s mouth. This can injure teeth or the jaw. A person having a seizure cannot swallow his or her tongue.

·   Do not try to give mouth-to-mouth breaths (like CPR). People usually start breathing again on their own after a seizure.

·   Do not offer the person water or food until he or she is fully alert.

 *According to the CDC​ 


After more tests and in-depth consults, WRNMMC neurosurgeons decided to perform an awake-craniotomy to remove the lesion and also the pencil-eraser sized portion of his brain tissue that had been impacted. Fast forward a couple of months, and that Sailor is no longer having seizures and is back to work at his duty station.

Epilepsy refers to a large group of neurological disorders characterized by chronic, spontaneous seizures, according to the National Institutes of Health’s National Institute of Neurological Disorders and Stroke (NINDS).

According NINDS, epilepsy disorders affect approximately three million Americans of all ages and ethnic groups. With the incidence of epilepsy being highest in early childhood, and growing fastest in the elderly population.

“Patients are initially evaluated and treated by a neurologist,” explained Sabersky. “If their case is complex or not responding to normal treatments, the patient is then referred to Navy Cmdr. (Dr.) Joseph Brown, fellowship trained epileptologist. “Brown will fully assess the patient and, if appropriate, will refer to our multi-disciplinary team for possible neurosurgery,” continued Sabersky.

Although he specializes in epilepsy, Sabersky sees a myriad of patients, “I frequently see patients for spinal degeneration and other pathologies as well as chronic pain, tumors and epilepsy that is not controlled with medications.”

The brain is essentially the master control center of the body,” explained Navy Cmdr. (Dr.) Randy Bell, service chief for neurosurgery at WRNMMC. “Its functions are numerous, and include the coordination and comprehension of all sensory input from the world around us, the initiation of movement and speech, the creation and delayed access of memories, and the coordination and maintenance of all bodily functions.

“Given the complex nature of the brain, dysfunction in any area can have devastating consequences, added Bell. “For instance, seizure activity in the occipital lobe could result in significant changes in vision that, depending on the reason for the seizure, could become permanent. Without a healthy functioning brain, interacting with the world around us in a meaningful way becomes difficult, and sometimes impossible.”

Although the WRNMMC neurology department averages 15 to 20 neurosurgeries a week, neurosurgery 

remains one of the most complex of all surgeries and involves multi-disciplines across the medical spectrum. “We work closely with the Departments of Neurology, Chronic Pain, Internal Medicine, Neuropathology, the Emergency Department and our 3-D Medical Application Center,” added Sabersky.

“I think that the common response to being referred to a neurosurgeon is fear,” explained the major. “I have found that many patients that come to my clinic are quite nervous. Though all surgeries have risks, neurosurgery is performed under the strictest and most regimented of systems to ensure patient safety.”

Research

Understanding the most complex organ in our body requires constant research.

“There have been many recent developments with drug treatments as well as implantable devices for the treatment of epilepsy,” according to Sabersky. “We are currently developing new protocols and acquiring new equipment to better treat our patient’s with epilepsy and movement disorders,” he added.

Through multi-institutional studies, like the Epilepsy Phenome/Genome Project, researchers will be able to identify more genes linked to epilepsy to uncover the genetic basis for some of the most common epilepsies, according to NINDS.  

In the future, Sabersky sees neurosurgery becoming “more minimally invasive and tailored to each patient’s disease process and well-being.”    

WRNMMC is also in the process of establishing a program with the Defense Advanced Research Projects Agency (DARPA) to look at brain/computer interface technology. The goal is to monitor and modulate not only seizures, but also behavior; and to treat those with PTSD, depression, anxiety and other mental health ailments. 

“These are like pacemakers for the brain,” explained Sabersky.

Sabersky also stated that WRNMMC’s National Intrepid Center of Excellence is performing epilepsy research to follow the long-term outcomes of people with post-traumatic epilepsy.