[00:00:00] Speaker A: From Riverside Health System, this is the Healthy youy Podcast where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you.
All right, welcome to the Healthy youy Podcast where we explore everyday health topics and meet the people who keep our communities well. I'm your host, Frankie Myers, and today we're talking about a condition that impacts many Americans. Epilepsy. Joining me is Dr. Elise Ashin.
[00:00:41] Speaker B: Thank you for inviting me. Yes, yes.
[00:00:45] Speaker A: A board certified neurologist with a special interest in sleep medicine and epilepsy. Dr. Ashin, welcome to the show.
[00:00:53] Speaker B: Thank you, thank you.
[00:00:55] Speaker A: Always glad to have you.
Before we dive into our topic, I'd love for our listeners to get to know you just a little bit better.
What first drew you to neurology and what fused your passion for helping patients live full lives with managing epilepsy?
[00:01:13] Speaker B: Well, my interest in epilepsy neurology first of all started at a young age just going through school and just learning about neuroanatomy and actually that was the motivation to go into medical school.
[00:01:26] Speaker A: Yes.
[00:01:26] Speaker B: Then as the training progressed, you get exposure to different patient population. And I was just drawn to the epilepsy patient population, just seeing the treatments available and how they respond to treatment and just how lives are changed with management of epilepsy. So I just wanted to be part of that process. Yes, yes, yes. She's just interesting physiology, patient encounters and then she's seeing our lives transform. Yes.
[00:01:53] Speaker A: Well, thank you for what you do. Thank you and your commitment and passion in this space.
So, Dr. Ashin, I'd like to walk you through some common misconceptions about epilepsy and have you help us separate myth from reality. I know I've heard some myths about epilepsy growing up myself. So I'm interested in hearing your response. First, some people believe that epilepsy is rare and only affects children. Is this a myth or reality?
[00:02:22] Speaker B: So that's a myth.
Epilepsy is quite common.
Fourth leading cause of fourth most common neurological condition in the world. In the United states, there are 3.4 million people living with the condition.
That's about 3 million adults, 470,000 children.
And there's data showing 1 in 26Americans will develop epilepsy in their lifetime. Okay, so it's not as rare, it's not as it's quite common. It's not a rare condition.
[00:02:53] Speaker A: Yes, but we don't talk about it enough.
[00:02:55] Speaker B: I know.
[00:02:56] Speaker A: Yes, that may be due to some of the stereo typical views about it that people are concerned with, maybe as to why they don't discuss or disclose.
[00:03:05] Speaker B: Yeah, stigma can be quite concerned.
[00:03:08] Speaker A: That's the exact word I'm looking for. Here's another common belief. People with epilepsy can swallow their tongue during a seizure. And I know growing up we were told to have like, you know, tongue blade is the medical. But get a spoon or a fork or something. So would you talk a little bit about those myths in particular?
[00:03:27] Speaker B: Yeah. So that is a myth. It's impossible to swallow the tongue. I know that's a common practice in different cultures where the first respond is to put something in the mouth. But that's the number one rule is never, never, never put anything in somebody's mouth. The biggest concern is safety. So making sure the person is on their side and that opens up the airway and that, you know, the tongue will stay away from the. They're not going to swallow the tongue.
[00:03:53] Speaker A: Yes. And that keeps them from choking or aspiring.
[00:03:55] Speaker B: Correct. Yeah. Right. So safety, safety first. Never put anything in their mouth.
[00:03:59] Speaker A: Absolutely.
So these misunderstandings really do impact how people respond to in the moment. How do you see myths like these affecting your patients and what role does education play in changing that?
[00:04:14] Speaker B: Well, these myths can be dangerous. Right. Where you may end up causing more harm than helping creating unsafe practices.
It's important to have education to only empower people to promote safety and also just learn more about the condition and know how to respond appropriately when this scenario occurs.
[00:04:39] Speaker A: Okay, very good, Great information.
Many people think of epilepsy only as convulsions. Can you explain what epilepsy really is?
[00:04:51] Speaker B: Sure. So I'll start off by just talking about what is a seizure. Right. So a seizure is in terms of epileptic seizure, it's a electrical phenomena. Right. It's a surge of electricity that takes control of the body depending and it comes on and manifests depending on the part of the brain involved in that network.
So not everybody falls to the ground and convulses.
So some people may have just abnormal sensation on one side of their face of the body.
Some people can have changes in visual hallucinations, certain changes in the vision, and then some people just blankly stare.
Some people, depending on the part of the electricity coming from that's, you know, like with temporal or epilepsy, they can have nausea, vomiting, just feel like an impending Doom. Or even feel like they're having a panic attack.
[00:05:48] Speaker A: Right.
[00:05:49] Speaker B: So it just depends on where it's coming from.
[00:05:51] Speaker A: Okay.
[00:05:51] Speaker B: And when these seizures come on and it's unprovoked, where it's just the person is not acutely ill or have anything going on with their metabolic derangement, like low blood sugar or anything going on with their kidney at the moment, we call that unprovoked seizure. And so epilepsy is a chronic neurological condition where somebody has recurrent unprovoked seizures.
[00:06:16] Speaker A: Okay.
[00:06:17] Speaker B: So you could be two or more unprovoked seizures in the lifetime.
[00:06:20] Speaker A: Okay.
[00:06:20] Speaker B: Or coming in with one unprovoked seizure with certain high risks.
[00:06:26] Speaker A: To be classified.
[00:06:27] Speaker B: Yeah. To be concerned about epilepsy, where you had one unprovoked seizure and then testing shows that abnormal eeg, abnormal mri, maybe the seizure came up out of sleep. So that's concerning. Like, hey, this person has a risk for having more seizures in the future, and treatment will be important.
[00:06:44] Speaker A: Do they know it's coming on? I've heard the term aura.
[00:06:47] Speaker B: Yeah.
[00:06:48] Speaker A: So can you talk a little bit about that?
[00:06:50] Speaker B: Yeah. So an aura, going back to what a seizure is, an electrical phenomena.
Some people, when that electricity starts to involve in that electrical network, that beginning of a seizure, it comes on like a warning, where people call it an aura.
Some people can feel their seizures coming on. Some people with temporal epilepsy, that sense of impending doom, anxious nausea, something we are just rising up the stomach.
But sometimes some people don't know.
[00:07:24] Speaker A: They don't know.
[00:07:24] Speaker B: It just comes out of nowhere. Okay. Yeah. Okay. Yeah. Good.
[00:07:28] Speaker A: Great information.
We mentioned earlier that about 3.4 million people in the United States live with epilepsy. 3 million adults and 470,000 children. Why do you see more adults than children living with epilepsy? And what does this difference tell us?
[00:07:47] Speaker B: So epilepsy can affect people at any age. And there's a variety of causes which we're going to go into a little bit later.
In the younger population, some of their seizures, as they get older, they can outgrow it.
That's considered two or more years where they no longer have seizures, they no longer need medication as an adult, they don't have the seizures anymore.
That tends to give a lower number in the children group. Then as people get older, older, and, you know, with the aging population is increasing, so that increase the prevalence in adults. And then in adults, they may start having may get seizures due to injury to the brain from other things like stroke or tumor or degenerative conditions.
[00:08:36] Speaker A: Okay. Okay, what are some of the most common causes or risk factors?
[00:08:43] Speaker B: Yeah, so that's kind of diving into what we're talking about earlier.
So again, it depends. There's a lot of variety of causes depending on the different age groups.
So it could be like a genetic condition.
[00:08:56] Speaker A: I was going to ask what is it hereditary?
[00:08:59] Speaker B: So there's certain genetic epilepsies which are passed along or this just comes from a change in the genetic makeup as a person is developing.
There's also, you know, how the brain develops. Sometimes there's what we call like cortical malformations or just certain parts of the brain do not go where they're supposed to be.
There's certain developmental disorders and then secondary causes, more so like in the adults, older age group, you know, things that the brain was okay, but then something injured it. You know, whether it's a stroke or a tumor or, you know, older population, neurodegenerative conditions like Alzheimer's, Head trauma. Head trauma, infection is key. And then, you know, people now paying attention to autoimmune, you know, whether. Yeah. Whether somebody has some kind of malignancy and then the body mounts an immune response called like a paraneoplastic process.
[00:09:58] Speaker A: Okay.
[00:09:59] Speaker B: So just variety of causes, but in most cases we don't know. Okay, so we call that idiopathic.
[00:10:08] Speaker A: All right. Yeah, Good, good stuff.
Epilepsy isn't just about seizures. Right.
Themselves. It also shapes the daily life of an individual from routines, safety to work, school and relationships. Can you just expand on and share what that looks like for patients and families?
[00:10:30] Speaker B: Yeah, it can vary. Right. So depending on the seizure control. So there are certain patients and their families, they're on a good team where they're on a medication or whatever modality they have that really controls their seizures and they get to live their day to day life, whether it's going to work, going to school, just living a full independent life. And then there's that situation where the seizures is not controlled. It's a new diagnosis. It's like, like, so there's a lot to take in. Right.
So for the patient, it can feel isolating.
It may feel alone. And then for the families they may feel overwhelmed or kind of helpless.
And in that situation they might try to do a lot. And then the patient feel overprotective.
And then in a situation where the seizures are happening so often or it's a newly diagnosed. We think about what are the work situation is their profession involving things that they cannot do. If they have uncontrolled seizures, like are they climbing ladders? Are they using heavy machinery? Are they working in a body of water?
I know driving comes in and then driving. Right. That's another. Another issue. Where does the job involve driving? Getting from point A to point B. So that can be a limit. And different states have different laws on when you're allowed to drive. Right.
Virginia, it could be anywhere from three to six months from the date of the last seizure.
And then with the effect of seizure itself and the medication side effects, those going to school, you think about school for performance when it comes to focus attention, memory falling behind.
So it can be quite challenging.
[00:12:16] Speaker A: And having a good rapport with the school nurse.
[00:12:19] Speaker B: Yeah, yeah.
[00:12:20] Speaker A: Knowing when those things come up. Absolutely.
When we look at the data, we often see the term active epilepsy. And how is that defined and why is it an important distinction?
[00:12:33] Speaker B: Sure.
So the active epilepsy is.
So somebody having an active epilepsy, somebody who has a diagnosis of their condition and they're on seizure medication to control it, or they've had a seizure in the past one year since. Important to know this. And it highlights those who need ongoing treatment, support and overall care and how we can kind of allocate resources to those individuals who really neither support.
[00:13:08] Speaker A: Yeah, Great, great, great information for someone who may be experiencing seizure. Seizures, That's a big word. Now, tongue tied there. Or has concerns about epilepsy. What type of provider should they start with and when is it time to see a specialist like yourself?
[00:13:27] Speaker B: Sure.
So most people start off with their primary care provider. I mean, somebody who just learn about seizure and comfortable about starting medication in a situation where there's concern about the diagnosis, the type of seizure, medication options. That's when I. Referral to the neurologist comes in play. At least that's what we get the referral to evaluate and assess and just confirm. Yes, we think this is a seizure or no, we don't. And if we do, what are the treatment options?
And then that's when.
If the treatment's gone beyond medication, where they continue to have seizures despite trying multiple medications, then we can refer to a comprehensive epilepsy incenter to offer additional options is appropriate at the time.
Early referral is really important.
[00:14:22] Speaker A: Yes, very good.
Once a diagnosis is made, what treatment options are available today and how do you help people find the right one?
[00:14:31] Speaker B: Sure.
[00:14:32] Speaker A: You alluded to that earlier when you talk about controlling. Getting the seizures controlled.
[00:14:38] Speaker B: Right.
[00:14:39] Speaker A: So you can get them back to normal everyday life.
[00:14:42] Speaker B: Yeah. Back to their baseline. Yes. Yeah. So, yeah. So treatments usually think of medications as first line.
And it's just a matter of working together and seeing what other medical conditions they have, side effect profile of the medication and then just seeing what is the lowest dose that can be most effective at the moment.
Then if one medication does not work and you can optimize that and then you add on a second medication or just trying different ones depending on what the seizure type is.
Again, paying attention to side effects and then other medications, medical conditions the person has.
And then if the person doesn't respond to two or more medications, then we get concerned about what other options are available. Right.
[00:15:35] Speaker A: Is there a protocol once they're on so many medications that you try different treatment methodology or there's no restrictions around that?
[00:15:42] Speaker B: Not really. Again, it's just working together and just seeing what works for the person versus what works for another. Because what works for you?
You know, there's a. It may not work for another person because I may give you one medication that works well, then another person, well, they have like maybe depression, anxiety. And if you give them that medicine, they may end up in a psychiatric hospital. It's like you just don't know.
[00:16:06] Speaker A: Yes.
[00:16:07] Speaker B: Yeah.
[00:16:07] Speaker A: Yeah, that makes sense.
[00:16:08] Speaker B: Yeah.
[00:16:10] Speaker A: What everyday steps can help people manage seizures.
[00:16:14] Speaker B: So it's really important to, you know, lifestyle is important and just taking medications as prescribed is really key because missing medication is one of the most common reason people have recurrent seizure.
And then sleep, sleep is important.
So having good sleep, hygiene, not taking naps throughout the daytime, avoiding screen time at night, making sure the sleep wake schedule is routine, and getting enough hours of sleep to make you feel refreshed and functioning in the daytime. Because sleep deprivation is a quite a common trigger for people to have seizures.
[00:16:53] Speaker A: Really?
[00:16:53] Speaker B: Okay. Yeah. And then stress is also another big one. So stress management is important.
So if you don't have any, you know, using coping mechanisms to deal with that and if it's okay to get help, so getting counseling and what can help manage that and then avoiding substances that can increase risk for having seizures like alcohol, then some people have specific triggers and they know and it's just key to avoid certain situations that can trigger seizure.
[00:17:24] Speaker A: All right, so we've talked about diagnosis and treatment. Now let's talk about. The community needs to know how to respond.
Just because someone experiences a seizure, it doesn't always mean that they have epilepsy.
But knowing how to respond in the moment is still critical.
If I'm with someone having a seizure, what should I do and what should I avoid doing?
[00:17:51] Speaker B: Sure.
It's a scary thing to Watch.
Somebody's having a seizure. The first thing to do is just stay calm, stay with the person and then pay attention to how long the seizure is happening. If it's getting to that three, four, five minute mark, that's when I just call 911.
That's five minute seizure. That's long and that's a medical emergency.
Then number two, stay safe, Keep the person safe. If there's any objects around, move the objects away from the person and then keep them on their side again, like we talked about before, you know, don't put anything in the mouth. Make sure the airway is open. If they're on the ground and on the side putting something soft on their head.
So just the three things to remember. Stay side. Safety.
[00:18:40] Speaker A: Safety. And don't restrain them.
[00:18:41] Speaker B: Do not restrain. Yeah, yeah.
[00:18:43] Speaker A: Clear. Clear the. Clear the environment so they can stay.
[00:18:46] Speaker B: Make sure they're safe. That's great information.
[00:18:48] Speaker A: Great information.
What is important for the public to understand regarding these steps?
Does that make sense? Yes. Does that make sense?
Why is it important for the public to understand these steps?
[00:19:04] Speaker B: It's really important to know.
Just keeps the person safe. Right. So safety is important thing and just knowing how to respond appropriately.
[00:19:16] Speaker A: Absolutely.
[00:19:17] Speaker B: And just, you know, saving lives, essentially. Right. Because these are things that can essentially, you know, instead of just standing there waiting for somebody, 10, 20 minutes into it, knowing like, hey, within five minutes I should call 91 1. This can help.
But the overall goal is safety for the patient.
[00:19:36] Speaker A: Yes, yes. That's great information. And because it's not something that we talk a whole lot about, this is going to be very helpful in educating.
[00:19:46] Speaker B: Education empowers people to act appropriately and know what to do.
[00:19:51] Speaker A: And clarifying some of the myths will help keep them safe as well. So thank you for that information.
Lastly, the Epilepsy foundation encourages people with epilepsy to create a seizure action plan. I love action plans. Can you explain what this is and why it matters?
[00:20:10] Speaker B: So these are steps that people around you can take whenever a seizure happens. And it empowers people to feel ready to act whenever a seizure occurs. This is specific instructions from first aid. Like we talked about this. Stay, stay with the person.
Safety and making sure they're on their side and when to call 911 vs. When to call their doctor.
So these are really good instructions to let people know, like, hey, you can act on this and help the person stay safe.
[00:20:44] Speaker A: Right, right. I just hear some reoccurring themes as we progress through that are so important. So thank you. Epilepsy can Feel overwhelming. What messages do you want people living with epilepsy to know and their loved ones to take away from today's interview?
[00:21:04] Speaker B: Yeah, I mean, it's definitely overwhelming to hear everything, but the biggest message is just people with epilepsy can live a full, active life with the right support and care.
So that's the most important thing. You know, it is treatable. There are people there for you from different support groups. Your physicians and people do fully live their lives like they want to.
[00:21:30] Speaker A: Well, thank you for what you do and taking time out of your busy schedule to come talk with us today.
So, looking ahead, what advances in epilepsy research or treatment give you the most hope for patients and families in the coming years?
[00:21:47] Speaker B: Well, there's exciting new advancements in treatment. You know, I know we talked about earlier about, about what are the treatment options and how we help people navigate the process. And I talked a lot about medication and side effects. But beyond medication and when the Comprehensive Epilepsy center is involved, the reason for referral to those areas is just considering different treatment modalities that are available.
Especially in the area of neuromodulation, there's different treatment option in that arena. It's not just vagus nerve stimulation. There's response neurostimulation, there's deep brain stimulation.
And beyond the neuromodulation, there's also other surgical options where they can do like laser ablation beyond just the resection. Kind of like people with temporal lobe epilepsy, if they meet the criteria, they can get that part of the temporal lobe taken out to get seizure freedom. But there's just exciting new options, especially for those who do not respond to medication because the medicine just treat the symptoms and try to prevent the seizures from happening.
But there's new areas looking at how we can modulate this network.
And the era of neuromodulation is exciting. And also talking about genetics. Right. We talked about some of these epilepsies are genetic causes. So there's like targeted gene therapies be looked into.
And then in the area of immune epilepsy, there's certain autoimmune epilepsies. So looking at the autoimmune process and potential immune therapies for those type of epilepsy, overall, there's hope for new options and giving hope for better seizure control and a better quality of life, which is the ultimate goal.
[00:23:46] Speaker A: Yes, yes. Well, thank you so much for taking time out of your busy schedule today and shedding light on epilepsy. From myths and treatments to the lived experience and to our audience. If today's episode gave you insight, share it with a friend and visit the epilepsy
[email protected] for resources and support. Until next time, stay healthy.
Thank you for listening to this episode of Healthy youy. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.
