Epilepsy - Yale Medicine Explains

Transcript

• 00:04A neuron has information
• 00:06and it goes through the
• 00:07axons, which you can think
• 00:08about as electrical wires to
• 00:11another neuron.
• 00:12Electrical impulses, they travel down
• 00:15the axon and trigger the
• 00:17release of some chemical
• 00:19neurotransmitters.
• 00:21And these neurotransmitters
• 00:22can cause either excitation or
• 00:25inhibition of the brain function.
• 00:27And it allows our brain
• 00:29cells, also called neurons, to
• 00:31communicate.
• 00:32You have over a billion
• 00:34neurons in the brain, and
• 00:35so it's pretty magical.
• 00:38So seizures are caused by
• 00:40sudden abnormal burst of electrical
• 00:42activity in the brain. And
• 00:43a seizure can look like
• 00:44almost anything. If it is
• 00:46affecting the motor areas in
• 00:48the brain, patients may notice
• 00:49some jerking movements of the
• 00:51certain part of the extremity.
• 00:53More and more brain when
• 00:54it gets involved, it causes
• 00:56loss of impairment.
• 00:59The seizure can be provoked
• 01:00or it can be unprovoked.
• 01:02Provoked seizures can occur in
• 01:04response to a specific trigger
• 01:06or a temporary condition. It
• 01:08could be high fever, low
• 01:09blood sugar, versus unprovoked seizures,
• 01:12they occur without an immediate
• 01:13trigger.
• 01:14So if you've had two
• 01:16seizures that are unprovoked, you
• 01:17have epilepsy. Or if you
• 01:19have one seizure
• 01:20and you have a structural
• 01:22problem in your brain that
• 01:23can cause another seizure, that
• 01:24is how epilepsy is defined.
• 01:30So diagnosis is so important
• 01:32because there are many different
• 01:33ways to treat seizures.
• 01:35And so understanding where they
• 01:36come from, the parts of
• 01:38the brain they affect, and
• 01:39the functions they affect
• 01:41has a direct correlation with
• 01:43what can be done.
• 01:45A brain MRI is one
• 01:46of the most useful tools
• 01:48that we have in evaluating
• 01:49a patient with epilepsy
• 01:51because it helps identify structural
• 01:53abnormalities
• 01:54in the brain. Like a
• 01:56stroke or if there is
• 01:57a brain tumor benign or
• 01:58malignant.
• 01:59So EEG is an electroencephalogram.
• 02:02It is basically measuring the
• 02:03electrical signals of the brain.
• 02:05You put some
• 02:07electrodes on the surface of
• 02:09the head
• 02:10to know where seizures are
• 02:11coming from.
• 02:13EEG is a fantastic technique,
• 02:15but it also has some
• 02:16of its limitations.
• 02:18Because when things come from
• 02:19very deep in the brain,
• 02:21it's difficult for EEG to
• 02:23accurately tell you where in
• 02:25that deep part of the
• 02:27brain
• 02:27decisions are coming from.
• 02:29So magnetoencephalography
• 02:32is another way of looking
• 02:33deep in the brain. Rather
• 02:35than electrical signals,
• 02:48referral to
• 02:51early referral to a comprehensive
• 02:53epilepsy center is the key
• 02:54to success.
• 02:57For epilepsy, the first line
• 02:58of treatment is anti seizure
• 03:01medications.
• 03:02Seventy percent of the patients
• 03:03respond very well to medications
• 03:06usually,
• 03:06and they will not have
• 03:08another seizures if they are
• 03:09taking their medicines on time.
• 03:11Now, if you've tried two
• 03:12medications
• 03:14for epilepsy and you still
• 03:16have unprovoked seizures,
• 03:18that is the definition of
• 03:20medication refractory epilepsy.
• 03:23We've learned that you can
• 03:25use surgery actually
• 03:27to treat
• 03:28these
• 03:29medication refractory seizures.
• 03:32We do have very minimally
• 03:34invasive
• 03:35technologies
• 03:36such as laser
• 03:37where through a two millimeter
• 03:40hole, we can actually
• 03:42remove
• 03:43tissue that causes seizures in
• 03:44the
• 03:45brain.
• 03:47And sometimes,
• 03:48seizures come from places
• 03:50that are extremely important
• 03:52in the brain such as
• 03:53language function.
• 03:54And so now, we have
• 03:56closed loop neuromodulation
• 03:58devices
• 03:59that will detect seizures and
• 04:00stimulate
• 04:01to short circuit them and
• 04:03so people can continue with
• 04:04their lives and and not
• 04:06lose function.
• 04:07And now, we're actually having
• 04:09newer things
• 04:10such as focused ultrasounds for
• 04:12the treatment of epilepsy.
• 04:15And it's lifeless surgery. You
• 04:17can use ultrasound
• 04:19waves to ablate regions of
• 04:22brain that could be causing
• 04:23seizures.
• 04:28So we have a really
• 04:29big research program at Yale.
• 04:31The epilepsy,
• 04:33teams are looking at, like,
• 04:34what impairs the consciousness during
• 04:36seizures. So if we can
• 04:37have a better understanding of
• 04:39consciousness, where it comes from,
• 04:41we can try to see
• 04:42how we can make our
• 04:43patients safer.
• 04:45In terms of epilepsy surgery,
• 04:47when we try to figure
• 04:48out what are the different
• 04:50zones doing, then we understand
• 04:52the epilepsy networks much better.
• 04:55At Yale, we have pioneered
• 04:58surgical
• 04:59interventions for epilepsy. We are
• 05:01involved in multiple clinical trials.
• 05:03Yale is definitely a forefront,
• 05:05a leader in the treatment
• 05:06of epilepsy.