June 25, 2025 • 38 mins
Speaking of Women's Health Podcast Host Holly L. Thacker, MD focuses on the complexities of seizures and epilepsy in this episode. Dr. Thacker explores the types of seizures, causes, and treatment options with particular attention to women's health and hormonal influences.
• Explanation of seizures and epilepsy
• Overview of different seizure types
• Discussion on causes of seizures
• Impact of hormonal changes on seizure activity
• Importance of accurate diagnosis and treatment
• Emphasis on follow-up care and management
• Resources for further information on epilepsy
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Holly L. Thacker, MD (00:05):
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the director of Speaking of
Women's Health, and I am back inthe Sunflower House for a new
episode all about seizures.
A new episode all aboutseizures.
(00:36):
Seizures is a surge of abnormalelectrical activity in the
brain.
It's also sometimes referred toas epilepsy, especially if it's
a chronic condition.
Um, some people can just haveone seizure in their life
because of fever or infection ortrauma or some metabolic
derangement, but if it's achronic condition, it's
generally referred to asepilepsy, and the most
(01:00):
recognizable symptoms of aseizure are temporary loss of
consciousness and uncontrollablemovements of the body, which is
termed convulsions.
This can really be verydramatic and scary, but not all
seizures look the same.
Some people just stop whatthey're doing and just stare off
(01:24):
into space for a few seconds.
Others may have muscular jerksor lose control of the body.
Some people, like I said, onlyhave one seizure in their life,
or others can have multipleseizures in a day.
So the experience with seizurescan be very different from
(01:46):
others, and there's someimportant women's health aspects
about seizures and seizuredisorder, which is why we
thought it would be veryimportant to cover this.
There's a number of differentcauses of seizures, because
there's many things that caninterfere with the brain's
(02:06):
electrical patterns.
This can range to rapid changesin blood sugar, illness,
infection, injury or otherneurologic conditions.
Now there's two major types ofseizures.
Generalized seizures areelectrical activity that starts
(02:30):
in both sides of the brain andthe body may shake.
There might be some staring.
It usually affects children oryoung adults, but it can occur
at any age.
Now focal seizures focal onsetseizures are electrical activity
(02:51):
that begins on one side of thebrain and usually just affects
one side of the body, and it mayor may not affect someone's
awareness and there can bephysical emotional effects.
There can be hallucinations,which is seeing things that
aren't there, or hearing thingsthat aren't there.
(03:13):
About 60% of people withepilepsy have focal seizures,
which also sometimes is called apartial seizure, and sometimes
the symptoms of a focal seizurecan be mistaken for signs of
mental illness or otherneurologic problems.
(03:36):
Now the types of generalizedseizure disorders include
absence seizures, which meansthe person just stops what
they're doing and stares.
Atonic seizures, or dropseizures are when there's
(04:00):
complete loss of muscle controland someone just drops right to
the ground.
Clonic seizures are shaking ofthe body and this involves
sometimes just shaking on oneside.
Now, myoclonic seizuresinvolves a quick jerk or twitch
that can just affect certainmuscle groups and then there is
(04:24):
secondary generalized seizures.
And if you have focal seizures,which is electrical activity
that starts in one part of thebrain followed by effects on the
entire brain Tonic-clonicseizures the muscles can really
stiffen, you can loseconsciousness and then have
convulsions and tonic seizuresyou may pass out and your
(04:48):
muscles might tighten up, butyou don't have full convulsions.
Now the types of focal seizuredisorders include focal onset
aware seizures or simple partialseizures.
You're aware of it when ithappens and you're actually able
to remember it.
Focal onset impaired awarenessseizures or complex partial
(05:12):
seizures you really loseawareness and experience
confusion when the seizurehappens and you cannot remember
what happened.
So seizures can happen for manydifferent reasons and they're
not limited to the followingAneurysms, brain tumors,
cerebral hypoxia or low oxygenlevel, cerebral vascular
(05:36):
disorder, diabetes, severe braintrauma or concussions,
especially one that involvesloss of consciousness,
degenerative brain diseases likeAlzheimer's disease and
frontotemporal dementia.
(05:56):
In women who are pregnant,eclampsia is preeclampsia, or
elevated blood pressure thatprogresses to seizures Anytime.
Any person has any electrolyteabnormality, like low sodium,
hyponatremia, changes in calciumlevels or magnesium.
(06:18):
Now epilepsy is when the personjust has this brain condition
without an identifiable cause.
That can happen frequentlywithout any underlying metabolic
or brain substrate problem.
Some genetic conditions mayalso predispose someone to
(06:42):
seizures.
May also predispose someone toseizures Now if there are
hormonal related changes thatcan affect the excitability of
the brain.
And some young women withepilepsy may have their first
seizures at the time of menarchebecause as the ovaries start to
(07:05):
go through puberty and makeestrogen, estrogen is brain
stimulatory, whereas you need afunctioning ovary and regular
ovulation to make progesterone,and progesterone, which protects
the lining of the uterus,prepares a fertilized egg for
implantation, is more of acentral depressant to the brain.
(07:30):
Hence natural progesterone cancause sleepiness or relaxation,
which is why when we prescribeit for menopausal women, we have
them take it in the evening.
Now, any kind of infection highfever, serious brain infections
like encephalitis or meningitiscan also cause seizures.
(07:52):
Any severe inflammatorycondition from autoimmune
conditions can also trigger aseizure.
If you didn't listen to mypodcast at the beginning of
season three on autoimmuneconditions in women with Dr
(08:13):
Al-Ghawi, that's a good one togo back to listen to Now.
Mental health concerns, whichare common, can sometimes
predispose someone to what'scalled psychogenic seizures.
So it's like a seizure but it'snot a true electrical
(08:34):
stimulation seizure and anotherterm for this may be conversion
disorder.
Now, if there's problems withhow the brain developed, like a
congenital abnormality, injurywith childbirth, any kind of
trauma to brain tissue can causescarring and be a focus of a
(09:00):
trigger for this aberrantelectrical activity that can
cause a seizure.
Certainly, toxins, poisons Imean carbon monoxide poisoning.
It's odorless and if you've gotcar exhaust fumes or poorly
vented areas.
That's why all homes andworkplaces should have carbon
(09:24):
monoxide detectors, because thiscan cause death and before
death may be seizures.
Certain venomous bites orstings may also predispose
someone to a seizure, to aseizure Certainly if you ever
witness anyone having anyunusual convulsive activity loss
(09:50):
of consciousness, jerking,biting the tongue, losing
control of bowels or bladder,which sometimes happens during
seizures.
Of course you want to assist theperson, call 911, make sure
that if they're vomiting, whichoccasionally happens, that
they're over to their side sothey're not inhaling the vomit,
(10:11):
that they have an open airway,that there's fresh air, that
they're not in some enclosedspace where there could be
carbon monoxide poisoning.
Any person who experiences anychange in consciousness or any
possible seizure or convulsivedisorder should, of course, go
to the emergency room, emergencydepartment, particularly if it
(10:36):
is the first time.
And anytime someone passes out,which isn't always a seizure,
it could be syncope, low bloodpressure, heart rhythm problems,
medication side effects, drugintoxication, intentional or
unintentional.
(10:56):
And certainly if you are aloneand you think you've had a first
time event, then of course youshould call 9-1-1 and contact
your physician.
Now, if you've had seizures inthe past, it's important to
watch for signs for another oneand having a second seizure.
(11:16):
Of course, even having a firstseizure does require a medical
evaluation, and the moreseizures one has, the more
likely it's that you'll havemore seizures.
So we generally want to treatthem and prevent them.
Now, childhood seizures ifyou're a parent or a grandparent
(11:38):
taking care of young children,who can frequently develop
infections quickly and highfevers that can really irritate
the brain.
But children can have seizuresfor many of the same reasons
that adults have seizures andcommon types of childhood
seizures that are included butare not limited to things such
(12:03):
as absence seizures, which ischildhood absence, epilepsy,
febrile seizures are probablythe most common and usually
those go away.
Infantile spasms, juvenilemyoclonic epilepsy, tonic-clonic
(12:23):
seizures there's a syndromecalled Lennox-Gastaut syndrome
and just being diagnosed withepilepsy, and probably epilepsy
is considered one of the mostcommon neurologic disorders and
it's the fourth most commonneurologic problem globally.
(12:47):
So migraine eclipses it, strokeeclipses it and Alzheimer's
disease eclipses it.
If you haven't heard thepodcast on migraine headache and
you're one of the 50% of peoplewith migraines, that's an
important one to listen to.
It's important to preventmigraine headaches because you
(13:08):
want to have adequate blood flowto the brain.
We've had several podcasts onmemory and brain fog and signs
of Alzheimer's disease andneuroprotective activities the
MIND diet.
So if you've missed thosepodcasts, diet.
(13:33):
So if you've missed thosepodcasts, those are good ones to
listen to.
Stroke is like a brain attackand certainly if someone has
neurologic symptoms slurredspeech, inability to move a limb
this is a medical emergency andyou do want to call 911.
Time is of the essence.
There's all different types ofstrokes.
It can be from a blood clotAtrial fibrillation is common,
(14:00):
more common in women as they getolder, particularly if they've
had high blood pressure.
And if you're in an irregularatrial fibrillation rhythm for
more than 48 hours, you can havea tiny clot as small as the tip
of a ballpoint pen that cancause devastating neurologic
problems by blocking blood flowto that brain.
(14:22):
There also can be lacunarinfarcts, which are when the
blood vessels, the tiny bloodvessels, are not functioning
well because of hypertension andthis has a very characteristic
appearance on CAT scan or MRI.
(14:44):
So you have been listening tothe Speaking of Women's Health
podcast and I am your host, drHolly Thacker.
I'm in the Sunflower Housetalking all about seizure
disorders and epilepsy, and thisis very important in women
because during pregnancy, womencan be predisposed to
(15:05):
preeclampsia, which is ametabolic problem.
Elevated blood pressure and insevere cases of eclampsia or
toxemia can be associated withseizures.
Furthermore, the onset ofmenstruation, which usually
brings more estrogen thanprogesterone, might be a time
(15:26):
that epilepsy is manifested.
And if you're a woman who has astable epilepsy and you're
going into menopause andthinking about hormone therapy,
we usually want to make surethat there's enough progesterone
on board and usually we justgive progesterone to protect the
uterus.
And so women who don't have auterus or an endometrium or
(15:47):
endometriosis usually don't needprogesterone.
But sometimes, if I'm concerned,there's any hormonal
stimulation to the brain, sinceestrogen is activating to the
brain, which is why it's a mildmood elevator.
It sometimes helps fatigue,helps antidepressant medicines
work better, helps with wordfinding difficulties.
There's estrogen receptors allthroughout the brain.
(16:09):
Anytime someone has anyepilepsy or has had prior
seizures, we want to be carefulto not overstimulate the brain,
and there's certainlymedications that tend to be
contraindicated in seizuredisorder, like bupropion or
(16:30):
Welbutrin.
That's a common medication weuse in perimenopause to kind of
boost energy.
It's used off-label to suppressthe appetite.
In higher doses it can be usedfor smoking cessation or
treatment of depression.
We use it off-label to boostdopamine, which sometimes will
help with climax and sexualfunction.
(16:50):
So in my practice of midlifehormonal menopausal medicine and
anti-aging and preventivemedicine, there's lots of
overlaps with the brain and soit's very important to
understand the functions andcommon neurologic problems and
furthermore, generally speaking,in any neurologic condition the
(17:13):
lack of estrogen usually makesthings worse.
Now, estrogen is not atreatment for Alzheimer's.
I do have lots of neurologistssend me patients who have
neurologic problems, whetherit's myasthenia gravis, which is
an autoimmune condition,whether it's Parkinson's disease
or multiple sclerosis, which ismore common.
(17:34):
The farther north one gets, andcertainly the lower the vitamin
D, the more likely someone isto have autoimmune conditions,
and so those conditions tend toget worse.
When a woman loses estrogen.
Woman loses estrogen.
So what is epilepsy?
Well, it's a neurologicdisorder in which a person, a
(18:03):
male or female, has two or morejust unprovoked, unexplained
seizures that occur more than 24hours apart.
So an epileptic seizure is anevent of altered brain function,
which can be very scary,obviously, and it's caused by
abnormal or excessive electricaldischarges from brain cells.
And epilepsy affects over threeand a half million people in
(18:27):
the United States and 50 millionpeople worldwide.
So we have about what 330 to350 million people in the United
States, so it's a relativelycommon condition.
So you may know someone who hasepilepsy, you may have epilepsy.
(18:49):
So you may know someone who hasepilepsy, you may have epilepsy
.
Or you may just want to knowabout it because you're
interested in health and beinghealthy and being strong and
being in charge, and it's kindof hard to be in charge when
you're losing control of yourconsciousness and your body.
(19:09):
So about 65% of newly diagnosedcases of epilepsy have no
obvious cause, but of theremaining 35%, the more common
reasons might be a stroke orsome congenital abnormality.
Those that we're just born withBrain tumor is always a concern
, particularly in an adult, justout of the blue who has their
(19:31):
first seizure.
I mean they always have to beevaluated to rule out a brain
tumor.
History of trauma, infection,any ingestions of any substances
has to be evaluated, and it'svery important to determine the
cause to help guide treatment.
(19:51):
So how does a physiciandiagnose epilepsy?
Well, it's aimed at identifyingthe type of seizure whether
it's epileptic versusnon-epileptic.
The cause identifying the causewhether it's generalized or
(20:15):
whether it's a partial, focalepilepsy, and then having the
neurologist or the epilepsyspecialist determine the best
treatment option.
And epilepsy types and causesare determined based on several
things.
First of all, the medicalhistory, and this is true with
(20:36):
any medical condition.
You really want a properdiagnosis first to get the right
treatment, and so a completeand accurate medical history is
important.
So your physician needs a verydetailed description of your
seizures as well as thesensations that you may feel
before and after these episodes.
(20:58):
Others who have often seen youeither before, during or after
the seizure, such as familymembers, close friends, should
be accessible or present to givethose historical details,
especially if you yourself havelost consciousness, and your
(21:20):
physician may ask you thefollowing questions.
So it's always good to beprepared anytime you go in for a
health care encounter, anytimeyou go in for a healthcare
encounter, do you experience awarning symptom or an aura
before the seizure occurs?
What's the first sign of yourseizure?
Do you lose consciousness?
(21:42):
How long do your seizures last?
How often do they occur?
What factors, if any, seem totrigger your seizures?
What age did you first developseizures?
What were the circumstancessurrounding the first event?
Have your seizures changed overtime?
What have been your priortreatments?
(22:05):
What medications and doses haveyou taken?
I mean, this is certainlysomething I recommend for all
patients, regardless of whoever,whatever their conditions are.
When you go and see a healthcareclinician, you should bring in
all your medicines not picturesthe actual bottles, patches,
(22:26):
supplements.
This is prescription andnon-prescription, not just a
list.
Don't just say, oh, look in thecomputer, that's what's in
there, because we really want toknow exactly what you're on and
when you take it.
It's very important to knowthis and to be able to document
it.
You also want to know with anymedical condition, including
(22:49):
seizure disorder, is when wereyou optimized or fully
controlled, and with any kind oftreatment did you experience
any unacceptable side effects?
And also knowing details aboutyour general health, as well as
your biological family members'health.
(23:11):
That's another thing when I'llask questions.
People might go on and ontalking about their beloved
father.
That might have been the manthat raised them and that they
consider emotionally theirfather.
But if it's not your biologicalfather, biological mother or
biological sibling, either fullor half, then that doesn't
really directly medically relateto your history.
(23:35):
I mean, certainly, if it's aninfectious disease and you've
been around people with, say,tuberculosis, which there's been
some outbreaks, for instance,or if you've been exposed to
other people with infectiousdiseases, then of course that
part of the history would beimportant.
You need to be honest alwayswhen talking with your
(23:58):
healthcare clinician about anyalcohol use, drug use.
It's also important for femalesto give information about their
obstetrical history, theirpregnancy, the delivery, the
postpartum and newborn periodsof time.
(24:19):
Now the physical examinationincludes a neuromuscular
evaluation of your musclestrength, your reflexes, your
cranial nerves, eyesight,hearing, your balance, your
cardiovascular system.
Tests might include seeing aneurologist to undergo a
(24:42):
detailed neurologic exam.
Many times an EEG, which is anelectroencephalogram, is done.
This lasts about 90 minutes andit provides very important
information many times about thetype and the location of your
epilepsy and it's a recording ofbrain waves done first by
(25:03):
attaching small disc electrodesto measured locations on your
head and these electrodes arethen connected to recording
devices called anelectroencephalogram Now an MRI.
A magnetic resonance imagingtest is an advanced imaging test
(25:24):
which takes about 15 minutes toan hour, and this allows your
physician to uncover possiblecauses of your epilepsy.
Mri uses magnetic and radiowaves to generate a detailed of
you of your brain, and socertainly if you have any
electronic implanted devicespacemakers, artificial joints, I
(25:48):
mean you're not allowed in theMRI room with anything that can
be magnetized.
Now blood tests can be alsovery helpful in evaluating your
status, so various compounds andcells normally present in your
blood, getting a good baselineof kidney and liver function.
(26:12):
Many times after someone beginstreatment with anti-seizure
medicines, periodic blood testsneed to be done.
Sometimes levels of seizuremedicines need to be done.
Some anticonvulsant medicationscan affect bone health, so as
an osteoporosis physician, Ialways inquire whether someone
(26:33):
has been on dilantin or anyseizure medicines that might
affect vitamin d metabolism.
Women contemplating pregnancyand breastfeeding need to have
discussions to find out what arethe safest types of medications
that are seizure medicines thatare used Now.
You may not have epilepsy, butyou still may have a physician
(26:56):
prescribe epilepsy medicines.
Many times, seizure medications.
Mood stabilizing medicationscan be used for women with mood
disorders.
Medicines like Neurontin, whichis gabapentin, and Lyrica,
which is the brand name, orpregabalin, are used to treat
(27:19):
pain conditions, fibromyalgia.
Sometimes we use it off-labelto treat hot flashes and sleep
disorders.
To treat hot flashes and sleepdisorders, lithium is used in
mood disorders and then Lamictalis also used in mood disorders,
and these can certainly.
(27:41):
Any type of medication thataffects the brain may have
effects on the developing fetus.
So it's very important to planpregnancies if you're on these
medications and be monitored.
Now, other tests maybe depend onyour condition and not all
neurologists specialize inepilepsy, so those that do are
(28:05):
called epileptologists.
They may recommend additionalor more specialized tests or
consultation, even with aneurosurgeon.
Sometimes there isneurosurgical procedures or
gamma knife procedures surgical,very localized procedures to
(28:26):
remove a seizure focus verylocalized procedures to remove a
seizure focus.
A neuropsychologist may domemory testing.
A neuro-ophthalmologist mayneed to be examining you,
particularly if there's anyinvolvement with vision, which
(28:48):
is the occipital part of thebrain, or the cranial nerve too.
Sometimes you actually may needto see a geneticist for genetic
assessment, and at thebeginning of season three we had
Ryan Noss come on talking aboutcancer genetics, but there are
(29:08):
also a geneticist thatspecialize in neurologic
problems, neurodegenerativeproblems, cardiovascular
problems.
Other tests may be considered,including an ictal single photon
(29:30):
emission computed tomography,called ictal spec, and this is
very interesting and it measuresblood flow to the brain and how
blood flow changes with seizureactivity.
A magnoencephalography, a MEGtest, is an advanced method of
(29:51):
recording and evaluating thebrain while it's actively
functioning, pinpointingabnormal changes in the brain.
And then we have the PET scanpositron emission tomography
which is a procedure that showschanges in the brain metabolism
that's associated with seizures.
It certainly takes a lot ofenergy in the brain for this
(30:15):
massive electrical activity inthe brain.
And then there is the SEG test,a stereo electroencephalography
, which is a minimally invasivesurgical procedure that places
electrodes in the targeted brainareas and then they're
monitored to precisely locatethe exact source of the seizure.
(30:38):
So this SEEG covers much morespecific area than just a
conventional EEG.
So how is epilepsy treated?
Well, the goal is to fullycontrol seizures, restore your
quality of life, eliminate therisk of premature death and in
(31:00):
most cases success is achievedthrough accurate diagnosis and
the choice of the right type anddosage of anti-seizure medicine
.
Sometimes epilepsy surgery maybe considered if anti-seizure
medicine fails to fully controlseizures, and sometimes the
surgery can be curative.
(31:21):
In terms of medical treatment,the most important advice is to
follow directions and take yourmedications exactly as directed,
and to never suddenly changemedicines or stop taking them
without consulting yourphysician.
And I tell people with any kindof potential life-threatening
(31:43):
condition or any chronic medicalcondition that requires
medication whether it's thyroidhormone medicine or osteoporosis
medicine or cardiovascularmedicine or seizure neurologic
medicine that you should alwayshave extra medicine on hand, so
in case of supply chain problemsor some disruption in your
(32:06):
schedule.
Also, you should plan inadvance to always see your
prescribing physician or theirAPP assistant, who can prescribe
at least on a regular basis,certainly at least every year.
In some conditions it mightneed to be more often.
(32:27):
Now, the type of anti-seizuremedicine you're given will
depend on the type of epilepsythat you have, and the dose
prescribed, of course, can varywith age, weight, gender and
other factors, and certainlyseizure medications can affect
the bone.
Some women that have seizuresassociated with menses might
(32:52):
have their menses suppressed,and so we do see a number of
women for hormonal consultationswho have seizure disorders.
With any medication, of course,there can be side effects and
with anti-seizure medicines wehave to be careful about
sleepiness or unsteady gait.
Usually they're mild and theypass, but certainly anytime
(33:15):
you're started on a new medicinethat can affect your brain you
have to be careful about drivingor operating machinery or
mixing it with alcohol or drugsthat also can affect your brain
function.
And having a good relationshipwith your medical team and
knowing who to call and what todo if there's problems is always
(33:38):
very good, because it's best tohave a plan rather than having
to rely on the emergency room.
And it may take a couple ofdifferent attempts to find the
right medicine and there mightneed to be a combination of
medications and during thisadjustment time period you may
need to have blood samples takento measure the seizure
(34:02):
medication levels.
But usually, once optimaltreatment's found and factors in
your life can change othermedicines, other conditions,
aging you still may need tweaksand adjustments.
Now, surgical treatment isgenerally reserved for those
people that are unresponsive tothe standard anti-seizure
(34:25):
medicines or people who justhave intolerable side effects
and to be considered for surgery.
Obviously, extensive neurologictesting may need to be done to
see if it's a localized areathat can be surgically removed
without causing damage toessential parts of the brain
involved in movement, sensation,speech, vision and memory brain
(34:49):
involved in movement, sensation, speech, vision and memory and
surgery.
Seizure-free rates aftersurgery can range from 30% to
over 80%, depending on thepatient's age and the location
and the cause, and theprinciples of epilepsy surgery
in infants and children, andadolescents and adults are
similar.
Epilepsy surgery in infants andchildren and adolescents and
(35:11):
adults are similar, but inchildren, age-related factors
such as cooperation and maturingbrain changes, which can
complicate the interpretation ofboth the EEG and the MRI, can
pose additional challenges.
On the other hand, pediatricpatients can be best suited for
epilepsy surgery, given they'restill developing brains and they
(35:32):
may be able to better adjust.
After tailored surgical removalof the epileptic section of the
brain, control seizures,including focused laser ablation
, implantation of smart devicesto detect and respond to
(35:52):
seizures, which are typicallyreferred to as responsive
neurostimulation, and thenstimulation of selected deep
areas of the brain through DBSdeep brain stimulation.
In terms of follow-up, you haveto be fully committed to
regular follow-up, you and yourcaregivers.
(36:13):
You need periodic exams and youneed to be evaluated to see
whether the medicine's working.
If you're having side effects,you may need other testing,
blood testing, other testingblood testing like blood count
and chemistries, maybepotentially a bone density,
(36:41):
possibly EEGs or MRIs or CATscans.
Now the Epilepsy Foundation isreally a great resource if you
or your family is looking foradditional information, and they
have a 24-7 helpline and theirwebsite, epilepsycom provides
free tools and resources.
And this concludes this podcaston seizure disorder and epilepsy
(37:02):
, and I hope that you learnedsomething and enjoyed listening
to this episode and don't missfuture episodes of our podcast.
Be sure to subscribe toSpeaking of Women's Health and
you can subscribe anywhere youlisten to podcasts Apple
(37:23):
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Remember be strong, be healthyand be in charge.
Welcome to the Speaking of Women's Health
podcast.
I'm your host, dr Holly Thacker, the director of Speaking of
Women's Health, and I am back inthe Sunflower House for a new
episode all about seizures.
A new episode all aboutseizures.
(00:36):
Seizures is a surge of abnormalelectrical activity in the
brain.
It's also sometimes referred toas epilepsy, especially if it's
a chronic condition.
Um, some people can just haveone seizure in their life
because of fever or infection ortrauma or some metabolic
derangement, but if it's achronic condition, it's
generally referred to asepilepsy, and the most
(01:00):
recognizable symptoms of aseizure are temporary loss of
consciousness and uncontrollablemovements of the body, which is
termed convulsions.
This can really be verydramatic and scary, but not all
seizures look the same.
Some people just stop whatthey're doing and just stare off
(01:24):
into space for a few seconds.
Others may have muscular jerksor lose control of the body.
Some people, like I said, onlyhave one seizure in their life,
or others can have multipleseizures in a day.
So the experience with seizurescan be very different from
(01:46):
others, and there's someimportant women's health aspects
about seizures and seizuredisorder, which is why we
thought it would be veryimportant to cover this.
There's a number of differentcauses of seizures, because
there's many things that caninterfere with the brain's
(02:06):
electrical patterns.
This can range to rapid changesin blood sugar, illness,
infection, injury or otherneurologic conditions.
Now there's two major types ofseizures.
Generalized seizures areelectrical activity that starts
(02:30):
in both sides of the brain andthe body may shake.
There might be some staring.
It usually affects children oryoung adults, but it can occur
at any age.
Now focal seizures focal onsetseizures are electrical activity
(02:51):
that begins on one side of thebrain and usually just affects
one side of the body, and it mayor may not affect someone's
awareness and there can bephysical emotional effects.
There can be hallucinations,which is seeing things that
aren't there, or hearing thingsthat aren't there.
(03:13):
About 60% of people withepilepsy have focal seizures,
which also sometimes is called apartial seizure, and sometimes
the symptoms of a focal seizurecan be mistaken for signs of
mental illness or otherneurologic problems.
(03:36):
Now the types of generalizedseizure disorders include
absence seizures, which meansthe person just stops what
they're doing and stares.
Atonic seizures, or dropseizures are when there's
(04:00):
complete loss of muscle controland someone just drops right to
the ground.
Clonic seizures are shaking ofthe body and this involves
sometimes just shaking on oneside.
Now, myoclonic seizuresinvolves a quick jerk or twitch
that can just affect certainmuscle groups and then there is
(04:24):
secondary generalized seizures.
And if you have focal seizures,which is electrical activity
that starts in one part of thebrain followed by effects on the
entire brain Tonic-clonicseizures the muscles can really
stiffen, you can loseconsciousness and then have
convulsions and tonic seizuresyou may pass out and your
(04:48):
muscles might tighten up, butyou don't have full convulsions.
Now the types of focal seizuredisorders include focal onset
aware seizures or simple partialseizures.
You're aware of it when ithappens and you're actually able
to remember it.
Focal onset impaired awarenessseizures or complex partial
(05:12):
seizures you really loseawareness and experience
confusion when the seizurehappens and you cannot remember
what happened.
So seizures can happen for manydifferent reasons and they're
not limited to the followingAneurysms, brain tumors,
cerebral hypoxia or low oxygenlevel, cerebral vascular
(05:36):
disorder, diabetes, severe braintrauma or concussions,
especially one that involvesloss of consciousness,
degenerative brain diseases likeAlzheimer's disease and
frontotemporal dementia.
(05:56):
In women who are pregnant,eclampsia is preeclampsia, or
elevated blood pressure thatprogresses to seizures Anytime.
Any person has any electrolyteabnormality, like low sodium,
hyponatremia, changes in calciumlevels or magnesium.
(06:18):
Now epilepsy is when the personjust has this brain condition
without an identifiable cause.
That can happen frequentlywithout any underlying metabolic
or brain substrate problem.
Some genetic conditions mayalso predispose someone to
(06:42):
seizures.
May also predispose someone toseizures Now if there are
hormonal related changes thatcan affect the excitability of
the brain.
And some young women withepilepsy may have their first
seizures at the time of menarchebecause as the ovaries start to
(07:05):
go through puberty and makeestrogen, estrogen is brain
stimulatory, whereas you need afunctioning ovary and regular
ovulation to make progesterone,and progesterone, which protects
the lining of the uterus,prepares a fertilized egg for
implantation, is more of acentral depressant to the brain.
(07:30):
Hence natural progesterone cancause sleepiness or relaxation,
which is why when we prescribeit for menopausal women, we have
them take it in the evening.
Now, any kind of infection highfever, serious brain infections
like encephalitis or meningitiscan also cause seizures.
(07:52):
Any severe inflammatorycondition from autoimmune
conditions can also trigger aseizure.
If you didn't listen to mypodcast at the beginning of
season three on autoimmuneconditions in women with Dr
(08:13):
Al-Ghawi, that's a good one togo back to listen to Now.
Mental health concerns, whichare common, can sometimes
predispose someone to what'scalled psychogenic seizures.
So it's like a seizure but it'snot a true electrical
(08:34):
stimulation seizure and anotherterm for this may be conversion
disorder.
Now, if there's problems withhow the brain developed, like a
congenital abnormality, injurywith childbirth, any kind of
trauma to brain tissue can causescarring and be a focus of a
(09:00):
trigger for this aberrantelectrical activity that can
cause a seizure.
Certainly, toxins, poisons Imean carbon monoxide poisoning.
It's odorless and if you've gotcar exhaust fumes or poorly
vented areas.
That's why all homes andworkplaces should have carbon
(09:24):
monoxide detectors, because thiscan cause death and before
death may be seizures.
Certain venomous bites orstings may also predispose
someone to a seizure, to aseizure Certainly if you ever
witness anyone having anyunusual convulsive activity loss
(09:50):
of consciousness, jerking,biting the tongue, losing
control of bowels or bladder,which sometimes happens during
seizures.
Of course you want to assist theperson, call 911, make sure
that if they're vomiting, whichoccasionally happens, that
they're over to their side sothey're not inhaling the vomit,
(10:11):
that they have an open airway,that there's fresh air, that
they're not in some enclosedspace where there could be
carbon monoxide poisoning.
Any person who experiences anychange in consciousness or any
possible seizure or convulsivedisorder should, of course, go
to the emergency room, emergencydepartment, particularly if it
(10:36):
is the first time.
And anytime someone passes out,which isn't always a seizure,
it could be syncope, low bloodpressure, heart rhythm problems,
medication side effects, drugintoxication, intentional or
unintentional.
(10:56):
And certainly if you are aloneand you think you've had a first
time event, then of course youshould call 9-1-1 and contact
your physician.
Now, if you've had seizures inthe past, it's important to
watch for signs for another oneand having a second seizure.
(11:16):
Of course, even having a firstseizure does require a medical
evaluation, and the moreseizures one has, the more
likely it's that you'll havemore seizures.
So we generally want to treatthem and prevent them.
Now, childhood seizures ifyou're a parent or a grandparent
(11:38):
taking care of young children,who can frequently develop
infections quickly and highfevers that can really irritate
the brain.
But children can have seizuresfor many of the same reasons
that adults have seizures andcommon types of childhood
seizures that are included butare not limited to things such
(12:03):
as absence seizures, which ischildhood absence, epilepsy,
febrile seizures are probablythe most common and usually
those go away.
Infantile spasms, juvenilemyoclonic epilepsy, tonic-clonic
(12:23):
seizures there's a syndromecalled Lennox-Gastaut syndrome
and just being diagnosed withepilepsy, and probably epilepsy
is considered one of the mostcommon neurologic disorders and
it's the fourth most commonneurologic problem globally.
(12:47):
So migraine eclipses it, strokeeclipses it and Alzheimer's
disease eclipses it.
If you haven't heard thepodcast on migraine headache and
you're one of the 50% of peoplewith migraines, that's an
important one to listen to.
It's important to preventmigraine headaches because you
(13:08):
want to have adequate blood flowto the brain.
We've had several podcasts onmemory and brain fog and signs
of Alzheimer's disease andneuroprotective activities the
MIND diet.
So if you've missed thosepodcasts, diet.
(13:33):
So if you've missed thosepodcasts, those are good ones to
listen to.
Stroke is like a brain attackand certainly if someone has
neurologic symptoms slurredspeech, inability to move a limb
this is a medical emergency andyou do want to call 911.
Time is of the essence.
There's all different types ofstrokes.
It can be from a blood clotAtrial fibrillation is common,
(14:00):
more common in women as they getolder, particularly if they've
had high blood pressure.
And if you're in an irregularatrial fibrillation rhythm for
more than 48 hours, you can havea tiny clot as small as the tip
of a ballpoint pen that cancause devastating neurologic
problems by blocking blood flowto that brain.
(14:22):
There also can be lacunarinfarcts, which are when the
blood vessels, the tiny bloodvessels, are not functioning
well because of hypertension andthis has a very characteristic
appearance on CAT scan or MRI.
(14:44):
So you have been listening tothe Speaking of Women's Health
podcast and I am your host, drHolly Thacker.
I'm in the Sunflower Housetalking all about seizure
disorders and epilepsy, and thisis very important in women
because during pregnancy, womencan be predisposed to
(15:05):
preeclampsia, which is ametabolic problem.
Elevated blood pressure and insevere cases of eclampsia or
toxemia can be associated withseizures.
Furthermore, the onset ofmenstruation, which usually
brings more estrogen thanprogesterone, might be a time
(15:26):
that epilepsy is manifested.
And if you're a woman who has astable epilepsy and you're
going into menopause andthinking about hormone therapy,
we usually want to make surethat there's enough progesterone
on board and usually we justgive progesterone to protect the
uterus.
And so women who don't have auterus or an endometrium or
(15:47):
endometriosis usually don't needprogesterone.
But sometimes, if I'm concerned,there's any hormonal
stimulation to the brain, sinceestrogen is activating to the
brain, which is why it's a mildmood elevator.
It sometimes helps fatigue,helps antidepressant medicines
work better, helps with wordfinding difficulties.
There's estrogen receptors allthroughout the brain.
(16:09):
Anytime someone has anyepilepsy or has had prior
seizures, we want to be carefulto not overstimulate the brain,
and there's certainlymedications that tend to be
contraindicated in seizuredisorder, like bupropion or
(16:30):
Welbutrin.
That's a common medication weuse in perimenopause to kind of
boost energy.
It's used off-label to suppressthe appetite.
In higher doses it can be usedfor smoking cessation or
treatment of depression.
We use it off-label to boostdopamine, which sometimes will
help with climax and sexualfunction.
(16:50):
So in my practice of midlifehormonal menopausal medicine and
anti-aging and preventivemedicine, there's lots of
overlaps with the brain and soit's very important to
understand the functions andcommon neurologic problems and
furthermore, generally speaking,in any neurologic condition the
(17:13):
lack of estrogen usually makesthings worse.
Now, estrogen is not atreatment for Alzheimer's.
I do have lots of neurologistssend me patients who have
neurologic problems, whetherit's myasthenia gravis, which is
an autoimmune condition,whether it's Parkinson's disease
or multiple sclerosis, which ismore common.
(17:34):
The farther north one gets, andcertainly the lower the vitamin
D, the more likely someone isto have autoimmune conditions,
and so those conditions tend toget worse.
When a woman loses estrogen.
Woman loses estrogen.
So what is epilepsy?
Well, it's a neurologicdisorder in which a person, a
(18:03):
male or female, has two or morejust unprovoked, unexplained
seizures that occur more than 24hours apart.
So an epileptic seizure is anevent of altered brain function,
which can be very scary,obviously, and it's caused by
abnormal or excessive electricaldischarges from brain cells.
And epilepsy affects over threeand a half million people in
(18:27):
the United States and 50 millionpeople worldwide.
So we have about what 330 to350 million people in the United
States, so it's a relativelycommon condition.
So you may know someone who hasepilepsy, you may have epilepsy.
(18:49):
So you may know someone who hasepilepsy, you may have epilepsy
.
Or you may just want to knowabout it because you're
interested in health and beinghealthy and being strong and
being in charge, and it's kindof hard to be in charge when
you're losing control of yourconsciousness and your body.
(19:09):
So about 65% of newly diagnosedcases of epilepsy have no
obvious cause, but of theremaining 35%, the more common
reasons might be a stroke orsome congenital abnormality.
Those that we're just born withBrain tumor is always a concern
, particularly in an adult, justout of the blue who has their
(19:31):
first seizure.
I mean they always have to beevaluated to rule out a brain
tumor.
History of trauma, infection,any ingestions of any substances
has to be evaluated, and it'svery important to determine the
cause to help guide treatment.
(19:51):
So how does a physiciandiagnose epilepsy?
Well, it's aimed at identifyingthe type of seizure whether
it's epileptic versusnon-epileptic.
The cause identifying the causewhether it's generalized or
(20:15):
whether it's a partial, focalepilepsy, and then having the
neurologist or the epilepsyspecialist determine the best
treatment option.
And epilepsy types and causesare determined based on several
things.
First of all, the medicalhistory, and this is true with
(20:36):
any medical condition.
You really want a properdiagnosis first to get the right
treatment, and so a completeand accurate medical history is
important.
So your physician needs a verydetailed description of your
seizures as well as thesensations that you may feel
before and after these episodes.
(20:58):
Others who have often seen youeither before, during or after
the seizure, such as familymembers, close friends, should
be accessible or present to givethose historical details,
especially if you yourself havelost consciousness, and your
(21:20):
physician may ask you thefollowing questions.
So it's always good to beprepared anytime you go in for a
health care encounter, anytimeyou go in for a healthcare
encounter, do you experience awarning symptom or an aura
before the seizure occurs?
What's the first sign of yourseizure?
Do you lose consciousness?
(21:42):
How long do your seizures last?
How often do they occur?
What factors, if any, seem totrigger your seizures?
What age did you first developseizures?
What were the circumstancessurrounding the first event?
Have your seizures changed overtime?
What have been your priortreatments?
(22:05):
What medications and doses haveyou taken?
I mean, this is certainlysomething I recommend for all
patients, regardless of whoever,whatever their conditions are.
When you go and see a healthcareclinician, you should bring in
all your medicines not picturesthe actual bottles, patches,
(22:26):
supplements.
This is prescription andnon-prescription, not just a
list.
Don't just say, oh, look in thecomputer, that's what's in
there, because we really want toknow exactly what you're on and
when you take it.
It's very important to knowthis and to be able to document
it.
You also want to know with anymedical condition, including
(22:49):
seizure disorder, is when wereyou optimized or fully
controlled, and with any kind oftreatment did you experience
any unacceptable side effects?
And also knowing details aboutyour general health, as well as
your biological family members'health.
(23:11):
That's another thing when I'llask questions.
People might go on and ontalking about their beloved
father.
That might have been the manthat raised them and that they
consider emotionally theirfather.
But if it's not your biologicalfather, biological mother or
biological sibling, either fullor half, then that doesn't
really directly medically relateto your history.
(23:35):
I mean, certainly, if it's aninfectious disease and you've
been around people with, say,tuberculosis, which there's been
some outbreaks, for instance,or if you've been exposed to
other people with infectiousdiseases, then of course that
part of the history would beimportant.
You need to be honest alwayswhen talking with your
(23:58):
healthcare clinician about anyalcohol use, drug use.
It's also important for femalesto give information about their
obstetrical history, theirpregnancy, the delivery, the
postpartum and newborn periodsof time.
(24:19):
Now the physical examinationincludes a neuromuscular
evaluation of your musclestrength, your reflexes, your
cranial nerves, eyesight,hearing, your balance, your
cardiovascular system.
Tests might include seeing aneurologist to undergo a
(24:42):
detailed neurologic exam.
Many times an EEG, which is anelectroencephalogram, is done.
This lasts about 90 minutes andit provides very important
information many times about thetype and the location of your
epilepsy and it's a recording ofbrain waves done first by
(25:03):
attaching small disc electrodesto measured locations on your
head and these electrodes arethen connected to recording
devices called anelectroencephalogram Now an MRI.
A magnetic resonance imagingtest is an advanced imaging test
(25:24):
which takes about 15 minutes toan hour, and this allows your
physician to uncover possiblecauses of your epilepsy.
Mri uses magnetic and radiowaves to generate a detailed of
you of your brain, and socertainly if you have any
electronic implanted devicespacemakers, artificial joints, I
(25:48):
mean you're not allowed in theMRI room with anything that can
be magnetized.
Now blood tests can be alsovery helpful in evaluating your
status, so various compounds andcells normally present in your
blood, getting a good baselineof kidney and liver function.
(26:12):
Many times after someone beginstreatment with anti-seizure
medicines, periodic blood testsneed to be done.
Sometimes levels of seizuremedicines need to be done.
Some anticonvulsant medicationscan affect bone health, so as
an osteoporosis physician, Ialways inquire whether someone
(26:33):
has been on dilantin or anyseizure medicines that might
affect vitamin d metabolism.
Women contemplating pregnancyand breastfeeding need to have
discussions to find out what arethe safest types of medications
that are seizure medicines thatare used Now.
You may not have epilepsy, butyou still may have a physician
(26:56):
prescribe epilepsy medicines.
Many times, seizure medications.
Mood stabilizing medicationscan be used for women with mood
disorders.
Medicines like Neurontin, whichis gabapentin, and Lyrica,
which is the brand name, orpregabalin, are used to treat
(27:19):
pain conditions, fibromyalgia.
Sometimes we use it off-labelto treat hot flashes and sleep
disorders.
To treat hot flashes and sleepdisorders, lithium is used in
mood disorders and then Lamictalis also used in mood disorders,
and these can certainly.
(27:41):
Any type of medication thataffects the brain may have
effects on the developing fetus.
So it's very important to planpregnancies if you're on these
medications and be monitored.
Now, other tests maybe depend onyour condition and not all
neurologists specialize inepilepsy, so those that do are
(28:05):
called epileptologists.
They may recommend additionalor more specialized tests or
consultation, even with aneurosurgeon.
Sometimes there isneurosurgical procedures or
gamma knife procedures surgical,very localized procedures to
(28:26):
remove a seizure focus verylocalized procedures to remove a
seizure focus.
A neuropsychologist may domemory testing.
A neuro-ophthalmologist mayneed to be examining you,
particularly if there's anyinvolvement with vision, which
(28:48):
is the occipital part of thebrain, or the cranial nerve too.
Sometimes you actually may needto see a geneticist for genetic
assessment, and at thebeginning of season three we had
Ryan Noss come on talking aboutcancer genetics, but there are
(29:08):
also a geneticist thatspecialize in neurologic
problems, neurodegenerativeproblems, cardiovascular
problems.
Other tests may be considered,including an ictal single photon
(29:30):
emission computed tomography,called ictal spec, and this is
very interesting and it measuresblood flow to the brain and how
blood flow changes with seizureactivity.
A magnoencephalography, a MEGtest, is an advanced method of
(29:51):
recording and evaluating thebrain while it's actively
functioning, pinpointingabnormal changes in the brain.
And then we have the PET scanpositron emission tomography
which is a procedure that showschanges in the brain metabolism
that's associated with seizures.
It certainly takes a lot ofenergy in the brain for this
(30:15):
massive electrical activity inthe brain.
And then there is the SEG test,a stereo electroencephalography
, which is a minimally invasivesurgical procedure that places
electrodes in the targeted brainareas and then they're
monitored to precisely locatethe exact source of the seizure.
(30:38):
So this SEEG covers much morespecific area than just a
conventional EEG.
So how is epilepsy treated?
Well, the goal is to fullycontrol seizures, restore your
quality of life, eliminate therisk of premature death and in
(31:00):
most cases success is achievedthrough accurate diagnosis and
the choice of the right type anddosage of anti-seizure medicine
.
Sometimes epilepsy surgery maybe considered if anti-seizure
medicine fails to fully controlseizures, and sometimes the
surgery can be curative.
(31:21):
In terms of medical treatment,the most important advice is to
follow directions and take yourmedications exactly as directed,
and to never suddenly changemedicines or stop taking them
without consulting yourphysician.
And I tell people with any kindof potential life-threatening
(31:43):
condition or any chronic medicalcondition that requires
medication whether it's thyroidhormone medicine or osteoporosis
medicine or cardiovascularmedicine or seizure neurologic
medicine that you should alwayshave extra medicine on hand, so
in case of supply chain problemsor some disruption in your
(32:06):
schedule.
Also, you should plan inadvance to always see your
prescribing physician or theirAPP assistant, who can prescribe
at least on a regular basis,certainly at least every year.
In some conditions it mightneed to be more often.
(32:27):
Now, the type of anti-seizuremedicine you're given will
depend on the type of epilepsythat you have, and the dose
prescribed, of course, can varywith age, weight, gender and
other factors, and certainlyseizure medications can affect
the bone.
Some women that have seizuresassociated with menses might
(32:52):
have their menses suppressed,and so we do see a number of
women for hormonal consultationswho have seizure disorders.
With any medication, of course,there can be side effects and
with anti-seizure medicines wehave to be careful about
sleepiness or unsteady gait.
Usually they're mild and theypass, but certainly anytime
(33:15):
you're started on a new medicinethat can affect your brain you
have to be careful about drivingor operating machinery or
mixing it with alcohol or drugsthat also can affect your brain
function.
And having a good relationshipwith your medical team and
knowing who to call and what todo if there's problems is always
(33:38):
very good, because it's best tohave a plan rather than having
to rely on the emergency room.
And it may take a couple ofdifferent attempts to find the
right medicine and there mightneed to be a combination of
medications and during thisadjustment time period you may
need to have blood samples takento measure the seizure
(34:02):
medication levels.
But usually, once optimaltreatment's found and factors in
your life can change othermedicines, other conditions,
aging you still may need tweaksand adjustments.
Now, surgical treatment isgenerally reserved for those
people that are unresponsive tothe standard anti-seizure
(34:25):
medicines or people who justhave intolerable side effects
and to be considered for surgery.
Obviously, extensive neurologictesting may need to be done to
see if it's a localized areathat can be surgically removed
without causing damage toessential parts of the brain
involved in movement, sensation,speech, vision and memory brain
(34:49):
involved in movement, sensation, speech, vision and memory and
surgery.
Seizure-free rates aftersurgery can range from 30% to
over 80%, depending on thepatient's age and the location
and the cause, and theprinciples of epilepsy surgery
in infants and children, andadolescents and adults are
similar.
Epilepsy surgery in infants andchildren and adolescents and
(35:11):
adults are similar, but inchildren, age-related factors
such as cooperation and maturingbrain changes, which can
complicate the interpretation ofboth the EEG and the MRI, can
pose additional challenges.
On the other hand, pediatricpatients can be best suited for
epilepsy surgery, given they'restill developing brains and they
(35:32):
may be able to better adjust.
After tailored surgical removalof the epileptic section of the
brain, control seizures,including focused laser ablation
, implantation of smart devicesto detect and respond to
(35:52):
seizures, which are typicallyreferred to as responsive
neurostimulation, and thenstimulation of selected deep
areas of the brain through DBSdeep brain stimulation.
In terms of follow-up, you haveto be fully committed to
regular follow-up, you and yourcaregivers.
(36:13):
You need periodic exams and youneed to be evaluated to see
whether the medicine's working.
If you're having side effects,you may need other testing,
blood testing, other testingblood testing like blood count
and chemistries, maybepotentially a bone density,
(36:41):
possibly EEGs or MRIs or CATscans.
Now the Epilepsy Foundation isreally a great resource if you
or your family is looking foradditional information, and they
have a 24-7 helpline and theirwebsite, epilepsycom provides
free tools and resources.
And this concludes this podcaston seizure disorder and epilepsy
(37:02):
, and I hope that you learnedsomething and enjoyed listening
to this episode and don't missfuture episodes of our podcast.
Be sure to subscribe toSpeaking of Women's Health and
you can subscribe anywhere youlisten to podcasts Apple
(37:23):
Podcasts, spotify, tune inwherever you listen and if
you've enjoyed this and you wantto support our podcast, please
share it with others and give usa five-star rating.
Remember be strong, be healthyand be in charge.
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