Our care team offers a patient-oriented, comprehensive team approach to the diagnosis and treatment of epilepsy. In addition to consultation services, we offer neurodiagnostic evaluations and medical, neuropsychological, and psychosocial services.
At Mount Auburn Hospital’s Epilepsy Clinic, our professionals recognize the stigma and discrimination that affect people with epilepsy and seizure disorders. We work with patients to dispel the public misunderstanding of epilepsy and its symptoms to encourage individuals to seek care. Our team of experts are committed to supporting you so you receive the most effective treatment, gain control of your seizures, and achieve the best quality of life possible.
Greg Lipshutz, MD
Greg M. Lipshutz, MD, joined the Neurology Department at Mount Auburn Hospital in 2009 and is an Instructor in Medicine in Neurology at Harvard Medical School. Dr. Lipshutz specializes in neurology and clinical neurophysiology, and his subspecialty is epilepsy. He participates in the direction of the EEG lab and has clinical interests in seizure and epilepsy. In addition to seeing patients at Mount Auburn Hospital, Dr. Lipshutz is a provider in the Department of Neurology at MIT Medical Center, Cambridge.
Edward Wolpow, MD
Dr. Edward R. Wolpow, Director of the Electromyography (EMG) Lab, has been a valued neurologist seeing patients at Mount Auburn Hospital since 1977. His clinical interests include epilepsy, electroencephalography (EEG), neuromuscular diseases, and stroke. He has lectured in clinical neurology at institutions including Harvard Medical school, MIT, and Boston University. Dr. Wolpow has taught the Clinical Neurology course in the Physician Assistant program at Northeastern University for more than 20 years, and has twice won the excellence in Teaching Award at Mount Auburn Hospital. He is past president of the National Puzzlers League.
Our team also works with experts who are:
- Advanced practice nurses
- EEG technologists
- Social workers
Epilepsy is characterized by abnormal electrical signals in the brain that result in recurrent, unpredictable, uncontrollable seizures. Approximately 64 million people worldwide have epilepsy making it the fourth most common neurological disorder. Epilepsy affects people of all ages. In the U.S., it is estimated that 3.4 million adults and 470,000 children have been diagnosed with epilepsy or a seizure disorder.
Epilepsy and seizure disorders can be very disruptive to a person’s life and can interfere with their ability to function or perform acts of daily living. Epilepsy can also cause other health problems. People with epilepsy have increased rates of anxiety and depression, and people who experience seizures are at risk for accidents or unintended injury, drowning, or sudden unexpected death in epilepsy (SUDEP). It is very important that patients who have experienced seizures be diagnosed and treated at the earliest opportunity.
What Causes Epilepsy
The two main categories of epilepsy are idiopathic (or primary) epilepsy, which has no known cause, and symptomatic (or secondary) epilepsy where the cause is known. Over half the cases of epilepsy are idiopathic. In those cases that are symptomatic with an identifiable cause, the origin may be due to biological or physical sources, including one of the following:
- Head or brain injury
- Genetic factors
- Birth injuries
- Structural abnormalities that developed during brain development
- Stroke or cerebrovascular disease
Because epilepsy is caused by abnormal activity in the brain, seizures can affect any process that is controlled by the brain in the location where the abnormal electrical activity occurs. This means the symptoms may be physical and cause involuntary movement of a part of the body or the entire body, or it could be psychological and may affect how a person thinks. Seizure signs and symptoms may include:
- Uncontrollable jerking movements
- Uncontrollable twitching
- Inappropriate repeated movements of one part of the body
- Repeated head nodding or rapid blinking
- Sudden falls, stumbling, or unusual clumsiness
- An episode of “staring” or appearing to be dazed
- Loss of consciousness or awareness
- Experiencing an unusual smell or taste
- Temporary confusion
- Psychic symptoms
- Short attention blackouts
- Mumbling or lack of response
- Memory gaps
- Brief change in feeling or a strange sensation
A seizure is a sudden, usually brief electrical event in the brain. Epilepsy is known as a spectrum condition because it includes a range of types of seizures. There are over 30 types of seizures, and some types are more severe than others. Seizures can last anywhere from a few seconds to several minutes depending on the type of seizure. How often a seizure occurs varies by person. Some people may only have a seizure every few months while some people have a seizure every few hours.
Seizures are very complex events that are primarily classified by where they begin in the brain and the level of awareness the person has during the seizure.
Where Seizures Begin
The four classifications for where seizures originate are based on whether the seizure affects one side of the brain (focal onset), both sides of the brain (generalized onset), if the seizure starts on one side of the brain but then spreads to both sides (focal to bilateral), or if the seizure location of origin is not known (unknown onset).
Focal Onset Seizures
Focal onset seizures occur in a specific area of the brain and may affect only one or two discreet functions. Focal onset seizures are further divided based on the person’s awareness.
- In focal aware seizures (also called simple partial seizures), the person remains awake and does not lose consciousness.
- In focal impaired seizures (also called complex partial seizures) the person’s awareness is impaired, and the may become unresponsive or lose consciousness. This type of seizure may last from a few seconds to up three minutes.
Focal onset seizures are also divided based on if and when physical movement or motor function is affected.
- Focal motor seizures happen when some type of physical movement occurs at the onset of the seizure. Examples of physical movement are muscle stiffening, twitching, or jerking.
- Focal non-motor seizures have sensation or emotional changes first, and physical changes may happen after.
- Sometimes a person may begin to feel symptoms before a seizure starts. Traditionally, a person experiencing these sensations is said to have epileptic auras. Often when a person experiences an aura they will know to take their medication because the occurrence of a seizure is imminent.
Generalized Onset Seizures
Generalized onset seizures occur when the abnormal electrical activity affects both sides of the brain or begins over the entire surface of the brain. This type of seizure tends to affect the entire body. Similar to focal seizures, generalized onset seizures are sub-divided based on whether physical changes occur during the seizure.
Generalized motor seizures are those that include:
- Tonic seizures which cause muscles to become stiff.
- Atonic seizures which cause a complete loss of muscle control. Individuals experiencing this type of seizure will suddenly drop.
- Clonic seizures are associated with rhythmic, jerking motions and may last up to seven minutes.
- Tonic-clonic seizures have characteristics of both tonic and clonic seizures where the individual experiences muscle stiffness, shaking, and will also lose consciousness.
Generalized non-motor seizures are those that involve brief changes in awareness and include:
- Absence seizures where a person stares off into space, or “blanks out” for short periods of time. These types of seizures may only last a few seconds.
Secondary Generalized Seizures
Secondary generalized seizures occur when abnormal electrical activity starts on one side of the brain as a partial seizure, but then spreads to both sides of the brain. As the seizure evolves the person loses consciousness.
There are many factors that can trigger a seizure in people with epilepsy, and different people may have different or unique triggers. Common factors that are known to trigger seizures include:
- Lack of sleep
- Missing or lapsed medication doses
- Emotional stress
- Fevers or illness
- Fluctuations in hormones such as during a woman’s menstrual cycle or pregnancy
- Consumption of alcohol
- Low blood sugar due to missed meals or physical activity
- Bright or flashing lights
Diagnosing epilepsy can be difficult and may take time. Many other conditions cause similar symptoms as those seen in patients with epilepsy. Your doctor or healthcare provider will ask you questions about your previous seizure experiences such as what happened before, during, or after them. It is important that you describe your seizures and what you were feeling as accurately as possible. If there were other people around at the time of the seizure, ask them to describe what happened. Their description will be very important especially if you do not remember having a seizure.
To help determine what type of epilepsy you may have, your doctor will do a neurological examination to test your motor abilities and mental function.
Your doctor may order an EEG to measure electrical activity in your brain. The EEG may be done either while you are awake or asleep. Your doctor may also order imaging tests such as an MRI or CT scan to look at the structure of your brain.
Sometimes the results of these tests will be normal, but normal test results do not mean the person does not have epilepsy.
At the Mount Auburn Hospital Epilepsy Clinic, our goal of treatment is “no seizures and no side effects”. Treatment for epilepsy is to control the seizures to improve the person’s function and quality of life and is based on the type, severity, and frequency of seizures. Not everyone who has epilepsy will require treatment, though.
Medication is the most common way of treating epileptic seizures, and different medications work better for certain types of seizures. Anti-epileptic drugs (AEDs) or anti-seizure drugs help about 7 out of 10 people who have epilepsy to control their seizures. There are almost 30 different AEDs available, and our team of healthcare experts thoroughly assess and evaluate patients to determine the most effective medication for you.
Finding the right medication that works best may mean having to try more than one. For some people, the side effects of certain medications may outweigh the medication’s benefit. If a person is experiencing too many side effects, their doctor may have them try one or more new medications to try to maximize the benefits and minimize the negative effects. If you are taking medication for seizures it is very important that you continue to take it as prescribed and talk to your doctor about any side effects that you are experiencing such as headaches, drowsiness, rash, or agitation.
Vagus Nerve Stimulation
If your seizures do not respond to several different medications, your doctor may suggest implanting a vagus nerve stimulation (VNS) device. This device is placed in the chest and has wires that connect to the vagus nerve on the left side of the neck. The stimulator sends signals through the vagus nerve to the brain to reduce the onset or frequency of seizures. Treatment with VNS is sometimes used in addition to medication, and is only used to reduce seizures in adults or children aged 12 years or older.
If you have partial onset epilepsy and have tried at least two medications but have not improved, your doctor may recommend a responsive neurostimulation (RNS) device. The RNS monitors the brain’s activity to detect and record specific brain activity that could lead to a seizure. When this type of activity is detected, the RNS device sends brief pulses of stimulation that disrupt the abnormal brain activity before a seizure occurs. This treatment is used only for people whose epilepsy is caused by abnormal brain activity in one or two very specific locations, or loci. The device is implanted under the scalp, and one or two wires are placed at the location of abnormal brain activity. This type of treatment is only used for people with epilepsy who are 18 years or older.
If you have tried medications for more than two years your seizures may be considered uncontrollable. Your doctor may recommend surgery to remove the part of your brain causing seizures if you have these types of uncontrollable seizures.
Some people with epilepsy, especially children, have improved greatly while eating a ketogenic diet which is very low in carbohydrates and high in fat. Eating this type of diet changes your body’s metabolism so that brain cells are less “excitable” but they are still able to communicate normally. If your doctor feels a ketogenic diet can help you he or she may have you work with a nutritionist.