SIMEDHealth

Epilepsy: Signs, Symptoms, and Treatment

Brain with lightning running through it with fact about how seizure medication does not help everyone with epilepsy graphic

For Epilepsy Awareness Month (November), we interviewed SIMED Neurologist Dr. Kraiyuth Vongxaiburana (Vong) to find out what epilepsy is and how it’s treated. But, to understand epilepsy, you must first be able to recognize the signs and symptoms of a seizure.

What is a Seizure?

A seizure is a surge of abnormal electrical discharges in the brain that disrupt normal brainwave patterns. Seizures can manifest in different ways, and Dr. Vong discussed two of them: a generalized seizure and a complex partial seizure.

Generalized Seizures

The most obvious manifestation is a surge of abnormal discharges throughout the brain. The patient loses consciousness and has a convulsion. They may become really stiff at first and draw their arms up. Then, they might begin to shake. The convulsion could end up lasting a minute or two. During that time, the person might lose control of their bladder or bite their tongue. To bystanders, the seizure should be obvious.

Complex Partial Seizure

This type of seizure is less obvious. The abnormal electrical activity is localized to one part of the brain and not generalized. The person might not have convulsions but might instead stare into space and have an oral or manual automatism. They might make repetitive movements with their mouth or hands, like fiddling with their clothes or the buttons on their clothing and smacking their lips.

What they’re doing might look semi-purposeful. Because their eyes are open, you might think they’re awake, but they don’t respond and aren’t actually aware of what’s happening. They might smell a smell that isn’t there or experience a rollercoaster sensation in their stomach. They might also feel a sense of déjà vu. If the seizure starts in one part of the brain and spreads to other parts, it can lead to a convulsion.

Epilepsy Infographic with seizure informationWhat is Epilepsy?

About 9 to 10 percent of people have a seizure in their lifetime which is about the same amount of people who are left handed, so it’s pretty common. But having a one-time seizure doesn’t diagnose epilepsy. Epilepsy is usually diagnosed if someone has more than one unprovoked seizure. Someone could also be diagnosed with epilepsy if they have one unprovoked seizure and have high risk for another, a brain tumor, or a brain abnormality.

Unprovoked seizures are not caused by external factors, like low sodium, meningitis, or alcohol withdrawal. If someone had multiple triggered seizures resulting from another factor, they would not be diagnosed with a seizure disorder or epilepsy. Dr. Vong estimates about 3% of people will be diagnosed with epilepsy at one point in their lifetime.

How is Epilepsy Diagnosed or Monitored?

When someone has a seizure, doctors look for a provoking factor. Doctors check for abnormalities in the bloodwork like low sodium and evidence of drugs as drug withdrawal could provoke a seizure.

The individual might get imaging done on their brain including an MRI or a CT scan that could indicate previous strokes or a brain tumor. An EEG, which is a test that monitors brainwaves, can indicate abnormal activity and discharges that would provoke a seizure. People might also get additional tests depending on their situation. Testing can indicate if a patient is at higher risk of having another seizure.

What are the Causes of Epilepsy?

Some forms of epilepsy are genetic and tend to run in families. Other times, people might have abnormalities in their brain or their brain can be formed differently.  Abnormal areas in the brain can initiate seizures, and temporal scarring can also trigger them. If patients had a stroke in the past, they have a greater risk of getting epilepsy.

How is Epilepsy Treated?

If a patient is diagnosed with epilepsy, they are put on antiepileptic or antiseizure medications. The medications decrease risk and prevent those individuals from having another seizure. About 60 to 65% of people on the medication can successfully control their seizures with the drugs; however, about 35% of people still have seizures despite taking the antiepileptic drugs.

What if the Medication Does Not Work?

Patients who do not respond to the drug have stubborn or intractable epilepsy. If someone has a seizure that isn’t controlled by medicine, they might have other forms of convulsions. For example, if the person has been under a lot of stress they might have a pseudoseizure, a convulsion that looks like a seizure but isn’t. Instead, the action is more of a psychological response to stress.

Determining whether or not the individual has a seizure is important because if they do not have a true seizure, they should not continue to take the seizure medication. Instead, they could see a psychologist who might help tease out the person’s stressors.

Another reason people adverse to the medication should be monitored is to indicate whether the seizures can be prevented with surgery. If you can see on the EEG that the seizure starts at the same place in the brain every time, the person might get seizure surgery which could cure them of their epilepsy. Most patients won’t need surgery and can be controlled with seizure medication, though.

What is the Difference Between a Stroke and a Seizure?

A stroke results from damage to the brain that blocks blood flow to the brain. In contrast, a seizure is an abnormal electrical event in the brain. Strokes can increase the risk of seizures and sometimes even cause seizures. Seizures can also mimic strokes. A specific type of seizure makes one side of the body weak.

What Age is Epilepsy Most Commonly Diagnosed At?

Epilepsy is diagnosed in all ages from infancy through adulthood. While the reasons people have seizures might differ, epilepsy can affect anybody.

Have you had a stroke, a seizure, or multiple seizures in the past? Speak with your primary care doctor or call SIMED Neurology in Gainesville at 352-224-2338 to get tested for epilepsy.

To schedule an appointment with Dr. Vong or another SIMED neurologist, call 352-374-2222 or request an appointment online.

 

Sleep Tips for a Better Night's Slumber

Woman sleeping peacefully in her bed while smiling

November is National Sleep Comfort Month, and sleep comfort has become more important than ever as many people today struggle with sleep related issues.

But how can you get a more restful sleep or recognize the signs of a sleep problem? We talked with SIMED Neurology and Sleep Center Dr. Kraiyuth Vongxaiburana (Vong) to find out everything you need to know to get a better night’s sleep!

How to Recognize if You Have a Sleeping Problem

A common symptom of most sleeping problem is waking up and not feeling refreshed or feeling tired. If you feel tired, something might have gone amiss while you slept. Not sleeping well could mean you have insomnia or other issues like sleep apnea.

Another indicator is if you have trouble falling asleep or wake up in the middle of the night and can’t get back to sleep. Sometimes, people might wake up often to use the restroom and think they have a urinary problem, but they really have sleep apnea. Snoring also might indicate that you have sleep apnea.

What is Sleep Apnea?

Sleep apnea is very common. More than 18 million people in the United States have sleep apnea. 

If you wake up and feel tired, if you snore loudly, or if your partner notices that you stop breathing at night or snore very loudly, you could have sleep apnea. Overweight people are more likely to have sleep apnea because when you’re overweight, your airway can relax and close, obstructing your breathing. The obstruction can cause you to snore loudly and stop breathing or not get a full breath of air.

When you have sleep apnea, your oxygen levels drop and you can wake up for short periods during the night without realizing. Waking up from sleep apnea can leave you unrefreshed in the morning and make your sleep fragmented. Even when you do get sleep, you might still feel lousy and like you haven’t slept. You can have trouble getting out of bed.

How Do You Diagnose and Treat Sleep Apnea?a man sleeping on a sofa with information about sleep apnea and the symptoms

You can participate in an overnight sleep study to find out if you have sleep apnea. SIMED performs overnight sleep studies which allow physicians to monitor your sleep patterns and determine your problem.

If you were diagnosed with sleep apnea, you might be prescribed a breathing machine called a CPAP. CPAPs have a mask that goes over your face and blows continuous air pressure into your airway to keep it open for more oxygen. Using a CPAP generally leads to decreased arousal, and people with sleep apnea feel more refreshed.

Why Should You Get Treated for Sleep Apnea?

Feeling more awake in the morning isn’t the only reason you should get treated. If left untreated, sleep apnea can lead to increased risk of high blood pressure, stroke, heart attack, and cardiac arrhythmias. Waking up throughout the night ramps up adrenaline and increases risk of many dangerous medical problems. It can even cause insomnia.

What is Insomnia?

Insomnia is another very common problem. About 30 to 40% of people have insomnia, and women tend to be more affected than men. Insomnia is when people have difficulty falling asleep or staying asleep.

People can have insomnia due to many different reasons. They might be uncomfortable or anxious and unable to sleep. Their circadian or sleep rhythm might be off. Patients might also have psychophysiological insomnia, meaning they are anxious about getting to sleep so they worry about sleeping and stare at the clock which makes sleeping even more difficult and creates a cycle where they’re more and more anxious and have increased difficulty sleeping. Breaking the cycle can be difficult, but working on good sleep hygiene can help.

10 Ways to Get a Better Night’s Sleep

If you have insomnia or trouble falling asleep, here are 10 tips for improving your sleep comfort.

1. If you have anxiety, write down everything that worries you. You don’t need to write everything down right before bedtime, but if you make a list a few hours earlier, you can get your worries out of your mind and into a journal.

2. Avoid stimulants like caffeine too close to bedtime. Don’t drink coffee or other caffeinated drinks past midafternoon.

3. Don’t constantly check the time. If you don’t fall asleep or have trouble falling asleep, after 30 minutes of trying, don’t stare at the clock. Instead, get up and do something calming for 10 minutes. For example, you could drink a glass of milk or read a book. Then try to go back to bed.

4. When in bed, try not to do other activities than sleep. If you’re working in bed or watching TV in bed, you train your mind to do other things than sleep in bed which can lead to your brain being more active at bed time.

infographic with 10 tips for a better night's sleep to help with sleeping problems

5. With smartphones, avoid screen time. You can easily answer your phone or check emails at night, but when you do, you train your mind to do other things at night besides sleeping and can end up resetting your sleep clock. The bright light can reset your circadian rhythm and make getting to sleep more difficult.

6. Avoid sunlight in the evenings. Especially in the summertime, try to get bright sunlight in the morning instead of the evening because it will make you feel more awake.

7. Exercise. Exercise in general has been shown to help people get to sleep and stay asleep. Some people find that exercising before bedtime can make sleeping more difficult, so exercise earlier in the day or whenever works best for you.

8. Set a good sleep schedule. Go to sleep at the same time every night and wake up at the same time every day. You should get 7 to 8 hours of sleep, and some people may even need 9 hours of sleep. Try not to take naps during the day to avoid throwing off your schedule. Create a good bedtime routine (like you might for your children) that includes turning off the TV, dimming the lights, and avoiding stimulation a couple of hours before bedtime. Some people might even take a warm bath.

9. In the bedroom, keep everything cool and comfortable. Keep the room as dark as possible, and keep noise to the minimum.

10. Use a mattress that works for you. Some people like more firm mattresses, and some people prefer softer mattresses. Experiment to find what works for you, and if you have sleep apnea, elevating the front of your bed can help because gravity won’t be working as much against you. If someone is sleeping flat, their airway can close. Sleeping on your side or elevating your bed can help open it. You can get a wedge to put under your mattress or get a mattress that elevates the head.

What about Sleep Aid Medications? Are They More Harmful or Helpful?

Over-the-Counter Medications

It’s okay to use sleep medications once in a while. A lot of over-the-counter antihistamines can help people get to sleep and feel better in the morning, but some can end up blocking acetylcholine which can affect memory. Older people should try to avoid antihistamine sleep medications and instead try medications containing melatonin. While some people can get addicted to sleep medications like Benadryl, most people won’t be addicted to over-the-counter medications.

Prescription Medications

Try to avoid prescription medications, specifically the addictive ones like ambien and restoril. For some, they are needed, but for others, the medication can work for a while, but when people get used to it, they build up a tolerance. Non-addictive medications like trazodone should be tried first to help with sleep before something with more potential tolerance for addiction.

Alternatives

If you use sleep aids, you can also practice good sleep hygiene and try out cognitive behavioral therapy with a therapist or psychologist. We can have difficulty sleeping because we’re anxious and set up a cycle where we worry about things which can make it more difficult to sleep. A psychologist would help tease out abnormal thoughts

Also, a psychologist could help people in a cycle of bad sleep realize getting a bad night’s sleep would not be the worst thing in the world. Those people might not worry so much about it and get a better night’s sleep.

 

If you have trouble sleeping, talk to your doctor about getting a sleep study done or contact SIMED’s sleep center at 352-224-2338. To schedule an appointment with Dr. Vong or another SIMED neurologist, call 352-374-2222 or request an appointment online.

 

 

Alzheimer's Dementia Resources and Health Tips

Older man plays a musical instrument called the accordion smiling with a statistic about dementia
You probably know someone with Alzheimer’s dementia. More than 5 million Americans live with Alzheimers, and many more people feel the effect as friends and family members of an individual with dementia.
November is Alzheimer’s Awareness Month, and we spoke with Dr. Anthony Ackerman, a practicing neurologist and sleep medicine physician at SIMED Neurology, to get the details on what people with Alzheimer’s can do to slow their memory loss and what resources they can use to get help.

Medications

The best medications to slow down memory loss are Aricept (Donepezil) and Namenda (Memantine). These medications have proven to work effectively in conjunction with each other. It’s important to make the distinction that Alzheimer’s medications don’t resolve the disease or  improve memory, but instead slow the decline.
While TV and magazine advertisements may offer alternative medications, Dr. Ackerman warns they may not have gone through as many well-designed studies and there may not be as much evidence supporting their benefits so users should be careful and discuss these alternatives with their physician.

Alzheimer's Infographic with tips for people with dementiaDiet

Diet is important for the brain, and Dr. Ackerman recommends the Mediterranean diet for almost everyone, but especially people with Alzheimer’s. 
The suggested guidelines for the diet, which was created by a team specifically to combat Alzheimer’s, include:
- Eating a green leafy vegetable and one other vegetable a day
- Snacking most days on nuts
- Eating beans every other day
- Eating poultry at least twice a week
- Eating fish at least once a week
- Drinking a glass of wine a day
- Eating berries at least twice a week
Foods that are unhealthy for the brain include: red meat, butter, stick margarine, cheese, pastries, sweets, and fried or fast food. These foods should be limited.

Exercise

Regular exercise is important for people with Alzheimer’s or people who have the potential to get Alzheimer’s. Exercise and a healthy diet ensure blood pressure and cholesterol are controlled and keep patients healthy. 

Sleep

Sleep is particularly important for cleaning up the debris and amyloid plaque in the brain of Alzheimer’s patients. Inefficient sleep or disruptive sleep can increase plaque buildup and Alzheimer’s symptoms. 
A leading cause for disruptive sleep is sleep apnea, so if you believe you might have sleep problems, getting tested and diagnosed is important. In a study done on people with sleep apnea, those who did not treat the apnea had greater plaque buildup compared to those who were treated. 
SIMED offers sleep testing for people who would like to get tested for sleep apnea, and Dr. Ackerman is one of our board certified sleep medicine specialists.

Keep the Brain Active

Activities like puzzles are good for people with Alzheimer’s. Crossword puzzles, Sudoku and similar activities can help maintain the neurologic pathways our brain uses to problem solve.
Alzheimer’s patients can benefit from playing games and being active with family and friends as well.
Playing musical instruments has also proven to be beneficial to people with memory loss. While Dr. Ackerman does not expect patients to learn a new instrument, patients who already play can benefit from practicing regularly.
Avoid passive activities like watching TV. 

Higher Education

Researchers have found that higher education protects the brain against dementia. People who have advanced degrees are less likely to get Alzheimer’s to the same extent as those without higher education.

Resources

ElderCare of Alachua County is a good resource for people with Alzheimer’s. They offer services that can help people over the age of 60 including a program called Al’z Place that provides care for people with Alzheimer’s disease five days a week.
The Alzheimer’s Association is another great place to look for resources on Alzheimer’s. On their website you can view the signs of Alzheimer’s and other important information about Alzheimer’s. 
Most people who have Alzheimer’s won’t notice the signs. Instead, family members or friends are more likely to recognize the changes. The Alzheimer’s Association is a good supplement to visiting a neurologist and a good resource for friends and families of patients with Alzheimer’s.
Dr. Ackerman also highly recommends the book “The 36 Hour Day” by Nancy Mace and Peter Rabins to care givers of people with dementia. The book includes information about research, different situations that can arise when taking care of people with dementia and plenty of other useful information.
 
If you or someone you know has Alzheimer’s, contact SIMED Neurology in Gainesville at 352-374-2222 or schedule an appointment online
You may also request an appointment online or call the number above to schedule an appointment with Dr. Ackerman. 
To see Dr. Ackerman or one of our sleep medicine specialists, call the SIMED Sleep Center at 352-224-2338.

National Sleep Awareness Week Reminds Us How Sleep is Important to Our Overall Health

National Sleep Awareness Week Reminds Us How Sleep is Important to Our Overall Health

Ask yourself the following questions:

  • Are you tired during the day, dozing off during a meeting, church or movie, while reading or watching TV, or when driving? 
  • Have you been told that you snore or have stopped breathing in your sleep?
  • Do you wake gasping or choking during sleep?
  • Do you have trouble staying asleep?
  • Do you wake up unrefreshed as opposed to wakening wide-eyed and bushy-tailed? 
  • Do you wake with a dry mouth, throat irritation or morning headache? 
  • Are you increasingly irritable, forgetful, depressed or anxious?
  • Have you been diagnosed with a hypertension, diabetes, thyroid disease, fibromyalgia, cardiac rhythm problem/atrial fibrillation, congestive heart failure, heart attack, stroke or early dementia?

If you answered yes to any of these questions, you may have obstructive sleep apnea.

What is sleep apnea?

Sleep apnea is a condition where your airway is blocked or partially blocked, causing interruptions in sleep, decreased oxygen to the heart and brain, and may contribute to the development of amyloid plaques in the brain. Amyloid plaques have been found in brains of individuals with Alzheimer-type dementia as well as other neurodegenerative disorders.  Left untreated, obstructive sleep apnea may lead to poor quality of life, contribute to diseases and even have dire consequences for your health, including hastening death. 

Individuals with chronic pain are often are treated with opiates (e.g., tramadol, hydrocodone, oxycodone or morphine); individuals with anxiety are often treated with benzodiazepines (e.g., alprazolam or clonazepam). These medications decrease the breathing drive and may lead to central sleep apnea.

Some individuals may have a combination of obstructive and central sleep apnea, called complex sleep apnea.  Other individuals, especially those who have heart failure, may have cycles of slowing down followed by speeding up in their breathing, which is known as periodic breathing.

How is sleep apnea diagnosed?

Sleep apnea is diagnosed with an overnight sleep study.  These can be done at home or in a sleep center. A center study is preferred because the monitoring can differentiate between the different types of sleep disorders.

A center sleep study consists of:

  • Electodes that are placed around the head to determine stages of sleep and around your eyes, nose and mouth (not to worry, no needles!) to measure breathing, mouth movements, and dream status
  • EKG (heart) monitor placed on your chest to monitor for abnormal heart rhythms,
  • Pulse oximetry to check for drops your oxygen levels,
  • Elastic bands around the chest and abdomen to determine when you are breathing, and finally
  • Electodes on the legs to monitor for leg movements

All of these connected wires which are bunched into a single connector that may be easily disconnected should you need to use the bathroom during the night.  Home studies are an option, but due to the fewer things being monitored are unable to tell the difference between obstructive, central or complex sleep apnea.  Home studies are also unable to identify other sleep disorders, such as periodic limb movements of sleep, nighttime teeth grinding (bruxism) or parasomnias (sleep talking, sleep walking, confusional arousals or REM sleep behavior disorder).

How is sleep apnea treated?

Fortunately, sleep apnea can be easily treated.  The most effective and most preferred method of treatment is positive airway pressure (CPAP or bilevel PAP) therapy.  This therapy consists of a mask that comfortably fits around the individual’s nose and/or mouth, providing the minimum air pressure necessary to keep the airway open, allowing air to reach the lungs and ultimately provide oxygen to the heart and brain.  For those who do not tolerate positive airway pressure therapy, there are alternatives, such has oral appliances that keeps the tongue and jaw forward; or surgical procedures, such implants to support the palate, uvulopalatopharygoplasty (UPPP) or electrical stimulators to keep the tongue from falling back and blocking the back of the throat. 

How can you get evaluated?

If you think that you, your spouse, family member or friend may have sleep apnea, talk to your primary care physician, who can refer you to SIMED Sleep Center for a formal sleep evaluation.  If your insurance does not require a referral and you would like to set up an appointment, you can call SIMED Sleep Center directly at (352) 224-2388 to set up your sleep evaluation.