- ALL RIGHT. I GUESS WE CAN GO
AHEAD AND START.

I WOULD LIKE TO WELCOME YOU ALL
TO THIS PATIENT CAREGIVER CALL,

TITLED "EPILEPSY
IN THE GERIATRIC POPULATION."

MY NAME IS SEAN GAMBLE, AND I'M

WITH THE--EMPLOYEE EDUCATION
SERVICES HERE IN ST. LOUIS.

AND I'M THE PROJECT MANAGER FOR
THESE SERIES OF CALLS.

ALL YOUR LINES ARE MUTED
AND WILL BE OPENED UP

AT THE END OF THE PRESENTATION
WHEN WE'RE READY FOR QUESTIONS.

BUT PLEASE LIMIT YOUR QUESTIONS
TO ONE OR TWO PER PERSON

TO ENSURE EVERYONE HAS A CHANCE
TO ASK ANYTHING THEY MAY NEED.

TO COMPLETE THE EVALUATION FOR
THIS PROGRAM,

PLEASE FOLLOW THE LINK FOUND
IN THE BROCHURE.

OR IF YOU DO NOT HAVE ACCESS
TO THE VA WEBSITE, YOU CAN

CONTACT ME AT
SEAN.GAMBLE@VA.GOV.

AND LET ME GO AHEAD AND WELCOME
OUR SPEAKER TODAY.

IT'S COLLETTE EVRARD.
IT'S ALL YOURS.

- THANK YOU, SEAN. HELLO,
EVERYONE.

I WOULD LIKE TO THANK YOU ALL
FOR CALLING IN TODAY

AND PARTICIPATING IN THIS AUDIO
CONFERENCE SERIES

SPONSORED BY THE VA.

I WORK AS A NURSE PRACTITIONER
AT THE EPILEPSY CENTER

AT THE PORTLAND, OREGON, VA.

AND IT IS MY PLEASURE TO TALK
TO YOU TODAY

ABOUT EPILEPSY AND THE GERIATRIC
POPULATION.

THIS IS SUCH AN IMPORTANT TOPIC,

AND I HOPE THAT YOU WILL FIND

THIS TALK HELPFUL
AND INFORMATIVE.

NOW, AS MANY OF YOU KNOW,
EPILEPSY SPARES NO GROUP.

ANYONE AT ANY AGE CAN DEVELOP
EPILEPSY.

IN FACT, IT IS ESTIMATED
THAT NEARLY 3 MILLION AMERICANS

AND 50 MILLION PEOPLE WORLDWIDE
HAVE EPILEPSY.

MANY PEOPLE ASSOCIATE
EPILEPSY WITH CHILDREN,

BUT THERE IS NOW EVIDENCE THAT
EPILEPSY STRIKES THE ELDERLY

MORE COMMON THAN ANY OTHER
AGE GROUP.

NOW, THERE ARE MANY CAUSES
AND RISK FACTORS

FOR DEVELOPING EPILEPSY,
BUT OFTEN THE CAUSE

CANNOT BE DETERMINED.

IN FACT, OVER HALF OF THE TIME,
THE CAUSE REMAINS UNKNOWN.

ONE OF OUR OBJECTIVES TODAY
WILL BE TO EXPLORE

SOME OF THE COMMON KNOWN
RISK FACTORS FOR DEVELOPING

EPILEPSY IN THE OLDER
POPULATION.

NOW, DIAGNOSING EPILEPSY
IN THE OLDER PATIENTS

CAN BE CHALLENGING BECAUSE OFTEN
GERIATRIC PATIENTS HAVE

OTHER CONDITIONS
THAT MAY RESEMBLE SEIZURES.

OUR SECOND OBJECTIVE TODAY
WILL BE TO EXPLORE

SOME OF THE COMMON CONDITIONS
THAT MIGHT MIMIC SEIZURES

IN THE GERIATRIC PATIENTS
AND MAKE DIAGNOSING

MORE COMPLICATED.

OUR THIRD AND FINAL OBJECTIVE
WILL BE TO REDUCE

SOME OF THE COMMON CONCERNS AND
CHALLENGES FACED

BY THE GERIATRIC PATIENT
WITH EPILEPSY.

SO JUST WHO IS CONSIDERED
A GERIATRIC PATIENT?

GENERALLY THOSE 65 YEARS
AND OLDER ARE

CONSIDERED GERIATRIC.

IT IS COMMON, THOUGH, TO DIVIDE
THE GERIATRIC POPULATION

INTO SUBGROUPS.

THE YOUNG OLD ARE THOSE AGED
65 TO 74;

THE MIDDLE OLD ARE THOSE AGED
75 TO 84;

AND THE OLD OLD ARE THOSE AGED
85 AND OLDER.

AS WE ALL KNOW, FOLKS OVER THE
AGE OF 65 HAVE VARYING DEGREES

OF DISABILITY AND ILLNESS.

WHILE SOME HAVE
NO PROBLEMS AT ALL,

OTHERS MAY HAVE MANY SERIOUS
HEALTH CONCERNS.

BECAUSE THE GERIATRIC PATIENT
MAY REACT TO ILLNESS AND DISEASE

DIFFERENTLY THAN THE YOUNGER
PATIENT, SPECIAL CONSIDERATIONS

DO NEED TO BE MADE WITH
THEIR EVALUATION AND TREATMENT.

NOW, THE POPULATION OF THOSE
65 AND OLDER IN THE U.S. IS

CONSIDERABLE, AND IT
IS EXPECTED TO GROW.

ACCORDING TO THE U.S. CENSUS
BUREAU,

THERE ARE ALMOST 40 MILLION
PEOPLE AGED 65 AND OVER

IN THE UNITED STATES.

THE CURRENT U.S. POPULATION
IS JUST OVER 311 MILLION.

SO THE NUMBER OF FOLKS AGED
65 AND OLDER IN THE U.S.

MAKES UP ABOUT 13% OF
THE POPULATION.

THAT'S AN IMPRESSIVE PERCENTAGE,

AND THIS NUMBER IS EXPECTED
TO GROW DRAMATICALLY.

THE U.S. CENSUS BUREAU ALSO
PREDICTS THAT BY 2030,

THERE WILL BE MORE
THAN 72 MILLION INDIVIDUALS

65 AND OLDER.

THIS WOULD BE ABOUT 19% OF
THE POPULATION.

AND, REMARKABLY,
THOSE 85 AND OLDER CONSTITUTE

THE FASTEST-GROWING SEGMENT
OF THE POPULATION.

AND WHAT ABOUT VETERANS?

WELL, COMPARED TO THE 13%
OF THE POPULATION, ABOUT 37%

OF THE CURRENT VETERAN
POPULATION IS 65 YEARS OLD

OR OLDER.

THERE ARE APPROXIMATELY
9.5 MILLION VETERANS

THAT ARE IN THIS AGE GROUP.

SO HOW COMMON IS EPILEPSY
IN THIS GROWING POPULATION

AND WHAT ARE THE USUAL CAUSES
OR RISK FACTORS?

WELL, ACCORDING TO THE EPILEPSY
FOUNDATION--

AND THIS IS A GREAT WEBSITE,
BY THE WAY. IT'S...

www.epilepsyfoundation.org--

MORE THAN 570,000 ADULTS
AGED 65 AND ABOVE HAVE EPILEPSY.

EPILEPSY AFFECTS ABOUT 1% OF
THE POPULATION,

BUT BY 75 YEARS OF AGE,
3% OF THAT POPULATION

CAN BE EXPECTED
TO CARRY THE DIAGNOSIS.

EPILEPSY IS THE THIRD MOST
COMMON NEUROLOGICAL DISORDER

IN THE UNITED STATES AFTER
ALZHEIMER'S DISEASE AND STROKE.

THE OCCURRENCE OF EPILEPSY IS
GREATER THAN CEREBRAL PALSY,

MULTIPLE SCLEROSIS, AND
PARKINSON'S DISEASE COMBINED.

IT'S FRUSTRATING THAT DESPITE
HOW COMMON EPILEPSY IS

AND THE WONDERFUL ADVANCES IN
DIAGNOSING AND TREATMENT,

EPILEPSY CONTINUES TO BE

ONE OF THE LEAST UNDERSTOOD
CHRONIC MEDICAL CONDITIONS.

NOW, BEFORE WE BEGIN DISCUSSING
CAUSES, I WOULD LIKE TO BRIEFLY

CLARIFY THE DIFFERENCE BETWEEN
HAVING A SEIZURE

AND BEING DIAGNOSED WITH
EPILEPSY.

NOW, AS MANY OF YOU KNOW,

THE BRAIN HAS CONSTANT
ELECTRICAL ACTIVITY

JUST AS THE HEART DOES.

A SEIZURE IS A SUDDEN SURGE
OF ELECTRICAL ACTIVITY

IN THE BRAIN.

IT USUALLY AFFECTS HOW
AN INDIVIDUAL FEELS OR ACTS

FOR A BRIEF PERIOD OF TIME.

IT'S IMPORTANT TO REMEMBER
THAT SEIZURES ARE NOT A DISEASE

IN THEMSELVES.

INSTEAD THINK OF THEM
AS A SYMPTOM

OF MANY DIFFERENT DISORDERS
THAT COULD AFFECT THE BRAIN.

ISOLATED SEIZURES CAN BE CAUSED
BY ANY CONDITION

THAT AFFECTS BRAIN FUNCTION.

THESE CONDITIONS COULD INCLUDE
DISTURBANCE IN YOUR BLOOD SUGAR,

DISTURBANCE
IN YOUR ELECTROLYTES.

FOR EXAMPLE
A REALLY LOW SODIUM.

DRUG OR ALCOHOL INTOXICATION
OR WITHDRAWAL IS

ALSO A MAJOR CAUSE OF ISOLATED
SEIZURES.

MANY METABOLIC CONDITIONS BECOME
MORE COMMON WITH AGING

AS DOES THE USE OF MULTIPLE
PRESCRIPTION MEDICATIONS.

IT IS IMPORTANT TO REMEMBER
THAT SEIZURES

CAN VARY DRAMATICALLY.

ONE INDIVIDUAL MAY HAVE
A SEIZURE THAT IS BARELY NOTICED

BY THOSE IN THE SAME ROOM

WHILE OTHERS HAVE SEIZURES
THAT ARE COMPLETELY DISABLING

WITH A LOSS OF CONSCIOUSNESS
AND CONVULSIONS.

ANOTHER IMPORTANT POINT IS THAT
HAVING A SEIZURE

DOES NOT NECESSARILY MEAN
THAT A PERSON HAS EPILEPSY.

EPILEPSY IS A CHRONIC NEUROLOGIC
CONDITION MANIFESTED

BY REPEATED UNPROVOKED SEIZURES.

MORE SIMPLY PUT, EPILEPSY IS
THE NAME GIVEN TO SEIZURES

THAT OCCUR MORE THAN ONCE

BECAUSE OF AN UNDERLYING
CONDITION IN THE BRAIN.

NOW, EPILEPSY IS USUALLY
DIAGNOSED

AFTER AN INDIVIDUAL HAS HAD
AT LEAST TWO SEIZURES

THAT WERE NOT CAUSED BY
A KNOWN MEDICAL CONDITION

SUCH AS ALCOHOL WITHDRAWAL
OR LOW BLOOD SUGAR.

REMEMBER, ANYONE AT ANY AGE
CAN HAVE A SEIZURE

IF THE BRAIN IS STRESSED
SUFFICIENTLY.

10% OF THE AMERICAN POPULATION
WILL EXPERIENCE A SEIZURE

IN THEIR LIFETIME, BUT ONLY
ABOUT 1% WILL GO ON TO BE

DIAGNOSED WITH EPILEPSY.

NOW, SOMETIMES EPILEPSY
CAN BE DIAGNOSED

AFTER JUST ONE SEIZURE
IF THE INDIVIDUAL HAS

A KNOWN CONDITION THAT
PLACES THEM AT RISK FOR HAVING

FUTURE SEIZURES.

OF THE MANY KNOWN RISK FACTORS,
OR CAUSES, FOR EPILEPSY,

STROKE, DEMENTIA, AND TUMOR ARE
TOP CONTENDERS IN THE ELDERLY.

IT ALSO APPEARS THAT THE AGING
PROCESS IN ITSELF IS

A RISK FACTOR FOR DEVELOPING
EPILEPSY.

IT IS WELL-ESTABLISHED THAT
CEREBROVASCULAR DISEASE IS

THE MOST COMMON DOCUMENTED CAUSE
OF SEIZURES IN THE ELDERLY.

AND AS THE POPULATION AGES,
IT WILL ACCOUNT

FOR AN INCREASINGLY HIGH PERCENT
OF TOTAL CASES OF SEIZURES

AND EPILEPSY.

CEREBROVASCULAR REFERS
TO BLOOD FLOW WITHIN THE BRAIN.

AND CEREBROVASCULAR DISEASE
INCLUDES ALL DISORDERS

IN WHICH AN AREA OF THE BRAIN
IS TEMPORARILY OR PERMANENTLY

AFFECTED BY BLEEDING
OR LACK OF BLOOD FLOW.

CEREBROVASCULAR DISEASE
INCLUDES STROKE,

CAROTID STENOSIS, ANEURYSMS,
AND VASCULAR MALFORMATION.

THERE ARE MANY WAYS IT CAN
RESULT IN SEIZURES OR EPILEPSY.

THE MOST COMMON IS STROKE.

ABOUT 795,000 AMERICANS
EACH YEAR SUFFER A NEW

OR RECURRENT STROKE.

THAT MEANS ON AVERAGE A STROKE
OCCURS ABOUT EVERY 40 SECONDS.

IT IS ESTIMATED THAT PREVIOUS
STROKES ACCOUNT

FOR UP TO 40%
OF ALL EPILEPTIC SEIZURES

IN THE ELDERLY POPULATION.

AND THOSE WHO SUFFER
A HEMORRHAGIC STROKE HAVE

TWICE THE RISK OF SEIZURES
AS COMPARED TO THOSE

WHO SUFFER
AN ISCHEMIC STROKE.

SOME OF YOU MAY WONDER
WHAT THE DIFFERENCE

BETWEEN AN ISCHEMIC STROKE
AND A HEMORRHAGIC STROKE IS.

WELL, AN ISCHEMIC STROKE OCCURS
AS THE RESULT

OF AN OBSTRUCTION OR A CLOT
WITHIN A BLOOD VESSEL

SUPPLYING BLOOD TO THE BRAIN.

IT IS THE MOST COMMON TYPE
OF STROKE.

THE STROKE ASSOCIATION REPORTS
THAT IT ACCOUNTS FOR 87%

OF ALL STROKE CASES.

THE UNDERLYING CONDITION FOR
OBSTRUCTION OR CLOTS TO OCCUR

IN A BLOOD VESSEL IS THE
DEVELOPMENT OF FATTY DEPOSITS

LINING THE VESSEL WALLS.

THIS CONDITION, AS MANY
OF YOU KNOW, IS CALLED

ARTERIOSCLEROSIS.

SO WHAT HAPPENS WHEN THE BLOOD
TO AN AREA OF THE BRAIN

IS OBSTRUCTED?

WELL, BRAIN CELLS ARE DAMAGED
AND DESTROYED.

IT IS THIS DAMAGED AREA
THAT POTENTIALLY BECOMES

A SOURCE OF FUTURE SEIZURES.

HEMORRHAGIC STROKE IS
FAR LESS COMMON.

IT ACCOUNTS FOR ABOUT 13% OF
STROKE CASES.

A HEMORRHAGIC STROKE RESULTS
FROM A WEAKENED VESSEL

THAT RUPTURES AND BLEEDS
INTO THE SURROUNDING BRAIN.

THE BLOOD ACCUMULATES
AND COMPRESSES

THE SURROUNDING BRAIN TISSUE.

THE TWO TYPES OF WEAKENED BLOOD
VESSELS THAT USUALLY CAUSE

HEMORRHAGIC STROKE ARE ANEURYSMS
AND ARTERIOVENOUS MALFORMATION,

MORE COMMONLY CALLED AVM.

AN ANEURYSM IS THE BALLOONING OF
A WEAKENED AREA

OF A BLOOD VESSEL.

IF LEFT UNTREATED, THE ANEURYSM
CONTINUES TO WEAKEN

UNTIL IT RUPTURES AND BLEEDS
INTO THE BRAIN.

AN ARTERIOVENOUS MALFORMATION,
OR AVM, IS A CLUSTER

OF ABNORMALLY FORMED
BLOOD CELLS.

ANY ONE OF THESE VESSELS CAN
RUPTURE, ALSO CAUSING BLEEDING

INTO THE BRAIN.

ALTHOUGH HEMORRHAGIC STROKE IS

LESS COMMON
THAN ISCHEMIC STROKE,

AN INDIVIDUAL WHO SUFFERS
HEMORRHAGIC STROKE IS

MORE LIKELY TO SUFFER SEIZURES.

IF SEIZURES OCCUR WITHIN A WEEK
OF THE STROKE,

THEN IT IS CALLED
AN ACUTE SYMPTOMATIC SEIZURE

AND OFTEN IS NOT
DIAGNOSED AS BEING EPILEPSY.

IF A SEIZURE OCCURS MORE
THAN A WEEK AFTER A STROKE

AND IF THERE IS MORE THAN ONE,
THERE IS A STRONGER CASE

FOR A DIAGNOSIS OF EPILEPSY.

NOW, THERE IS SO MUCH MORE
INFORMATION THAT WE COULD REVIEW

CONCERNING STROKE
AND CEREBROVASCULAR DISEASE.

WE COULD SPEND A WHOLE HOUR
JUST ON THIS TOPIC ALONE.

BEFORE WE MOVE ON, THOUGH,
I WOULD LIKE TO REVIEW

THE WARNING SIGNS OF STROKE.

SUDDEN NUMBNESS OR WEAKNESS
OF THE ARMS, FACE, OR LEGS,

ESPECIALLY ON ONE SIDE
OF THE BODY;

SUDDEN CONFUSION, TROUBLE
SPEAKING OR UNDERSTANDING;

SUDDEN TROUBLE SEEING
IN ONE OR BOTH EYES;

SUDDEN TROUBLE WALKING,
DIZZINESS, OR LOSS OF BALANCE;

SUDDEN SEVERE HEADACHES
WITH NO KNOWN CAUSE.

I WOULD ALSO LIKE TO GIVE YOU
ANOTHER EXCELLENT WEBSITE.

AND MUCH OF THE INFORMATION
ABOUT STROKE

THAT I JUST GAVE YOU CAN BE
FOUND THERE.

IT IS THE STROKE ASSOCIATION,
AND THE WEBSITE IS

www.strokeassociation.org.

IT REALLY LAYS INFORMATION OUT
IN A CONCISE

AND EASY TO UNDERSTAND FORMAT.

I AM NOW GOING TO CHANGE GEARS
A BIT AND TALK

ABOUT DEMENTIA AND EPILEPSY.

EPILEPTIC SEIZURES ARE KNOWN TO
OCCUR MORE FREQUENTLY

IN PATIENTS WITH DEMENTIA

THAN AMONG HEALTHY
ELDERLY INDIVIDUALS.

DEMENTIA IS THE NAME FOR
A GROUP OF BRAIN CONDITIONS

THAT MAKE IT HARDER TO REMEMBER,
REASON, AND COMMUNICATE.

THE MOST COMMON FORM OF DISEASE
IS ALZHEIMER'S DISEASE.

THERE ARE OTHER TYPES
OF DEMENTIA, INCLUDING

VASCULAR DEMENTIA,
FRONTOTEMPORAL DEMENTIA,

AND LEWY BODY DEMENTIA.

YEARS AGO, SOMEONE WITH DEMENTIA
MIGHT HAVE BEEN REFERRED TO

AS SOMEONE WHO WAS SENILE.

AND IT WAS COMMONLY THOUGHT
TO BE A NORMAL PART OF AGING.

BUT WE NOW KNOW THAT DEMENTIA IS
NOT NORMAL.

DEMENTIA IS CAUSED BY ONGOING
DAMAGE TO CELLS IN THE BRAIN.

NOW, THERE IS NO SINGLE TEST
THAT DETECTS DEMENTIA.

TYPICALLY, THE DIAGNOSIS IS
BASED ON MULTIPLE FACTORS.

THESE USUALLY INCLUDE
THE INDIVIDUAL'S SYMPTOMS,

MEDICAL HISTORY, AND THE RESULTS
OF COGNITIVE TESTS.

THESE ARE TESTS THAT MEASURE
MEMORY, LANGUAGE,

AND OTHER ABILITIES.

NOW, BLOOD TESTS ARE DONE TO
HELP RULE OUT OTHER PROBLEMS

AND ALSO BRAIN IMAGING TESTS
SUCH AS AN MRI

OR A CAT SCAN MAY BE PERFORMED.

AS I STATED BEFORE, ALZHEIMER'S
DISEASE IS THE MOST COMMON FORM

OF DEMENTIA.

IT IS ESTIMATED THAT ABOUT
5 MILLION PEOPLE HAVE

ALZHEIMER'S DISEASE
IN THE UNITED STATES.

ALZHEIMER'S DISEASE TYPICALLY
PROGRESSES SLOWLY.

DURING ITS PROGRESSION,

THERE IS A PROTEIN CALLED
BETA-AMYLOID

THAT GRADUALLY ACCUMULATES
IN THE BRAIN.

THIS PROTEIN FORMS A PLAQUE,

AND IT IS THOUGHT THAT
THIS PLAQUE CAUSES NERVE DAMAGE

IN THE BRAIN.

NOW, THIS CHANGES OUR THOUGHTS
AND LEADS TO THE DECLINE

OF MEMORY AND MOTOR FUNCTION.

AND IT'S ALSO PRESUMED THAT
THESE CHANGES LEAD

TO AN INCREASED RISK OF
RECURRING SEIZURES.

CERTAINLY, NOT EVERYONE
WITH ALZHEIMER'S DISEASE

OR ANOTHER TYPE OF DEMENTIA
WILL EXPERIENCE A SEIZURE.

BUT IT DOES PLACE THEM
AT A HIGHER RISK.

ANOTHER RISK FACTOR FOR
DEVELOPING EPILEPTIC SEIZURES

IN THE ELDERLY IS BRAIN TUMOR.

A BRAIN TUMOR IS A COLLECTION
OF DAMAGED CELLS THAT MULTIPLY

OUT OF CONTROL WITHIN THE BRAIN.

BRAIN TUMORS ARE SOMETIMES
REFERRED TO AS A NEOPLASM,

GROWTH, MASS, OR A LESION.

A BRAIN TUMOR CAN BE CLASSIFIED
AS EITHER PRIMARY OR SECONDARY.

A SECONDARY TUMOR IS SOMETIMES
REFERRED TO AS METASTATIC.

PRIMARY BRAIN TUMORS DEVELOP
IN THE BRAIN AND GENERALLY

REMAIN THERE

WHILE SECONDARY BRAIN TUMORS
ARE CANCERS THAT DEVELOP

SOMEWHERE ELSE IN THE BODY
AND LATER SPREAD TO THE BRAIN.

THE MOST COMMON CANCERS
THAT SPREAD TO THE BRAIN ARE

LUNG AND BREAST CANCERS.

A BRAIN TUMOR CAN BE BENIGN
OR MALIGNANT.

MALIGNANT BRAIN TUMORS
GROW RAPIDLY AND INVADE

OTHER CELLS.

BENIGN BRAIN TUMORS GENERALLY
DO NOT GROW SO RAPIDLY.

HOWEVER, EVEN BENIGN TUMORS CAN
CAUSE SEIZURES

AND SOMETIMES EVEN
BE LIFE THREATENING.

SO HOW DO BRAIN TUMORS CAUSE
SEIZURES?

WELL, A BRAIN TUMOR TAKES UP
SPACE WITHIN THE SKULL

THAT CAN INTERFERE
WITH NORMAL BRAIN ACTIVITY.

IT CAN INCREASE PRESSURE
IN THE BRAIN, SHIFT THE BRAIN,

PUSH THE BRAIN AGAINST
THE SKULL.

AND IT CAN INVADE AND DAMAGE
NERVES AND HEALTHY BRAIN TISSUE.

THE LOCATION OF A BRAIN TUMOR
WILL INFLUENCE

THE TYPE OF SYMPTOMS THAT OCCUR.

THE AMERICAN BRAIN TUMOR
ASSOCIATION STATES

THAT BETWEEN 25 TO 40% OF PEOPLE
DIAGNOSED WITH A BRAIN TUMOR

WILL HAVE A SEIZURE AT SOME
POINT DURING THEIR ILLNESS.

NOW, WHO GOES ON TO HAVE
RECURRING SEIZURES DEPENDS

ON THE TYPE, SIZE, LOCATION,
AND TREATMENT OF THE TUMOR.

SO THE OUTCOME CAN VARY
DRAMATICALLY

FROM INDIVIDUAL TO INDIVIDUAL.

NOW, SOMETIMES SEIZURES
WILL OCCUR AFTER BRAIN SURGERY

EITHER FOR TUMOR REMOVAL
OR FOR ANOTHER REASON.

THESE SEIZURES MAY OCCUR SOON
AFTER THE SURGERY,

OR THEY MAY OCCUR

MONTHS OR EVEN YEARS AFTER
THE SURGERY HAS BEEN DONE.

AND THIS IS A REALLY IMPORTANT
DISTINCTION TO MAKE:

IF THE SEIZURE OCCURS
IMMEDIATELY AFTER THE SURGERY,

IT WOULD BE CONSIDERED
A PROVOKED SEIZURE.

BUT IF A PATIENT CONTINUES
TO HAVE SEIZURES

LONG AFTER THE SURGERY
HAS TAKEN PLACE,

THE SEIZURES ARE CONSIDERED
UNPROVOKED,

AND THE PATIENT WILL LIKELY BE
GIVEN THE DIAGNOSIS OF EPILEPSY.

THE BRAIN OF A PERSON WHO HAS
HAD BRAIN SURGERY CAN HAVE

ABNORMAL NERVE CONNECTIONS MADE.

THESE NEW IRREGULAR CONNECTIONS
ARE THOUGHT TO BE THE CAUSE

OF A SEIZURE.

NOW, THERE ARE MANY OTHER
CAUSES, OR RISK FACTORS,

FOR EPILEPSY.

TRAUMATIC BRAIN INJURY

AND CERTAIN INFECTIONS,
SUCH AS MENINGITIS,

CAN ALSO BE MAJOR RISK FACTORS
FOR DEVELOPING EPILEPSY.

FOR SOME,
IT RUNS IN THEIR FAMILY.

BUT EPILEPSY THAT IS THOUGHT
TO STEM FROM A GENETIC INFLUENCE

IS USUALLY DIAGNOSED AT
A YOUNGER AGE.

AND AS I STATED EARLIER,
FOR MANY,

THE DEVELOPMENT OF EPILEPSY
REMAINS A MYSTERY.

NOW, SOME INDIVIDUALS HAVE NO
KNOWN RISK FACTORS FOR EPILEPSY,

YET BEGIN HAVING SEIZURES
FOR NO APPARENT REASON.

NOW, LET'S LOOK AT SOME OF
THE CHALLENGES

INVOLVED IN DIAGNOSING EPILEPSY
IN THE ELDERLY.

THE VETERANS ADMINISTRATION
COOPERATIVE STUDY GROUP

COMPLETED A LARGE
MULTI-CENTER STUDY IN 2004

THAT LOOKED AT TREATMENT OF
EPILEPSY IN VETERANS

AGED 60 OR OLDER, WITH
NEW-ONSET PARTIAL SEIZURES.

BASED ON THE RESULTS
OF THE STUDY,

THE RESEARCHERS CONCLUDED THAT
THERE IS A SIGNIFICANT DELAY

IN THE TREATMENT OF EPILEPSY
IN THE ELDERLY.

THIS STUDY FOUND
THAT ONLY 24% OF PATIENTS

WERE INITIALLY DIAGNOSED WITH
EPILEPSY WHEN THEY PRESENTED

TO THEIR HEALTH CARE PROVIDER.

THEY ALSO FOUND THAT
IT TOOK AN AVERAGE OF 19 MONTHS

FROM THE TIME SEIZURES BEGAN

TO THE TIME EPILEPSY WAS
DIAGNOSED.

ONCE DIAGNOSED AND TREATMENT
STARTED, EPILEPSY IN THE ELDERLY

WAS FOUND TO BE EASIER
TO CONTROL

WHEN COMPARED TO EPILEPSY
THAT BEGINS AT A YOUNGER AGE.

SO WHY IS IT SUCH A CHALLENGE
TO DIAGNOSE EPILEPSY

IN THE OLDER PATIENTS?

ONE VERY IMPORTANT FACTOR
IS THAT EPILEPSY OFTEN EXPRESSES

ITSELF DIFFERENTLY IN
THE GERIATRIC POPULATION.

SO IT'S MORE FREQUENTLY MISSED
OR MISDIAGNOSED.

THE APPEARANCE OF EPILEPSY
IN THE ELDERLY IS

OFTEN QUITE DIFFERENT THAN
IN YOUNGER ADULTS AND CHILDREN.

WHEN MANY PEOPLE THINK
OF EPILEPSY, THEY THINK

OF A DRAMATIC GENERALIZED
TONIC-CLONIC SEIZURE,

OR WHAT MANY CALL A GRAND MAL
SEIZURE.

BUT THE SYMPTOMS OF SEIZURES
IN OLDER PATIENTS ARE

OFTEN SUBTLE AND REALLY CAN BE
EASILY MISSED.

IN YOUNGER ADULTS AND CHILDREN
WITH EPILEPSY, ABOUT 60% PRESENT

WITH GENERALIZED
TONIC-CLONIC SEIZURES.

BUT ONLY ABOUT 30% OF OLDER
INDIVIDUALS WITH EPILEPSY HAVE

THESE TYPES OF SEIZURES.

THE MOST COMMON TYPE OF SEIZURE
IN THE ELDERLY PATIENT

WITH EPILEPSY IS CALLED
A COMPLEX PARTIAL SEIZURE,

OR A FOCAL SEIZURE.

I WOULD LIKE TO SPEND JUST
A FEW MINUTES EXPLAINING

THE DIFFERENCE BETWEEN THESE
TWO TYPES OF SEIZURES.

NOW, THERE ARE MANY TYPES OF
SEIZURES.

AND NEUROLOGISTS THAT SPECIALIZE
IN EPILEPSY ARE CONTINUING

TO UPDATE THEIR THINKING

ABOUT HOW TO CLASSIFY
THE VARIOUS TYPES.

TYPICALLY, SEIZURES ARE
CLASSIFIED INTO TWO CATEGORIES--

PARTIAL OR FOCAL SEIZURES

AND PRIMARY
GENERALIZED SEIZURES.

THE DIFFERENCE BETWEEN THESE
TWO TYPES IS HOW THEY BEGIN.

PRIMARY GENERALIZED SEIZURES
INVOLVE THE WHOLE BRAIN

AND THEREFORE INVOLVE
THE WHOLE BODY.

HEREDITARY, OR GENETIC, FACTORS
ARE IMPORTANT

WITH PRIMARY
GENERALIZED SEIZURES.

AND DIAGNOSIS IS USUALLY MADE
AT A YOUNGER AGE.

NOW, THERE ARE MANY TYPES
OF GENERALIZED SEIZURES.

SOME ARE CONVULSIVE, AND
OTHERS ARE NON-CONVULSIVE.

THE OLDER PATIENTS WITH A NEW
DIAGNOSIS OF EPILEPSY

PRESENT WITH WHAT WE CALL
COMPLEX PARTIAL SEIZURES.

PARTIAL, OR FOCAL, SEIZURES
START IN ONE PART OF THE BRAIN.

THAT IS, THE FOCAL POINT
OF THE BRAIN.

AND AFFECTS THAT PART OF
THE BODY CONTROLLED

BY THAT PART OF THE BRAIN.

THIS TYPE OF SEIZURE IS OFTEN
RELATED TO A STROKE, TUMOR,

OR A HEAD INJURY.

MORE OFTEN, THE CAUSE
IS UNKNOWN.

A SIMPLE PARTIAL SEIZURES
IS AN EXAMPLE

OF A TYPE OF FOCAL SEIZURE
IN WHICH

THERE'S NO ALTERATION
IN CONSCIOUSNESS.

THE SYMPTOMS OF THE PERSON
EXPERIENCING

SIMPLE PARTIAL SEIZURES
WILL DEPEND ON THE FUNCTION

THAT PART OF THE BRAIN CONTROLS.

THE SEIZURE MAY INVOLVE FEELINGS
OF DEJA VU,

AND PROBLEMS, LIKE,
WITH SMELL OR TASTE

OR SENSATIONS IN THE STOMACH,
SUCH AS BUTTERFLIES OR NAUSEA.

PATIENTS OFTEN REFER TO THIS
AS THEIR "AURA."

THE PERSON REMAINS ALERT

THROUGHOUT A SIMPLE PARTIAL
SEIZURE

AND CAN REMEMBER WHAT HAPPENED.

THIS TYPE OF SEIZURE USUALLY
LASTS A SECOND TO A MINUTE.

A SIMPLE PARTIAL SEIZURE
CAN PROGRESS

TO A COMPLEX
PARTIAL SEIZURE.

AGAIN, THESE ARE BOTH EXAMPLES
OF FOCAL SEIZURES

THAT BEGIN WITH
AN ELECTRICAL DISCHARGE

IN JUST ONE LIMITED AREA
OF THE BRAIN.

COMPLEX PARTIAL SEIZURES
ARE DIFFERENT

THAN SIMPLE PARTIAL SEIZURES

BECAUSE THEY DO ALTER
CONSCIOUSNESS.

THE PERSON EXPERIENCING
A COMPLEX PARTIAL SEIZURE

MAY APPEAR TO BE STARING OFF
INTO SPACE

OR CONFUSED AND DAZED
FOR A MINUTE OR TWO.

THEY MAY DO STRANGE
AND REPETITIVE THINGS

LIKE FIDDLING WITH THEIR CLOTHES
OR MAKING CHEWING MOVEMENTS

OR UTTERING UNUSUAL SOUNDS.

COMPLEX PARTIAL SEIZURES ARE
THE MOST COMMON SEIZURE TYPE

AFFECTING THE ELDERLY.

THE SEIZURE TYPICALLY LASTS FOR
JUST ONE OR TWO MINUTES,

BUT THE PERSON MAY BE CONFUSED
AND DROWSY

FOR MINUTES TO SEVERAL HOURS
AFTERWARDS

AND OFTEN WILL HAVE
NO MEMORY OF THE SEIZURE

OR THE EVENTS JUST BEFORE
OR AFTER.

WITH THE ELDERLY, THOUGH, THIS
POST-SEIZURE PERIOD OF CONFUSION

IS REALLY UNPREDICTABLE.

IT CAN LAST MUCH LONGER
THAN IN YOUNGER ADULTS.

NOW, PERIODS OF CONFUSION--
LAPSES IN MEMORY OR TIME

AND STARING OFF INTO SPACE--
ARE SOMETIMES ATTRIBUTED

TO AGING.

AND IF THE INDIVIDUAL ALREADY
CARRIES A DIAGNOSIS OF DEMENTIA,

THE LAPSE IN MEMORY OR TIME
THAT IS THE SEIZURE

MIGHT BE THOUGHT TO REPRESENT
WORSENING DEMENTIA.

NOW, SOMETIMES COMPLEX PARTIAL
SEIZURES CAN PROGRESS

TO WHAT IS CALLED A SECONDARILY
GENERALIZED SEIZURE.

SECONDARILY GENERALIZED SEIZURES
ARE REFERRED TO AS SECONDARY

BECAUSE THEY
ONLY BECOME GENERALIZED

AFTER THE PARTIAL SEIZURE
HAS BEGUN.

THESE OCCUR WHEN A BURST OF
ELECTRICAL ACTIVITY

IN A FOCAL AREA OF THE BRAIN
WHERE THE PARTIAL SEIZURE BEGAN

SPREADS THROUGHOUT
THE ENTIRE BRAIN.

THE GENERALIZED CONVULSIVE STAGE
OF THESE SEIZURES USUALLY LASTS

ABOUT ONE TO TWO MINUTES,

SIMILAR TO
A PRIMARY GENERALIZED SEIZURE.

REMEMBER, WITH SECONDARILY
GENERALIZED SEIZURES,

THERE'S A LOSS OF CONSCIOUSNESS.

AND SOMETIMES THE PARTIAL
SEIZURE SPREADS SO FAST

THAT THE INDIVIDUAL
HAS NO WARNING.

AND THERE APPEARS TO BE THIS
SUDDEN LOSS OF CONSCIOUSNESS.

OFTEN THIS CAN HAPPEN WITH
OBVIOUS CONVULSIONS.

BUT SOMETIMES IT APPEARS
AS IF THE INDIVIDUAL

HAS JUST SIMPLY BLACKED OUT.

SO WHAT ELSE CAN LOOK LIKE THIS?

WHAT ELSE CAN CAUSE
A SUDDEN LOSS OF CONSCIOUSNESS?

WELL, A SUDDEN TEMPORARY LOSS
OF CONSCIOUSNESS FOLLOWED BY

A SPONTANEOUS RECOVERY
IS REFERRED TO AS SYNCOPE.

THIS IS A REALLY COMMON PROBLEM,
ESPECIALLY AMONG THE ELDERLY.

IN FACT, IT IS RESPONSIBLE
FOR ABOUT 740,000 VISITS

TO THE EMERGENCY DEPARTMENT
EACH YEAR IN THE UNITED STATES.

SYNCOPE IS NOT CONSIDERED
A DISEASE IN ITSELF,

BUT RATHER, IT'S A SYMPTOM
OF ONE OR MORE CONDITIONS.

IT ACCOUNTS FOR ABOUT 3% OF ALL
THE EMERGENCY DEPARTMENT VISITS

AND ABOUT 2 TO 6% OF
ALL HOSPITAL REMISSIONS

IN THE UNITED STATES EACH YEAR.

NOW, SYNCOPE CAN OCCUR
AT ANY AGE,

BUT IT'S MORE COMMONLY
SEEN IN TEENAGERS

AND PEOPLE 70 YEARS OF AGE
OR OLDER.

THOSE 80 AND OLDER ARE
3 TO 4 TIMES MORE LIKELY TO HAVE

A SYNCOPAL EVENT
THAN A YOUNGER ADULT.

NOW, TRYING TO IDENTIFY
THE SOURCE OF SYNCOPE IS

OFTEN REALLY DIFFICULT
BECAUSE THERE ARE

SO MANY POTENTIAL CAUSES.

WE MUST ALSO CONSIDER THE FACT
THAT MANY PEOPLE WILL HAVE

MULTIPLE POTENTIAL CAUSES FOR
SYNCOPAL EVENTS.

AND A CORRECT DIAGNOSIS OF
THE UNDERLYING PROBLEM CAN TAKE

SOME TIME.

MANY PEOPLE WILL EXPERIENCE
A WARNING SIGN

BEFORE A SYNCOPAL EVENT,
SUCH AS FEELING DIZZY,

BEING LIGHTHEADED.

THEY MAY FEEL THAT THEIR VISION
IS STARTING TO CLOSE IN.

SOME CAN BECOME SWEATY
AND MAY FEEL SLIGHTLY NAUSEATED.

AFTER THE EPISODE,
THE INDIVIDUAL MAY FEEL TIRED

OR MAY BE WEAK BUT SHOULD NOT
HAVE THE CONFUSION

THAT IS COMMONLY SEEN AFTER
A SEIZURE.

NOW, IN THE ELDERLY, THE WARNING
SIGNS FOR SYNCOPE

MAY BE NONEXISTENT, OR THEY MAY
BE ABBREVIATED

IN COMPARISON TO YOUNGER PEOPLE.

WHEN AN INDIVIDUAL HAS
A SIMPLE PARTIAL SEIZURE

THAT EVOLVES INTO A SECONDARILY
GENERALIZED SEIZURE,

THEY MAY INITIALLY EXPERIENCE

A STRANGE OR UNPLEASANT
SENSATION IN THEIR STOMACH,

CHEST, OR HEAD.

AND THEY CAN ALSO HAVE INCREASED
HEART RATE WITH SWEATING.

THESE SENSATIONS CAN OCCUR
JUST BEFORE THE INDIVIDUAL HAS

A LOSS OF CONSCIOUSNESS.

SO I HOPE YOU CAN SEE HOW
A SYNCOPAL EVENT AND A SEIZURE

CAN OFTEN BE CONFUSED WITH
EACH OTHER IN THE ELDERLY.

SO WHAT CAUSES SYNCOPE?

SYNCOPE IS DUE TO A TEMPORARY
REDUCTION IN BLOOD FLOW

AND, CONSEQUENTLY, A SHORTAGE
OF OXYGEN IN THE BRAIN.

THIS LEADS
TO THE LIGHTHEADEDNESS

AND SOMETIMES BLACKOUT EPISODES.

THERE'S A LONG LIST OF CAUSES
OF SYNCOPE.

AND SOME ARE HEART-RELATED,
AND SOME ARE NOT.

ONE COMMON CAUSE THAT IS NOT
HEART-RELATED IS ORTHOSTATIC,

OR SOMETIMES CALLED
POSTURAL HYPOTENSION.

THIS TYPE OF HYPOTENSION IS
A DROP IN BLOOD PRESSURE

DUE TO CHANGE
IN YOUR BODY POSITION

TO A MORE UPRIGHT POSITION

AFTER LYING OR SITTING
FOR A PERIOD OF TIME.

AS WE AGE, OUR BODIES DON'T
RESPOND AS QUICKLY

TO POSITION CHANGES.

AND THE MINOR ADJUSTMENTS OUR
BODIES MUST MAKE

IN ORDER TO MAINTAIN
ADEQUATE BLOOD PRESSURE

FREQUENTLY BECOMES IMPAIRED
AS WE AGE.

WHEN WE CHANGE POSITIONS FROM
LYING DOWN TO QUICKLY STANDING,

IT'S ESTIMATED THAT BETWEEN
ONE AND TWO PINTS OF BLOOD

BRIEFLY POOL IN OUR LEGS.

NOW, IN YOUNGER PEOPLE,

THIS DECREASE
IN CIRCULATING BLOOD VOLUME

ALERTS THE NERVOUS SYSTEM
TO CORRECT THE PROBLEM.

THE NERVOUS SYSTEM SIGNALS
THE BLOOD VESSELS IN THE LEGS

TO CONTRACT AND THE HEART
TO BEAT A BIT FASTER.

THIS PROTECTS US FROM
LARGE DROPS IN BLOOD PRESSURE.

UNFORTUNATELY, AS WE AGE,
OUR HEART

CAN'T ALWAYS QUICKLY
OR EFFECTIVELY RESPOND.

AND THIS MEANS THE ELDERLY
ARE MORE VULNERABLE

TO A DECREASE IN BLOOD PRESSURE
AND POSSIBLY BLACKING OUT.

MEDICATIONS ARE ANOTHER COMMON
CAUSE OF SYNCOPE IN THE ELDERLY.

IN FACT, ADVERSE EFFECTS
FROM MEDICATIONS ARE

THE MOST COMMON CAUSE OF
POSTURAL HYPOTENSION

IN OLDER ADULTS.

DRUGS USED TO TREAT HIGH BLOOD
PRESSURE ARE COMMONLY TO BLAME,

BUT THERE ARE MANY OTHER
MEDICATIONS

THAT CAN BE INVOLVED.

SYNCOPE
MAY BE DUE TO PRESCRIPTION

OR OVER-THE-COUNTER MEDICATION.

SOMETIMES SYNCOPE RESULTS FROM
THE INTERACTION

BETWEEN TWO OR MORE DRUGS

OR IT CAN BE A RESPONSE TO
STARTING A NEW MEDICATION,

ESPECIALLY FOR TREATING
HIGH BLOOD PRESSURE.

SOMETIMES IT IS
AFTER A CHANGE IN DOSE

AND SOMETIMES IT CAN OCCUR

WITH LONG-TERM CHRONIC TREATMENT

WITH THE SAME DRUG.

OLDER PATIENTS SHOULD HAVE
THEIR MEDICATIONS REVIEWED

REGULARLY,

AND SHOULD PAY SPECIAL ATTENTION
TO SLOWING THE PROCESS

OF CHANGING THE POSITIONS FROM
LYING TO STANDING.

HEART CONDITIONS ARE ALSO KNOWN
TO COMMONLY CAUSE

SYNCOPAL EVENTS IN THE ELDERLY.

ONE OF THE MOST COMMON CARDIAC-
OR HEART-RELATED CAUSES

OF SYNCOPE IS AN ABNORMAL
HEART RHYTHM.

OTHER CAUSES INCLUDE

ABNORMALITIES OF HEART VALVE

AND WIDESPREAD DISEASE
OF THE HEART MUSCLE

CALLED CARDIOMYOPATHY.

SYNCOPE THAT IS CAUSED
FROM A HEART PROBLEM

IS THE MOST SERIOUS TYPE
OF SYNCOPE,

AND THE RISK DOES INCREASE
WITH AGE.

THERE MAY BE NO WARNING SIGN,

BUT OFTEN THE INDIVIDUAL MAY
FEEL TIGHTNESS IN THE CHEST,

SHORTNESS OF BREATH,

OR AN UNUSUAL AWARENESS
OF THE HEARTBEAT,

CALLED A PALPITATION.

PALPITATIONS MAY FEEL AS IF
THE HEART'S FLUTTERING, RACING,

OR POUNDING WITH UNUSUAL FORCE
IN THE CHEST.

OFTEN, WHEN WE ARE UNCERTAIN
IF AN EVENT IS NEUROLOGIC

OR CARDIAC, WE WILL
SIMULTANEOUSLY ORDER TESTS

TO LOOK AT THE ELECTRICAL
ACTIVITY

OF BOTH THE BRAIN AND THE HEART.

WHEN WE LOOK AT THE ELECTRICAL
ACTIVITY IN THE BRAIN,

IT IS CALLED AN EEG.

WHEN WE LOOK AT THE ELECTRICAL
ACTIVITY IN THE HEART,

IT IS CALLED AN EKG.

AN ABNORMAL HEART RHYTHM IS
OFTEN DIAGNOSED IN AN EKG,

BUT SOMETIMES A LONGER
MONITORING PERIOD IS REQUIRED.

IF YOUR SYMPTOMS ARE RECURRING
FREQUENTLY--

LIKE EVERY DAY
OR EVERY OTHER DAY--

YOUR PROVIDER MAY ORDER
A HOLTER MONITOR.

THIS IS A RECORDING DEVICE WHICH
CONTINUOUSLY RECORDS

YOUR HEART RHYTHM
FOR 24 OR 48 HOURS.

YOU MAY BE ASKED TO KEEP
A DIARY

TO NOTE THE TIMES THAT YOUR
EPISODES OCCUR.

THE DIARIES CAN THEN BE COMPARED
TO YOUR RHYTHM

TO SHOW WHETHER
THE SYMPTOMS ARE RELATED

TO ANY ABNORMALITIES.

NOW, IF YOUR EVENTS OCCUR
LESS FREQUENTLY,

YOUR PROVIDER MAY ORDER
A LONG-TERM EVENTS RECORDER

WHICH YOU CAN USE FOR UP
TO A MONTH.

TYPICALLY YOU'RE INSTRUCTED
TO PRESS A BUTTON

THAT FREEZES THE RECORDING
WHEN YOU EXPERIENCE AN EVENT.

AND YOU MAY ALSO BE ASKED TO
KEEP THE DIARY WITH THIS AS WELL

IN ORDER TO COMPARE YOUR
SYMPTOMS TO THE RHYTHM.

THE TREATMENT FOR HEART RHYTHM
PROBLEMS USUALLY INVOLVES

MEDICATION, BUT SOMETIMES
A PACEMAKER IS REQUIRED.

I WOULD NOW LIKE TO MOVE FROM
EVENTS INVOLVING

SUDDEN LOSS OF CONSCIOUSNESS

TO EVENTS INVOLVING
SUDDEN CONFUSION.

SUDDEN CONFUSION IS
A COMMON SYMPTOM

OF COMPLEX PARTIAL SEIZURES.

BUT IT IS ALSO A SYMPTOM
THAT CAN BE CAUSED

BY ONE OF THE MANY
SEIZURE IMITATORS.

ONE COMMON CONDITION THAT
CAN PRODUCE SUDDEN CONFUSION IS

A TRANSIENT ISCHEMIC ATTACK,
OR A T.I.A.

A T.I.A. IS OFTEN CALLED
A MINI-STROKE,

BUT IT SHOULD BE CONSIDERED
A WARNING STROKE,

A WARNING THAT SHOULD BE TAKEN
VERY SERIOUSLY.

A T.I.A. IS CAUSED BY A CLOT.

THE DIFFERENCE BETWEEN A STROKE
AND A T.I.A. IS

THAT WITH A T.I.A., THE BLOCKAGE
IS TEMPORARY.

T.I.A. SYMPTOMS OCCUR RAPIDLY

AND LAST A RELATIVELY
SHORT TIME.

MOST T.I.A.s LAST JUST
MINUTES,

BUT IT CAN LAST LONGER.

THE WARNING SIGNS OF A T.I.A.
ARE EXACTLY THE SAME

AS FOR A STROKE.

AND AS WE REVIEWED EARLIER,
THESE SIGNS CAN INCLUDE

SOME NUMBNESS OR WEAKNESS,
VISION CHANGES, AND CONFUSION,

OR TROUBLE UNDERSTANDING
SIMPLE STATEMENTS.

UNLIKE A STROKE WHEN A T.I.A.
IS OVER,

THERE'S NO PERMANENT INJURY
TO THE BRAIN.

NOW, IN TIME ALL CLOTS WILL
DISSOLVE,

BUT WHETHER THERE IS DAMAGE
OR NOT DEPENDS ON HOW LONG

THE CLOT IS IN PLACE.

BECAUSE THERE'S NO WAY
TO PREDICT

WHEN A CLOT WILL DISSOLVE ON
ITS OWN,

IT'S CRUCIAL TO CALL 911.

IF YOU OR A LOVED ONE DEVELOPS
ANY STROKE SYMPTOMS,

PLEASE GET TO
THE EMERGENCY ROOM,

WHERE YOU CAN BE EVALUATED.

PLEASE. DON'T WAIT TO SEE
IF THE SYMPTOMS WILL GO AWAY.

STROKE AND T.I.A. ARE
MEDICAL EMERGENCIES.

REMEMBER, TIME LOSS IS
BRAIN LOSS.

NOW, SOMETIMES THE AFTERMATH OF
A SEIZURE CAN BE CONFUSED

WITH A T.I.A. OR STROKE.

THERE IS A NEUROLOGICAL
CONDITION

CALLED TODD'S PARALYSIS

IN WHICH A SEIZURE IS FOLLOWED
BY A BRIEF PERIOD

OF TEMPORARY PARALYSIS
OR WEAKNESS

ON ONE SIDE OF THE BODY.

THE PARALYSIS CAN LAST FROM
UNDER AN HOUR

TO OVER 24 HOURS.

AND IT'S ESTIMATED TO OCCUR IN
ABOUT 13% OF SEIZURE CASES.

THE SYMPTOMS OF TODD'S PARALYSIS
DEPEND ON THE AREA OF THE BRAIN

WHERE THE SEIZURE TOOK PLACE.

SOMETIMES SPEECH
AND VISION IS AFFECTED.

ULTIMATELY, THOUGH,
FULL FUNCTION IS RESTORED.

AND IT CAN BE MORE EASILY
DIAGNOSED WHEN IT OCCURS

AFTER A WITNESSED SEIZURE.

DIAGNOSIS OF TODD'S PARALYSIS
IS CRUCIAL, THOUGH,

BECAUSE THE SYMPTOMS CAN CLOSELY
RESEMBLE THOSE OF A STROKE.

AND IT'S IMPORTANT
TO DISTINGUISH BETWEEN THE TWO

BECAUSE THE TREATMENTS, OF
COURSE, ARE VERY DIFFERENT.

SO GOING BACK TO CONDITIONS THAT
MAY BE CONFUSED WITH A SEIZURE,

ANOTHER LESS COMMON CONDITION IS
CALLED TRANSIENT GLOBAL AMNESIA.

TRANSIENT GLOBAL AMNESIA IS
A SUDDEN TEMPORARY EPISODE

OF MEMORY LOSS THAT
CAN'T BE ATTRIBUTED

TO A MORE COMMON
NEUROLOGICAL CONDITION,

SUCH AS EPILEPSY OR STROKE.

DURING AN EPISODE OF
TRANSIENT GLOBAL AMNESIA,

YOUR RECOLLECTION
OF RECENT EVENTS

SIMPLY CEASES TO EXIST.

SO YOU CAN'T REMEMBER WHERE
YOU ARE OR HOW YOU GOT THERE.

YOU MAY ALSO DRAW A BLANK
WHEN ASKED TO REMEMBER

THINGS THAT HAPPENED A DAY OR
A MONTH BEFORE.

WITH TRANSIENT GLOBAL AMNESIA,
YOU DO REMEMBER WHO YOU ARE.

AND YOU ARE ABLE TO RECOGNIZE
IMPORTANT PEOPLE IN YOUR LIFE.

THE DURATION IS USUALLY
NO MORE THAN 24 HOURS.

AND THERE IS A GRADUAL
RETURN OF MEMORY.

ALTHOUGH TRANSIENT GLOBAL
AMNESIA ISN'T HARMFUL,

THERE'S NO EASY WAY
TO DISTINGUISH THE CONDITION

FROM OTHER LIFE THREATENING
ILLNESSES

THAT CAN ALSO CAUSE
SPREADING MEMORY LOSS.

SPREADING AMNESIA IS MUCH MORE
LIKELY TO BE CAUSED BY A STROKE

OR A SEIZURE THAN BY
TRANSIENT GLOBAL AMNESIA.

REMEMBER, ANOTHER EVALUATION IS
WHENEVER YOU DEVELOP

SUDDEN MEMORY LOSS.

ANOTHER MORE COMMON CONDITION

THAT MAY BE CONFUSED WITH
SEIZURES IS A PERIOD

OF UNCONTROLLED SLEEPINESS.

A STUDY BY THE NATIONAL
INSTITUTE ON AGING REPORTS

THAT OVER HALF OF STUDY
RESPONDENTS AGED OVER 65

REPORT SLEEP PROBLEMS FOR
EXCESSIVE DAYTIME SLEEPINESS.

SOME PEOPLE WHO APPEAR TO DRIFT
OFF DURING A CONVERSATION

OR PERHAPS STARE OFF INTO SPACE
AT INAPPROPRIATE TIMES

MIGHT BE THOUGHT TO BE
EXPERIENCING PARTIAL SEIZURES.

ON THE FLIP SIDE OF THAT, THOSE
THAT MAY INDEED BE EXPERIENCING

A COMPLEX PARTIAL SEIZURE MAY
BE THOUGHT TO JUST BE

EXCESSIVELY SLEEPY.

EXCESSIVE SLEEPINESS CAN BE
DUE TO A VARIETY OF FACTORS,

INCLUDING MEDICATION
SIDE-EFFECTS, PAINS,

MISSED OR INTERRUPTED SLEEP,

OR A SLEEP DISORDER.

SLEEP PROBLEMS ARE COMMON AMONG
OLDER ADULTS,

AND OFTEN IT CAN BE DIFFICULT
TO SEPARATE DISEASE PROCESSES

FROM CHANGES IN SLEEP
WITH NORMAL AGING.

THERE ARE MANY SLEEP DISORDERS,

INCLUDING NARCOLEPSY,
PERIODIC LEG MOVEMENTS,

RESTLESS LEG SYNDROME,
AND SLEEP APNEA.

SLEEP APNEA IS A COMMON PROBLEM.

ANYONE CAN DEVELOP OBSTRUCTIVE
SLEEP APNEA,

BUT IT'S MORE COMMONLY SEEN
IN MIDDLE-AGED AND OLDER ADULTS

AND PEOPLE WHO ARE OVERWEIGHT.

SLEEP APNEA OCCURS
TWO TO 3 TIMES MORE OFTEN

IN ADULTS OLDER THAN 65.

SO OLDER PATIENTS SHOULD BE
ESPECIALLY MINDFUL

OF SLEEPING EVALUATION

OR CONCERNS OVER POSSIBLE
SLEEP APNEA.

SEVERAL TYPES OF
SLEEP APNEA EXIST,

BUT THE MOST COMMON TYPE IS
OBSTRUCTIVE SLEEP APNEA

WHICH OCCURS WHEN YOUR THROAT
MUSCLES INTERMITTENTLY RELAX

AND BLOCKS YOUR AIRWAY
DURING SLEEP.

SLEEP APNEA NOT ONLY CAUSES
SLEEP LOSS, BUT IT PUTS

A STRAIN ON THE HEART AND CAN
LEAN TO HIGH BLOOD PRESSURE

AND INCREASED RISK FOR STROKE.

UNDIAGNOSED SLEEP APNEA
INCREASES THE RISK OF STROKE

BY 2 1/2 TIMES AMONG
THE ELDERLY.

SLEEP APNEA IN ELDERLY PATIENTS
OFTEN GOES UNDIAGNOSED

OR IT'S DIAGNOSED AS SNORING.

DIFFICULTY FALLING
AND STAYING ASLEEP

COMBINED WITH A LACK OF
DEEP SLEEP RESULTS

IN POOR QUALITY OF LIFE
AND INCREASED RISK

FOR THE OLDER PATIENTS.

SOMETIMES, THE EXCESSIVE
DAYTIME SLEEPINESS THAT IS

A RESULT OF SLEEP APNEA CAN BE
CONFUSED FOR OTHER CONDITIONS.

DR. BOUDREAU FROM THE PORTLAND
VA GAVE A WONDERFUL PRESENTATION

ON EPILEPSY AND SLEEP
THIS PAST JANUARY.

AND I WOULD URGE ALL OF YOU
WITH SLEEP ISSUES TO LISTEN

TO DR. BOUDREAU'S TALK,

AND, OF COURSE, TO WORK CLOSELY
WITH YOUR OWN PROVIDER

REGARDING YOUR
SPECIFIC SLEEP ISSUES.

OF COURSE, THERE ARE OTHER
CONDITIONS

THAT CAN MIMIC SEIZURES,

BUT WE HAVE COVERED SOME OF THE
MORE COMMON ONES THIS MORNING.

REMEMBER, IF YOU OR YOUR LOVED
ONE DEVELOPS ANY NEW BEHAVIORS

SUSPICIOUS OF SEIZURES,

LET YOUR PROVIDER KNOW
AS SOON AS POSSIBLE.

IF THE EVENT INVOLVES ANY OF
THE SYMPTOMS ASSOCIATED

WITH STROKE, PLEASE
GET EVALUATED URGENTLY.

I WOULD NOW LIKE TO DISCUSS SOME
OF THE COMMON CONCERNS

AND CHALLENGES FACED

BY GERIATRIC PATIENTS
WITH EPILEPSY.

MANY OF THE CHALLENGES FACED BY
THE GERIATRIC PATIENT,

IF IT'S RETIREMENT, THE DEATH
OF FRIENDS AND LOVED ONES,

AND INCREASED ISOLATION OCCUR

REGARDLESS OF CHRONIC MEDICAL
CONDITIONS LIKE EPILEPSY.

WITH A DIAGNOSIS OF EPILEPSY,
THERE ARE CERTAIN CONCERNS

THAT BECOME MORE SIGNIFICANT.

INCREASED INJURY DUE TO FALLS
OR MOTOR VEHICLE ACCIDENTS,

LOSS OF INDEPENDENCE,
AND DEPRESSION ARE

JUST A FEW OF THE CHALLENGES
THAT ARE AMPLIFIED

IN THIS POPULATION.

FALLS ARE A HUGE CONCERN
FOR THE GERIATRIC PATIENT,

WHETHER THERE IS A DIAGNOSIS
OF EPILEPSY OR NOT.

WHEN YOU ADD IN
THE INCREASED RISK OF FALLS

DUE TO A SEIZURE
OR THE INCREASED RISK OF A FALL

DUE TO SIDE-EFFECTS
OF A MEDICATION,

THERE IS GOOD REASON FOR
INTENSIFIED CONCERN.

THE YEARLY OCCURRENCE OF FALLS
AMONG ELDERLY INDIVIDUALS

LIVING IN THE COMMUNITY
INCREASES FROM 25% AT AGE 70

TO 35% AT AGE 75 AND OVER.

AND FALLS ARE EVEN MORE COMMON
IN NURSING HOMES.

THE NATIONAL SAFETY COUNCIL
ESTIMATES THAT PERSONS

OVER THE AGE OF 65 HAVE
THE HIGHEST DEATH RATE

FROM INJURY, AND FALLS ACCOUNT
FOR ABOUT 1/2 OF THE DEATHS

DUE TO INJURY IN THE ELDERLY.

NOW, FALLS IN THE ELDERLY ARE
CAUSED BY A NUMBER OF FACTORS.

THE ENVIRONMENT CAN BE
PARTICULARLY DANGEROUS

AS ONE GETS OLDER.

STEPS, THROW RUGS,
AND POOR LIGHTING

CAN ALL LEAD TO INCREASED
FALLING WHEN COMBINED

WITH PHYSICAL INSTABILITY.

WHEN A NEW MEDICATION IS ADDED
AND BALANCE BECOMES

MORE OF A CHALLENGE, THE STEPS
TO THE BASEMENT

OR THE THROW RUG THAT HAS BEEN
IN THE HALL FOR YEARS

MAY NOW BE A PROBLEM.

IT IS SO IMPORTANT TO DISCUSS
ANY SIDE-EFFECTS THAT YOU ARE

EXPERIENCING WITH YOUR PROVIDER.

MANY OF THE ANTIEPILEPTIC DRUGS
CAN CAUSE INCREASED DIFFICULTY

WITH BALANCE.

SOMETIMES A SMALL ADJUSTMENT
IN THE DOSE CAN MAKE

AN EXTRAORDINARY DIFFERENCE
IN THE QUALITY OF LIFE.

ANOTHER COMPLICATING FACTOR IS
THAT MANY ANTIEPILEPTIC DRUGS

CAN AFFECT BONE STRENGTH,

ADDING INCREASED RISK FOR
DEVELOPING OSTEOPOROSIS.

OSTEOPOROSIS OCCURS
WHEN THE BODY FAILS TO FORM

ENOUGH NEW BONE WHEN TOO MUCH
OLD BONE IS REABSORBED

BY THE BODY OR BONE.

THE LEADING CAUSE OF
OSTEOPOROSIS IN THE ELDERLY...

BY A DROP IN ESTROGEN IN WOMEN
AT THE TIME OF MENOPAUSE

AND DECREASE IN TESTOSTERONE
AS MEN AGE.

WOMEN OVER THE AGE OF 50
AND MEN OVER THE AGE OF 70

HAVE A HIGHER RISK OF
OSTEOPOROSIS.

AN INDIVIDUAL WHO TAKES
AN ANTIEPILEPTIC DRUG MAY BE

AT AN EVEN HIGHER RISK OF
DEVELOPING OSTEOPOROSIS

AND SUBSEQUENT BONE FRACTURES

DUE TO MEDICATION INTERFERING
WITH THE BODY'S ATTEMPTS

TO MAKE NEW BONE.

NOW, SOME OF THE OLDER
ANTIEPILEPTIC DRUGS,

SUCH AS, YOU KNOW,
BARBITAL, PHENYTOIN,

WHICH MANY OF YOU KNOW
AS DILANTIN,

AND CARBAMAZEPINE, WHICH YOU
MAY KNOW AS TEGRETOL,

ARE KNOWN TO AFFECT BONE HEALTH

MORE THAN THE NEWER
ANTIEPILEPTIC DRUGS.

NOW, IF YOU ARE ON ONE OF
THESE OLDER MEDICATIONS

AND YOUR SEIZURES ARE
WELL-CONTROLLED

AND YOU FEEL GOOD ON
THE MEDICATION,

YOU AND YOUR PROVIDER MAY
DECIDE TO CONTINUE

WITH YOUR CURRENT REGIMEN.

YOUR PROVIDER WILL LOOK AT
MANY FACTORS IN DECIDING

WHICH DRUG IS THE BEST FOR YOU.

AND YOU BOTH NEED TO WEIGH
THE RISKS AND THE BENEFITS

OF YOUR TREATMENT.

CALCIUM AND VITAMIN "D" ARE
KNOWN TO INCREASE

BONE DENSITY AND STRENGTH,

AND YOUR PROVIDER MAY ADD
THESE SUPPLEMENTS

IF YOU'RE NOT ALREADY
TAKING THEM.

YOUR PROVIDER MAY ALSO HAVE YOUR
BONES PERIODICALLY EVALUATED

WITH A TEST CALLED A DEXA SCAN.

THIS IS A SPECIAL X-RAY
THAT MEASURES

YOUR BONE MARROW DENSITY.

NOW, IF YOU HAVE HAD A FALL,
FEAR OF FUTURE FALLS

CAN BE VERY DEBILITATING.

ANXIETY RELATED TO THE FEAR
OF ANOTHER FALL HAS STOPPED

MANY ELDERLY INDIVIDUALS FROM
PARTICIPATING IN ACTIVITIES

THAT THEY ONCE ENJOYED.

PLEASE DISCUSS WITH YOUR
PROVIDER AND WITH YOUR FAMILY

YOUR FEARS.

DECREASED ACTIVITY CAN RESULT
IN BECOMING WEAKER

AND MORE VULNERABLE.

TO PREVENT FALLS, YOU HAVE
TO FIND THE UNDERLYING CAUSE

AND TREAT IT.

THE CAUSE MIGHT
BE ENVIRONMENTAL.

AND RELATIVELY SIMPLE FIXES,
SUCH AS BETTER LIGHTING

OR REMOVAL OF THROW RUGS,
CAN IMPROVE THE ENVIRONMENT.

IT MAY BE RELATED TO MEDICATION
SIDE-EFFECTS,

AND A DOSE ADJUSTMENT

OR A MEDICATION CHANGE
MAY BE IN ORDER.

IF IT IS RELATED TO UNCONTROLLED
SEIZURES,

A DOSE ADJUSTMENT,
MEDICATION CHANGE,

OR AN ADDITION OF ANOTHER
MEDICATION MAY NEED TO OCCUR.

I'M GOING TO SPEND JUST
A VERY BRIEF AMOUNT OF TIME

ON DRIVING.

I KNOW THAT DRIVING IS
A VERY IMPORTANT TOPIC

FOR THOSE WITH EPILEPSY.

YOU KNOW, EACH STATE HAS
INDIVIDUAL DRIVING REGULATIONS.

AND FOR THOSE OF YOU WITH
EPILEPSY THAT ARE DRIVING

REGARDLESS OF YOUR AGE,
I STRONGLY RECOMMEND KNOWING

THE LAWS IN YOUR STATE.

MANY PEOPLE WHO HAVE HAD
SEIZURES--

GERIATRIC PATIENTS INCLUDED--
ARE ABLE TO RETURN TO DRIVING

ONCE THEIR SEIZURES
ARE UNDER CONTROL.

BUT YOUR RETURN TO
SAFE DRIVING CAN DEPEND

ON THE FOLLOWING FACTORS:

THE CAUSE OF YOUR SEIZURES;

THE TYPE OF SEIZURE
YOU TYPICALLY HAVE;

THE LAWS OF THE STATE IN WHICH
YOU ARE LICENSED;

AND HOW LONG YOU HAVE BEEN
FREE OF SEIZURES

THAT AFFECT YOUR AWARENESS.

DRIVING RESTRICTIONS CAN VARY
FROM 3 MONTHS TO A YEAR

DEPENDING ON YOUR STATE.

REMEMBER, DRIVING WITH EPILEPSY
MEANS BALANCING

THE NEED FOR INDEPENDENCE
AGAINST THE NEED FOR SAFETY.

LOSS OF A DRIVER'S LICENSE
CAN MOST CERTAINLY THREATEN

THE INDEPENDENCE
OF AN ELDERLY ADULT,

ESPECIALLY ONE LIVING ALONE.

I WANT TO MENTION, AARP's
DRIVER'S SAFETY PROGRAM.

IT'S A LARGE NATIONAL PROGRAM
THAT EDUCATES OLDER ADULTS

ON DRIVING SAFELY AND FINDING
TRANSPORTATION ALTERNATIVES

IF THEY HAVE LOST THEIR LICENSE.

AND THAT CAN BE FOUND AT
www.aarp.org.

FOR SOMEONE WHO'S BEEN DIAGNOSED
WITH ALZHEIMER'S DISEASE

OR ANOTHER DEMENTIA, THE ISSUE
IS NOT WHETHER THE PERSON

WILL HAVE TO STOP DRIVING,
IT'S WHEN THAT MUST HAPPEN.

LOCAL ALZHEIMER'S ASSOCIATION
CHAPTERS

OR LOCAL ALZHEIMER'S SUPPORT
GROUPS

HAVE CARING PEOPLE WITH
EXPERTISE

IN HELPING FAMILIES
AND CAREGIVERS

DEAL WITH THE DRIVING ISSUE.

AND YOU CAN FIND YOUR LOCAL
ALZHEIMER'S SUPPORT GROUP AT

www.Alzheimers.org.

I WOULD LIKE TO TALK A LITTLE
BIT ABOUT DEPRESSION.

DEPRESSION IS A COMMON PROBLEM
AMONG THE ELDERLY

AND IS A COMMON PROBLEM WITH
THOSE DIAGNOSED WITH EPILEPSY.

PATIENTS WITH EPILEPSY ARE KNOWN
TO HAVE A HIGHER OCCURRENCE

OF DEPRESSIVE DISORDERS
THAN THE GENERAL POPULATION.

AND ACCORDING TO
THE MENTAL HEALTH FOUNDATION,

DEPRESSION IS MORE COMMON IN
THE ELDERLY

THAN IN ANY OTHER AGE GROUP,

AFFECTING ABOUT 20% OF THOSE
LIVING IN THE COMMUNITY

AND ABOUT 40% OF THOSE LIVING
IN NURSING HOMES.

IT IS ESTIMATED THAT ABOUT
5 MILLION AMERICANS

AGED 65 AND OLDER ARE
CLINICALLY DEPRESSED.

AND ABOUT ONE MILLION SUFFER
FROM MAJOR DEPRESSION.

MANY OF THESE INDIVIDUALS
HAVE STRUGGLED WITH DEPRESSION

FOR MOST OF THEIR LIVES WHILE
OTHERS CAN DEVELOP DEPRESSION

LATE IN LIFE.

DEPRESSION CAN AFFECT
AN INDIVIDUAL AS LATE

AS IN THEIR 80s
AND IN THEIR 90s.

NOW, OLDER ADULTS WITH
DEPRESSION

ARE MORE LIKELY
TO COMMIT SUICIDE

THAN ARE YOUNGER PEOPLE WITH
DEPRESSION.

INDIVIDUALS 65 YEARS OF AGE
AND OLDER ACCOUNT

FOR 19% OF DEATHS BY SUICIDE.

AND ELDERLY WHITE MEN ARE
THE GREATEST AT RISK

FOR SUICIDE.

THE RATE PEOPLE AGES 80 TO 84
IS MORE THAN TWICE THAT

OF THE GENERAL POPULATION.

AND I JUST WANTED TO LET
EVERYONE KNOW OF

THE NATIONAL VETERANS SUICIDE
PREVENTION HOTLINE.

MANY OF YOU KNOW IT WAS CHANGED
FROM THE VETERANS CRISIS LINE.

AND THAT CONFIDENTIAL TOLL-FREE
HOT LINE IS 1-800-273-8255.

AND, YOU KNOW, DEPRESSION IN
THE ELDERLY OFTEN GOES UNTREATED

BECAUSE IT IS MISTAKEN AS
A NORMAL PART OF AGING,

OR A NATURAL REACTION TO
CHRONIC ILLNESS,

A LOSS, OR MAYBE A SOCIAL
TRANSITION.

AND IT CAN BE DIFFICULT
TO DETECT

BECAUSE LIKE OTHER THINGS,
DEPRESSION IN THE ELDERLY

OFTEN PRESENTS DIFFERENTLY.

AND SOMETIMES THE FAMILY
AND EVEN THE PATIENT

DOESN'T RECOGNIZE THE SYMPTOMS.

AND THERE CAN BE SYMPTOMS LIKE
FATIGUE, APPETITE LOSS,

TROUBLE SLEEPING,
OR TROUBLE EATING.

AND THESE CAN BE MISTAKEN AS
PART OF THE AGING PROCESS

OR MAYBE A SIGN OF
THEIR CHRONIC ILLNESS.

AS A RESULT, EARLY SIGNS
OF DEPRESSION MAY BE IGNORED.

IT'S REALLY IMPORTANT TO DISCUSS
ANY NEW CONCERNS YOU HAVE

WITH YOUR PROVIDER.

SOMETIMES THE SYMPTOMS OF
DEPRESSION ARE SIDE-EFFECTS

OF A PRESCRIBED DRUG.

AND YOU ARE PARTICULARLY AT RISK
IF YOU ARE TAKING

MULTIPLE MEDICATIONS.

NOW, WHILE THE NEWS RELATED
TO SIDE-EFFECTS

OF SOME PRESCRIPTION MEDICATIONS
CAN AFFECT ANYONE,

OLDER ADULTS ARE MORE SENSITIVE
BECAUSE AS WE AGE,

OUR BODIES BECOME LESS EFFICIENT

AT METABOLIZING
AND PROCESSING DRUGS.

IF YOU FEEL DEPRESSED AFTER
STARTING AN ANTIEPILEPTIC DRUG

OR ANY NEW MEDICATION, TALK
TO YOUR PROVIDER RIGHT AWAY.

AND HE MAY BE ABLE TO LOWER
THE DOSE OF YOUR MEDICATION

OR SWITCH YOU TO ANOTHER
MEDICATION

THAT DOESN'T IMPACT YOUR MOOD.

ALSO, ALCOHOL MAKES SYMPTOMS
OF DEPRESSION--

IRRITABILITY AND ANXIETY--
WORSE.

AND IT ALSO IMPAIRS
YOUR BRAIN FUNCTION.

AND ALCOHOL INTERACTS NEGATIVELY
WITH NUMEROUS MEDICATIONS,

INCLUDING ANTIDEPRESSANTS
AND ANTIEPILEPTIC DRUGS.

IF YOU OR A LOVED ONE HAS
A DRINKING PROBLEM,

YOUR LOCAL VA MEDICAL CENTER
OR VET CENTER HAS

SPECIAL PROGRAMS TO HELP YOU
OVERCOME ALCOHOL PROBLEMS.

SO I'D LIKE TO BRIEFLY REVIEW
SOME, HOPEFULLY, HELPFUL TIPS

FOR GETTING THE MOST OUT OF
YOUR VISIT

WITH YOUR MEDICAL PROVIDER.

ALWAYS HELPFUL TO HAVE SOMEONE
THAT IS CLOSE TO YOU

ACCOMPANY YOU TO YOUR CLINIC
APPOINTMENT.

OFTENTIMES, THEY CAN DESCRIBE
OR EXPLAIN EVENTS

THAT YOU MAY NOT REMEMBER.

BE SURE TO HAVE A LIST
OF ALL YOUR CURRENT MEDICATIONS

AND DOSES.

THIS IS ESPECIALLY IMPORTANT IF
YOU RECEIVE CARE

FROM DIFFERENT PROVIDERS
AT DIFFERENT FACILITIES.

IT'S ALSO IMPORTANT TO SHARE
NEW STRESSORS

OR BIG CHANGES IN YOUR LIFE.

AS MANY OF YOU KNOW, INCREASED
STRESS AND SLEEP DEPRIVATION

ARE TRIGGERS FOR SEIZURES.

AND BEFORE YOUR APPOINTMENT,
PICK THE TOP 3 CONCERNS

THAT YOU MOST WANT TO DISCUSS
AT YOUR VISIT.

AND I RECOMMEND BRINGING IN
NOTEBOOKS WITH YOUR QUESTIONS

ALREADY WRITTEN OUT.

I ALSO RECOMMEND THAT MY
PATIENTS KEEP A POCKET CALENDAR,

IF POSSIBLE, TO TRACK THEIR
SEIZURES.

IT'S VERY HELPFUL FOR YOUR
PROVIDER TO HAVE AN IDEA

OF HOW FREQUENTLY YOU ARE HAVING
YOUR SEIZURES

AND ANY EVENTS SUSPICIOUS OF
SEIZURES.

OK, YOU KNOW, SOMETIMES IF
A PATIENT IS HAVING

INCREASED EVENTS AND A NEW EVENT
AND WE'RE UNCERTAIN

WHETHER THE EVENTS ARE SEIZURES,
YOU MAY WANT TO ADMIT THEM

FOR SEVERAL DAYS TO
A SPECIALIZED MONITORING UNIT.

AND DURING THIS ADMISSION,
THE INDIVIDUAL WILL ALSO HAVE

CONTINUOUS EEG RECORDINGS
OF BRAIN WAVES

WHILE THEY ARE ALSO UNDER
CONTINUOUS VIDEO SURVEILLANCE.

IF THE INDIVIDUAL HAS
A TYPICAL EVENT,

POSSIBLY A SEIZURE, WE'RE
ABLE TO REVIEW THE EVENT

ON VIDEO OR SIMULTANEOUSLY
REVIEW IT WITH THE BRAIN WAVE

AND EEG.

AND THIS IS REALLY CONSIDERED
THE GOLD STANDARD

FOR DISTINGUISHING
NON-EPILEPTIC EVENTS

FROM EPILEPTIC EVENTS.

AND WE DO THIS AT
THE PORTLAND VA

AND IT'S DONE AT MANY VAs
ACROSS THE U.S.

SO I KNOW WE'RE GETTING CLOSE
ON TIME.

I'D LIKE TO CONCLUDE BY
HIGHLIGHTING

JUST A FEW IMPORTANT POINTS.

ANYONE AT ANY AGE CAN
DEVELOP EPILEPSY.

BUT NOW THERE IS EVIDENCE THAT
IT STRIKES THE ELDERLY

MORE COMMONLY THAN ANY OTHER
AGE GROUP.

EPILEPSY PRESENTS DIFFERENTLY
IN THE ELDERLY

THAN IT DOES AT A YOUNGER AGE.

AND IF ANYONE IS LOOKING

JUST FOR A GENERALIZED
TONIC-CLONIC SEIZURE,

THE DIAGNOSIS MAY BE MISSED.

THE UNDERLYING CAUSES OFTEN
REMAIN UNKNOWN.

OF THE MANY KNOWN RISK FACTORS
AND CAUSES--

STROKE, DEMENTIA, TUMOR,
AND TRAUMATIC BRAIN INJURY

ARE TOP CONTENDERS
IN THE ELDERLY.

BECAUSE EVEN THE ELDERLY
USUALLY PRESENT DIFFERENTLY

THAN IN YOUNGER POPULATIONS,

THE DIAGNOSIS CAN USUALLY
BE CHALLENGING.

THE GERIATRIC PATIENT
WITH EPILEPSY FACES

MANY OF THE CONCERNS
AND CHALLENGES

AS THE YOUNGER ADULT.

BUT THESE CONCERNS...

THESE INCLUDE CONCERNS
OVER HOW THE DIAGNOSIS

WILL AFFECT THEIR SOCIAL LIFE,
DRIVING RESTRICTIONS,

AND THE POTENTIAL LOSS
OF INDEPENDENCE.

CLOSING ON A POSITIVE NOTE,
A NEW DIAGNOSIS OF EPILEPSY

IN ELDERLY PATIENTS,
IT'S USUALLY EASIER TO CONTROL

COMPARED TO EPILEPSY--
THAT BEGINS AT A YOUNGER AGE.

MOST ELDERLY PATIENTS
WITH EPILEPSY RESPOND WELL

TO ANTIEPILEPTIC DRUGS
WITH LOWER DOSES--

ESPECIALLY THE NEWER MEDICATIONS

THAT HAVE LESS IMPACT ON
BONE HEALTH

AND FEWER INTERACTIONS WITH
OTHER MEDICATIONS.

OF COURSE, THE DECISION
REGARDING THE BEST MEDICATION

FOR YOU TAKES MANY FACTORS
INTO CONSIDERATION...

[CROSSTALK]

IF YOU ARE DIAGNOSED LATER
IN LIFE WITH EPILEPSY,

THERE IS A GOOD CHANCE THAT YOU
WILL BE ABLE TO OBTAIN

EASIER CONTROL--
WITH MEDICATION

AND RETURN TO YOUR PREVIOUS
LEVEL OF HEALTH.

THE POINT OF THIS EDUCATION
SERIES IS TO EMPOWER YOU

WITH KNOWLEDGE.

AND I HOPE THAT YOU HAVE FOUND
THIS TALK INFORMATIVE.

I WOULD LIKE TO THANK ALL OF
YOU FOR YOUR ATTENTION

THIS MORNING.

IT WAS MY PLEASURE TO SPEAK
WITH YOU.

WE HAVE TIME FOR A FEW
QUESTIONS.

AND I'D LIKE TO OPEN UP
THE PHONE LINES.

JUST A REMINDER BEFORE WE GET
STARTED ON QUESTIONS,

TRY TO LIMIT YOUR QUESTIONS
TO JUST ONE OR TWO.

AND, ALSO, TRY NOT TO ASK
TOO PERSONAL OF A QUESTION

THAT MAY BE BETTER TO DISCUSS
WITH YOUR PROVIDER.

DOES ANYONE HAVE A QUESTION?

- HI. I DO HAVE A QUESTION...
- I'VE GOT A QUESTION...

- OK. I'M SORRY. ONE AT A TIME.

AND COULD YOU PLEASE
REPEAT YOUR QUESTION?

- I'VE GOT A QUESTION ABOUT
ALTERNATIVE TREATMENT

WITH DIET.

I HAVE HEARD THAT SOME PEOPLE
CAN CONTROL THEIR SEIZURES

TO SOME DEGREE BY DIET.

AND I WAS CURIOUS AS TO WHETHER
THAT WAS TRUE OR NOT.

- THAT'S A REALLY GOOD QUESTION.

THERE IS A SPECIAL DIET.

IT'S CALLED A KETOGENIC DIET.

AND IT HAS BEEN SHOWN TO
DECREASE THE FREQUENCY

OF SEIZURE FOR SOME PEOPLE,

BUT IT DOESN'T TAKE THE PLACE
OF MEDICATION.

SO A KETOGENIC DIET IS A DIET
THAT'S REALLY IN FAT

AND IT'S LOW IN CARBOHYDRATES.

AND, NORMALLY, THE BODY USES
CARBOHYDRATES FOR FUEL,

BUT WITH A KETOGENIC DIET,
IT'S SO LOW IN CARBOHYDRATES

THAT YOUR BODY IS FORCED TO USE
FAT AS ITS CHIEF SOURCE OF FUEL.

SO WHEN YOUR BODY USES FAT
FOR ENERGY, KETONES ARE MADE.

AND THAT'S WHY THE DIET IS
CALLED KETOGENIC, BY THE WAY,

BECAUSE IT MEANS
KETONE-PRODUCING.

I'M NOT SURE WHY, BUT THERE
SEEMS TO BE A RELATIONSHIP

BETWEEN HAVING HIGHER
KETONE LEVELS

AND BETTER SEIZURE CONTROL.

YOU KNOW, THE KETOGENIC DIET CAN
BE PRETTY DIFFICULT TO STICK TO.

AND SOME HAVE FOUND THAT
THE MODIFIED ATKINS DIET

CAN WORK IN A SIMILAR WAY

AND IT'S EASIER TO FOLLOW.

AND IT'S ALSO BEEN FOUND TO
DECREASE

THE FREQUENCY OF SEIZURES.

YOU KNOW, BUT AGAIN, NEITHER
OF THESE DIETS HAVE BEEN FOUND

TO STOP SEIZURES IN ADULTS.

AND THEY CERTAINLY WOULDN'T
TAKE THE PLACE OF MEDICATION.

ALSO, YOU KNOW, I WANT TO SAY,
IT IS REALLY IMPORTANT

THAT YOU WORK WITH A DIETICIAN
AND A NEUROLOGY PROVIDER

IF YOU ARE THINKING ABOUT
STARTING

ONE OF THESE SPECIAL DIETS.

YOU KNOW, I DON'T THINK EITHER
DIET PROVIDES

ALL THE VITAMINS AND MINERALS
THAT ARE FOUND

IN A BALANCED DIET.

SO YOU REALLY WOULD NEED
THE GUIDANCE OF A DIETICIAN

TO HELP YOU.

AND I CAN'T STRESS ENOUGH
THAT IF THIS IS SOMETHING

YOU WERE THINKING
ABOUT TAKING ON

TO PLEASE BE SURE TO TALK TO
YOUR NEUROLOGY PROVIDER FIRST.

DID THAT ANSWER ANY OF YOUR
QUESTIONS?

- YES, THANKS. ARE THERE ANY
OTHER ALTERNATIVE TREATMENTS

OUT THERE THAT CAN STOP
SEIZURES?

- HUH. AS FAR AS ALTERNATIVE
TREATMENTS, I'M NOT SURE

OF ANY THAT HAVE BEEN PROVEN
TO COMPLETELY STOP

SEIZURE ACTIVITY.

YOU KNOW, I THINK KNOWING ALL
OF THE POTENTIAL TRIGGERS

FOR SEIZURES AND DOING YOUR BEST
TO AVOID THEM IS REALLY HELPFUL.

MOST PEOPLE KNOW THAT INCREASED
STRESS AND SLEEP DEPRIVATION

CAN TRIGGER SEIZURES.

SO, YOU KNOW, WITH EXERCISING,
PRACTICING YOGA, MEDITATING

MAY DECREASE YOUR STRESS LEVEL
AND MAY HELP YOU SLEEP BETTER.

AND THESE KINDS OF ALTERNATIVE
THERAPIES

COULD POSSIBLY DECREASE
SEIZURES.

BUT THEY WOULDN'T TAKE THE PLACE
OF MEDICATION OR SURGERY.

IS THAT CLEAR?

- YEAH. CAN I ASK YOU
ONE MORE QUESTION?

- UH, OK. JUST ONE MORE. SURE.

- I'VE HEARD OF A NERVE
STIMULATION DEVICE--

I READ ABOUT IT--THAT CAN HELP
STOP SEIZURES.

AND I DIDN'T KNOW IF THAT WAS
TRUE, SO...

- OK. OK, SO YOU'RE ASKING ABOUT
THE NERVE STIMULATION DEVICE.

- YES.

- OK, WELL, THERE ARE TWO
DEVICES.

ONE IS CALLED
A VAGUS NERVE STIMULATOR.

AND THE OTHER IS CALLED
A DEEP BRAIN STIMULATOR.

I'M MORE FAMILIAR WITH
THE VAGAL NERVE STIMULATOR

BECAUSE IT'S FDA-APPROVED
AND WE USE THEM VERY FREQUENTLY

AT THE VA.

WE USUALLY REFER TO THEM
AS VNS--VAGAL NERVE STIMULATOR.

SO THE VNS IS APPROVED AS
AN ADD-ON TREATMENT

FOR DIFFICULT-TO-CONTROL
EPILEPSY.

SO TO ANSWER YOUR QUESTION,
IT'S NOT MEANT TO BE

A SOLO TREATMENT.

IT WOULDN'T SOLELY CONTROL
THE SEIZURES.

AND IT'S TYPICALLY USED IN
ADDITION TO MEDICATION.

AND IT DOES INVOLVE
A SURGICAL PROCEDURE

IN WHICH A BATTERY IS PLACED
IN YOUR CHEST

AND THEN A WIRE IS WRAPPED
AROUND THE VAGUS NERVE,

WHICH IS IN YOUR NECK.

AND IT WORKS BY SENDING
SMALL ELECTRICAL IMPULSES

TO THE VAGUS NERVE IN YOUR NECK.

AND THEN THESE IMPULSES GO TO
THE BRAIN

AND HELP TO PREVENT SEIZURES,
HOPEFULLY.

AND THE DEVICE DELIVERS THESE
PULSES OF ELECTRICAL STIMULATION

THROUGHOUT THE DAY.

AND IT'S BEEN SHOWN TO REDUCE
THE FREQUENCY OF--SEIZURES,

BUT IT DOESN'T COMPLETELY STOP
THEM IF THAT WAS YOUR QUESTION.

- YEAH.

- YOU KNOW, THE VNS,
IT ALSO HAS A WAND THAT'S USED.

AND IT HAS A--MAGNETIC DEVICE
IN THIS WAND.

AND THE MAGNET CAN BE USED
TO DELIVER AN EXTRA PULSE

OF STIMULATION, AND YOU PASS
THIS MAGNET OVER YOUR CHEST

WHERE THE DEVICE IS IMPLANTED
WHEN YOU SENSE THAT A SEIZURE

IS GOING TO HAPPEN.

AND FOR SOME PEOPLE,
THAT EXTRA STIMULATION

CAN STOP THE SEIZURE OR MAKE IT
LESS SEVERE.

SO, YOU KNOW, IT HELPS.

NOW, DEEP BRAIN STIMULATION
I'M NOT AS FAMILIAR WITH.

IT'S ANOTHER TYPE OF DEVICE
THAT DELIVERS

AN ELECTRICAL STIMULATION, BUT
IT DELIVERS THAT STIMULATION

DIRECTLY TO THE BRAIN
IS MY UNDERSTANDING,

WHERE THE VNS DELIVERS TO
THE VAGUS NERVE.

AND THE DEEP BRAIN STIMULATION
DEVICE IS NOT APPROVED YET.

SO I DON'T SEE PATIENTS AT
THE VA WITH IT.

BUT I THINK THAT IT'S CLOSE
TO BEING APPROVED.

AND ANOTHER THING WITH
THE DEEP BRAIN STIMULATOR,

IT'S PLACED IN THE BRAIN,

SO IT DOES INVOLVE MORE OF
A RISK THAN THE VNS.

OF COURSE, YOUR NEUROLOGY
PROVIDER WILL HAVE

INFORMATION FOR YOU ON
THESE DEVICES.

AND IF YOU ARE A CANDIDATE
FOR THE VNS, THE COMPANY

THAT MAKES THE DEVICE ALSO HAS
A REALLY GOOD INFORMATIONAL DVD

THAT GOES INTO A LOT OF DETAIL.

I HOPE THAT HELPS.

- YES. THANK YOU SO MUCH FOR
THIS INFORMATION.

- YEAH! SURE! WE HAVE TIME
FOR ANOTHER QUESTION

IF ANYONE ELSE HAS A QUESTION.

- I HAVE A QUESTION...

- I DO HAVE A QUESTION ABOUT--

I HEARD YOU TALK ABOUT
SOMETHING CALLED

COMPLEX PARTIAL SEIZURES...

- UH-HUH.

- ...MY AUNT, SHE HAD
A STROKE A COUPLE YEARS AGO.

AND I THINK SHE'S BEEN HAVING
SOMETHING CALLED

ABSENCE SEIZURES.

ARE ABSENCE SEIZURES THE SAME AS
WHAT YOU'RE TALKING ABOUT

AS THE PARTIAL ONES?

- YEAH. WELL. IT'S DIFFICULT TO
COMMENT ON THE TYPE OF SEIZURE

YOUR AUNT IS HAVING WITHOUT
EVALUATING HER

OR, YOU KNOW, HAVING ACCESS
TO HER WHOLE MEDICAL HISTORY.

BUT IF YOU'RE SAYING THAT SHE
HAD A STROKE A COUPLE YEARS AGO

AND THEN BEGAN HAVING SEIZURES
WHICH INVOLVED STARING,

IT SOUNDS LIKE SHE MAY BE HAVING
COMPLEX PARTIAL SEIZURES,

NOT ABSENCE SEIZURES.

BUT, OF COURSE,
I CAN'T SAY FOR CERTAIN

WHAT YOUR AUNT'S SEIZURE TYPE
IS, BUT IT DOES SOUND LIKE

COMPLEX PARTIAL SEIZURES,

WHICH ARE DIFFERENT THAN TRUE
ABSENCE SEIZURES. YOU KNOW...

MANY OF MY PATIENTS THAT HAVE
COMPLEX PARTIAL SEIZURES REFER

TO THEM AS ABSENCE SEIZURES

BECAUSE THEY HAVE EITHER READ
OR HEARD OR SAW ON THE INTERNET

THAT ABSENCE SEIZURES ARE
STARING SPELLS.

BUT ABSENCE SEIZURES, OR
SOMETIMES PEOPLE WILL CALL THEM

A PETIT MAL SEIZURE,

ARE ACTUALLY A TYPE OF
GENERALIZED SEIZURES

AND ARE SEEN MORE COMMONLY
IN CHILDREN THAN IN ADULTS.

AND, YOU KNOW, THESE ABSENCE
SEIZURES,

THERE ARE LAPSES OF AWARENESS.

AND BECAUSE THEY'RE STARING,

IT CAN LAST A FEW SECONDS--

AND THEY ARE FAR MORE COMMON
IN CHILDREN THAN IN ADULTS.

AND SO ABSENCE SEIZURES USUALLY
START QUITE YOUNG,

LIKE AT 5--BETWEEN 5
AND MAYBE 12 YEARS OF AGE,

BUT THEY RARELY START
AT 20 TO 30.

BUT, YOU KNOW, SOMETIMES THEY'RE
MISSED,

AND A DIAGNOSIS IS MADE
LATER IN LIFE.

I HOPE THAT
ANSWERS YOUR QUESTION.

- ...WAS ABOUT 74 YEARS OLD.

AND WE'VE BEEN THROUGH, LIKE--

I DON'T KNOW--LIKE 3 DIFFERENT
KINDS OF MEDICATION.

AND SHE, LIKE, HER HANDS
ARE REALLY SHAKY.

SHE'S GOT, LIKE, A TREMOR.

IS A TREMOR, LIKE, ASSOCIATED
WITH THIS EPILEPSY

OR IS THAT SOMETHING ELSE
THAT IT COULD BE?

- YEAH. I'M SORRY SHE'S
HAVING PROBLEMS.

YOU KNOW, IT'S HARD TO SPECULATE
WHAT THE POSSIBLE CAUSE

OF YOUR AUNT'S TREMORS ARE,
YOU KNOW, WITHOUT EVALUATING HER

OR HAVING ACCESS TO HER,
YOU KNOW, MEDICAL HISTORY.

IN GENERAL, I DON'T SEE
AN INCREASE IN TREMORS

IN PATIENTS SPECIFICALLY BECAUSE
THEY HAVE EPILEPSY.

SOMETIMES, IT'S A SIDE-EFFECT
FROM THEIR MEDICATION.

I MEAN, SOMETIMES I SEE IT
IN A DRUG CALLED LAMOTRIGENE

OR A DRUG CALLED DEPAKOTE.

AND SOMETIMES A SMALL ADJUSTMENT
IN THE MEDICATION DOSE

CAN MAKE A BIG DIFFERENCE.

BUT SOMETIMES THE MEDICATION
NEEDS TO BE CHANGED.

AND SOMETIMES IT IS A TREMOR
THAT HAS NO CORRELATION

TO ANY MEDICATION OR TO
THE DIAGNOSIS OF EPILEPSY.

YOU KNOW, AND SOMETIMES IT'S A
SYMPTOM OF PARKINSON'S DISEASE.

THERE ARE MANY POSSIBLE REASONS
FOR A TREMOR.

AND I WOULD STRONGLY RECOMMEND
HAVING A DISCUSSION

WITH YOUR NEUROLOGY PROVIDER
ABOUT IT.

IF YOU CAN BE PRESENT AT
THE VISIT OR WRITE A NOTE,

IT WOULD BE VERY HELPFUL.

SOMETIMES ELDERLY
PATIENTS FORGET.

OR ESPECIALLY IF THE TREMORS
COME AND GO

AND THEY MAY NOT BE PRESENT
DURING THE VISIT

WITH THE PROVIDER.

SO I WOULD RECOMMEND, IF
POSSIBLE, ATTENDING THE VISIT.

I HOPE THAT HELPS.

- YEAH. IT DID. DID YOU SAY
LAMOTRIGENE CAUSES TREMORS?

BECAUSE SHE'S ON SOMETHING
CALLED LAMICTAL.

IS THAT THE SAME THING?

- YEAH. YEAH. LAMOTRIGENE IS
GENERIC FOR LAMICTAL.

AND IT CAN--IT CAN CAUSE TREMORS
IN SOME INDIVIDUALS.

YOU KNOW, THE ELDERLY ARE REALLY
SENSITIVE TO MEDICATION.

AND SOMETIMES, LIKE I SAID,
EVEN A SMALL ADJUSTMENT

CAN MAKE A BIG DIFFERENCE.

BUT SOMETIMES THE MEDICINE
NEEDS TO BE CHANGED.

YOU KNOW, BUT THERE ARE SO MANY
POSSIBLE CAUSES

THAT IT'S REALLY IMPORTANT THAT
SHE BE EVALUATED,

THAT HER PROVIDER TAKE A LOOK
AT THE TREMORS.

AND, YOU KNOW, THE TREMORS
COULD BE FROM LAMICTAL,

BUT THEY COULD REPRESENT
SOMETHING ELSE COMPLETELY.

SO GET HER IN AS SOON
AS POSSIBLE FOR EVALUATION, OK?

- YEAH. UM, SO SHE'S DOING OK
ON THE LAMICTAL...

AND IT'S BEEN A WHILE.

I THINK ABOUT 6 MONTHS.

IS THIS SOMETHING THAT SHE'S
GONNA HAVE TO BE ON

FOR THE REST OF HER LIFE,
OR, YOU KNOW,

HOW IS IT
WITH WHAT YOU'VE DONE THERE?

- OH, THAT'S A HARD QUESTION.

AND PROBABLY, ONE--AGAIN,
BEST DISCUSSED

WITH HER PROVIDER.

YOU KNOW, CONSIDERING HER AGE
AND YOU'RE TELLING ME

THAT HER SEIZURES BEGAN
AFTER A STROKE

AND WERE DIFFICULT TO CONTROL
INITIALLY, YOU KNOW, SHE HAS

A REALLY BIG RISK FACTOR FOR
RECURRENT SEIZURES.

AND SHE MOST LIKELY WOULD NEED
TO STAY ON MEDICATION.

BUT HER NEUROLOGY PROVIDER THAT
KNOWS HER FULL MEDICAL STORY IS

BEST SUITED TO GUIDE HER WITH
THAT DECISION.

WE DO HAVE PATIENTS THAT COME
OFF OF MEDICATION,

BUT A LOT OF FACTORS NEED TO BE
CONSIDERED WHEN MAKING

THAT DECISION.

I WISH YOU THE BEST OF LUCK.

- OK, I GUESS I'LL HAVE TO TALK
TO HER PROVIDER. THANK YOU.

- OK. YES, GOOD LUCK. THANK YOU.

- I HAVE A QUESTION.
- YES?

- I'M WONDERING BESIDES THE
OBVIOUS--ALCOHOL, ET CETERA--

ARE THERE ANY OTHER THINGS
I SHOULDN'T BE DRINKING?

I MEAN, FOR EXAMPLE, I DRINK
COFFEE.

- YEAH. WELL, YOU KNOW,
MODERATION.

AND, YOU KNOW, SOMETIMES IT
DEPENDS ON WHY YOU'RE DRINKING

SAID COFFEE.

IF YOU'RE CHRONICALLY
SLEEP DEPRIVED

AND YOU'RE NOT GETTING ENOUGH
REST EVERY NIGHT

AND YOU'RE FINDING THAT YOU NEED
INCREASED CAFFEINE INTAKE,

YOU KNOW, CERTAINLY I WOULDN'T
RECOMMEND ENERGY DRINKS

OR, YOU KNOW, HIGHLY CAFFEINATED
PRODUCTS.

BUT IT'S REALLY IMPORTANT THAT
YOU BE GETTING ADEQUATE SLEEP

EACH NIGHT BECAUSE WE KNOW THAT
SLEEP DEPRIVATION IS

A TRIGGER FOR SEIZURES.

SO IF YOU'RE FINDING THAT
YOU'RE NEEDING TO INCREASE

YOUR COFFEE INTAKE OR YOUR
CAFFEINE INTAKE

TO HELP YOU OVERCOME SLEEPINESS
DURING THE DAY,

THAT'S A DIFFERENT ISSUE.

- YEAH. WELL, I HAVE APNEA,
SLEEP APNEA.

AND I USE A SLEEP AP MACHINE
AT NIGHT.

- YEAH. YEAH.
- YEAH. SO...

I GUESS A DOUBLE WHAMMY.

- YEAH. AND, YOU KNOW, ALSO,
I RECOMMEND NOT DRINKING

CAFFEINATED PRODUCTS LATER
IN THE DAY, YOU KNOW.

TO HELP WITH YOUR SLEEP QUALITY
AT NIGHT, IT'S REALLY IMPORTANT

THAT YOU STOP DRINKING COFFEE,
SODAS, TEAS LATER IN THE DAY

SO IT DOESN'T INTERFERE WITH
YOUR SLEEP AT NIGHT.

- YEAH. I USUALLY DON'T HAVE
ANY COFFEE, YOU KNOW,

BEYOND, LIKE, 9:00 OR 10:00
IN THE MORNING.

AND THEN MAYBE I'LL HAVE
A CUP IN THE AFTERNOON.

- YEAH.

- MAYBE I HAVE TO GIVE THAT UP.

- YEAH. DO YOU FIND THAT YOU'RE
SLEEPING WELL AT NIGHT?

- NO. BUT I HAVEN'T SLEPT
WELL IN YEARS.

- YEAH. YEAH...

- BECAUSE OF THE SLEEP APNEA,
I'LL GET, YOU KNOW,

MAYBE 3 OR 4 SOLID HOURS,

BUT THEN I'LL WAKE UP.
AND THEN, YOU KNOW,

IT'S THE DIFFICULTY
GETTING BACK TO SLEEP.

AND, YOU KNOW, IT'S A STRUGGLE.

- YEAH. YEAH. WELL, YOU KNOW,
CONTINUE TO WORK

WITH YOUR SLEEP PROVIDER,
YOUR NEUROLOGY PROVIDER

TO HELP GET THE BEST QUALITY
SLEEP YOU CAN

BECAUSE IT'S SO IMPORTANT WITH
PATIENTS THAT HAVE EPILEPSY

THAT THEY GET GOOD SLEEP.

WELL, GOOD LUCK.

- I'VE TAKEN TRAZODONE,

YOU KNOW, LIKE A HALF A TABLET.

AND IT JUST KNOCKED ME OUT
THE NEXT DAY.

OUT OF ALL THE MEDICATION
I'M TAKING, THE TRAZODONE

JUST KICKED MY BUTT, SO I'M
NOT DOING ANY OF THAT.

SO...NONE OF THOSE.

- YEAH. KEEP WORKING WITH
YOUR PROVIDER.

YOU KNOW, BRING IT UP AT
YOUR NEXT APPOINTMENT.

LET HER KNOW THE TIME SPAN
OF YOUR SLEEP EACH NIGHT,

WHAT'S WAKING YOU UP.

IS THERE DIFFICULTY GETTING
TO SLEEP?

YOU KNOW, BE SURE YOU REVIEW
ALL THAT

BECAUSE IT'S SUCH
AN IMPORTANT ISSUE.

- OK...

- OK. GOOD LUCK.

- GREAT. THANKS VERY MUCH.
THANKS.

THANKS FOR YOUR
PRESENTATION TODAY.

I APPRECIATE IT.

- YEAH! MY PLEASURE. THANK YOU.
THANK YOU.

WELL, I THINK OUR TIME IS UP.

I'D LIKE TO THANK EVERYONE AGAIN
FOR YOUR ATTENTION

AND FOR CALLING IN TODAY.

THANK YOU, SEAN.

- THANK YOU. THANK YOU,
EVERYBODY FOR CALLING IN.

AND JUST STAY TUNED.

WE WILL HAVE ANOTHER PATIENT
AUDIO CALL WITHIN A FEW MONTHS

AND YOU'LL START SEEING
ADVERTISEMENTS FOR IT.