- I WOULD LIKETO WELCOME YOU ALL
	TO THIS PATIENTAND CAREGIVER CALL
	TITLED "INTRODUCTIONTO EPILEPSY AND SEIZURES."
	THIS IS OUR FIRST CALLFOR PATIENT AND CAREGIVERS.
	MY NAME IS SEAN GAMBLE.
	I AM WITH THE EMPLOYEEEDUCATION SERVICEHERE IN ST. LOUIS,
	AND I AM THE PROJECT MANAGERFOR THIS SERIES OF CALLS.
	ALL YOUR LINES AREGOING TO BE MUTED
	AND WILL BE OPENED UPAT THE END OF THE PRESENTATION
	WHEN WE'RE READY FORQUESTIONS AND ANSWERS.
	I WANT TO INTRODUCE TODAYDR. NINA GARGA.
	SHE'S GOING TO BE TALKINGABOUT "INTRODUCTION TOEPILEPSY AND SEIZURES."
	DR. GARGA, IT'S ALL YOURS.
	- THANK YOU, SEAN.
	I AM GOING TO SPENDMOST OF TODAY TALKING
	ABOUT SOME OF THE BASICSABOUT WHAT ARE SEIZURES,
	WHAT ARE SOME OFTHE SYMPTOMS OF SEIZURES,
	WHAT DOES IT MEANTO HAVE EPILEPSY,
	HOW THAT DIAGNOSIS IS MADE,WHAT ARE THE TREATMENT OPTIONS.
	SO THAT'S JUST AREALLY BRIEF OVERVIEW OFWHAT WE'LL COVER TODAY.
	I WORK AT THE SAN FRANCISCOVA EPILEPSY CENTER...
	- Recording: SOMEONE HASENTERED THE CONFERENCE.
	- ...TAKING CARE OF PATIENTSWHO HAVE SEIZURES AND EPILEPSY.
	SO JUST A REAL BASICINTRODUCTION--WHAT IS A SEIZURE?
	WELL, A SEIZURE IS SOMETIMESCALLED AN ELECTRICAL STORM.
	IT'S BASICALLY A BRIEF,TEMPORARY DISTURBANCE
	OF THE ELECTRICAL ACTIVITYOF THE BRAIN.
	NOW, THE BRAIN HAS ELECTRICALACTIVITY GOING ON CONSTANTLY.
	IT'S HOW WE CONTROL MOVEMENT,VISION, ALL OF OUR OTHER SENSES.
	SO WHEN A SEIZURE HAPPENS,
	THERE IS DISREGULATIONOF THE NORMAL ACTIVITY
	AND TOO MUCH ACTIVITYHAPPENS ALL AT ONCE,
	FROM EITHER A PART OF THE BRAINOR THE WHOLE BRAIN.
	AND THAT CAN HAPPEN OUT OFTHE BLUE, WITH NO WARNING,
	AND BE COMPLETELY UNPREDICTABLE.
	NOW, EPILEPSY ISACTUALLY A DISORDER
	THAT'S CHARACTERIZED BYHAVING RECURRING SEIZURES.
	SOME PEOPLE CALL ITA SEIZURE DISORDER,
	BUT WE ESSENTIALLY USETHE TWO WORDS INTERCHANGEABLY,
	SO SEIZURE DISORDERGENERALLY MEANS EPILEPSY.
	AND IT CAN BE FORANY NUMBER OF REASONS
	THAT SOMEBODY HASRECURRING SEIZURES.
	SO WHO HAS EPILEPSY?
	WELL, OVER TWO MILLIONAMERICANS HAVE IT,
	AND ABOUT 200,000 NEW CASESOF SEIZURES AND EPILEPSY
	OCCUR EVERY YEAR.
	ABOUT HALF OF PEOPLEWITH EPILEPSY
	START HAVING SEIZURESBEFORE THEY TURN 25 YEARS OLD,
	BUT ANYONE CAN GET ITAT ANY TIME,
	AND NOW THERE ARE JUST ASMANY PEOPLE WITH EPILEPSYWHO ARE 60 OR OLDER
	AS THERE ARE CHILDREN AGE 10AND YOUNGER WITH EPILEPSY.
	SO EVEN THOUGHTRADITIONALLY,
	A LOT OF PEOPLE THINKOF EPILEPSY AS HAPPENINGTO CHILDREN OR BABIES,
	THIS IS REALLY A DISEASETHAT AFFECTS ALL SORTSOF PEOPLE AT ALL AGES.
	SO ABOUT ONE PERCENTOF THE GENERAL POPULATIONDEVELOPS EPILEPSY
	OVER THE COURSEOF THEIR LIFE.
	THE RISK IS HIGHER IN PEOPLEWITH CERTAIN MEDICAL CONDITIONS.
	THESE INCLUDETRAUMATIC BRAIN INJURY,
	STROKE, ALZHEIMER'S DISEASE,AUTISM, BRAIN TUMORS,
	OR OTHER ABNORMALITIESOF BLOOD VESSELS.
	BUT THAT'S JUST A SMALL GROUP OFDISORDERS THAT CAN LEAD TO IT.
	THERE ARE A WHOLE BUNCH OFOTHER PROBLEMS OR INJURIES
	THAT CAN LEAD TO EPILEPSY.
	SO WHAT CAUSES EPILEPSY?
	WELL, IN ABOUT 70% OF PEOPLEWITH EPILEPSY, WE DON'T KNOW.
	WE DON'T KNOWWHY THEY HAVE IT.
	WE HAVE SOME VAGUE IDEA BASED ONRISK FACTORS OR GENETICS,
	BUT IT'S NOT ALWAYSVERY CLEAR.
	IN ABOUT A THIRDOF PATIENTS,
	WE CAN IDENTIFY THE EXACT CAUSEAS BEING HEAD TRAUMA
	OR AN OLD INFECTIONOF THE BRAIN,
	A BRAIN TUMOR OR STROKE,
	OR GENETICS IN GENERAL--THAT IT RUNS IN THEIR FAMILY--
	AND IN SOME CASES,
	WE CAN EVEN FIND THE GENEINVOLVED THAT'S CAUSING IT.
	SO HOW DO WE IDENTIFYWHAT IS A SEIZURE,
	AND WHAT ARE SOME OF THESYMPTOMS OF A SEIZURE?
	WELL, TO KNOW THAT,YOU HAVE TO FIRST KNOW
	THAT THERE ARE SEVERAL DIFFERENTTYPES OF SEIZURES.
	THERE ARE WHAT WE CALLPARTIAL SEIZURES ANDGENERALIZED SEIZURES.
	NOW, THAT'S A VERYSIMPLE DISTINCTION
	TO BASICALLY DISTINGUISHWHAT HAPPENS DURING THE SEIZURE.
	SO FOR A PARTIAL SEIZURE, ONLY APART OF THE BRAIN IS INVOLVED,
	AND THAT'S WHYIT'S CALLED PARTIAL.
	IT'S USUALLYIN ONE FOCAL AREA,
	AND THE SYMPTOMS DURINGTHE SEIZURE WILL BE
	BASICALLY SOME DISRUPTIONASSOCIATED WITH
	THAT PART OF THE BRAIN'SNORMAL ACTIVITY.
	SO FOR INSTANCE, IF THEAREA CAUSING THE SEIZURE
	IS IN THE VISUAL PARTOF THE BRAIN,
	THAT CONTROLS SEEING AND VISIONAND PROCESSING OF VISION,
	THEN A SEIZURE THAT STARTS THEREMAY HAVE SYMPTOMS
	SUCH AS FLASHING LIGHTS ORSTRANGE PATTERNS IN THE VISION.
	FOR OTHER PEOPLEWHO HAVE PARTIAL SEIZURES
	THAT ORIGINATE INOTHER PARTS OF THE BRAIN,
	SUCH AS THE FRONTAL LOBE,WHERE MOTOR CONTROL IS,
	THEY MAY HAVE TWITCHINGOR JERKING OF THE BODY
	ON THE OPPOSITE SIDE.
	AND FOR PEOPLEWHO HAVE SEIZURES
	THAT START IN THE TEMPORALLOBE OF THE BRAIN,
	THAT TENDS TO BE INVOLVEDMORE WITH MEMORY OR WITHOTHER PSYCHIC PHENOMENA,
	SO SOME PEOPLE EXPERIENCESYMPTOMS LIKE D䨡‰VU
	OR CONFUSION OR JUSTAN INABILITY TO RESPOND
	WHILE THEY STARE AHEADAND CANNOT INTERACT.
	SO THOSE ARE SOME EXAMPLESOF PARTIAL SEIZURES.
	THERE ARE MANY OTHERPOSSIBILITIES FORHOW THEY MAY BEGIN,
	BUT THAT'S JUST A SMALLSUBSET OF EXAMPLES.
	THE OTHER MAJOR TYPE OF SEIZUREIS A GENERALIZED SEIZURE.
	NOW, WHEN PEOPLE SAY,"I HAD A SEIZURE,"
	MOST PEOPLE THINK OFTHE GENERALIZED SEIZURE,
	WHERE THE WHOLE BODYIS CONVULSING,
	SO WE OFTEN CALLA GENERALIZED SEIZUREA CONVULSIVE SEIZURE.
	WE FREQUENTLYREFER TO IT ALSO
	AS A GENERALIZEDTONIC-CLONIC SEIZURE,
	WHICH JUST MEANS THAT THE BODYIS VERY STIFF AT THE BEGINNING
	AND THEN IT BEGINS TO JERKRHYTHMICALLY UNTIL IT ENDS.
	NOW, WHAT I'VEEXPLAINED TO YOU SO FAR
	IS A LITTLE BIT OFAN OVERSIMPLIFICATION,
	AND THERE ARE ACTUALLYSEVERAL OTHER SEIZURE TYPES
	THAT MAY FITIN EITHER CATEGORY,
	SO IT'S NOT NECESSARILY
	COMPLETELY ASSTRAIGHTFORWARD AS THAT.
	BUT THE VERY BASICS IS THATSEIZURES ARE EITHER FOCAL
	OR THEY ARE GENERALIZED.
	SOME SEIZURES CAN BEGIN AS AFOCAL SEIZURE AND THEN SPREAD--
	THE ELECTRICAL ACTIVITY CANSPREAD THROUGHOUT THE BRAIN
	AND BECOMEA GENERALIZED SEIZURE
	THAT INVOLVESTHE ENTIRE BRAIN AT ONCE.
	
	THE REASON THAT IT'S IMPORTANTFOR YOUR DOCTOR TO KNOW
	WHETHER IT STARTS IN ONE AREAOR STARTS IN THE WHOLE BRAIN
	IS THAT IT CAN AFFECTOUR THOUGHT PROCESS
	ON WHAT HAS CAUSEDYOUR SEIZURE DISORDER
	OR YOUR LOVED ONE'SSEIZURE DISORDER
	AS WELL AS AFFECT WHATMEDICATIONS WE MIGHTCHOOSE TO TREAT IT,
	BECAUSE THERE AREDIFFERENCES IN HOW WE APPROACH
	THOSE TWO TYPES OF SEIZURES.
	SO WHAT PATIENTS AND WHATCAREGIVERS SHOULD KNOW
	ABOUT SYMPTOMS THATMAY INDICATE SOMEBODYHAS A SEIZURE DISORDER--
	THEY SHOULD LOOK FORTHINGS LIKE PERIODS OFA PATIENT BLACKING OUT
	OR BEING CONFUSEDWITH ALTERED MEMORY.
	THEY MAY HAVE COMPLETELYFORGOTTEN THAT CERTAINTHINGS HAPPENED.
	THEY MAY HAVE OCCASIONALFAINTING SPELLS
	OR, ESPECIALLY IN CHILDRENOR SOME ADULTS,
	THEY HAVE EPISODESOF BLANK STARING.
	SOMETIMES A SEIZURE CANPRESENT AS A SUDDEN FALL
	THAT HAPPENS FORNO APPARENT REASON,
	AND ALSO, THERE CAN BE EPISODESOF JUST BLINKING OR CHEWING
	AT INAPPROPRIATE TIMES.
	NOW, I UNDERSTAND THAT AFTERDESCRIBING ALL OF THESE,
	PROBABLY MOST OF US CANTHINK OF ANY TIME WHEN WE'VEDONE ONE OF THESE THINGS.
	IT DOESN'T MEAN THATANY TIME SOMEBODY FALLSFOR NO APPARENT REASON,
	THAT IT'S A SEIZURE,
	BUT THESE ARE JUST SOMEOF THE SYMPTOMS THAT CAN OCCUR,
	AND IF THEY'RE HAPPENINGREPEATEDLY IN THE SAME PERSON,
	IT CAN REALLY START TOPOINT AT EITHER SOME TYPEOF NEUROLOGICAL DISORDER
	OR SPECIFICALLYA SEIZURE DISORDER.
	AND IT'S IMPORTANTTO NOTE THESE THINGS,
	BECAUSE NOT ALL SEIZURESARE THE BIG SEIZURES WHEREYOU CONVULSE AND JERK.
	SO WHY MIGHT PEOPLEHAVE SEIZURES?
	WELL, I TALKED ABOUT SOMEOF THE RISK FACTORS--
	HAVING A BRAIN INJURYOR A STROKE
	OR ANOTHER PROCESSGOING ON IN THE BRAIN,
	OR WE JUST DON'T KNOW.
	BUT IN ANY PERSON WHO HASA TENDENCY TO HAS SEIZURES,
	ARE THERE CERTAIN THINGSTHAT MAKE THEM MORE LIKELYTO HAVE A SEIZURE
	TODAY OR TOMORROW,BUT NOT A WEEK FROM NOW?
	THERE DEFINITELY ARE.
	ALTHOUGH SEIZURES AREUNPREDICTABLE AND CANHAPPEN AT ANY TIME,
	THERE ARE CERTAIN THINGSTHAT MAY TRIGGER A SEIZURE
	IN SOMEBODY WHO HAS EPILEPSY ORHAS A TENDENCY TO HAVE SEIZURES.
	THOSE TYPES OF THINGSCAN INCLUDE MISSINGTHEIR MEDICATIONS,
	WHICH IS ACTUALLYTHE NUMBER ONE REASON
	THAT SOMEBODY WITH EPILEPSYHAS A SEIZURE--
	BECAUSE THEY FORGOTTO TAKE THEIR MEDICINEOR RAN OUT OF MEDICINE.
	OTHER TRIGGERS CAN BE THINGSLIKE STRESS OR ANXIETY,
	HORMONAL CHANGES,ESPECIALLY IN WOMEN
	WHO ARE HAVINGMENSTRUAL CYCLES.
	DEHYDRATION AND CHANGES INYOUR BODY'S ELECTROLYTE BALANCE
	CAN DEFINITELYTRIGGER A SEIZURE.
	THAT DOESN'T MEAN THATEVERYBODY SHOULD GO OUT ANDSTART DRINKING GATORADE,
	BUT DEFINITELY,DRINKING ENOUGH WATER
	AND STAYING HYDRATEDIS REALLY IMPORTANT.
	LACK OF SLEEPOR BEING EXTREMELY FATIGUED
	IS VERY WELL KNOWNTO CAUSE SEIZURES
	IN PEOPLE WITH A TENDENCY.
	IN FACT, IT CANEVEN CAUSE A SEIZURE INA PERSON WITHOUT EPILEPSY
	WHO MAY BE EXTREMELYSLEEP-DEPRIVED OR EXHAUSTED.
	PHOTOSENSITIVITY.SO, FLASHING LIGHTSAND BRIGHT LIGHTS
	CAN SOMETIMES CAUSESEIZURES IN CERTAIN TYPESOF SEIZURE DISORDERS.
	AND ALSO, VERY IMPORTANTLY,DRUG AND ALCOHOL USE
	OR INTERACTIONSWITH MEDICATIONS
	CAN CAUSE SEIZURES.
	VARIOUS DRUGS CANCAUSE SEIZURES DIRECTLY,
	AND OTHER THINGS, LIKE ALCOHOL,CAN EITHER TRIGGER SEIZURES
	OR TRIGGER THEM WHEN THE ALCOHOLIS WEARING OUT OF YOUR BODY.
	A LOT OF MEDICATIONSCAN CAUSE SEIZURESAS A SIDE EFFECT,
	OR, SPECIFICALLY, IF YOUTAKE TWO MEDICINES THATINTERACT WITH EACH OTHER,
	SOMETIMES THE END RESULTCAN BE A SEIZURE.
	SO IT'S IMPORTANTTO KNOW THIS
	AND THAT YOUR SEIZUREDOCTOR KNOWS WHATALL YOUR MEDICINES ARE
	SO THEY CAN HELP TELL YOUIF YOU'RE ON A MEDICATION
	THAT MIGHT BE MAKING YOURSEIZURE DISORDER WORSE
	AND LOOK TOWARDSCHANGING THAT.
	SO WHAT SHOULD YOU DO
	IF YOU'RE SEEING SOMEBODYHAVING A SEIZURE?
	WELL, THE FIRST THING TO DOIS NOT TO PANIC.
	IT'S IMPORTANT TO STAY CALMAND TRACK THE TIME.
	YOU DON'T WANT TORESTRAIN THE PERSON,
	BUT YOU WANT TO HELP THEMAVOID HAZARDS,

	SO YOU SHOULD PROTECT THEIRHEAD, REMOVE THEIR GLASSES,
	AND MAYBE LOOSEN ANY TIGHT ITEMSOF CLOTHING AROUND THEIR NECK.
	YOU SHOULD MOVE ANYTHINGHARD OR SHARP OUT OF THE WAY
	AND TURN THE PERSONON THEIR SIDE...
	[CLEARS THROAT]
	EXCUSE ME.
	AND POSITION THEIR MOUTHTOWARD THE GROUND
	SO THAT THEY DON'T SWALLOW
	IF THEY'RE FOAMING AT THE MOUTHOR VOMITING.
	YOU WANT TO LOOK AND SEE IFTHEY'RE WEARING A BRACELET,
	AN I.D. BRACELET, THAT INDICATESTHAT THEY HAVE EPILEPSY
	OR A SEIZURE DISORDER.
	AND YOU SHOULD ALSO KNOW THATIF YOU TELL THEM WHAT TO DO,
	THEY MAY NOT UNDERSTANDVERBAL INSTRUCTIONS
	DURING OR AFTER A SEIZUREFOR QUITE SOME TIME.
	YOU WANT TO STAY WITH THEM UNTILTHAT PERSON IS FULLY AWARE
	AND HELP REORIENT THEM.
	AND IF THE SEIZURELASTS A LONG TIME,
	SUCH AS MORE THAN 5 MINUTES,
	OR IF IT'S A PERSON WHOYOU DON'T KNOW IF THEY'VEEVER HAD A PRIOR SEIZURE,
	YOU SHOULD CALL 911OR AN AMBULANCE.
	
	SO WHAT SHOULD YOU NOT DOIF SOMEBODY IS HAVING A SEIZURE?
	THERE ARE A LOT OF THINGS THATCAN BE DANGEROUS TO THE PERSON.
	YOU SHOULD NOT PUT ANYTHINGIN THE PERSON'S MOUTH.
	THEY COULD BITE DOWNON YOUR FINGERS
	AND INJURE YOU, AS WELL,
	AND IT'S NOT LIKELYTO HELP THEM.
	PREVENTING THEM FROMSWALLOWING THEIR TONGUEOR BITING THEIR TONGUE
	IS REALLY NOT ADVISABLEIF YOU HAVE TO PUTSOMETHING IN THEIR MOUTH.
	THERE'S AN OLD ADAGETHAT YOU SHOULD STICKA LEATHER WALLET
	OR SOMETHING IN THEIR TEETHSO THEY DON'T HURT THEMSELVES,
	BUT THAT'S REALLY MORE DANGEROUSTHAN IT IS HELPFUL,
	ESPECIALLY IF IT'SSOMETHING SMALL.
	THEY CAN SWALLOW IT, OR THEYCOULD BREAK THEIR TEETH ON IT.
	SO IT'S BETTER TO HELPGET THEM ON THEIR SIDE
	SO THAT THEY DON'TSWALLOW THEIR VOMIT,
	RATHER THAN PUTTINGSOMETHING IN THEIR MOUTH.
	YOU SHOULD NOT GIVE THEM ANY OFTHEIR SEIZURE MEDICINES BY MOUTH
	WHILE THEY'REHAVING A SEIZURE,
	ESPECIALLY IF IT'S ONEWHERE THEY'RE CONVULSING.
	YOU KNOW, DOCTORS WILL SOMETIMESGIVE OTHER INSTRUCTIONS
	TO PATIENTS AND CAREGIVERSIN VERY SPECIFIC SITUATIONS
	THAT MAY BE SAFER,BUT IN GENERAL,
	UNLESS YOU'VE BEEN INSTRUCTEDON A SPECIFIC WAY TO DO THIS,
	YOU SHOULD NOT GIVE HELP TOSOMEBODY HAVING A SEIZURE,
	ESPECIALLY DURING ONE.
	YOU SHOULD KEEP THE PERSONON THEIR BACK,
	WITH THEIR FACE UP,
	OR ON THEIR SIDE WITHTHEIR HEAD PROTECTED,
	DEPENDING ON HOW SEVERETHE SEIZURE IS.
	
	SO WHEN SHOULD YOU CALL 911OR EMERGENCY MEDICAL SERVICES?
	WELL, LIKE I SAID BEFORE,
	IF A PERSON IS HAVINGA CONVULSIVE SEIZURE
	WHEN THEY'VE NEVER HADA SEIZURE BEFORE
	OR YOU DON'T KNOW IFTHEY'VE HAD A SEIZURE BEFORE,
	YOU SHOULD CALL,
	OR IF THEY'RE HAVING A SEIZURETHAT LASTS MORE THAN 5 MINUTES,
	EVEN IF YOU KNOWTHEY HAVE EPILEPSY.
	WHEN IT LASTS MORE THAN 5MINUTES, IT CAN BE MORE SERIOUS,
	AND THEY MAY NEEDIMMEDIATE MEDICAL ATTENTION.
	IF SOMEBODY IS HAVINGA FOCAL SEIZURE
	LIKE I DESCRIBED EARLIER,WHERE THEY'RE NOT CONVULSING
	BUT THEY ARE CLEARLY IMPAIREDIN THEIR AWARENESS,
	YOU DON'T ALWAYSHAVE TO CALL 911,
	BUT IF IT'S LASTING A LONG TIME,LIKE MORE THAN 5 MINUTES,
	YOU SHOULD PROBABLY CALL 911.
	IF YOU KNOW THE PATIENT
	AND THEY TYPICALLY HAVEVERY LONG FOCAL SEIZURES,
	LASTING 10 MINUTES,
	THAT'S OK, IF THAT'S THE NORMALDURATION FOR THAT INDIVIDUAL,
	AND YOU DON'T HAVE TOCALL 911, NECESSARILY,
	IF THAT'S THE TYPICALAMOUNT OF TIME IT TAKESFOR THEIR SEIZURES TO PASS
	AND THEIR DOCTOR KNOWS ITAND THEY'RE WORKING ON A PLAN.
	BUT ANYTHING THAT YOUTHINK IS BEYOND USUAL
	IN TERMS OF THE LENGTHOF THE FOCAL SEIZURE,
	THEN YOU SHOULD CONSIDERCALLING FOR HELP.
	ANOTHER REASON TO CALL 911 ISIF A PATIENT HAS ONE SEIZURE
	AND THEN THEY HAVEANOTHER SEIZURE
	BEFORE THEY'VE RECOVEREDIN BETWEEN THEM.
	SO IF A PERSON ISHAVING A CONVULSION
	AND THE CONVULSION ENDSAND THEY'RE TIRED
	AND THEY'RE STARTING TOCOME AROUND BUT THEY HAVEN'TREALLY COME AROUND YET
	AND THEN THEY HAVEANOTHER CONVULSION,
	THAT CAN BE A VERY SERIOUSMEDICAL EMERGENCY,
	AND YOU SHOULDDEFINITELY CALL 911.
	ALSO, IF THE PERSON IS INJUREDFROM THE SEIZURE OR PREGNANT,
	IT WOULD BE IMPORTANT TO CALL.
	IF YOU KNOW THAT THEYHAVE DIABETES OR ANOTHERMEDICAL CONDITION,
	IT'S DEFINITELYWORTH CALLING,
	BECAUSE SOMETIMES EVENTHE EMERGENCY MEDICAL PERSONNEL
	CAN GIVE THEMAN INJECTION OF SUGAR
	OR SOME OTHERTYPE OF TREATMENT
	THAT MAY BE IMPORTANT TOHELP THEM RECOVER COMPLETELY
	AND NOT CONTINUETO HAVE SEIZURES.
	IF THE PERSON IS RECOVERINGTOO SLOWLY, YOU CAN CALL 911,
	IF YOU'RE CONCERNED THATTHIS IS NOT NORMAL FOR THEM
	IF YOU KNOW THEM
	OR IF IT'S SOMEBODY YOUDON'T KNOW AND THEY'RERECOVERING SLOWLY,
	OR IF THEY DON'T RESUME THEIRNORMAL PATTERN OF BREATHING.
	WHEN YOU'RE IN DOUBT,IF YOU REALLY DON'T KNOW,
	THE BEST THING TO DOIS TO CALL FOR HELP.
	SO MOVING AWAY FROMTHE SEIZURE SAFETY,
	WHEN YOU SEE THEY DOCTOR,HOW DO THEY DIAGNOSE EPILEPSY?
	LIKE I MENTIONEDTO YOU BEFORE,
	SOMETIMES THE SYMPTOMSARE A LITTLE BIT UNCLEAR
	AND CAN BE AS MILD AS HAVINGEPISODES OF LOSS OF MEMORY
	OR LOSS OF TIME.
	SO WHAT WE DO,WHEN WE SEE YOU IN THE CLINIC,
	IS WE TAKE A VERY CAREFULHISTORY FROM BOTH THEPATIENT AND THE CAREGIVER,
	SOMEBODY WHO HASWITNESSED THE SEIZURES,
	TO GET A VERY ACCURATEDESCRIPTION OF WHATTHE SEIZURES ARE LIKE
	AND WHAT THE PATTERN HASBEEN OVER THE PREVIOUSWEEKS AND MONTHS.
	WE TRY TO GETA LOT OF INFORMATION
	ABOUT WHETHER THERE'S ANYRISK FACTORS FOR SEIZURES
	AND IF ANY OTHER TESTINGHAS ALREADY BEEN DONE.
	THEN WE EXAMINE THE PATIENT,PERFORMING A NEUROLOGICAL EXAM
	TO SEE IF THERE'SANY FEATURES ON THE EXAM
	THAT HELP POINT US TOWARDSA SEIZURE DISORDER
	OR A NEUROLOGICAL PROBLEM THATMIGHT CAUSE A SEIZURE DISORDER.
	AND BY THE END OFTHE VISIT, IF NECESSARY,
	WE ORDER TESTS, WHICH CANINCLUDE BLOOD TESTS,
	A TEST OF THE BRAINWAVESCALLED AN EEG,
	IMAGING TESTS TO LOOK ATPICTURES OF THE BRAIN,
	THAT CAN BE EITHER A CAT SCANOR AN MRI OR A PET SCAN.
	AND WE USE ALL THAT INFORMATIONTO TRY TO COME TO A CONCLUSION
	ABOUT WHETHER THE PERSONHAS EPILEPSY.
	NOW, REMEMBER, I SAID THATEPILEPSY IS A TENDENCYTO HAVE RECURRENT SEIZURES,
	SO IF THE PATIENTHAS ONLY HAD ONE SEIZURE,
	SOMETIMES WE'RE NOT ALWAYS SURE,AFTER DOING ALL OF THAT,
	WHETHER THEY HAVE EPILEPSYOR WHETHER THEY'RE LIKELYTO HAVE ANOTHER SEIZURE,
	BUT THE GOAL OF DOING ALL OFTHAT EVALUATION AND TESTS
	IS TO FIGURE OUT WHETHERTHIS IS GOING TO HAPPEN AGAIN
	AND WHETHER WE CAN DO ANYTHINGTO CONTROL IT OR CURE IT.
	SO WHAT SHOULD YOU TELL YOURDOCTOR ABOUT YOUR SEIZURES?
	WELL, YOU SHOULDDESCRIBE YOUR SYMPTOMS
	AND HAVE WITNESSESOR CAREGIVERS DESCRIBETHE SYMPTOMS THAT THEY SEE.
	YOU SHOULD DEFINITELYEXPLAIN THE SEIZURE PATTERN.
	SOME PEOPLE WILL KNOW THAT THEYHAVE ABOUT ONE SEIZURE A WEEK
	OR ONE SEIZURE A MONTH,
	ALL THAT INFORMATIONIS REALLY HELPFUL.
	ALSO, KNOWING WHETHERTHERE'S ANY OTHER PATTERN
	RELATED TO SLEEP OR INTAKEOF CERTAIN MEDICATIONS OR DRUGS
	IS VERY HELPFULFOR YOUR DOCTOR TO KNOW.
	YOU WANT TO TELL THEM IF THERE'SANY PRE-SEIZURE ACTIVITY.
	WHAT DO I MEAN BY THAT?
	YOU WANT TO TELL THEM IF YOUHAVE ANY SYMPTOMS THAT INDICATE
	THAT YOU THINK YOU'REGOING TO HAVE A SEIZURE.
	OR IF YOU'RE A CAREGIVER,IF YOU'VE WITNESSEDANY SORT OF SYMPTOMS
	THAT TEND TO OCCUR BEFORETHE PATIENT HAS A SEIZURE,AGAIN AND AGAIN.
	SOMETIMES WE USE THE WORD "AURA"TO DESCRIBE THAT ACTIVITY.
	YOU ALSO WANT TO TELL THE DOCTORIF YOU'RE ON A MEDICATION
	AND WHETHER THAT MEDICATIONIS WORKING FOR YOU
	AND HOW WELL YOU'RE ABLETO TAKE YOUR MEDICINEON TIME EVERY DAY.
	IT'S REALLY IMPORTANTTO KEEP A SEIZURE RECORDOR A SEIZURE DIARY,
	AND THIS CAN BE AS SIMPLE ASHAVING A LITTLE POCKET CALENDAR
	WHERE YOU MARK THE DAYSTHAT YOU HAD SEIZURES,
	OR YOUR CAREGIVER MARKSTHE DAYS THAT YOU HAD SEIZURES.
	KEEPING THAT RECORDMAKES IT A LOT EASIERTO WORK WITH YOUR DOCTOR
	ON ADJUSTING MEDICATION DOSESTO BETTER CONTROL THEM
	AND TO GET AN IDEA OFWHETHER WHAT WE'VEALREADY DONE IS WORKING.
	
	SO WHAT'S THE GOALOF TREATMENT IN EPILEPSY?
	WELL, WE'D LIKETO REACH A POINT
	WHERE A PATIENTIS HAVING ZERO SEIZURES
	OR AS FEW SEIZURESAS POSSIBLE.
	WE CALL THATSEIZURE FREEDOM.
	AND WE ALSO TRYTO ACHIEVE SEIZURE FREEDOM
	WITH NO SIDE EFFECTS FROMANTI-SEIZURE MEDICINES.
	NOW, THAT'S NOTALWAYS POSSIBLE,
	SO SOMETIMES WE'LL ALLOWSOME SIDE EFFECTS
	IF THEY'RE ACCEPTABLETO THE PATIENT
	AS WELL AS OVERALL,IN TERMS OF LOOKING AT ISSUES
	WITH MEDICATIONS CAUSINGSIDE EFFECTS THAT WE THINKARE NOT ACCEPTABLE.
	SO THE GOAL IS SEIZURE FREEDOMAND NO SIDE EFFECTS,
	OR AS CLOSE TO THATAS POSSIBLE.
	AND WE WANT TO HELP THEPERSON WITH EPILEPSY LEAD AFULL AND PRODUCTIVE LIFE.
	THIS DOESN'T HAVE TO BESOMETHING THAT RUNS YOUR LIFE.
	SO HOW DO WE DECIDE WHONEEDS TO BE ON MEDICATION
	OR NEEDS TREATMENTIN GENERAL FOR SEIZURES?
	WELL, A LOT OF THATHAS TO DO WITH THE PATTERN
	OF WHAT'S HAPPENED UP UNTIL THEPOINT WHERE WE NEED TO SEE YOU.
	SO FOR PATIENTS WHERE WE MIGHTNOT GIVE THEM TREATMENT
	OR SEIZURE MEDICATION,
	THEY MIGHT BE PEOPLE WHO HAVEONLY HAD ONE SEIZURE
	AND WE'RE NOT CONVINCEDTHAT THEY'RE GOING TOHAVE ANOTHER SEIZURE,
	AND IT MAY BE BETTERTO WAIT AND SEE.
	IF THE PATIENT ISNEUROLOGICALLY NORMAL,
	MEANING WHEN WE DOOUR NEURO EXAM, WE CAN'TFIND ANYTHING ABNORMAL,
	THEN WE MIGHT NOTRUSH TO TREAT.
	ALSO, IF A PATIENTIS YOUNGER, IT MAY NOTBE AS URGENT TO TREAT,
	AND WE MAY WAIT AND SEEWHAT HAPPENS.
	ALSO, IF WE'RE MORE CONCERNEDABOUT SIDE EFFECTS
	FROM MEDICATIONSIN CERTAIN INDIVIDUALS,
	WE MAY BALANCE WHETHER OR NOTIT'S WORTH TREATING.
	PATIENTS THAT WE DOWANT TO TREAT MOREAGGRESSIVELY EARLY ON
	ARE THE ONES WHO WE ORDERSOME TESTS ON, SUCH AS THEEEG, AND IT'S ABNORMAL,
	AND IT SUGGESTS THATTHEY'RE VERY LIKELYTO HAVE ANOTHER SEIZURE.
	FOR PATIENTS WHO HAVE ALREADYHAD SEVERAL SEIZURES,
	WE'RE MORE LIKELY TO TREAT,
	AND ACTUALLY THE PATIENTSWITH FOCAL SEIZURES
	THAT START IN ONE AREAOF THE BRAIN
	WE'RE MORE LIKELY TO TREAT,
	BECAUSE THOSE HAVE A TENDENCYTO RECUR MORE OFTEN.
	EVEN IF THE PATIENT HASONLY HAD ONE SEIZURE,
	IF THEY ARE A DRIVERAND THEY WANT TO RESUME DRIVING,
	WE WILL OFTEN TREAT WITHMEDICATIONS TO HELP ACHIEVETHAT GOAL FASTER.
	WE ALSO CONSIDER WHETHERTHE PATIENT IS ELDERLY
	AND IF THEY HAVE OTHERNEUROLOGICAL DISEASES
	THAT MAY BE LEADINGTO THE EPILEPSY,
	WE MAY BE MORELIKELY TO TREAT.
	BUT ALL IN ALL, A LOT OF IT ISA RISK/BENEFIT ANALYSIS
	IN LOOKING AT THE INDIVIDUAL
	AND WHY WE THINKTHEY HAVE SEIZURES
	AND IF IT'S SOMETHING THATWE CAN MODIFY WITH TREATMENT.
	SO WHAT ARE THETYPES OF TREATMENT?
	WELL, I'VE MENTIONEDMEDICATION, WHICH ISREALLY THE MAINSTAY
	OF TREATMENT FOR SEIZURESAND EPILEPSY,
	BUT THERE ARE ALSOSOME OTHER TREATMENTS,
	SUCH AS SURGERY OR OTHERNON-MEDICATION TREATMENTS
	LIKE SPECIAL DIETS OR DEVICESSUCH AS A VAGUS NERVE STIMULATOR
	AND OTHER LIFESTYLEMODIFICATIONS.
	AND I'M GOING TOGO THROUGH THESE INA LITTLE BIT MORE DETAIL
	OVER THE NEXT15 MINUTES OR SO.
	WHEN I SAY LIFESTYLEMODIFICATIONS, WHAT DO I MEAN?
	I MEAN GETTINGVERY REGULAR SLEEP
	AND TRYING TO DO SOMESTRESS REDUCTION IN YOUR LIFE
	SO THAT THE SEIZURES ARELESS LIKELY TO COME BACK
	OR DOING THINGS LIKEREDUCING OR ELIMINATINGDRUG AND ALCOHOL INTAKE.
	SO GETTING BACKTO MEDICATIONS--
	THERE ARE ABOUT 15-20 DIFFERENTSEIZURE MEDICATIONS
	OUT THERE ON THE MARKET.
	THERE ARE SO MANY TOCHOOSE FROM THAT IT MAYBE HARD TO FIGURE OUT
	WHY DID YOUR DOCTOR PICKONE DRUG VERSUS ANOTHER.
	SOME OF THE FACTORSTHAT CAN AFFECT WHICHMEDICATION WE CHOOSE
	INCLUDE THE TYPE OF SEIZURESOR THE EPILEPSY SYNDROME.
	NOW, REMEMBER I MENTIONED
	THAT FOCAL SEIZURESAND GENERALIZED SEIZURES
	DON'T ALWAYS RESPONDTO THE SAME MEDICINE,
	SO THAT CAN REALLYHELP US PICK A DRUG
	OR AT LEAST ELIMINATESOME OPTIONS.
	WE ALSO LOOK AT THESIDE EFFECTS OF EACH DRUG.
	EVERY SINGLE MEDICATION WE HAVECAN CAUSE SIDE EFFECTS,
	BUT EACH ONE CAUSESDIFFERENT SIDE EFFECTS,
	SO SOMETIMES WE TRY TOMATCH UP A MEDICATION THATHAS A CERTAIN SIDE EFFECT
	WITH SOMETHING THATA PATIENT CAN TOLERATE
	OR ACTUALLY A POSITIVESIDE EFFECT THAT MAYWORK IN THEIR FAVOR.
	FOR INSTANCE, SOME SEIZUREMEDICINES ARE SEDATING,
	AND FOR A PATIENT WHO HASINSOMNIA A LOT OF THE TIMEAND TROUBLE SLEEPING,
	WE MAY ACTUALLY PICKONE THAT'S SEDATING IFIT'S TAKEN AT BEDTIME.
	OTHER MEDICINES MAY ACTUALLYCAUSE SOME DIFFICULTY SLEEPING,
	AND PATIENTS MAY LIKE THATIF THEY'RE ON OTHER MEDICINES
	THAT ARE MAKING THEMFEEL TOO SEDATED.
	SO YOU CAN SEE HOW WE CANTRY TO USE THE SIDE EFFECT
	TO OUR ADVANTAGE SOMETIMES.
	OTHER SEIZURE MEDICINESALSO TEND TO HELP
	WITH HEADACHES OR MIGRAINES,
	SO THAT MAY HELP USPICK A MEDICINE
	IF THE PATIENT ALSO HASA HEADACHE DISORDER.
	WE LOOK AT THE PATIENT'S AGE,NOT JUST WHEN WE PICK A DRUG,
	BUT ALSO WHEN WE PICKHOW MUCH OF IT TO PUT YOU ON.
	WE LOOK AT YOUR LIFESTYLE.
	IF YOU'RE WORKINGOR A STUDENT
	AND YOU'RE HAVING TO CONSTANTLYTHINK AND BE ON YOUR FEET
	AND, YOU KNOW, MAYBE EVENDELIVER CARE TO OTHER PEOPLE,
	WE HAVE TO BE VERY CAREFUL ABOUTNOT GIVING SEDATING MEDICINES
	OR MEDICINES THAT MAYMAKE YOU FEEL LIKEYOU'RE THINKING SLOWER.
	UM...LET'S SEE.
	A FEW OTHER POINTS.
	IF IT'S A WOMAN WHO ISTHINKING ABOUT HAVING CHILDREN
	OR IS AT THAT AGE WHERETHEY MIGHT HAVE CHILDREN,
	WHETHER OR NOT THEY WANT TO,INTENDED OR NOT,
	WE MAY CHOOSECERTAIN MEDICINES
	THAT ARE LESS LIKELY TOCAUSE PROBLEMS FOR THE FETUS.
	SO THERE'S A WHOLE LOT OF THINGSTHAT WE TAKE INTO ACCOUNT
	WHEN WE PICK A MEDICINE.
	ONE OF THE THINGS THATI ALWAYS THINK ABOUT IS,
	WHAT OTHER MEDICATIONSIS THIS PERSON TAKING,
	AND IF I GIVE THEM ONEMEDICINE, WILL IT INTERACTWITH THE OTHER PILL?
	WILL IT MAKE THE OTHER PILLNOT WORK AS WELL,
	OR WILL THE OTHER PILLNOT MAKE IT WORK AS WELL?
	SO THOSE ARE A LOT OFDECISIONS THAT GO INTOCHOOSING A MEDICINE.
	BUT ONCE WE PICK A MEDICINE,WHAT ARE SOME OF THE THINGS
	THAT MIGHT MAKE THEMEDICINE WORK FOR YOUOR NOT WORK FOR YOU?
	WELL, MOST IMPORTANT ISCONSISTENT USE OF THE MEDICINE--
	TAKING IT AS PRESCRIBEDAND TRYING YOUR BESTNOT TO MISS DOSES.
	THAT'S PROBABLYTHE MOST IMPORTANT THING
	WHETHER THE MEDICINECONTROLS THE SEIZURES,
	BUT THERE'SOTHER THINGS, AS WELL.
	IT MAY BE THAT THE DOSEIS NOT HIGH ENOUGH
	OR THAT IT'S JUST NOTTHE RIGHT MEDICATION
	FOR YOUR INDIVIDUAL SEIZUREDISORDER OR SEIZURE TYPE.
	SOMETIMES THERE'S AN ISSUEWITH THE MEDICATION ITSELF,
	AND, FOR SOME REASON,THAT DOESN'T WORK
	WITH OTHER MEDICATIONSTHE PERSON IS TAKING
	OR FOR THEIR PARTICULAR CASE.
	SO IN ABOUT HALF OF PEOPLE,
	IF YOU START THEMON A MEDICATION,
	THE SEIZURES WILLBE ELIMINATED.
	IN ABOUT ANOTHER30% OF PATIENTS,
	THE SEIZURESWILL BE REDUCED,
	BUT THEY MAY NOT BECOMPLETELY ELIMINATED.
	AND THEN IN ABOUT 20%OF PATIENTS, WITH ANYGIVEN MEDICINE,
	THE SEIZURES WILL NOTRESPOND WELL.
	AND IT'S REALLY HARDTO KNOW UP FRONT
	WHICH CATEGORY ANY GIVENPERSON WILL BE IN,
	AND SO SOMETIMESIT FEELS A LITTLE BITLIKE TRIAL AND ERROR
	IN WORKING TOWARDSFINDING THE RIGHT MEDICINEFOR THE RIGHT PERSON.
	SO WE TALKED ABOUT SEIZURECONTROL FROM THE MEDICINES
	AND TAKING THE MEDICINES,BUT WHAT ARE THE SIDE EFFECTS?
	I MENTIONED THAT FEELINGDROWSINESS OR HAVINGDIFFICULTY SLEEPING
	ARE SOME COMMONSIDE EFFECTS.
	OTHER COMMON SIDE EFFECTSOF A LOT OF OUR MEDICINES
	CAN BE FEELING CLUMSYOR IRRITABLE OR NAUSEATED.
	ANOTHER ONE IS GETTING A RASHOR AN ALLERGIC REACTION.
	THE SIDE EFFECTS ARESOMETIMES RELATED
	TO THE DOSE OFMEDICINE YOU'RE TAKING,
	AND IT MAY BE THATLOWERING THE DOSE CAN GETRID OF THE SIDE EFFECTS
	BUT STILL KEEPSEIZURE CONTROL.
	SO DEVELOPING A SIDE EFFECTDOESN'T NECESSARILY MEAN
	THAT WE CAN'T FIND A WAY TOGIVE YOU THE SAME MEDICINE,
	BUT IN A DIFFERENT WAYOR A DIFFERENT DOSE
	TO HELP YOUR SEIZURES.
	IT'S ALSO IMPORTANT,IF YOU HAVE A SIDE EFFECT,
	TO KNOW WHETHER IT'SA SIDE EFFECT THAT SHOULDMAKE YOU STOP THE MEDICINE
	OR IF IT'S A SIDE EFFECTTHAT YOU JUST NEED TO REPORT
	AND THEN MAKE A PLANWITH YOUR DOCTOR ONHOW TO LOWER THE DOSE
	IN A WAY THAT WON'T MAKE YOUHAVE A LOT OF SEIZURES
	BUT WILL HELP YOU GET RIDOF THE SIDE EFFECT.
	SOME WARNING SIGNS OF POSSIBLESERIOUS SIDE EFFECTS
	FOR WHICH YOU SHOULD ALWAYSCALL YOUR DOCTOR RIGHT AWAY
	AND EVEN CONSIDER GOINGTO AN EMERGENCY ROOMFOR IMMEDIATE ATTENTION
	WOULD INCLUDE THINGS LIKE RASHALONG WITH NAUSEA AND VOMITING,
	A SEVERE SORE THROATOR MOUTH ULCERS,
	IF YOU'RE HAVING A PROLONGEDFEVER, EASY BRUISING,
	OR BLEEDING IN DIFFERENTPARTS OF THE BODY--
	WE CALL IT PINPOINT BLEEDING,UNDER THE SKIN.
	HAVING A LOT OFWEAKNESS OR FATIGUE,
	HAVING SWOLLEN GLANDSAND A LACK OF APPETITEOR ABDOMINAL PAIN
	CAN ALSO BE SERIOUS.
	SO THOSE ARE THINGS THAT YOUSHOULDN'T WAIT A MONTH OR TWO
	UNTIL YOUR NEXT APPOINTMENT WITHYOUR DOCTOR TO TALK ABOUT.
	THOSE ARE THINGS THATWARRANT AN IMMEDIATE CALL
	AND POTENTIALLY,EMERGENCY CARE.
	THE OTHER ONES THAT I TALKEDABOUT, LIKE THE CLUMSINESS,DROWSINESS, IRRITABILITY,
	THOSE TYPES OFSIDE EFFECTS--
	OF COURSE, YOU SHOULDALWAYS CALL YOUR DOCTOR
	AND TRY TO DISCUSS ITAS SOON AS POSSIBLE,
	BUT THEY MAY NOT BE AS EMERGENTAS THE OTHER ONES I MENTIONED.
	SO, MOVING AWAYFROM MEDICINES,
	I MENTIONED THAT SURGERYIS SOMETIMES AN OPTIONFOR TREATING EPILEPSY.
	SO WHAT ARE SOME OFTHE FACTORS THAT INFLUENCE
	WHETHER OR NOT WE WANT TOOFFER SURGERY TO A PATIENT?
	WELL, ONE, THE FIRST THING,THE MOST IMPORTANT THING,
	IS WE HAVE TO DETERMINE
	HOW LIKELY IS IT THAT THESEIZURES ARE DUE TO EPILEPSY.
	AND THIS GETS BACKTO THE WHOLE ISSUE
	OF WHAT IS JUST A SEIZUREAND WHAT IS EPILEPSY.
	SO FOR US TO DETERMINETHAT THE SEIZURES ARE
	ELECTRICAL ACTIVITY FROMTHE BRAIN THAT'S ABNORMAL,
	AND THAT THAT'SWHAT'S GOING ON CONSISTENTLY,
	IS IMPORTANT FOR US TO DECIDETHAT SURGERY IS EVEN AN OPTION.
	THEN WE HAVE TO DECIDE IFSURGERY IS LIKELY TO HELP
	THIS INDIVIDUAL SITUATION
	AND WHETHER WE CANIDENTIFY THE FOCUS THAT'SCAUSING THE SEIZURES.
	WE HAVE TO THINK ABOUTWHETHER OTHER TREATMENTSHAVE BEEN ATTEMPTED,
	AND HAVE SIMILAR TREATMENTSBEEN TRIED?
	SO HAS THE PERSON EVENTRIED A MEDICATION
	OR TRIEDA COUPLE OF MEDICINES?
	THAT'S REALLY IMPORTANT BECAUSESOMETHING LIKE TAKING A MEDICINE
	MAY BE A BETTER OPTIONTHAN SURGERY.
	IT JUST DEPENDS ONTHE CIRCUMSTANCESFOR THE INDIVIDUAL.
	AND THEN WE HAVE TO THINK OFTHE OVERALL RISKS AND BENEFITS.
	YOU KNOW, DOING SURGERYIS NOT A SIMPLE THING,
	AND THERE ARE DEFINITELYRISKS THAT GO ALONG WITHHAVING ANY SURGERY,
	AS WELL AS SPECIFIC RISKS TOREMOVING A PART OF THE BRAIN
	THAT'S CAUSING SEIZURES,
	AND, YOU KNOW, PART OF THEEVALUATION LEADING UP TO SURGERY
	IS LOOKING AT, HOW RISKYWILL THIS BE FOR THIS PATIENT,
	AND IS IT WORTH IT?
	AND THAT IS NOTAN EASY QUESTION TO ANSWER.
	IT IS VERY INDIVIDUAL,AND IT'S BASED ON A LOT OF TIME
	AND TESTING DONEWITH YOUR DOCTOR.
	BUT THAT BEING SAID,FOR SOME PATIENTS,
	SURGERY ISDEFINITELY AN OPTION,
	AND IT'S OFTEN THE BESTTREATMENT FOR THEIR EPILEPSY.
	SO IT'S DEFINITELY SOMETHING
	THAT YOU SHOULDDISCUSS WITH YOUR DOCTOR.
	I MENTIONED SOMETHING CALLEDA VAGUS NERVE STIMULATOR.
	NOW, THIS DEVICE IS SOMETHINGTHAT'S USED TO TREAT EPILEPSY,
	AND IT'S DIFFERENTTHAN A MEDICATION.
	IT'S ACTUALLY A WIRETHAT'S PLACED IN THE NECK
	OVER THE VAGUS NERVE.
	IT'S RIGHT NEXT TO THEPLACE WHERE YOU CAN FEELYOUR PULSE IN YOUR NECK.
	AND THAT WIREHAS SOME POINTS ON IT
	THAT DELIVER ELECTRICALSTIMULATION TO THE NERVE,
	AND SOMEHOW, THAT ELECTRICALSTIMULATION AFFECTS THE BRAIN
	AND CHANGES SOME OFTHE ELECTRICAL ACTIVITY
	OVER LONG PERIODS OF TIMETO TRY TO REDUCE SEIZURES,
	AND THE DOCTOR CAN CONTROL
	HOW MUCH ELECTRICALSTIMULUS IS GIVEN
	BY PROGRAMMING ITAND CHANGING THE SETTINGS.
	SO THIS TREATMENT--WE CALL IT VNS FOR SHORT--
	IS USED TO TREAT PARTIALSEIZURES OR FOCAL SEIZURES
	WHEN MEDICATIONS DON'T WORK
	AND IF OTHER TYPES OFSURGERY AREN'T AN OPTION
	OR AREN'T A GOOD OPTION.
	AND IT OFTENREDUCES SEIZURES,
	BUT IT RARELY COMPLETELYCONTROLS THEM.
	IT'S A DIFFERENT SITUATIONIN CHILDREN
	WHO HAVE STRICTTYPES OF EPILEPSY--
	THE VNS CAN ACTUALLY CONTROLTHE SEIZURES MUCH BETTER
	OR AT LEAST CONTROLTHE DISABLING SEIZURES.
	SO IT'S DEFINITELYWORTH DISCUSSING,
	JUST LIKE OTHER MEDICATIONSAND SURGERY.
	IT'S DEFINITELYNOT FOR EVERYBODY,
	BUT IT CAN BE A VERY GOOD CHOICEFOR SELECT PATIENTS,
	AND THAT'S DEFINITELYSOMETHING WE CAN DO
	AT THE SAN FRANCISCO VAAND AT MANY INSTITUTIONS
	AROUND THE COUNTRYAND IN THE BAY AREA.
	DIET--WHAT CAN PEOPLEDO WITH THEIR DIET
	THAT CAN SOMETIMESHELP CONTROL SEIZURES?
	WELL, WE LEARNEDA LONG TIME AGO
	THAT PATIENTS WHO WERESTARVING, OR PEOPLE WHO WEREUNDERGOING STARVATION,
	THAT THEY HADAN ANTI-EPILEPTIC EFFECT.
	SO IF YOU HAD A SEIZURE PATIENTWHO HAPPENED TO BE STARVING,
	THEY HAD FEWER SEIZURES.
	NOW, WE DON'T WANT TOMAKE OUR PATIENTS STARVE,
	BUT WHEN SOMEBODY IS STARVING,WHAT THEY'RE DOING IS,
	THEY'RE BURNING FAT FOR ENERGYINSTEAD OF SUGAR.
	AND YOU MAY HAVE HEARDOF THE ATKINS DIET.
	THERE'S ANOTHER DIETCALLED THE KETOGENIC DIET
	WHICH IS KIND OF SIMILARTO THE ATKINS DIET
	WHERE YOU BASICALLY TRICKYOUR BODY INTO THINKINGTHAT IT'S STARVING
	BY ADJUSTING THE RATIOOF FATS, PROTEINS, ANDCARBOHYDRATES IN A DIET.
	AND PUTTING THE BODYINTO THAT STATE
	OF THINKING IT'S STARVINGWHEN IT'S NOT ACTUALLY STARVING
	CAN SOMETIMES HELPREDUCE THE SEIZURES.
	WE USE THIS DIET MOSTLY TO TREATSEVERE EPILEPSY IN CHILDREN,
	BUT IN SOME ADULTSAND ADOLESCENTS,
	IT CAN BE EFFECTIVE.
	BUT IT'S A VERY DIFFICULTDIET TO STICK WITH,
	SO IT CAN ONLY BE DONEIF SOMEBODY IS MAKINGA STRONG COMMITMENT--
	BOTH THE PATIENTAND THEIR CAREGIVER--
	TO WORKING ON STAYINGWITHIN THE DIET.
	A LOT OF THE TIMES, THIS DIET ISSTARTED IN THE HOSPITAL
	TO HELP TRANSITION THE PATIENTINTO THAT STATE OF STARVATION
	AND THEN CONTINUED ONTHE OUTSIDE AFTER THEY GO HOME.
	
	SO I JUST WANTED TO MAKEA COUPLE OF COMMENTS
	ON EPILEPSY IN VERYSPECIFIC POPULATIONS,
	AND I TOUCHED ON THISA LITTLE BIT ALREADY,
	BUT I WANTED TO TALKABOUT EPILEPSY IN WOMEN.
	I MENTIONED THAT HORMONALEFFECTS CAN AFFECT SEIZURES.
	NOW, HORMONES CHANGEDURING PUBERTY, MENOPAUSE,
	AND REGULAR MONTHLY CYCLESIN MENSTRUATING WOMEN.
	AND THE CHANGES BETWEENESTROGEN AND PROGESTERONE
	AND THE CYCLESTHAT PEOPLE GO THROUGH
	CAN DEFINITELY AFFECTSEIZURE FREQUENCY,
	SO A LOT OF WOMEN WILL SAY,
	"OH, MY SEIZURES ALWAYSGET WORSE OR MORE FREQUENT
	THE FEW DAYS BEFOREMY PERIOD OR THE FEW DAYSAFTER MY PERIOD."
	AND THAT'S NORMAL,TO NOTICE THAT VARIATION.
	IT DOESN'T HAPPEN FOR EVERYBODY,BUT IT CAN HAPPEN.
	ALSO, AN IMPORTANTTHING TO REMEMBER
	IS THAT BIRTH-CONTROL PILLSMAY NOT BE AS EFFECTIVE
	IN WOMEN WHO HAVE EPILEPSY
	AND WHO ARE TAKING MEDICATIONSTO CONTROL THE SEIZURES.
	SO THAT'S SOMETHINGTHAT WE HAVE TO CONSIDER
	WHEN WE TAKE CARE OF WOMENWHO DON'T WANT TO GET PREGNANT
	AND ALSO HAVE EPILEPSY.
	A LOT OF OUR MEDICATIONS,AS I MENTIONED BEFORE,
	CAN BE RISKY IF A PATIENT ISPREGNANT OR BREASTFEEDING.
	THESE MEDICATIONS CAN INCREASETHE RISK FOR BIRTH DEFECTS--
	NOT ALL OF THEM,BUT MANY OF THEM DO,
	AND IT'S AN IMPORTANTCONVERSATION TO HAVEWITH YOUR DOCTOR
	IF YOU'RE PREGNANT OR THINKINGABOUT BECOMING PREGNANT.
	IT'S IMPORTANT FOR USTO BE ABLE TO ADJUST YOURMEDICATIONS OR YOUR DOSES
	AND COME UP WITHTHE BEST COMBINATION
	TO MAKE BOTH THEPATIENT WITH EPILEPSYAND THEIR FETUS SAFE.
	I DO WANT TO STRESS, THOUGH,THAT ANY WOMAN WHO IS PREGNANT
	SHOULD NOT NECESSARILY STOPTHEIR SEIZURE MEDICINES,
	BECAUSE HAVING A SEIZURE CANALSO BE A RISK TO THE FETUS.
	SO IT'S A RISK/BENEFITANALYSIS AGAIN.
	EPILEPSY IN OLDER ADULTSIS ALSO
	A LITTLE BIT OF A SPECIAL GROUPOF PEOPLE I WANTED TO MENTION.
	ONE OF THE REASONS IS THAT OLDERADULTS CAN HAVE FOCAL SEIZURES
	THAT ARE OFTEN UNRECOGNIZEDOR MISDIAGNOSED,
	SO IT CAN BE A LITTLEBIT HARD TO ASSESS.
	ALSO, OUR MEDICATIONS--
	SOMETIMES THE SAME DOSETHAT WORKS FOR SOMEBODYWHO'S 40 YEARS OLD
	IS JUST TOO MUCH MEDICINEFOR A PATIENT WHO'S 70,
	AND A LOT OF TIMES,THEY END UP ON THE SAME DOSES,
	AND THEY HAVE A LOTOF SIDE EFFECTS,
	SO WE DEFINITELY TREAT OLDERADULTS A LITTLE BIT DIFFERENTLY
	WHEN THEY HAVE SEIZURES,
	AND WE HAVE TO TAKE CERTAINTHINGS INTO CONSIDERATION.
	FINALLY, ONE THING THATPEOPLE HAVE A LOT OFQUESTIONS ABOUT IS DRIVING.
	IF I HAVE SEIZURESOR IF I HAVE EPILEPSY,
	CAN I DRIVE A CAR?
	AND EVERY TIME I THINKABOUT THIS, I REMEMBER
	WHEN I WAS 16 YEARS OLDAND GETTING MY LICENSE
	THAT THE LITTLE BOOK THATTHE DMV MAKES HAS, YOU KNOW,
	IN BIG PRINT ACROSS THE FRONTAND THE BACK,
	"DRIVING IS A PRIVILEGE.IT IS NOT A RIGHT."
	AND THIS IS A REAL PROBLEMBECAUSE WE LIVE IN A SOCIETY
	WHERE BEING ABLE TO DRIVE MEANSBEING ABLE TO BE INDEPENDENT,
	AND IT'S A REALLY BIG DEAL,
	AND IT'S A VERY DIFFICULTTHING TO DEAL WITH.
	SO WHAT SHOULD YOU KNOW?
	WELL, EVERY STATE HAS DIFFERENTLAWS ABOUT DRIVING AND EPILEPSY.
	IN CALIFORNIA, ANY PATIENTWHO HAS HAD A SEIZURE
	WITH LOSS OF AWARENESS OR LOSS OF CONSCIOUSNESS
	MUST BE REPORTED TO THEDEPARTMENT OF PUBLIC HEALTH.
	THAT'S THE SAME DEPARTMENT THATWE REPORT INFECTIOUS DISEASES TO
	AND OTHER THINGSFOR EPIDEMICS.
	BUT BASICALLY, YOUR DOCTORIS REQUIRED BY LAW
	TO REPORT YOU TOTHE DEPARTMENT OF PUBLIC HEALTH
	IF YOU'VE HAD A SEIZUREWHERE YOU'VE LOST AWARENESSOR CONSCIOUSNESS.
	IF THEY DON'T REPORT YOU,THEY CAN GO TO JAIL,
	SO IT IS NOT A SMALL THING.
	IT'S SOMETHING THAT HASTO BE DONE, UNFORTUNATELY,
	AND IT PUTS USIN A TOUGH POSITION,
	BUT THIS IS DONE FORYOUR SAFETY AS WELL ASTHE SAFETY OF THE PUBLIC.
	NOW, ONCE THE DEPARTMENT OFPUBLIC HEALTH HAS BEEN INFORMED,
	THEY INFORM THE DMV,
	AND THE PATIENT USUALLY GETS APACKET OF PAPERWORK IN THE MAIL
	THAT THEY HAVE TO FILL OUTWITH THEIR DOCTOR,
	AND A HEARING GETS ARRANGEDFOR THAT PATIENT
	TO SEE A DRIVERMEDICAL EVALUATION DOCTOR
	THAT'S HIREDTHROUGH THE DMV.
	AND ULTIMATELY,THAT MEDICAL OFFICERTHAT'S THROUGH THE DMV
	IS GOING TO DECIDEWHETHER THAT PATIENT'SLICENSE GETS SUSPENDED
	AND/OR WHENTHEY GET IT BACK.
	NOW, YOUR DOCTORDOES HAVE INPUT,
	BECAUSE THEY FILL OUTTHIS FORM WITH YOU,
	BUT IT'S NOTTHEIR FINAL DECISION.
	IN MOST STATES,THE DMV WANTS TO KNOW
	THAT YOU HAVE BEEN SEIZURE-FREEFOR ABOUT 6 MONTHS,
	AND THAT CAN BE EITHERON MEDICINE OR OFF MEDICINE,
	BEFORE THEY LIFTSUSPENSION ON YOUR LICENSE.
	NOW, THERE'S DEFINITELYVARIATIONS.
	SOME STATES HAVE3-MONTH WAITING PERIODS.
	OTHERS HAVE 12-MONTHWAITING PERIODS.
	AND IN A LOT OF CASES,YOUR DOCTOR MAY SAY
	THAT FOR SPECIAL REASONS,THEY SHOULD WAIT LONGER
	OR A SHORTER TIMEFOR ANY INDIVIDUAL PATIENT.
	THAT CAN BE GUIDED BY HOW HARDYOUR EPILEPSY IS TO TREAT
	OR HOW DIFFICULT IT IS FOR YOUTO STAY ON MEDICATION.
	SO...
	I JUST WANTED TO CONCLUDE BYSAYING THAT OUR GOAL, AGAIN,
	IS TO LET PATIENTS LIVEFULL, PRODUCTIVE, HAPPY LIVES,
	EVEN IF THEY HAVE EPILEPSYAND A SEIZURE DISORDER.
	SO I WANT YOU TO REMEMBERTHAT YOU MAY HAVE EPILEPSY,
	BUT EPILEPSYDOESN'T HAVEYOU,
	AND SO WE WANT TO WORKTOGETHER WITH YOU
	TO MAKE YOUR LIFEAS GOOD AS POSSIBLE
	WHILE YOU'RE DEALINGWITH THIS DISEASE.
	I'M GOING TO OPEN IT UPFOR QUESTIONS AND ANSWERSIN JUST A MOMENT.
	
	- LET'S SEE WHATTHE OTHER PEOPLE SAY.
	[INDISTINCT]
	- HELLO?
	- HI. DOES ANYBODY HAVEA QUESTION OR ANYTHINGTHEY WANT TO DISCUSS?
	- YES. YOU WERE TALKINGABOUT MISDIAGNOSIS OF SYMPTOMS
	AND TREATMENTSIN OLDER ADULTS.
	- YES.
	- WHAT...CAN YOU GIVESOME EXAMPLES OF THAT?
	- SURE, SURE.A LOT OF TIMES--
	I'LL GIVE YOU ONE EXAMPLE.THIS MAY NOT APPLY,
	BUT A LOT OF PATIENTSWHO HAVE CONDITIONS
	LIKE ALZHEIMER'S DISEASEOR DEMENTIA
	MAY HAVE EPISODES OF CONFUSIONOR LAPSES IN MEMORY,
	AND A LOT OF TIMES,WE THINK, "OH, THAT'SJUST THE DEMENTIA,"
	BUT ACTUALLY, A SUBSETOF PATIENTS WITH DEMENTIADO DEVELOP SEIZURES,
	AND THEY'RE THOSEFOCAL SEIZURES,
	WHERE ALL THAT MAY HAPPENIS THAT THEY MAY STAREOR BE NONRESPONSIVE.
	SO IT CAN BE REALLYHARD TO TELL,
	IS THAT THE DEMENTIA,OR IS THAT A SEIZURE?
	SO THAT'S ONE EXAMPLE.
	- AND IS THERE, LIKE,A CERTAIN AGE
	WHERE THESE THINGSBECOME PERMANENT
	AND IT'LL NEVER CHANGE,EVEN WITH MEDICATION?
	HOW DOES THAT WORK?
	- THAT'S A VERY GOOD QUESTION.
	SEIZURES AND EPILEPSYHAVE A NATURAL HISTORY.
	IN SOME PEOPLE, THEY CANGROW OUT OF THEM WITH AGE,
	SO, IN FACT,GETTING OLDER CAN HELP,
	AND IN OTHER PATIENTS,THEY CAN GET WORSE WITH AGE.
	BUT IT'S VERY INDIVIDUAL,SO I WOULD NEVER SAY THAT,
	IF YOU STILL HAVE SEIZURESBY THE TIME YOU'RE 70,
	YOU'RE ALWAYS GOINGTO HAVE SEIZURES,
	OR IT'S DEFINITELY GOINGTO GET WORSE THE OLDER YOU GET.
	IN FACT, MEDICATIONS MAYCONTROL THEM COMPLETELY.
	NOW, YOU MAY HAVE TOSTAY ON MEDICATIONSFOR MOST OF YOUR LIFE,
	BUT OTHER PEOPLE CANCOME OFF OF MEDICINES
	AFTER A FEW YEARS,EVEN IF THEY'RE 65, 70, 80,
	AND STOP HAVING SEIZURES.
	- YEAH. I'M REALLY REFERRINGTO THE DEMENTIA ANDCONFUSION SIDE OF THINGS.
	- OK.
	- YOU WERE TALKING ABOUTFREEZING FOR PERIODS
	AND MISDIAGNOSIS OF THAT.
	- YEAH, AND NOT BEINGCERTAIN ABOUT DIAGNOSIS.
	WELL, WHEN SOMEBODY HAS MEMORYPROBLEMS OR FREEZING EPISODES,
	SOMETIMES THOSE GET WORSEOVER TIME WITH EPILEPSY,
	AND SOMETIMES THEYACTUALLY GET BETTER.
	THE UNDERLYING PROCESSIF SOMEBODY HAS DEMENTIAMAY CONTINUE TO GET WORSE,
	BUT ACTUALLY, AS SOMEOF THOSE CONNECTIONS
	IN THE BRAIN CHANGEWITH THE PROGRESSION,
	SOMETIMES THE EPILEPSYACTUALLY GOES AWAY.
	SO IT DOESN'T--
	HAVING A PROGRESSIVE DISORDERLIKE DEMENTIA
	DOESN'T ALWAYS MEAN THATTHE SEIZURES GET WORSE WITH IT.
	- OK.
	- IT'S VARIABLE.
	- YEAH. I KNOW SITUATIONSARE VERY INDIVIDUAL
	FOR EVERY PERSON THAT'SON IT--OR HAS IT, RATHER.
	- EXACTLY.
	- WHAT ABOUT, LIKE...
	FREEDOM TO BE ABLETO LIVE YOUR OWN LIFE
	AND NOT BEHOLDEN TO
	EVERYTHING THATYOUR DOCTOR SAYS OR...
	I KNOW THAT YOU SAIDTHAT IT'S GOOD TO HAVEA CONSTANT AMOUNT OF SLEEP
	AND HAVE YOUR DRUGSON TIME AND THAT, BUT...
	- THAT'S REALLY HARD.
	I THINK I UNDERSTANDWHAT YOU'RE ASKING.
	YOU KNOW, DO YOU HAVE TO DOEVERYTHING YOUR DOCTOR SAYS?
	DO YOU HAVE TO FOLLOW SUCHA REGIMENTED LIFESTYLE?
	THAT MAKES IT HARD TO REALLYHAVE THE LIFE THAT YOU WANT,
	AND I THINK THAT'SA TOUGH QUESTION.
	I THINK IT'S ALL A BALANCE
	BETWEEN GETTINGWHAT YOU WANT OUT OF LIFE
	AND BEING SAFE.
	I THINK THAT DOCTORSOFTEN RECOMMEND THINGSVERY SPECIFICALLY,
	AND AS A PATIENT,IT IS SORT OF UP TO YOU
	HOW MUCH OF THATYOU WANT TO DO.
	THE PROBLEM IS THAT IFPEOPLE HAVE ONGOING SEIZURESTHAT AREN'T CONTROLLED,
	THERE CAN BE SERIOUSINJURY OR EVEN DEATHASSOCIATED WITH SEIZURES,
	AND SO WE TRY OUR BESTTO RECOMMEND WHAT WETHINK SHOULD BE DONE.
	BUT IT'S DEFINITELY ANINDIVIDUAL CHOICE HOW MUCHOF THAT YOU WANT TO ACCEPT.
	- CAN YOU HEAR ME?
	- YES. GO AHEAD.
	- YOU CAN. YES. I'M WONDERINGIF THIS GENTLEMAN IS THROUGH
	WITH HIS QUESTIONS.
	ALL RIGHT. WHAT IS THEMEDICATION OF CHOICE--
	- ONE OTHER THINGI HAD TO SAY...HELLO?
	- SORRY. GO AHEADWITH YOUR QUESTION.
	- WHAT IS THE MEDICATION OFCHOICE FOR ABSENCE SEIZURES?
	- ABSENCE SEIZURES USUALLY OCCURIN CHILDREN OR ADOLESCENTS,
	AND THERE IS ONE MEDICINETHAT IS USED MOST OFTEN
	WHEN IT OCCURS IN CHILDRENAND ADOLESCENTS.
	IT'S CALLED ETHOSUXIMIDE.
	HOWEVER, IF A PERSON HASABSENCE SEIZURES BUT ALSOHAS CONVULSIVE SEIZURES,
	OR MULTIPLE SEIZURE TYPES,WHICH A LOT OF PEOPLE WITHABSENCE SEIZURES DO HAVE,
	THEN SOMETIMES THEY CHOOSEA DIFFERENT MEDICINECALLED DEPAKOTE,
	WHICH HAS A COUPLE OFOTHER NAMES, BUT IT'SBASICALLY VALPROIC ACID.
	BUT THERE ARE ACTUALLYTWO OR THREE OTHER OPTIONS,
	AND IT KIND OF DEPENDSON WHO THE PERSON IS
	AND IF THEY'RE A WOMAN OR A MANAND WHETHER THERE'S RISK--
	THINGS LIKE THAT.
	- ALL RIGHT. AND WHAT'S THEPREDOMINANCE OF ABSENCE SEIZURES
	IN ADULTS,IN THE ADULT POPULATION?
	- IT'S ACTUALLY NOTTHAT PROMINENT UNLESSIT STARTED AS A CHILD,
	BUT I SHOULD PROBABLYCLARIFY ONE THING--
	A LOT OF DOCTORS WILL SAYYOU HAVE ABSENCE SEIZURES
	OR THAT MAY BE A TERM THATPEOPLE USE IN THE PUBLIC,
	BUT WHAT THEY REALLY MEANSOMETIMES IS THAT YOU'REHAVING FOCAL SEIZURES
	WHERE YOU'RE STARINGOR NOT RESPONDING.
	SO IN CHILDREN,AN ABSENCE SEIZURE MEANS
	THAT THERE'S A COUPLE OFSECONDS WHERE YOU'REBLINKING AND NOT RESPONDING
	AND YOU LOSE AWARENESS,AND THEN YOU IMMEDIATELYRETURN TO NORMAL.
	THOSE CAN HAPPEN HUNDREDSOF TIMES A DAY, AND THAT'SAN ABSENCE SEIZURE.
	BUT A LOT OF PEOPLE WILLUSE THE WORD ABSENCE SEIZURE
	TO INDICATE A FOCAL SEIZUREWHERE SOMEBODY IS STARING
	AND NOT RESPONDINGFOR A MINUTE OR TWO,
	AND THAT'S VERY DIFFERENT,
	SO THE TREATMENT BY MEDICINEIS ACTUALLY VERY DIFFERENT
	IF YOU'RE HAVINGTHE FOCAL SEIZURES
	WHERE YOU'RE JUST IMPAIREDIN YOUR AWARENESS.
	SO IT'S NOT COMMON TO HAVE
	THE TRUE ABSENCESEIZURES AS AN ADULT
	UNLESS YOU'VE HAD THEM SINCECHILDHOOD OR ADOLESCENCE.
	- I SEE.- YEAH.
	- ALL RIGHT. THANK YOU.
	- A LOT OF PEOPLE WITH THATHAVE PETIT MAL SEIZURES,
	AND THE TRADITIONALPETIT MAL SEIZUREIS AN ABSENCE SEIZURE,
	BUT MOST PEOPLE USE THATTO DESCRIBE ANY SEIZURE,
	WHETHER IT'SABSENCE OR FOCAL,
	WHERE YOU'RE JUST KIND OFCONFUSED OR OUT OF IT.
	- I SEE. ALL RIGHT.THANK YOU VERY MUCH.
	- OTHER QUESTIONS?
	- I SEEM TO HAVE A LOTOF ABSENCE SEIZURES
	OR FOCAL SEIZURES...
	- YEAH.
	- WHERE IT'S LIKE,BLINK, AND I'M GONE,
	AND SOMETIMES A STATE OFCONFUSION WHERE I CAN'T...
	I KNOW THE WORD IN MY HEAD, BUTI CAN'T GET MY MOUTH TO SAY IT.
	THINGS LIKE THAT, YOU KNOW?
	- I THINK THOSE SYMPTOMS CANDEFINITELY BE A SEIZURE,
	BUT SOMETIMES THEY'RE NOT,AND WHEN IT GETS CONFUSING,
	ESPECIALLY, LIKE YOU WERESAYING, WHEN YOU'RE OLDERAND HAVE MEMORY PROBLEMS
	AND YOU'RE NOT SUREIF IT'S A SEIZURE ANDYOUR DOCTOR IS NOT SURE,
	THERE IS SOME TYPE OFTESTING THAT WE CAN DOTO DISTINGUISH IT,
	AND THAT INVOLVES BEING INTHE HOSPITAL FOR SEVERAL DAYS
	AND TRYING TO TRIGGER THEEVENTS AND CAPTURE THEMAND RECORD THE BRAINWAVES.
	SOMETIMES THAT CAN ACTUALLYMAKE THE DIAGNOSIS.
	- IS THIS AN EEG?
	- IT'S AN EEG, BUT IT'SDONE WITH GLUE INSTEAD OFPASTE ON YOUR HEAD,
	SO YOU GLUE THE ELECTRODES ON,AND YOU STAY ON THE EEG
	WITH A VIDEO CAMERAFOR 3-7 DAYS IN THE HOSPITAL.
	AND A LOT OF TIMES IF YOU'REON SEIZURE MEDICINE,
	THEY REDUCE THEMDURING THE TEST
	TO TRY TO SEE WHATTHE SEIZURES--OR WHATTHE EPISODES ARE LIKE
	AND TO FIGURE OUT IFTHEY'RE SEIZURES OR NOT,
	BECAUSE THE PROBLEM ISIF THEY'RE NOT SEIZURES
	AND THEY'RE RAISINGYOUR MEDICINE,
	YOUR SEIZURE MEDICINETO TRY TO CONTROL THEM,
	IT CAN GIVE YOU A LOT OFDANGEROUS SIDE EFFECTSAND NOT HELP YOU AT ALL.
	THAT'S WHY THE TESTIS SOMETIMES DONE.
	- RIGHT.
	- SO, YOU KNOW, THERE ARE A LOTOF CENTERS AROUND THE COUNTRY
	THAT CAN DO THAT TESTING--WE'RE ONE OF THEM--
	BOTH AT VA's AS WELL AS ATOTHER UNIVERSITIES AND EVENSOME PRIVATE GROUPS.
	SO IT'S PRETTY READILY AVAILABLEIN MANY PARTS OF THE COUNTRY.
	- THANK YOU.
	DO YOU KNOW ANYTHINGABOUT THE SIDE EFFECTS
	OF THE DRUG VIMPAT?
	- YES. VIMPAT ISA RELATIVELY NEW DRUG
	THAT WAS APPROVED BYTHE FDA, I THINK ABOUTONE TO TWO YEARS AGO,
	AND THE OTHER NAME FOR ITIS LACOSAMIDE.
	NOW, THAT MEDICINEIS PRETTY NEW.
	THE MOST COMMONSIDE EFFECT ON IT
	THAT PEOPLE REPORTIS DIZZINESS.
	AND I'VE USED THAT MEDICINEWITH A COUPLE OF PATIENTS
	HERE AT SAN FRANCISCO VA,
	AND ONE OF THEM, FOR SURE,HAD A LOT OF DIZZINESS ON IT,
	AND ANOTHER ONE DIDN'T,
	SO IT CAN HAPPEN TO SOMEAND NOT OTHERS.
	BUT IT HAS VERY FEWSIDE EFFECTS BEYOND THAT,
	AT LEAST AS FAR ASWE KNOW SO FAR,
	AND IT'S A PRETTY SAFE MEDICINETO MIX WITH OTHER PILLS,
	SO THERE'S VERY FEWINTERACTIONS.
	- OK. PEOPLE IN MY EPILEPSYGROUP HAVE TOLD ME
	THAT IT'S VERY INDIVIDUALAND SOME PEOPLE HAVEGREAT RESULTS ON IT,
	ARE TOTALLY FREEOF SEIZURES,
	AND OTHERS GET, LIKE,HEARING LOSS
	AND OTHER STRANGE SIDE EFFECTSOR SOMETHING.
	- OH. I WOULDAGREE WITH THAT--
	THAT IT CAN BEVERY INDIVIDUAL.
	- AND IS THERE ANY WAYTO PREDICT?
	- YOU KNOW, THAT'S AREALLY GOOD QUESTION,
	AND I HAVE TO REITERATE THATIT'S VERY HARD TO PREDICT
	WHICH PATIENT WILLRESPOND TO WHICH MEDICINE.
	I MEAN, WE HAVE A FEW RULES,WHERE WE AVOID CERTAIN MEDICINES
	IN SOME PEOPLE WHERE WE KNOWIT WILL GET WORSE OR NOT HELP,
	BUT IN THE END, WE'RE LEFTWITH LIKE 10 DIFFERENT PILLSTHAT WE CAN CHOOSE FROM,
	AND IT'S REALLY HARD TOKNOW WHICH ONE WILL WORK,
	AND SOMETIMES ONE MEDICINEDOESN'T WORK, BUT YOU NEEDA COMBO OF TWO MEDICINES.
	SO UNFORTUNATELY,IT SOMETIMES REALLY ISTRIAL AND ERROR,
	AND SOMETIMES THE BESTWE CAN DO IS TRY ONE OUT,
	SEE IF IT WORKS,AND THEN IF IT DOESN'T,TRY SOMETHING ELSE.
	BUT WE USED EDUCATEDDECISION-MAKING
	IN PICKING THE MEDICINESONE BY ONE TO DO OUR BEST.
	- AND IS THEREANY RECORDS OR REPORTS
	OF WHAT DRUGS HAVEINTERACTIONS WITH VIMPAT--
	THE EXTREMES OR WHATEVER?
	- YOU KNOW, I THINK--I DON'T KNOW
	IF I CAN ANSWER THAT QUESTIONDIRECTLY RIGHT NOW,
	BUT WHAT I CAN TELL YOU, WHAT ALOT OF PHARMACIES WILL DO IS
	IF A PATIENT ISPRESCRIBED LACOSAMIDE,
	WE HAVE THESE AUTOMATEDPROGRAMS THAT RUN CHECKS
	BETWEEN ALL THE OTHERMEDICINES THAT THE PATIENTGETS THROUGH THAT PHARMACY
	AND MAKES SURE THATIT DOESN'T INTERACT.
	SO IF I ORDER IT ONA PATIENT, I GET AN ALERT
	THAT POPS UP ON MY SCREENWHEN I ORDER THE MEDICINE
	THAT SAYS, OH, YOU'REORDERING VIMPAT.
	PLEASE MAKE SURETHAT THE PATIENT
	DOESN'T HAVE THIS OR THISBEFORE YOU PROCEED.
	OR, IS IT OK TO GIVE THIS, EVENTHOUGH THEY'RE ON THIS DRUG?
	SOMETIMES THERE CANBE AN INTERACTION.
	SO A LOT OF PHARMACIESAND MEDICAL CENTERS AREUSING PROGRAMS LIKE THAT
	TO REDUCE THE RISKOF GIVING SOMETHING--
	MAKING AN ERROR, BASICALLY.
	- OK. I'VE BEEN ON DILANTINAND PHENOBARBITAL
	PRETTY MUCH ALL MY LIFE,SINCE I WAS ABOUT 5 YEARS OLD.
	IS THERE ANYNEGATIVE EFFECTS
	FROM BEING ON THOSETWO DRUGS FOR SO LONG?
	30 YEARS.
	- WELL, SO, YES AND NO.
	YOU KNOW, THE POSITIVEEFFECT IS IF THEY ARECONTROLLING SEIZURES,
	THAT'S GREAT, AND IT'SREALLY IMPORTANT TOBE FREE OF SEIZURES.
	NEGATIVE EFFECTS--WELL, WE KNOW THATBOTH OF THOSE MEDICINES
	CAN CAUSE PROBLEMSWITH BONE HEALTH
	WHEN THEY'RE TAKEN FOR MORETHAN 10 OR 15 YEARS IN MEN,
	AND EVEN FOROVER 5 YEARS IN WOMEN.
	SO THE BIGGEST RISKIS OSTEOPOROSIS
	AND WEAKENING OF THE BONES,
	AND THAT CAN BE CHECKED WITHA BONE SCAN PRETTY EASILY,
	AND IF IT HAS OCCURRED,
	OUR OPTIONS ARETO CHANGE MEDICINES
	OR TO JUST ADD CALCIUMAND VITAMIN D TO THE THINGSTHAT YOU TAKE EVERY DAY
	TO TRY TO REDUCETHE PROBLEM.
	AND SOMETIMES ITCAN BE A LITTLE MORECOMPLICATED THAN THAT.
	ALSO, SOME PEOPLE GETCONCERNED THAT LONG-TERMUSE OF PHENOBARBITAL
	CAN AFFECT MOOD AND MEMORY,BUT I THINK THAT'S ALSOPRETTY INDIVIDUAL.
	COMING OFF OF A MEDICINELIKE PHENOBARB
	AFTER MANY, MANY YEARSIS ACTUALLY REALLY HARD,
	SO I WOULD RECOMMENDTHAT YOU HAVE A MEETING
	WITH A NEUROLOGISTOR YOUR DOCTOR ABOUT IT
	AND TRY TO FIGURE OUT IFIT'S THE RIGHT THING FOR YOU,
	AND IF IT'S NOTCONTROLLING YOUR SEIZURES,
	WHETHER THERE'S A BETTER OPTIONTHAT WILL CONTROL THEM BETTER.
	- YEAH. I HAVE A DOCTOR,
	AND THAT WAS ONE OFTHE THINGS HE MENTIONED--
	THE OSTEOPOROSIS,THE BONE WEAKENINGFROM THOSE TWO DRUGS.
	- YEAH. IT ALSO HAPPENS
	WITH A MEDICINE CALLEDTEGRETOL, AS WELL.
	BUT AGAIN,YOU HAVE TO WEIGH
	THE BENEFIT OF IT CONTROLLINGSEIZURES WITH THAT RISK
	AND DECIDE WHETHER IT'SWORTH COMING OFF OF IT
	OR JUST MAKINGOTHER ADJUSTMENTS.
	CAN I ACTUALLY SEE, IS THEREANYBODY ELSE WHO HAS A QUESTION?
	
	- WE'RE GOING TO HAVE TOWRAP UP THE CALL, DR. GARGA.
	- OK.- I WANT TO THANK YOU
	FOR GIVING ALL THEINFORMATION YOU DID TODAY,
	AND I HOPE EVERYBODY CAN JOIN USFOR THE NEXT PATIENT CALL
	THAT WE'LL BE HAVINGIN THE NEAR FUTURE.
	WE'LL BE PLANNING IT AND SENDINGTHE INFORMATION OUT.
	- IS THAT THREE MONTHSFROM NOW, OR...
	- WE WILL GET IT OUT AS SOON ASWE GET A FIRM DATE.
	- AND IT'S JUSTA ONE-HOUR THING?
	- YES, JUST ONE HOUR.THAT'S IT.
	- IS THERE GOING TO BEMORE QUESTION-AND-ANSWERTIME, OR WHAT?
	- WE'LL DISCUSS THAT WHENWE'RE IN OUR PLANNING PHASE,
	AS FAR AS WHAT WE'RE GOING TO DOWITH THE NEXT PATIENT CALL,
	BECAUSE THIS WAS THE FIRST ONE,SO WE WERE STILL NEW AT IT.
	NOW WE GOT SOME INFORMATION,AND WE CAN PLAN ACCORDINGLY.
	- I'D ASK THAT YOUPUT MORE TIME FOR
	THE QUESTION-AND-ANSWER PHASE,
	RATHER THAN JUST15 MINUTES.
	- ALL RIGHT.WE CAN DO THAT.
	THANK YOU, DOCTOR.
	- THANKS FOR YOUR FEEDBACK.THANK YOU.
	- THANK YOU.
	- THANK YOU.-BYE.