JEDDAH, 17 September — Under the auspices of the Saudi Chapter of Epilepsy, the Pan-Arab Union of Neurological Societies and Dr. Erfan and Bagedo Hospital, the Jeddah Neuroscience Update held its first annual symposium at the Westin Hotel on Sept. 11-12. The main topic was epilepsy.
Two eminent speakers addressed the problem — Dr. Michel Baulac, a consultant neurologist and the head of the Epilepsy Center at a Paris hospital, and Dr. Arthur Grant, assistant professor in neurology and the director of the Comprehensive Epilepsy Center at an American hospital.
The feeling is that epilepsy is not properly dealt with in Saudi Arabia even though it is very common. This may be due to the stigma associated with it, the social and economic problems, improper diagnosis and ignorance of the range of available treatments.
Dr. Baulac explained that epilepsy is an electric charge in the brain and that there are essentially three different types of epilepsy. The first is a generalized seizure when the person falls down and has convulsions.
The second is a partial seizure or complex partial seizure when the person loses consciousness without falling down and also loses control of body movements.
The third type is called absence seizure and occurs when a person becomes blank for a few seconds and simply stares without speaking. For doctors one of the main difficulties in diagnosing epilepsy correctly is that they rarely witness the seizure and so have to rely on what people say.
Dr. Baulac said that 40 percent of epilepsy was genetic but that it was rarely hereditary. There are acquired factors that cause epilepsy — including brain tumors, strokes and brain malformations.
Dr. Baulac emphasized new research being carried out on anticipating epileptic seizures. For the vast majority of epileptics, seizures occur suddenly in the absence of identifiable external precipitants. The unpredictability represents a major threat and a cause of disability and mortality. Prediction of seizure onset, even if short term, would provide time for applying preventive measures to minimize seizure risk and so improve quality of life.
Dr. Baulac spoke about being able to anticipate seizures from EEG recordings. "We apply sophisticated mathematical methods detecting certain hidden properties which are called dynamic properties. These properties cannot be identified with the naked eye and therefore we rely on 24-hour video-EEG monitoring of the patient in the hospital and wait for a seizure."
Based on the analysis, doctors then contemplate removing the seizure focus —where the seizure originates in the brain. A more recent procedure, and this is what Dr. Baulac is working on, is to use a system similar to a cardiac pacemaker. A small tube is implanted at the seizure focus, and using computer technology, sudden abnormalities are detected and then a drug is delivered through the tubes to block the seizure by stimulating the brain. This procedure is not yet available in Saudi Arabia.
Dr. Grant said, "There have been many advances in medical and surgical treatment of epilepsy. There has been an explosion of new drugs over the last 10 years and while none are perfect, each one expands our choices for treatment." He spoke about the importance of preoperative evaluation of Temporal Lobe Epilepsy (TLE), the most common type of epilepsy. Approximately 30 percent of patients with TLE will be medically intractable. This group of TLE patients is most likely to experience the morbidity and lower quality-of-life associated with both uncontrolled seizures and AED side-effects. Fortunately, at least 50 percent of them can be treated with surgical resection of the seizure focus without post-operative neurologic deficits. The pre-surgical evaluation will help doctors recommend the best treatment option for patients: Resective temporal lobe surgery, invasive intracranial video-EEG monitoring or medical management.
"The new medications are better than the old in that they are safer and have fewer side-effects," said Dr. Grant.
"Most patients need to take more than one medication because each works differently but they complement each other. The goal is to prevent the seizure and therefore patients must take their medication every day which means they always experience side-effects." These include mild sedation, mild cognitive slowing and some have specific side-effects that are rare but serious such as rashes, changes in blood count and hepatitis. Some of the old drugs if used over a period of many years may cause osteoporosis (bone loss) especially among women.
A new diagnostic procedure that has recently become available at Dr. Erfan Hospital is MR Spectroscopy. "It is regular MRI with new software," explained Dr. Sattam Lingawi, consultant neuroradiologist. "The data is presented as a wave pattern instead of an image and we compare the abnormal pattern of the diseased area in the brain with the normal pattern. This gives us a specific diagnosis without taking a biopsy of the brain and it is 95 percent accurate."
Dr. Lingawi continued, "Society’s view of epilepsy has changed because of the new treatments and their effectiveness in reducing people’s suffering. People’s understanding has improved and with the availability of data, they have become better informed."
The conference recommended a public awareness campaign in which epilepsy would be explained and shown to be a treatable disorder.