Epilepsy Talk

Which type of doctor is best for you? | July 9, 2022

We all know that epilepsy is not a one-type-fits-all condition.  Nor are the answers to seizure control.  But there are plenty of options out there.  Here are just a few…  

Neurologist

The neurologist is a specially trained physician who diagnoses and treats disorders in the nervous system, whether caused by disease or injury. This includes diseases of the brain, spinal cord, nerves, and muscles. Neurologists possess a comprehensive knowledge of the neurological structures of the body, including the cerebral cortex and its division into various lobes and their individual jobs in making the body work as a whole.

Neurologists perform physical examinations to test vision, memory, speech, balance, muscle strength and movement because such functions can be impaired by neurological disorders. They also perform tests such as EEG (electroencephalograph), MRI (magnetic resonance imaging), CAT scan, (computed axial tomography), spinal tap and other diagnostic procedures. Once a diagnosis has been confirmed, the neurologist will determine the best course of treatment. If surgery is needed, the neurologist does not perform the surgery but will monitor the patient.

Behavioral Neurologist

Behavioral neurologists are usually found in centers that focus on one neurological disorder or condition, such as epilepsy. Some hospitals and centers have set up a “cognitive neurology” or “behavioral neurology” program. These are usually outpatient programs that include a team of specialists. These teams typically include a neuropsychologist, a neuropsychiatrist, a clinical social worker, and a clinical psychologist.

They work on such problems as psychogenic seizures which are most likely triggered by emotional stress or trauma. Some people with epilepsy have psychogenic seizures in addition to their epileptic seizures. It’s a legitimate seizure and should be treated that way, but it is not caused by a problem in the brain.

Then there are physiologic non-epileptic seizures which can be triggered by some sort of change in the brain — typically a change in the supply of blood or oxygen rather than electrical activity.  It’s important to differentiate a seizure from that of a behavioral disorder, but it’s difficult.

Epileptologist

An epileptologist is a neurologist who has taken at least an additional 2 years of specialized training in epilepsy and usually treats the most difficult epilepsy cases.  Epileptologists are significant as experts in seizures and seizure disorders, anticonvulsants, and special situations involving seizures, such as cases in which all treatment intended to stop seizures has failed.

Usually, the setting is a program which has multidisciplinary support such as outpatient and inpatient, medical, surgical and experimental treatments, psychology and psychiatry.

In addition to patient care, epileptologists are often engaged in research, which is far-ranging.  The research may include antiepileptic drugs, surgery techniques, genetic factors, biochemical elements, computer modeling, diagnostic tests or a host of other fields.  

Neurosurgeon

A neurosurgeon treats people whose seizures cannot be controlled by medication. Epilepsy surgery can benefit patients who have seizures associated with structural brain abnormalities, such as benign brain tumors and malformations of blood vessels, the genetic disorder tuberous sclerosis, and strokes. The goal of epilepsy surgery is to identify an abnormal area of brain cortex from which the seizures originate and remove it without causing any major functional impairment.

Surgery is most commonly performed to treat partial epilepsy, since only one area of the brain is involved. After surgery, many patients will be seizure-free, while others will have better controlled seizures. A few patients may not improve and will need to explore further treatment options.

Improved technology has made it possible to identify more accurately where seizures originate in the brain and advances in surgery have made operative management safer. The benefits of surgery should always be weighed carefully against its risks, because there is no guarantee that it will be successful in controlling seizures.

Pediatric Neurosurgeon

This is a neurosurgeon with specialized training and experience in pediatric epilepsy surgery. However, prior to the surgery, the patient must be evaluated by a team of epileptologists, neuroradiologists, neuropsychologists, and neurosurgeons with specialized training in patients with refractory epilepsy. Most of these teams are in large academic medical centers with affiliations to medical schools. The team tailors the surgery for each child on an individual basis.

Early surgical intervention with a variety of techniques specifically designed to reduce or to eliminate seizure spread or frequency can be performed safely in children with excellent seizure and neurological outcomes.

While the risks of surgery must be considered in any intervention, they should also be weighed against a lifetime of seizures and their impact on the developing brain from a functional and cognitive standpoint.

Psychiatrist

Seizures that are psychological in origin are often called psychogenic (or “faux”) seizures. These seizures are most likely triggered by emotional stress or trauma. And some people with epilepsy have psychogenic seizures in addition to their epileptic seizures.

And depression is no stranger to those with epilepsy.  One study stated that 80% of the patients with epilepsy were also diagnosed as having a depressive disorder. Upwards of 60% of these individuals had a history of significant episodes of depression.  And 10-32% experience symptoms of anxiety.  So psychiatric therapy is often a help in getting over the hurdles.

Nutritionist

It may be worth a full nutritional analysis to determine if you are suffering from deficiencies associated with epilepsy such as Zinc and Magnesium. Other nutrients may also be helpful, including Vitamins B-6 and B-12, Vitamin E and Selenium — all of which have been known to significantly lower seizure rates. AEDs themselves can deplete important nutrients such as Folic Acid, Vitamin D and Calcium.

A nutritionist may suggest The Ketogenic Diet – a high fat, adequate protein, low carbohydrate diet which works by fasting and creating ketones which cause seizures to often lessen or disappear.  The Atkins Diet — which is slightly less restrictive than the Ketogenic Diet — is another option.  Or you might choose the Modified Atkins Diet (MAD) which is more user-friendly, less restrictive, and as effective as the Ketogenic Diet.  And finally, there is The Glutamate-Aspartate Restricted Diet (G.A.R.D) — a life-long elimination diet.

Naturopath

A naturopathic doctor treats the whole person, taking into account the interaction of their physical, mental, and emotional factors in causing a condition.  Naturopathic medicine recognizes the importance of the whole person instead of just single organ systems or particular symptoms.

When it comes to epilepsy, naturopathy and a range of related treatment methods may have a good deal to offer, as long as it is coordinated with your neurological care.

Options include: aromatherapy, acupuncture, behavior control, biofeedback, massage, stress management, to name just a few.

Homeopathy

The main argument for treating epilepsy — or any disease — homeopathically is because each patient is different. Though they may be diagnosed with the same disease or disorder, their symptoms are different, as are their responses to treatment and medication. This is why people believe there are many benefits to treating epilepsy based on symptoms rather than the generalized disease. By being able to zero in on exact symptoms which patients are experiencing, it’s believed that homeopathy will have a better chance of treating those specific symptoms.

Alone, homeopathy may not help all cases of epilepsy. But together, with conventional  treatment for epilepsy, it’s seen success as a supportive line of treatment.  And in cases of drug resistant epilepsy, people often  do respond significantly to homeopathy. 

Resources:

https://www.healthline.com/find-care/articles/neurologists/neurologist

https://www.houstonmethodist.org/blog/articles/2020/jan/6-signs-its-time-to-see-a-neurologist/

https://en.wikipedia.org/wiki/Behavioral_neurology

https://www.emotiv.com/glossary/behavioral-neuroscience/

https://www.epilepsy.com/stories/what-epileptologist-and-who-needs-one

https://www.webmd.com/a-to-z-guides/what-is-neurosurgeon

https://www.drloudonpediatricneurosurgery.com/blog/what-is-pediatric-neurosurgery/

http://www.medicinenet.com/pediatric_epilepsy_surgery/page5.htm

http://www.everydayhealth.com/epilepsy/understanding/when-are-seizures-not-epilepsy.aspx

https://www.epilepsy.com/diagnosis/healthcare-team

https://epilepsysociety.org.uk/living-epilepsy/wellbeing-and-epilepsy/diet-and-nutrition

https://www.epilepsy.com/treatment/dietary-therapies#:~:text=Dietary%20therapy%20is%20an%20approach,control%20seizures%20in%20some%20people.

https://www.healthline.com/health/natural-treatments-epilepsy

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