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Epilepsy (transcript)
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(Announcer1)     This week on "Second Opinion", neurologists Dr. Robert Gross,

(Dr. Gross) "It's entirely reasonable not to treat a first seizure".  

(Announce1)Dr. Bruce Hermann,

(Dr. Bruce Hermann) "one reason for concealing, there are other reasons for",

(Announce1) along with special guest Tony Coelho,

(Tony) "just because I have a seizure periodically, they don't realize that I'm with it everyday when I wake up in the morning, am I going to have one today?"  

(Announce1) Join panelist regulars Dr. Lou Papa, civilian Elissa Orlando, and "Second Opinion" host Dr. Peter Salgo in a revealing look at Epilepsy and seizures.

(Announcer2)    Major funding for "Second opinion is provided by the Blue Cross and Blue Shield Association.  An association of independent blue plans.  Committed to better knowledge leading to better more affordable healthcare for consumers.

(Dr. Salgo)     Welcome to "Second Opinion", where each week we solve a real medical mystery.  When we close this case file a half an hour from now, you'll not only know the outcome of this week's case, you'll be better able to take charge of your own healthcare.  I'm your host, Dr. Peter Salgo.  And our case file contains the story of Allison.  Well you've already met the healthcare team assembled to tackle this case.  Some are doctors.  Some are not.  No one on the panel knows this case except for our resident civilian, Elissa Orlando.  Nice to see you again Elissa.

(Elissa)     Thanks Peter.

(Dr. Salgo)    Let's get right to the case.  Because I want to tell you a little bit about Allison.  Allison is a 20-year-old college senior.  Straight A student.  She has been brought to the doctor on campus, her campus physician, by her boyfriend who says that he heard her breathing noisily in the night and couldn't wake her up for a long time.  He also says here, I'm reading, that her arm was twitching at the time.  Now Lou, put yourself in that position.  You're the campus doc.  What do you want to know?

(Dr. Papa)         Well a couple things I want to know.  I want to know what she was doing the night before.

(Dr. Salgo)     She was up late.  It's finals time.  And the campus doc obviously would know that.

(Dr. Papa)          Right.

(Dr. Salgo)     She was cramming.  She had a few drinks.  Anything else you want to know?

(Dr. Papa)         Any other substances used or ...

(Dr. Salgo)     Well she was smoking cigarettes.  And she does deny since you asked, any other substances.

(Dr. Papa)         And her history.  She is otherwise healthy.  Has never had any injuries?  Never had any head trauma?

(Dr. Salgo)     Nothing at all.

(Dr. Gross)      Drinking a lot of caffeine the night before?

(Dr. Salgo)     She was drinking coffee non-stop that whole evening.  Smoking some cigarettes.

(Dr. Papa)        And on her examination, there was nothing at all.

(Dr. Salgo)     No.  Absolutely normal.  Blood pressure, temperature, reflexes.  Everything.  Normal awareness.  Nothing else.  They got a red cell count and a white cell count.  That was normal.

(Dr. Papa)         Okay.

(Dr. Peter Salgo)     Anything else you want?

(Dr. Papa)         I would like to see a drug screen.

(Dr. Salgo)     All right.

(Dr. Papa)         I mean it's nice what she tell us but -

(Elissa)     You don't believe her?

(Dr. Papa)         I do believe her, but ...

(Dr. Salgo)    Oh ye of little faith.

(Dr. Papa)         But I like to be complete.  You know.  It is college.  

(Dr. Salgo)      I could tell you they didn't send it off.

(Dr. Papa)         Otherwise she has no fever.  She has no infections.  She's feeling fine now.

(Dr. Salgo)     That's correct.  She's in your office.  She feels fine now.  What do you want to do?

(Dr. Papa)         Well this is a real conundrum because one of the things I worry about is if what she had was seizure-like activity.

(Elissa)     Wait.  She's a college student.  She's been up all night.  She's cramming.  She's doing stuff she hasn't done like smoking and you know.  Can't you just have a bad night?  Can't it just be a rough night sleeping?  Maybe there's not anything wrong with her.

(Dr. Papa)         When you do sleep, I mean you do have - we all have these episodes where you kind of jerk a little bit as you're falling asleep.  They're called -

(Elissa)     Yes.  My arm twitched when I fall asleep or I'm ...

(Dr. Papa)        This sounds like...  

(Elissa)     [chuckles]
(Dr. Papa)         But I think this sounds like it's a little bit different.  It sounds like it was a little bit more predictable and prolonged.  And the breathing is usually not effected in something like that.  And that's...

(Dr. Salgo)     Well I can tell you something.  That her campus physician is as concerned as you are.  But he sees a lot of kids.  So he sends her for an EEG.

(Dr. Papa)         Uh-huh.

(Dr. Salgo)     Which they can get at the nearby medical center.  Came back nothing.  

(Dr. Papa)         Uh-huh.

(Dr. Salgo)     Nothing on the EEG or the brain wave scan.  And at this point, our guest panel, there is a woman in front of you with a normal EEG, normal blood test, normal physical exam, abnormal history.  What are you going to do?

(Dr. Papa)         You kind of described some of this that she was up late.  And she was drinking a lot of caffeine and she had a couple of drinks.  And you know, people can have seizures when that happens.  But the focality of it is a little bit concerning.  Usually when people have those, kind of the whole brain gets you know, short wired.  And this focality has me of a little bit concerned, why that would happen in that one specific ...

(Elissa)     You mean the arm is the focality?

(Dr. Papa)         Just the - yes.

(Dr. Gross)      Yes.

(Dr. Papa)        Right.

(Dr. Salgo)      Well I'll tell you what they did.  Because this physician is used to seeing a lot of kids under a lot of stress.  Staying up late at night.  Drinking, smoking at exam time.  And in his judgment, the best thing to do was to let her go home.  So as long as she had a negative EEG, which she did.  So home she goes.  She finished the semester.  Gets good grades by the way.  And she's going to spend some time at home since she graduated.  And while she is sitting there with her mom in the kitchen at home, she falls over.  Loses consciousness.  And she is seen to be shaking all over.  Now not just one arm.  But they are shaking diffusely.  She also loses control of her bladder.  There is urine on the kitchen floor.  In the fall, she bumps her head on the counter then.  She is noticed to be bleeding as well.  So her mom brings her to the Emergency Room.  What do you want to do now?

(Dr. Papa)         Now you have a much better story.  I mean this is a much more definitive story.  It sounds like it's more generalized seizure activity.

(Dr. Salgo)     But let me stop you for a second.  Because if you objected to the story before because you didn't see her seize.

(Dr. Lou Papa)         Right.

(Dr. Salgo)    Or see this stuff.  You didn't see this one either, did you?

(Dr. Bruce Hermann)      Didn't see it but you're getting a history from multiple observers of abnormal events that are episodic occurring at different points in time.  It becomes a more believable story.

(Dr. Gross)     It's entirely reasonable not to treat a first seizure.  The idea being, and we, Lou spoke to this, is that you can have provoking factors that will induce a seizure.  It's still not clear to me that this is what we would call epilepsy, a problem in the brain where seizures recur.  It could be some other cause.

(Dr. Salgo)     How would you define a seizure?  We've used the word a lot.  Define it for us.

(Dr. Gross)     Well the simplest way to view it is a change in behavior that happens because of a change in the electrical activity of the brain.

(Dr. Salgo)     So does it mean that your brain is abnormal?

(Dr. Gross)     It means that a part of the brain is functioning abnormally, at least at that point in time.

(Dr. Salgo)     Okay.

(Dr. Gross)     And you can see that on a brain wave test and EEG at the time that it's happening.  But an EEG may be normal at other times.

(Elissa)     Isn't the shaking all over enough to indicate a seizure?  That's what I though a seizure looked like.

(Dr. Gross)     It's enough to indicate a seizure.  But it may not be enough to indicate a diagnosis of epilepsy.

(Dr. Salgo)     Well let me tell you some more history if you'd like.  Would you like some more about Allison?

(Dr. Blackburn)     Yes.

(Dr. Salgo)     She's in the emergency room.  And her mother is talking to the doctor.  Her mother says that when Allison was young she had what she calls a fever seizure as a young child.  What is that, and does that impact on what's going on here?

(Dr. Blackburn)     It certainly could.

(Dr. Salgo)     Okay.

(Dr. Blackburn)     I mean lots of children will have seizures when they have high fevers.  Some of those children will go on to develop seizures independent of fever.

(Dr. Salgo)     So she has had a seizure as a child with one diagnosis.  She has something that happened in college.  That's a second diagnosis.  She has a third diagnosis perhaps, or a third event.  This time she's injured.  Wouldn't there have been a time that the doc could have raised a warning flag and said, you've got to watch out for this?

(Dr. Papa)         You're talking about warning large numbers of people on a rare instant that is like you know, before you get on a plane saying, now be careful.  These things could crash.  [laughter]  It's the same type of thing.

(Dr. Peter Salgo)     They can.

(Dr. Papa)         They can.  Right.  But I think it's, I think in lots of ways it's going to kind of change the way that person behaves.  You tell them you know, this could happen at any point.

(Dr. Salgo)     Well Tony, you're the only one here to the best of my knowledge who has actually suffered a seizure.  So why don't you tell me what that feels like.  What does that do to you?

(Tony Coelho)         Well first off, what I do is I get claustrophobic.  Everything starts to close in on me.  I don't know if it is seconds or minutes.  I have no idea.  But it closes in and I wake up after that.  So I don't know when it actually occurs or anything else.  But it is the closing in feeling.

(Dr. Salgo)     So you have no recall for the actual seizure event.  This is common right?

(Tony)         None whatsoever.

(Dr. Gross)     Yes.

(Elissa Orlando)     Then when you wake up, are you -

(Tony)         Tired.

(Elissa)     Somewhere - you're very, very tired?

(Tony)         Exhausted.

(Elissa)     And are people standing over you looking at you sometimes?  

(Tony)         Oh yes.

(Elissa)     I mean it has to - it can't be a good experience to wake up like that and not know what's happened to you.

(Tony)         Just recently I had a seizure in a rather famous restaurant.  And I got claustrophobic.  And the next thing I did was to wake up and I was back, fell back on my chair on the floor.  And my feet were still in the chair as if I were sitting down.

(Dr. Salgo)     [chuckles]

(Tony)         And when I woke up I could hear voices.  I could not communicate, but I could hear voices.  And the voices were saying different things.  And there were 100 people standing around me.

(Dr. Salgo)     Now did you ever get hurt when you had one of these seizures?

(Tony)         If you, the worst thing is hurting your head.  Falling back.

(Dr. Salgo)     Uh-huh.

(Tony Coelho)         Falling back and hurting your head.  And that has happened to me once.  But that's the one thing you worry about.  You know.  And that's why people don't drive.  That's a lot of reasons why you have to be careful.  Because you lose total control.  I have lost body control.  I wake up and I have lost bladder control and so forth.  So it is embarrassing at times.  But you know that's the way it is.

(Dr. Salgo)     But you seem to be coping with it.

(Tony)         Oh yes.  I don't - I'm stronger because of my epilepsy.  

(Dr. Salgo)     Uh-huh.

(Tony)         Not weaker.  I have to know who I am and deal with it.  So that makes me a stronger person.

(Dr. Salgo)     Now when you see kids that have gotten this diagnosis made, how does it make a kid feel to be diagnosed with epilepsy?  What's typically going on?

(Dr. Blackburn)     Depends on the age of the child.  Often it's a very disruptive event.  It has a big impact on self-esteem.

(Dr. Salgo)     How common is seizures in the United States?

(Dr. Gross)     In this country it's about one percent of the population.

(Dr. Salgo)     That's a lot of people.  

(Elissa)     It's a lot.

(Dr. Salgo)     That's three million.

(Dr. Gross)     That's a lot of people.  It peeks in childhood.  And that's due mostly to the developmental abnormalities of the brain that begin to show up in childhood.  And it goes up again in the elderly population.

(Dr. Salgo)     What are the after effects of seizures, and how do they affect the body afterwards?

(Dr. Bruce Hermann)     Well it depends on the seizure.  So many times, some individuals after an absence or petit mal attack can bounce back very quickly and resume their activity.  Sometimes after a relatively minor partial seizures can be whipped for you know, hours.

(Dr. Salgo)     Well let's pause just for a moment.  Sum up where we are before we go forward.  One of the key things to remember here before we move on is that seizures are symptoms of abnormal brain activity.  They can be traumatic effects, and can cause injury.  So it's important to know the signs of a seizure, to get a proper diagnosis of your seizure even though that diagnosis I would assume carries some stigma.  Getting to the diagnosis is important.

(Dr. Gross)     Yes.

(Dr. Salgo)     So that's what Allison did.  I'll tell you.  Allison goes to her doctor.  Her doctor diagnosed her seizures.  Sends her to another neurologist.  Does Allison have epilepsy?

(Dr. Gross)     She's had two seizures as an adult.  One of which may have been provoked.  And she had fever related seizures as a child.  So she's had but one unprovoked event.  And that's in a grey zone.  However, I think I and most of my colleagues would treat at this point.  But an MRI scan here is crucial.

(Dr. Salgo)     Are there such things as non-epileptic seizures?

(Dr. Gross)     Yes there are.

(Dr. Salgo)     And what are they?

(Dr. Gross)     There are lots of different types.  It's the uniform experience across the country that in referral centers - in epilepsy centers that about 30 percent of the people referred to those centers, have non-epileptic seizures.  Events that look like seizures that are not caused by abnormal brain electrical activity.

(Elissa)     So what are they doing?

(Tony)         But you just said looked like seizures.  That means they didn't have a seizure.

(Elissa)     Are they faking it?

(Dr. Gross)     They look like seizures.  There may be -

(Dr. Salgo)     But then it wasn't a seizure.

(Dr. Gross)     - a stiffening.  No.  That's right.  That's correct.

(Dr. Salgo)     Okay.  You said had a seizure but whatever.  But -

(Dr. Robert Gross)     Had an attack that looks like a seizure but is not.  Right.  That's good point.  And so our job is to figure that out.  And the way we do that is we bring people into the hospital.  Put EEG wires on their head.  We video them.  And we wait for them to have a typical attack.  And if the brain waves are normal 99 percent of the time, it means that this is non-epileptic.  Now there are lots of causes of non-epileptic attacks.  But the most common cause is what we call psychogenic.  It's a cause that is caused by a psychological problem.

(Elissa)     Does that mean they are faking it then?

(Dr. Gross)     No.

(Tony)         No.

(Dr. Gross)     No.

(Dr. Gross)     Absolutely not.  

(Elissa)        So what's it mean then?

(Dr. Gross)     It doesn't mean their crazy.  It doesn't mean they are
faking it.  This is a psychological problem that is not under their control.

(Dr. Salgo)     Well I can tell you about Allison because I can tell you what's in the chart.  Her doctor decided and on the basis of evidence that he had I suppose, that Allison was not having psychogenic seizures.  He actually did diagnose her with epileptic seizures.  So now that we see this note, how would he have come to that diagnosis?

(Dr. Bruce Hermann)     Through the diagnostic tests.

(Dr. Papa)         Yes.

(Dr. Gross)     Hopefully an EEG, and MRI.  If you see an abnormality on an EEG that is epilepsy-like, then obviously it greatly supports the diagnosis.

(Dr. Salgo)     But we just said that a lot of EEGs are normal.

(Dr. Gross)     Yes.  But sometimes you can see abnormalities.  Sleep deprivation helps.

(Dr. Salgo)     Let me stop you there.  Sleep deprivation helps.

(Dr. Gross)     I'm sorry.  It helps hardly anyone does it?

(Dr. Salgo)     [chuckles]

(Dr. Gross)     It helps make the diagnosis.

(Dr. Salgo)     So you are going to deliberately deprive people of sleep?

(Dr. Gross)     Yes.  Get a few hours of sleep the night before.  There is something about the drowsy state, the sleep state that brings out epileptic activity in the brain.

(Dr. Salgo)    What are the health implications to the rest of their body?  What else happens to epileptics?

(Dr. Gross)     It's ... I'm going to back up from that.  Because I think the psychosocial whammy is bigger.  She can't drive.  In most states, she would not be allowed to drive.  And that period varies by state anywhere from a few months to a year until there is a demonstration that no seizures are occurring.  It is very difficult to obtain or maintain competitive employment, continue in school for many people if you can't drive in this society.

(Dr. Salgo)     Tony, when they made the diagnosis of epilepsy in you, what were the immediate effects of that?  What could you not do that you previously thought you could do?

(Tony)         First off I want to correct you on one thing.  

(Dr. Salgo)     Yes.

(Tony)         I am not an epileptic.

(Dr. Salgo)     Okay.

(Tony)         I have epilepsy.

(Dr. Salgo)    Okay.

(Tony)         Big difference.

(Dr. Salgo)     Tell me the difference.

(Tony Coelho)         Well the difference is that I am a person that just happens to have epilepsy.  And don't try to identify me that way.  I mean I am comfortable with it.  But a lot of people with epilepsy deeply resent being called an epileptic.

(Dr. Salgo)     Is that right?

(Tony)         And I don't blame them because the term implies something different.

(Dr. Salgo)     So let me rephrase the question.  You have epilepsy?

(Tony)         Yes I do.

(Dr. Salgo)     They made the diagnosis.  What did you suddenly not, what were you suddenly not able to do that you could do before?

(Tony)         First off, my parents rejected it because they didn't want to have a son who has epilepsy.  And for years we didn't talk.  Secondly, I lost my drivers license.  Lost insurance.  Thirdly, I was told I couldn't be a Catholic priest because under Canon law established in 400 a.d. it said that people with epilepsy or have - people with epilepsy or possessed by the devil cannot be a priest.  And over the years people combined the two.  Now thank God that law has been changed.  I immediately felt I was different.  I became suicidal.  I drank and had real problems.  Because I had been rejected by everything I had ever loved.  And I don't think people really pay attention to the psychological side.  What happens to me as a person?  Twenty-four/ seven.  Twenty-four/seven I'm thinking I may have a seizure.  People don't - you know.  They...just because I have a seizure periodically, they don't realize that I'm with it everyday when I wake up in the morning.  Am I going to have one today?

(Dr. Salgo)     I think it's time to sort of blow your cover a little bit because you are not just Tony, our guest here.  But your also Congressman Tony, Tony COELHO who was so moved by the diagnosis, so moved by what happened in your life you started to change the world.  Tell us a little bit about that.

(Tony)         I decided that when I got elected to Congress that I had a podium.  And I believe strongly that when you have a podium, do something with it.  Then I decided that you know one of the big problems with those of us with epilepsy and people with disabilities is that we don't have our basic rights.  We don't have a right to go to court if some doctor messes up or somebody else messes up and discriminates.  And so I authored The Americans with Disabilities Act.  

(Dr. Salgo)     So you're the guy?

(Tony)         I'm the guy.

(Tony)         And now it's the law of the land in 18 different countries.  And the U.N. has considered it as part of its charter.  And we have a Supreme Court who is going backwards here while other nations are going forward.  But it is the law of the land.  And made great progress.

(Dr. Salgo)     I can't let you get off the Supreme Court without attacking them at least once.

(Dr. Salgo)     Tell us this story because it is beyond belief to me, anyway.

(Tony)         Well the Supreme Court has ruled in a particular case saying that those of us with epilepsy that while we're having the actual seizure, we may be disabled.  But we're not disabled.  And so consequently we're not covered by the ADA.  And the Congress did not intend us to be covered by the ADA.  And my response always to that has been well, wait a minute.  I authored it.  You think I would have made sure that I was included as part of it?  Why else would I have written it?

(Dr. Salgo)     What about parents concealing it?  I mean, Tony's parents concealed it from him.  And I guess in part because they didn't really believe the diagnosis.  Or didn't want the diagnosis.  Is this common?

(Dr. Blackburn)     That's one reason for concealing.  There are other reasons for concealing.  People are afraid because what we have now defined as not grand mal, but the generalized seizures is what everyone thinks of.  People are afraid of sharing the information for fear their child is going to be automatically put in special education.

(Tony)         Right.

(Dr. Blackburn)     Or be rejected by all of their friends.  Allison is on the brink of you know she has graduated from college.  That's when people should blossom forth and be on their own.  And now, as hard as it is for parents to let go anyway, her parents now have another reason to go well, but I am going to pull you back in close.

(Tony)         Yes.

(Dr. Lynn Blackburn)     I don't understand this.  And until I do you're not going anywhere.

(Dr. Salgo)     Let's take a break here just for a moment before we shift gears.  And just review some of the things that we need to remember before we move on.  A diagnose of epilepsy has both personal and social consequences.  It is a common diagnosis and it is a misunderstood condition.  Both by doctors and by the folks who suffer from the disease.  So let me go forward a bit.  What are you guys going to recommend right now for Allison?

(Dr. Gross)     Well that's the $64 billion question.

(Dr. Gross)     So I get it.  Okay.  So we don't know the type of seizure disorder that she has.  And this matters because different medicines are good for different types of seizure disorders.  So you want a medicine that will produce control.  But which will minimize adverse effects.

(Tony)         I think the critical point here that he is making is that he is talking about something that's called quality of life.  Don't drug me up so I don't have any life.  

(Dr. Salgo)     Allison is a straight A student.  So what does she do?  Child of the 21st century?  

(Elissa)     Goes to the internet.

(Dr. Salgo)     She goes to the computer.

(Elissa)     [chuckles]

(Dr. Salgo)     Goes on the Web.  And she reads about the Ketogenic diet, which has been reported to do a lot of good.  I heard this exhale of breath.

(Dr. Salgo)     I wasn't looking.  But since you seem to have had a reaction, go right ahead and talk about it.

(Dr. Blackburn)         Well the Ketogenic diet, you can describe better what's involved in the diet.  But it is a very restrictive diet.  And for someone who is starting out, going to be living independently, taking on that kind of burden where if you you know, if you go out with friends, you probably can't eat what they are eating.  You've got to bring along your own stuff.  Would be -

(Elissa)      Would it work for her seizures?

(Dr. Blackburn)     It depends on the seizures.

(Dr. Salgo)     Tell me this.  Can you describe -

(Dr. Gross)     It likely would not.  Yes, the diet in brief is sort of a supercharged version of the Atkins diet.  So it is very high in fat.  And the body begins to burn the fat and make this chemical called Ketones.   

(Tony Coelho)         But before we get overly critical, there are some kids who have only responded to that.  And I go back to my thing about quality of life.  Let's not be overly critical on one drug or one approach.

(Dr. Blackburn)     Right.

(Tony)         I agree that most kids would not respond favorably.  But...

(Dr. Gross)     What the operative word there is kids.  Because it's a good treatment in children.

(Dr. Bruce Hermann)     Right.

(Dr. Salgo)     So it does work in kids.

(Dr. Gross)     Yes.  But for a 20-year-old she's getting at the point where it is likely not going to work.

(Dr. Salgo)     Well let me tell you what happens.  Allison goes on Dilantin.  That's what her doctor puts her on.  A standard anti-seizure medication.  Before we go any further, what are the side effects of Dilantin?  Is it a pleasant drug?

(Dr. Papa)         No it's not.  

(Dr. Salgo)      Lou looks awful.

(Dr. Papa)         It's not a pleasant drug.  I men there is a risk of rashes.  They all can cause sedation, liver test abnormalities.  There is unusual effects on your gums and the lining of your mouth.

(Dr. Gross)     Yes, swelling of the gum.

(Dr. Papa)         So it is not pleasant.  A lot of these drugs you know are not completely risk free.

(Dr. Gross)     Dilantin is one of those medicines that's associated with a two-fold greater loss in bone mass.   Two-fold per year.  

(Dr. Bruce Hermann)      Also results in some cognitive slowing, which can effect academic performance and -

(Dr. Papa)         Balance issues as well.

(Dr. Bruce Hermann)      Yes.  Lots of drug interactions.

(Dr. Salgo)     Well she doesn't like the Dilantin.  She was told she couldn't go on the Ketogenic diet, much as she would like for it to work.  So she goes back to the Web and this time she starts to look at more radical solutions.  And she has read that there is such a thing as surgery for epilepsy.  I'm going to ask you to show me a little bit about what epilepsy surgery is all about.  You can show it to the camera right there.

(Dr. Gross)     So we're looking here.  Here is the front of the brain.  Here is the back.  And actually I am going to flip it around here so we can get the whole view.  Most seizures in adults - and Allison may or may not apply here - have seizures coming from this part of the brain.  This is the temporal lobe, or the part that is right underneath the temple.  This part is particularly suitable to surgical treatment.  If the seizures are not well controlled by medication, this is, we're talking about a permanent irreversible treatment.  And that spot can be safely operated on.

(Dr. Papa)         I mean we're really way ahead of the curve here.  There is a lot of risks that you're taking on with it.  I'm not sure that even a neurosurgeon would say I would consider at this point.

(Dr. Gross)     He ought not to.

(Dr. Salgo)     Tony how are you being treated right now?

(Tony)          I took Phenobarbital for 40 years.

(Dr. Salgo)     Uh-huh.

(Tony)          And I just switched last year because it hasn't worked that well lately.  And Phenobarbital as the docs will tell you is not a very pleasant drug.  But I have switched and I am very happy with the new drug.

(Dr. Salgo)     What I want to do now is just stop for one more moment and to remind people about one more key thing.  Sum up one of the key things to remember here before we move on.  The goal of epilepsy treatment is to stop seizures.  It is simply that easy.  If you can stop the seizures, that should be the goal.  Do we all agree on that?

(Tony)         No I don't.

(Dr. Salgo)     I knew you wouldn't agree with it.

(Tony)         The goal - it's an interesting concept.  But those of us with epilepsy, we want a better quality of life.  You can stop maybe my seizures.  But I am so drugged up I can't participate in life at all.  And some docs think that is the goal.  And so they go out there.  Drug me up.  And I can't participate.  My parents are happy because I don't have any seizures.  You know, probably other people are happy because I don't have seizures.  But I'm not.

(Dr. Salgo)     We've all been discussing what to do about seizures to keep them from happening.  You alluded to what you would do if you saw somebody having a seizure.  Very quickly in you know, 10 seconds or less if that is possible.  What do you do if you are a bystander and somebody is seizing?

(Dr. Gross)     You need to help them be safe.  So that may mean getting them down on the ground, rolled on the side so that any secretions don't go down into the lungs.  And don't put anything in the mouth.

(Dr. Salgo)     Okay.  I want to thank all of you for being here.  This has been just terrific.  Just a great, great discussion.  There are a few things I think we should leave our viewers with.  You should remember that seizures are symptoms of abnormal brain function.  They can be traumatic events, which can cause injury.  So it is important to know the signs of a seizure and to get a proper diagnosis.  A diagnosis of epilepsy has both personal and social consequences.  It is a very common and a very misunderstood condition.  Now the goal of epilepsy treatment as I said is to stop the seizures.  But I think Tony really has a very important point.  It's to the control the seizures so that they are controlled enough the person has a quality of life worth living.  Is that fair, Tony?

(Tony)         That's fair.

(Dr. Salgo)     That's great.  Thank you again very, very much for being here.  My final message is of course this.  Taking charge of your health means being informed and having honest communication with your doctor.  I'm Dr. Peter Salgo and I'll see you next time for another "Second Opinion".

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