Your doctor speaks II; Epilepsy: Is There a Problem?

The University of Illinois Medical Center campus in Chicago percents your doctor speaks during the series doctors in the colleges of medicine dentistry pharmacy nursing and graduate college at the University of Iowa and I will discuss the latest advances in cancer and heart research. Painless dentistry psychiatry nursing care and modern drugs. All of these and more will be presented on your doctor speaks. Your host for this series is Jack Gray camera coordinator of public service radio and TV programming for the University of Illinois Medical Center campus and champagne Urbana. This is Jack Grammer bring you another program that we do with staff members from the University of Illinois Medical Center campus in Chicago. Our guest Dr. Louis Boshes director of the epilepsy consultation clinic at the University of Illinois Medical Center and an attending neurologist and psychiatrist Michael Reese Hospital and Medical Center and chief of neurology clinics.

Michael Reese Hospital Doctor lashes of course is probably the most well. And renowned experts and a few epilepsy and are subject to is epilepsy. Dr. Bosches what is epilepsy mystery Heimer epilepsy I should tell you what mediately is not an illness. It is a symptom. I would call it a condition which is caused by a malfunction of the brain which may affect anybody at any time. If I could liken it say to an onset of a violent storm emanating out of the brain it would equal that. The word itself is derived from the Greek from the proposition than an irregular verb meaning to act upon. To see to catch hold up. What happens then is a specific group of cells in the brain become sensitive become irritable they discharge and the brain fires

this mystery calmer we call seizure activity. This is epilepsy inherited in the sense of the word no. Epilepsy is not inherited. I would safely say that epilepsy has a DI Athersys a tendency to exist in certain people but truly it is not inherited except in one condition. This we call Central is so phallic or otherwise known as petty mild epilepsy and even then the tendency is so small between one and four percent may have an inherent that tendency. A mystery Carmen let me give you a rule of thumb and we are asked about this all the time. For example if a set of parents come to the doctor and ask whether any offspring they are planning might have epilepsy. I asked for it in this fashion. If either parent in other words both parents do not have seizures the possibility of their having a baby with seizures would be 1 in 200.

If one of the pair or one of the parents has seizures then the odds drop to one and a hundred. And if both parents have seizures the possibility of their having a baby with seizures would be a one in 50 or one in 80. In other words for strict timer you can see that the tendency is not too bad and the odds are not too bad. The big question doctor and that is what causes epilepsy. Well the cashier is a rather big one too. I would say this if there are truly two major divisions in the so-called epilepsy in about 75 percent of all cases that we see we see brain cells which cause seizures when they explode as I've already told you. And when this happens a seizure results but still we do not have a specific cause. This we call it the idiopathic on the other hand we have 25 percent left and they have causes what are

they. Now there can be childbirth and child injury resulting at childbirth. There can be other injuries like blows to the head falls automobile accidents assaults. There can be infections inflammations like encephalitis meningitis. There can be growths in the brain. Now there are two kinds of gross There are good gross or so-called But mine and there are malignant ones. The so-called malignant tumors there can be mad a bollock disturbances such as diabetes us with blood sugar difficulties resulting And what happens then is that there is not enough sugar circulating in the brain and this can result in not seizures or other metabolic conditions may result with aisle seizures as an aftermath or as what we call the stigmata are what we call a sequel. You know we hear about emotional problems that people have today and it seems to be prevalent in medical science.

I would like to know Are there any emotional aspects associated with it. With epilepsy were the cause of epilepsy. You know Mr. Rigg Harmer just about 15 minutes ago one of the members of my staff came to me in the clinic to tell me of a young man and he felt that there might be emotional causes resulting in his seizures. I would rather say it in this fashion emotional disturbances alone do not cause epilepsy. However in individuals who have a predisposition to seizures these are the ones who are super sensitive or very sensitive to stimulation to emotional disturbances. And when they are upset they have seizures when they have seizures they become upset. In other words they are in a circle Mr Rick Heimer and one fires the other. So this is where an emotional upset may cause a seizure and of course we attempt for patients not to become upset especially

in children. We have parents as much as possible see that their children are not disturbed emotionally. Doctor how is epilepsy diagnosed. Actually you have to be constipation clinic. Well the diagnosis of epilepsy involves a great deal. We want a history if we can get a history from the end of it you'll have seizures fine. If he cannot give us his history then any member of his family might parents for a child an observer who has seen the seizure can tell us. But generally we have a picture of repeated episodes of fainting weakness dazing of convulsions. I mean coordination of movements are involuntary jerking of the movements movements of the head or limb which may worry a patient or a parent who sees this in a child and then he brings that child or the patient himself comes to the clinic. This we call taking a history.

After we take this very complete history then we make a complete medical examination. The medical examination is the same as a medical examination for any condition in the body which a patient comes to see the doctor. However we also add a neurological examination. Now this means that we examine certain major systems within the so-called central nervous system which consists of the brain and the spinal cord and in the peripheral nervous system which consists of the nerves which come forth from the brain and from the spinal cord and we also consider the cerebellum as another sort of us nervous system. So we examined the nerves the cranial nerves which come from the brain. We examine the sensory aspects of the body by responses to certain stimuli which cause response to the patient. We examine motion in the patient and we correlate emotion one side to the other. We examine for strength. We examine reflexes there are normal

reflexes which are called Deep reflexes or the superficial reflexes. We look for abnormal reflexes which are reflexes that are only seen and have normal conditions. We examine the long tracks or the peripheral nervous system and we examine the cerebellar system. Not after that is done. Then we go to the laboratory. Not within the laboratory we have certain other studies which are very meaningful and very necessary for a patient. Every one of our patient receives X-ray examinations of the brain and the chest. These are musts. Then we do a complete blood counts of every patient we do serology In other words we look for material disease on every patient district Heimer. There are no exceptions. We do blood chemistries to see where the way saw the blood whether there are large amounts or small amounts or falls within normal limits. And then we are very very careful about the sugar content within the blood. We do want to call a

fasting blood sugar we do what is called a two hour postprandial sugar. And if we dont like the results then we do sugar studies which sometimes take five or six hours. These are the most important studies that we do with them. The structure of the clinic and then we go on to some other studies. While you want to talks specifically about these other studies that's right I can tell you that the next very important study is the brain wave test now this is called electroencephalogram feed. Now just as the heart immense electricity so does the brain and what we do is we attach little wires this is a painless procedure to the outside of the skull in various areas over the frontal areas over what we call the temporal areas. By that I mean Mr. Rigg armor our temples the pride all areas which are behind the front part of the brain and then the occipital which is the back part of our brain and then we hook the individual up to a set up to a sheen

called the electroencephalogram care operators. And from this comes forth a record which we can see a record which is amplified and the brain cells are almost like little tiny electrical generators and they shoot up this little amount of electricity which we see how in the paper this we call an electroencephalogram. The electroencephalogram is a record itself which we read in other words this is a guy which we use in evaluating the patient and in treating the patient. Now if we see a good deal of abnormality and some of the studies I've already mentioned then we need more studies how the studies are done in the hospital. Sometimes in the hospital a complete examination is necessary often only part not within these other examinations we do the following. We do air studies of the brain which are called normal on several graphs are we put hair into the ventricles or openings within the brain called a

ventricular gram. However before that we do a spinal puncture and then there's another study that sometimes we have to do called an arterial grama which we put in a dye or a contrast media into blood vessels along the side of the neck or into the crack of the elbow and what we call the brachial artery. And this guy goes up to the brain and we take a picture of the brain this is also a rather routine examination and certain specific instances and and a very excellent examination which is made to help us find the cause for the individual having seizures. I mean to say doctor you give a complete and thorough examination to the head of thank you but every one of these patients warrants one of these and if he doesn't we're selling him short. Let's turn to epilepsy itself and how it effects a child or an adult. How does it affect or does it. The mind of a child and adult for adult for instance. It's of the person's ability to learn if this impaired at all.

No mystery Heimer the answer is No I don't believe that the seizure itself has any bearing on a child's mental capabilities. As a matter of fact some very brilliant kids have seizures and speaking of brilliancy. Supposing I were to tell you that past history there were in some very famous people who had seizures. Let me give you a few ideas of some of these and you will tell me whether or not their minds are affected now there is somebody named Beethoven and Julius Caesar and Dan T and Charles Dickens and Hondo old Napoleon even Alfred Nobel of the Nobel Prize Paganini Saint Paul Rousseau Shillman. Ah let's see there's Shelley and Socrates Tolstoy and Tchaikovsky Bongo. These were pretty bright Yes I mean yes really I think I have yeah I mean they left their mark the whole class. However there are some children you must understand who have severe brain damage. Now they have multiple handicaps including physical handicaps. They have mental retardation and then they have seizures as well. Now these are brain

damaged children. And we can expect them to have a mind problems. But our sample epileptic children. Oh no no no problem we we're not worried. But we must be very careful because in some of these children when they do receive too much medication they can become a little fuzzy and a little slow down. Well this of course will depend on the physician to make sure and the diagnosis and so forth and the treatment which is up to a person like yourself. So there is no complication Martin or any doctor or any doctor. OK we got a doctor's role let's talk about the parents role if we may. What can parents do or other family members for that matter and helping the physician in treating a child or other family member who hasn't collapsed. What can they do. Hi I'm glad you brought this question up mystery Geimer because obviously you are thinking in terms of the entire family right now this young doctor who came to me earlier this afternoon told me that this boy that he was seeing was having a great deal of trouble with his mother and with his father. And we see so much of it

so obviously much of the success in managing us someone who has a seizure is in the path and the family itself on the parents episode Childline brothers and sisters. On other members of the family because this is so important what I'm trying to point out is that there should be a proper mental attitude within the family first to accept the fact that the child has a symptom not an illness that this is not such a terrible illness that this is something that can be handled very properly. And mind you Mr. Rigg Hiero we can control seizures in patients with drugs up to 80 or 85 percent of the population that we see in our offices in our clinics. That's a good percentage are very high. There must be complete confidence within the doctor not only by the patient but also by the family and encouraging that family member to the come to the clinic to encourage a patient to take his

medicine. And this is what we expect. We must also have the family feel that this child or other member of the family is not so terribly involved that he cannot do things that other people do who do not have seizures both at home and school in the community in the church and the factory in the office and where and other words what we want is complete understanding. What are some of the problems that must be faced once the diagnosis of epilepsy has been made. Well I will ready answer part of the yes your IRA but let me just say first let me again emphasize the word acceptance. Yes. First the parents of the patient boss accept the fact that the condition exists and following this the child should be accepted for what he is and he is still deserving of the same amount of love and understanding that he would have if he didn't have seizures because we must understand that some people have

ignorant feelings about this lack of understanding. There is fear there is prejudice on the part of the family in the community amongst neighbors in the school. In the public generally not these biased attitudes Mr Rick IME are changing slowly in the light of increased medical knowledge and social understanding. But they can be discouraged on less contracted by solid information of such as what you and I are attempting to do today doctor. We've heard the term seizure. Applied to epilepsy on what should be observed during a season of what should be done. I'm not talking about the physicians part of it for somebody else who might be around when a person has a seizure. How it would be very amusing if I were to say to you doing hardly anything. You're having a seizure. The most important thing to do during a seizure is to see that the person having a seizure is not hurt. If I were to tell you that we do

not want anything pushed into our mouth anymore I am telling you the latest thoughts within the country including some of our major medical advisory councils even responsible to the president of this country. If it is a child the child should be allowed to just lie. On the ground or on him a room on the floor until a seizure is over the head should be turned to the side where the child can be carried after the seizure to a bed until he is fully conscious. If it's an adult again I must tell you just simply allow the patient to have his seizure. TURN THE have to the side so that saliva may run out of the mouth. Perhaps a jacket can be put under the person's head but do not hold him tight Do not try to stop the seizure. I want people to know that I let the individual have his seizure and have it completely and that is the end of the seizure. But push nothing into the mouth. First we do not want to injure the

individual's teeth and furthermore are you who are trying to be a good Samaritan. We do not want your finger bitten so as you as you indicated do the least amount the less you do the better. Seizures are self-limiting they and it is only very rare there is a condition called status epileptic because when seizures become continuous This is very rare and it is a truly a medical emergency. But this would be handled properly. It could be a condition that would immediately necessitate the presence of a doctor and more. But it is so rare that we very rarely expect it. Yes well let's talk about some cures if we can kind of talk about a cure for epilepsy. Or I suppose it's management of epilepsy. Well I like your second word management better mystery Heimer I'd like the word controlled. I have already told you that we can control seizures in almost 80 to 85 percent of our normal population. The

15 percent that are left for Hap's between 1 and 10 percent can be improved between 1 and 5 percent stays stationary and wants a 3 percent stay on improved and we have something for that too. When we find that we cannot manage our epileptic patients with medications administering harm we have almost 25 different drugs at the present time for justice. Then we can turn to surgery and we are using surgery here at the University of Illinois School of Medicine. We have had a program and surgery for the removal of what we call Hampel Epogen exult which in other words we were both parts of the brain or perhaps an entire LOEBBECKE of brain for seizures. And I must tell you this mystery camera that we are even operating upon children removing these bad areas are these areas of the brain that are firing that cannot be controlled by medication and the results are simply dramatic. They are so good.

That's fantastic I'm glad to hear that. Let's let's turn to if we can a short time we have let's turn to the future for an individual has a legacy is it good I ask you I know it's good. Indeed it is Mr. Rick However the future fireball is only good for the medicines which are coming forth. Every day are good medicines in my laboratory right now we have four medications that we are working on with some very excellent promise into the future. We hope to have a medication one day that will be able to handle practically every individual has seizures. We are learning more and more about the human being in terms of his bodily metabolism. His chemistry we are doing things in order to prevent seizures in other words the overall look for seizures is so much better. The fear is the superstitions the ignorances are being dispelled by people such as yourself with your radio and your

television programs where you can reach huge segments of our population is paying off. Public opinion is getting better and better. And we're seeing this in terms of legislature within certain states. There are times when people with seizures were not permitted to marry and now only two states have still statutes on their books and even they're a little lax about that automobile driving a lot of driving is very important and we are seeing that people with seizures will have such a tiny percentage of actions due to seizures are permitted to drive when they are free of seizures for a year. And we see these patients regularly. There's also the question of insurance which is becoming better and better and finally Mr. Rick I'm or even the epileptic component of the Immigration Act has been rewritten now and people who have seizures are permitted into our country. This is a good it's it shows that we're becoming more mature and outlook

towards epilepsy. Do you think we are if this is absolutely a mystery a crime or a new look at epilepsy differ from what it is been in the past. Well it's good I'm glad to read that this is coming about. Doctor's been a pleasure having you on it's been a most interesting and informative program. Our guest has been Dr. Louis poshest director of the epilepsy consultation clinic at the University of Illinois Medical Center and a pending neurologist psychiatrist Michael Reese Hospital Medical Center and chief neurology neurology clinics. Michael Reese Hospital and Medical Center. You have just heard another in the series your doctor speaks produced by the University of Illinois Medical Center campus in Chicago in cooperation with this station during the series. Such topics as cancer and heart research painless dentistry psychiatry nursing care and modern drugs will be presented on your doctor

speaks. Your host for the series is Jack Gray camera coordinator of public service radio and TV programming for the universe their own II Medical Center campus and Champaign Urbana. Your doctor speaks is produced and directed by Mr. Reagan. This program was distributed by the national educational radio network.