Dr. Bannout, in a white coatm with a group of students and residents during a teaching session about seizures

Dr. Bannout with residents and medical students at the Epilepsy Monitoring Unit in LLUH Medical Center

Epilepsy, a brain disorder that causes recurring, unprovoked seizures, affects approximately 3.4 million people in the U.S., according to the Epilepsy Foundation.

For those newly diagnosed, understanding the condition and its impact on daily life can feel overwhelming and frightening. Firas Bannout, an epilepsy specialist at Loma Linda University Health, shares valuable information to help newly diagnosed patients navigate their journey and understand treatment options.

Epilepsy vs. Seizures

The terms epilepsy and seizures are often used interchangeably, but they refer to different concepts. A seizure is a sudden surge of excessive brain electrical activity that may be a single occurrence and can be provoked by an identifiable trigger, such as alcohol, illicit drug use, certain medications, or metabolic disorders.

An individual is diagnosed with epilepsy when they experience two or more unprovoked seizures or have a single unprovoked seizure with a high risk of recurrence, determined by specific factors, including family history of epilepsy, brain structure abnormalities, abnormal diagnostic tests, and seizure types.

Causes of epilepsy 

The cause of epilepsy, which requires a clinical diagnosis, varies for each patient. Following a pattern of unprovoked seizures, doctors examine numerous aspects such as medical history, brain imaging, and EEG tests to analyze brainwave patterns and assess possible causes of epilepsy. 

According to Bannout, “the main types of epilepsy causes are structural, genetic, metabolic, and autoimmune.”

  • Structural: Structural brain issues, such as tumors, brain injury, infections, or congenital brain abnormalities, can lead to epilepsy by disrupting normal brainwave networks.

  • Genetic: Previously known as idiopathic epilepsy, this type is believed to have a genetic origin, even if no specific gene is identified.

  • Metabolic: Related to the way the body breaks down food and electrolytes

  • Autoimmune: Refers to dysregulation of the immune system.

Challenges of epilepsy

Individuals with epilepsy can face significant adjustments to daily life as the condition affects a person's social, emotional, and psychological well-being. In addition to the unpredictability of seizures, Bannout acknowledges that those with epilepsy may experience the following challenges:

Social stigma: Misunderstandings about epilepsy can lead to discrimination or social isolation, impacting relationships and self-esteem. 

Employment and financial challenges: Many people with epilepsy face barriers in finding or maintaining employment due to potential safety and liability concerns, which can lead to financial strain.  

Driving restrictions: Depending on the frequency of seizures and state laws, individuals may be restricted from driving. 

Mental health struggles: Higher rates of depression, anxiety, and sometimes increased risk of suicide are common among people with epilepsy. 

Cognitive impairments: Seizures and medications can affect memory, concentration, and cognitive function, making it challenging to complete tasks, study, or work. 

Sudden unexpected death in epilepsy (SUDEP): Patients with epilepsy are at risk for a rare but serious condition called SUDEP, which affects approximately one in 1,000 people annually. SUDEP’s cause remains unknown. Raising awareness and informing patients about SUDEP is vital, as it allows individuals and families to take the appropriate precautions.

Treatment options

Loma Linda’s Level 4 Epilepsy Center, the highest level recognized by the National Association of Epilepsy Centers, aims to balance effective seizure management while helping patients maintain a high quality of life. 

“Our goal is to make sure patients feel in control of their lives,” Bannout says. “Instead of a lifelong disability, we like patients to be engaged in society and continue to work and go to social activities rather than live inside the diagnosis of epilepsy.”

In addition to medication, Loma Linda’s Epilepsy Center offers a wide range of evaluation and treatment options, including:

Epilepsy Surgery Evaluation

  • Imaging studies, including MRI, SPECT, and PET scans

  • Observation in the Epilepsy Monitoring Unit to evaluate brain activity with long-term inpatient video EEG monitoring 

  • Intracranial EEG monitoring, including stereoelectroencephalography (S-EEG), a minimally invasive procedure, advancing thin wires through very small incisions to determine the exact location of seizures 

Surgical Options

  • Seizure focus resection, safely removing an area of brain tissue where seizures originate

  • Laser Ablation Therapy, using MRI guidance, a laser uses heat to eliminate the brain tissue causing abnormal electrical activity

  • Disconnection surgery like Corpus Callosotomy or hemispherectomy/hemispherectomy, disconnecting a seizure network, depending on the type of epilepsy

Neuromodulation Therapy

  • Responsive Neurostimulation (RNS), an implantable device that detects seizures and delivers an electrical impulse directly to specific areas of the brain to abrupt and/or prevent seizures

  • Deep Brain Stimulation (DBS), implanting electrodes into each thalamic region of the brain, and stimulating these areas with small regular electrical impulses via a programmer implanted in the chest

  • Vagus Nerve Stimulation (VNS), an implantable device that sends electrical impulses to the vagus nerve on a scheduled basis to disrupt abnormal brain activity

Regardless of the treatment, Bannout ensures that the team strives to offer a supportive, personalized approach, taking on the burden of managing epilepsy to allow patients the freedom to focus on what matters most to them.

“We work to help patients understand they are not alone and have support.” 

For those living with epilepsy, the journey may have challenges, but with modern treatments and a strong support network, a fulfilling life is possible. If you have tried and failed to manage your epilepsy with medications, ask your neurologist for a referral to the Loma Linda Comprehensive Epilepsy Center or call us at 909-558-2880.