Q: How long should I wait to decide if a medication change has been effective?
A: Antiepileptic medications act in different ways and work differently with each person. A change in medication is a slow process and it involves weaning off one medication slowly introducing another at the same time. Or it may be introducing a new medication in addition to the old one. Either way, the true effectiveness of the second medication won’t be apparent until the changeover process is complete and the medication dose at an effective level for you. Ideally this effective level shouldn’t be causing too many unwanted side effects, because that is would not be considered effective if you have to live with unacceptable side effects to get seizure control.
So the time period will be different for everyone. A rough time period would be 3-6 months, but sometimes seizure patterns wax and wane a bit, or a new medication may initially work well, then become less effective, so it is probably best to wait 6-12 months unless you are having unacceptable side effects.
Q: What is the difference between Alzheimer’s Disease and epilepsy related memory loss?
A: Memory problems are a common complaint as we age however the difference between having a memory problem and Alzheimer’s Disease is “the difference between forgetting where you parked your car and the fact that you even own a car”. One of the first symptoms of Alzheimer’s Disease is memory impairment or loss, especially of episodic memory. Episodic memories are long-term memories of specific events that were personally experienced at a particular time or place in the past.
Alzheimer’s can damage all parts of the brain associated with remembering where you are in the present time. However, Alzheimer’s Disease is also associated with many other symptoms such as:
- A change in behaviour: it can cause the person to become depressed and withdrawn from society.
- Wandering: Someone with Alzheimer’s can often be found wandering outside of their home for no specific reason or with no recollection of how they got there and no ability to find their way home.
- Diminished reasoning: Alzheimer’s can affect the waysomeone thinks and their ability to handle abstract thoughts.
- Movement problems such as losing sense of touch or being able to walk or use their hands.
People with epilepsy frequently complain of memory difficulties especially related to short-term memory. There are many possible types and causes of memory issues in people with epilepsy, such as:
- Transient memory loss associated with seizures
- Post seizure memory loss
- Memory difficulties in between seizures – may be due to:
- Epileptiform activity in the brain (but not causing seizures)
- Poor functioning of the memory area of the brain because it is where the seizures originate
- Sleep disturbances or sleep disorders
- Medication unwanted side effects
Sometimes it can be hard to distinguish epilepsy from dementia (including Alzheimer’s disease) in seniors, and sometimes seizures can be missed in people with dementia. Seizure symptoms in this age group include:
- Suspended awareness
- Hearing or seeing things
- Sporadic memory loss
The main difference being that seizures are sporadic, and the person should return to their normal behaviour in-between seizures.
The reality is, if you have an awareness or insight that your memory is poor it is unlikely that you have Alzheimer’s Disease. If you are worried it would be worth raising your concerns with your treating doctor.
Q: What can trigger an epileptic seizure?
A: Some people find that particular things make it more likely that they’ll have a seizure. These are called ‘triggers’ and aren’t the actual cause of the epilepsy. Even if you only ever have seizures in response to a trigger, something else has made your brain prone to firing off the clusters of messages that causes a seizure.
There are many different triggers but some common ones include:
- Missing medication
- Sleep deprivation
- Alcohol and drug use
- The menstrual cycle
- Reflex triggers such as flashing lights and geometric patterns
It is really important to become familiar with your triggers so you know what is more likely to cause a seizure for you, and then you can possibly take actions to avoid your triggers.
Q: I’ve been diagnosed with psychogenic non-epileptic seizures. What is it and why was my EEG abnormal if I don’t have epilepsy?
A: People with psychogenic non-epileptic seizures (PNES) are often misdiagnosed with epilepsy. Similarly, many have had EEGs reported as abnormal. This may be because:
- It is quite possible to have an abnormal EEG without having epilepsy. A small percentage of the population have an abnormal EEG but no physical signs or symptoms of seizures
- EEG is a very complex and specialised area, and sometimes some EEG features that may be within normal range can look abnormal or very similar to epilepsy abnormalities.
- It is also possible to have both PNES and epilepsy. About 10% of people with PNES also have epilepsy. If you have both, it is very important that you and your family learn to distinguish between the epileptic seizures and the psychogenic non-epileptic seizures.
Psychogenic non-epileptic seizures (PNES) are the most common condition misdiagnosed as epilepsy. Approximately one in five people referred to a neurologist for review of difficult-to-control seizures have PNES instead of epilepsy, and about 10% of people with PNES also have epilepsy. Your doctor may also use the terms Conversion Disorder or Functional Neurological Disorder.
Q: What is an aura? My doctor says they are seizures.
A: Yes that’s right. An aura is actually a focal seizure where a person retains awareness. Often it happens just before a more significant seizure so people call it an aura or warning, but it is actually the start of the seizure. It can serve as a warning sign, but it can happen on its own as well. The way it presents is different from person to person, but typically people who have auras (focal aware seizures) don’t lose awareness. For more information on focal seizures go to https://www.epilepsy.org.au/about-epilepsy/understanding-epilepsy/