House Calls Magazine, a publication by Alachua County Medical Society,

features articles by SIMEDHealth Neurologists Drs. Vongxaiburana and Yancey; 

An overview of multiple sclerosis by Dr. Vongxaiburana, and Update on Parkinson's disease by Dr. Yancey.

Scroll down to keep reading.

 

More than 200,000 people are diagnosed with epilepsy every year in the United States. November is Epilepsy Awareness Month, and we talked to SIMEDHealth Neurologist Dr. Kraiyuth Vongxaiburana (“Dr. Vong”) about epilepsy and what treatment options are available for patients.

1. What is epilepsy?

Epilepsy is a neurological disorder that causes reoccurring unprovoked seizures. Unprovoked seizures are those not triggered by an apparent metabolic abnormality. A patient is diagnosed if they have more than two seizures in 24 hours, or they've had one unprovoked seizure, with the risk of another seizure is more than 60% over the next ten years. Dr. Vong says, "Electroencephalogram (EEG) and MRI tests along with the history of the first seizure help determine the risk of having recurrent seizures. Persons having a seizure that was triggered by a source such as extreme hypoglycemia, drug abuse, or low sodium levels, had a provoked seizure, and this patient isn't diagnosed."

2. What is a seizure, and what happens during it?

 Dr. Vong explains, "A seizure is an abnormal, excessive surge of electrical discharges in the brain that disrupt normal brain wave patterns. There are several types of seizures, but the main types are generalized tonic-clonic seizures and complex partial seizures."

 During a generalized tonic-clonic seizure, abnormal electrical activity affects both sides of the brain. The person will typically lose consciousness, become stiff, and then start to shake. The seizure can last a minute or two. The person can bite their tongue, experience urinary incontinence, and be very confused for a few minutes after the seizure.

 During a complex partial seizure, the abnormal electrical activity is localized to only a portion of the brain. These seizures are much more challenging to spot. "For example, a person could lose focus, and appear awake but not respond to external stimuli appropriately. They also might talk or move without conscious thought or intention. The patient may make repetitive movements with their mouth or hands, fiddle with their clothes or the buttons on their clothing, or smack their lips. A complex partial seizure typically lasts a couple of minutes but may last longer.", says Dr. Vong.

3. What are the causes of epilepsy?

 In many cases, the cause remains elusive. Dr. Vong states, "In older patients, a previous stroke may be the source of their epilepsy. Other reasons could be an abnormal collection of blood vessels, congenital brain abnormalities, brain tumors, or scarring or loss of neurons in the temporal lobe. A history of head trauma with loss of consciousness also may predispose someone to have seizures. Genetics also play a role. If a parent has idiopathic epilepsy, there is about a 10% chance that their child will also have epilepsy."

4. There is no cure for epilepsy, so what can doctors do for patients with this disorder?

 Patients are treated with antiepileptic drugs. Medications decrease the risk of future seizures. "Typically, around 60-70 percent of patients will remain seizure-free on antiepileptic drugs.", says Dr. Vong. In those patients with intractable epilepsy or epilepsy that isn't controlled with medications, a portion of those patients may be surgery candidates. For instance, if it is determined a patient's seizure originates from only one part of their brain, it may be possible that removing that part of their brain might cure their epilepsy or at least reduce the frequency of their seizures.

5. Are there long-term effects of seizures on the brain? If so, what are they?

 Dr. Vong says, "Some patients may have a few seizures per year, and their cognition may be unaffected. However, in some patients, repeated seizures can lead to worse memory and cognition. One particularly troubling complication of epilepsy is status epilepticus." Status epilepticus is seizure activity that lasts for more than 30 minutes. Status epilepticus is a medical emergency and can lead to permanent brain damage or death. Forty-two thousand deaths per year may be due to status epilepticus. If someone has a new-onset seizure or if someone with known epilepsy has a convulsion that lasts for more than 5 minutes, then they should be taken to the hospital immediately.

 "Another rare complication of epilepsy is SUDEP, Sudden Unexpected Death of Someone with Epilepsy.", Dr. Vong explains the cause of SUDEP is unknown though some feel that a seizure may trigger a cardiac arrhythmia leading to the sudden death. Luckily, SUDEP is relatively rare as it occurs in only about 1 in 1,000 epileptic patients.

 

If you want to learn more about epilepsy and treatment options, click here to schedule an appointment with Dr. Vong.

For Epilepsy Awareness Month (November), we interviewed SIMED Neurologist Dr. Kraiyuth Vongxaiburana (Vong) to find out what epilepsy is and how it’s treated. But, to understand epilepsy, you must first be able to recognize the signs and symptoms of a seizure.

What is a Seizure?

A seizure is a surge of abnormal electrical discharges in the brain that disrupt normal brainwave patterns. Seizures can manifest in different ways, and Dr. Vong discussed two of them: a generalized seizure and a complex partial seizure.

Generalized Seizures

The most obvious manifestation is a surge of abnormal discharges throughout the brain. The patient loses consciousness and has a convulsion. They may become really stiff at first and draw their arms up. Then, they might begin to shake. The convulsion could end up lasting a minute or two. During that time, the person might lose control of their bladder or bite their tongue. To bystanders, the seizure should be obvious.

Complex Partial Seizure

This type of seizure is less obvious. The abnormal electrical activity is localized to one part of the brain and not generalized. The person might not have convulsions but might instead stare into space and have an oral or manual automatism. They might make repetitive movements with their mouth or hands, like fiddling with their clothes or the buttons on their clothing and smacking their lips.

What they’re doing might look semi-purposeful. Because their eyes are open, you might think they’re awake, but they don’t respond and aren’t actually aware of what’s happening. They might smell a smell that isn’t there or experience a rollercoaster sensation in their stomach. They might also feel a sense of déjà vu. If the seizure starts in one part of the brain and spreads to other parts, it can lead to a convulsion.

What is Epilepsy?

About 9 to 10 percent of people have a seizure in their lifetime which is about the same amount of people who are left handed, so it’s pretty common. But having a one-time seizure doesn’t diagnose epilepsy. Epilepsy is usually diagnosed if someone has more than one unprovoked seizure. Someone could also be diagnosed with epilepsy if they have one unprovoked seizure and have high risk for another, a brain tumor, or a brain abnormality.

Unprovoked seizures are not caused by external factors, like low sodium, meningitis, or alcohol withdrawal. If someone had multiple triggered seizures resulting from another factor, they would not be diagnosed with a seizure disorder or epilepsy. Dr. Vong estimates about 3% of people will be diagnosed with epilepsy at one point in their lifetime.

How is Epilepsy Diagnosed or Monitored?

When someone has a seizure, doctors look for a provoking factor. Doctors check for abnormalities in the bloodwork like low sodium and evidence of drugs as drug withdrawal could provoke a seizure.

The individual might get imaging done on their brain including an MRI or a CT scan that could indicate previous strokes or a brain tumor. An EEG, which is a test that monitors brainwaves, can indicate abnormal activity and discharges that would provoke a seizure. People might also get additional tests depending on their situation. Testing can indicate if a patient is at higher risk of having another seizure.

What are the Causes of Epilepsy?

Some forms of epilepsy are genetic and tend to run in families. Other times, people might have abnormalities in their brain or their brain can be formed differently.  Abnormal areas in the brain can initiate seizures, and temporal scarring can also trigger them. If patients had a stroke in the past, they have a greater risk of getting epilepsy.

How is Epilepsy Treated?

If a patient is diagnosed with epilepsy, they are put on antiepileptic or antiseizure medications. The medications decrease risk and prevent those individuals from having another seizure. About 60 to 65% of people on the medication can successfully control their seizures with the drugs; however, about 35% of people still have seizures despite taking the antiepileptic drugs.

What if the Medication Does Not Work?

Patients who do not respond to the drug have stubborn or intractable epilepsy. If someone has a seizure that isn’t controlled by medicine, they might have other forms of convulsions. For example, if the person has been under a lot of stress they might have a pseudoseizure, a convulsion that looks like a seizure but isn’t. Instead, the action is more of a psychological response to stress.

Determining whether or not the individual has a seizure is important because if they do not have a true seizure, they should not continue to take the seizure medication. Instead, they could see a psychologist who might help tease out the person’s stressors.

Another reason people adverse to the medication should be monitored is to indicate whether the seizures can be prevented with surgery. If you can see on the EEG that the seizure starts at the same place in the brain every time, the person might get seizure surgery which could cure them of their epilepsy. Most patients won’t need surgery and can be controlled with seizure medication, though.

What is the Difference Between a Stroke and a Seizure?

A stroke results from damage to the brain that blocks blood flow to the brain. In contrast, a seizure is an abnormal electrical event in the brain. Strokes can increase the risk of seizures and sometimes even cause seizures. Seizures can also mimic strokes. A specific type of seizure makes one side of the body weak.

What Age is Epilepsy Most Commonly Diagnosed At?

Epilepsy is diagnosed in all ages from infancy through adulthood. While the reasons people have seizures might differ, epilepsy can affect anybody.

Have you had a stroke, a seizure, or multiple seizures in the past? Speak with your primary care doctor or call SIMED Neurology in Gainesville at 352-224-2338 to get tested for epilepsy.

To schedule an appointment with Dr. Vong or another SIMED neurologist, call 352-374-2222 or request an appointment online.

 

November is National Sleep Comfort Month, and sleep comfort has become more important than ever as many people today struggle with sleep related issues.

But how can you get a more restful sleep or recognize the signs of a sleep problem? We talked with SIMED Neurology and Sleep Center Dr. Kraiyuth Vongxaiburana (Vong) to find out everything you need to know to get a better night’s sleep!

How to Recognize if You Have a Sleeping Problem

A common symptom of most sleeping problem is waking up and not feeling refreshed or feeling tired. If you feel tired, something might have gone amiss while you slept. Not sleeping well could mean you have insomnia or other issues like sleep apnea.

Another indicator is if you have trouble falling asleep or wake up in the middle of the night and can’t get back to sleep. Sometimes, people might wake up often to use the restroom and think they have a urinary problem, but they really have sleep apnea. Snoring also might indicate that you have sleep apnea.

What is Sleep Apnea?

Sleep apnea is very common. More than 18 million people in the United States have sleep apnea. 

If you wake up and feel tired, if you snore loudly, or if your partner notices that you stop breathing at night or snore very loudly, you could have sleep apnea. Overweight people are more likely to have sleep apnea because when you’re overweight, your airway can relax and close, obstructing your breathing. The obstruction can cause you to snore loudly and stop breathing or not get a full breath of air.

When you have sleep apnea, your oxygen levels drop and you can wake up for short periods during the night without realizing. Waking up from sleep apnea can leave you unrefreshed in the morning and make your sleep fragmented. Even when you do get sleep, you might still feel lousy and like you haven’t slept. You can have trouble getting out of bed.

How Do You Diagnose and Treat Sleep Apnea?

You can participate in an overnight sleep study to find out if you have sleep apnea. SIMED performs overnight sleep studies which allow physicians to monitor your sleep patterns and determine your problem.

If you were diagnosed with sleep apnea, you might be prescribed a breathing machine called a CPAP. CPAPs have a mask that goes over your face and blows continuous air pressure into your airway to keep it open for more oxygen. Using a CPAP generally leads to decreased arousal, and people with sleep apnea feel more refreshed.

Why Should You Get Treated for Sleep Apnea?

Feeling more awake in the morning isn’t the only reason you should get treated. If left untreated, sleep apnea can lead to increased risk of high blood pressure, stroke, heart attack, and cardiac arrhythmias. Waking up throughout the night ramps up adrenaline and increases risk of many dangerous medical problems. It can even cause insomnia.

What is Insomnia?

Insomnia is another very common problem. About 30 to 40% of people have insomnia, and women tend to be more affected than men. Insomnia is when people have difficulty falling asleep or staying asleep.

People can have insomnia due to many different reasons. They might be uncomfortable or anxious and unable to sleep. Their circadian or sleep rhythm might be off. Patients might also have psychophysiological insomnia, meaning they are anxious about getting to sleep so they worry about sleeping and stare at the clock which makes sleeping even more difficult and creates a cycle where they’re more and more anxious and have increased difficulty sleeping. Breaking the cycle can be difficult, but working on good sleep hygiene can help.

10 Ways to Get a Better Night’s Sleep

If you have insomnia or trouble falling asleep, here are 10 tips for improving your sleep comfort.

1. If you have anxiety, write down everything that worries you. You don’t need to write everything down right before bedtime, but if you make a list a few hours earlier, you can get your worries out of your mind and into a journal.

2. Avoid stimulants like caffeine too close to bedtime. Don’t drink coffee or other caffeinated drinks past midafternoon.

3. Don’t constantly check the time. If you don’t fall asleep or have trouble falling asleep, after 30 minutes of trying, don’t stare at the clock. Instead, get up and do something calming for 10 minutes. For example, you could drink a glass of milk or read a book. Then try to go back to bed.

4. When in bed, try not to do other activities than sleep. If you’re working in bed or watching TV in bed, you train your mind to do other things than sleep in bed which can lead to your brain being more active at bed time.

5. With smartphones, avoid screen time. You can easily answer your phone or check emails at night, but when you do, you train your mind to do other things at night besides sleeping and can end up resetting your sleep clock. The bright light can reset your circadian rhythm and make getting to sleep more difficult.

6. Avoid sunlight in the evenings. Especially in the summertime, try to get bright sunlight in the morning instead of the evening because it will make you feel more awake.

7. Exercise. Exercise in general has been shown to help people get to sleep and stay asleep. Some people find that exercising before bedtime can make sleeping more difficult, so exercise earlier in the day or whenever works best for you.

8. Set a good sleep schedule. Go to sleep at the same time every night and wake up at the same time every day. You should get 7 to 8 hours of sleep, and some people may even need 9 hours of sleep. Try not to take naps during the day to avoid throwing off your schedule. Create a good bedtime routine (like you might for your children) that includes turning off the TV, dimming the lights, and avoiding stimulation a couple of hours before bedtime. Some people might even take a warm bath.

9. In the bedroom, keep everything cool and comfortable. Keep the room as dark as possible, and keep noise to the minimum.

10. Use a mattress that works for you. Some people like more firm mattresses, and some people prefer softer mattresses. Experiment to find what works for you, and if you have sleep apnea, elevating the front of your bed can help because gravity won’t be working as much against you. If someone is sleeping flat, their airway can close. Sleeping on your side or elevating your bed can help open it. You can get a wedge to put under your mattress or get a mattress that elevates the head.

What about Sleep Aid Medications? Are They More Harmful or Helpful?

Over-the-Counter Medications

It’s okay to use sleep medications once in a while. A lot of over-the-counter antihistamines can help people get to sleep and feel better in the morning, but some can end up blocking acetylcholine which can affect memory. Older people should try to avoid antihistamine sleep medications and instead try medications containing melatonin. While some people can get addicted to sleep medications like Benadryl, most people won’t be addicted to over-the-counter medications.

Prescription Medications

Try to avoid prescription medications, specifically the addictive ones like ambien and restoril. For some, they are needed, but for others, the medication can work for a while, but when people get used to it, they build up a tolerance. Non-addictive medications like trazodone should be tried first to help with sleep before something with more potential tolerance for addiction.

Alternatives

If you use sleep aids, you can also practice good sleep hygiene and try out cognitive behavioral therapy with a therapist or psychologist. We can have difficulty sleeping because we’re anxious and set up a cycle where we worry about things which can make it more difficult to sleep. A psychologist would help tease out abnormal thoughts

Also, a psychologist could help people in a cycle of bad sleep realize getting a bad night’s sleep would not be the worst thing in the world. Those people might not worry so much about it and get a better night’s sleep.

 

If you have trouble sleeping, talk to your doctor about getting a sleep study done or contact SIMED’s sleep center at 352-224-2338. To schedule an appointment with Dr. Vong or another SIMED neurologist, call 352-374-2222 or request an appointment online.